WFR - Wilderness First Responder Sudden and Severe Illnesses Questions and Answers — Questions and Answers
Question 1: A member of your hiking party, a known diabetic, becomes confused, irritable, and starts stumbling. Their skin is pale and sweaty. Which of the following is the most appropriate immediate action?
- Administer their prescribed insulin injection immediately.
- Provide them with a sugary drink or food, like fruit juice or candy. (Correct answer)
- Encourage them to rest and drink plenty of water.
- Perform a detailed secondary assessment to check for injuries from stumbling.
Correct answer: Provide them with a sugary drink or food, like fruit juice or candy.
The patient is exhibiting classic signs of hypoglycemia (low blood sugar), which include altered mental status (confusion, irritability), pale and sweaty skin, and poor coordination. The most critical intervention is to rapidly raise their blood sugar. Providing a simple sugar that can be quickly absorbed is the priority. Administering insulin would further lower their blood sugar, which could be fatal. Water will not address the low blood sugar, and a secondary assessment, while important, is not the immediate life-saving action required.
Question 2: You are leading a group on a multi-day trip when a participant is stung by a bee. They quickly develop hives all over their body, start wheezing, and complain of a tight throat. What is the most critical intervention for this patient?
- Administering an oral antihistamine like diphenhydramine.
- Applying a cold compress to the sting site.
- Assisting the patient with their prescribed epinephrine auto-injector. (Correct answer)
- Beginning immediate evacuation to the nearest hospital.
Correct answer: Assisting the patient with their prescribed epinephrine auto-injector.
This patient is experiencing anaphylaxis, a severe, life-threatening allergic reaction. The signs include systemic hives, respiratory distress (wheezing), and airway compromise (tight throat). The definitive and life-saving treatment for anaphylaxis is the prompt administration of epinephrine. While antihistamines are a secondary treatment and evacuation is necessary, neither is the most critical first step. A cold compress only addresses the local reaction.
Question 3: During a lunch break on a trail, a 60-year-old man suddenly complains of a severe headache, slurs his speech, and has a noticeable facial droop on one side. Which sudden illness should you suspect, and what is a key part of your management plan?
- Heart Attack; have the patient chew four baby aspirins.
- Seizure; restrain the patient to prevent injury.
- Stroke; note the exact time of symptom onset and prepare for evacuation. (Correct answer)
- Hypoglycemia; immediately administer sugar.
Correct answer: Stroke; note the exact time of symptom onset and prepare for evacuation.
The unilateral facial droop, slurred speech, and severe headache are classic signs and symptoms of a stroke (Cerebrovascular Accident - CVA). A critical piece of information for definitive medical care is the time of symptom onset, as it can determine treatment options like thrombolytics. Management in the field includes protecting the patient's airway, providing comfort, and preparing for urgent evacuation. While aspirin is used for heart attacks, it's contraindicated for certain types of strokes. Restraining a seizure patient is not recommended, and the symptoms are not typical for hypoglycemia.
Question 4: A fellow backpacker suddenly collapses, becomes rigid, and begins to convulse. The seizure lasts for approximately 90 seconds. After the convulsions stop, the patient is groggy and disoriented. Which of the following is NOT an appropriate action in managing this patient?
- Moving objects away to protect the patient from injury during the seizure.
- Placing a bite stick or wallet in the patient's mouth to prevent them from biting their tongue. (Correct answer)
- Placing the patient in the recovery position after the convulsions cease.
- Timing the duration of the seizure and monitoring their breathing.
Correct answer: Placing a bite stick or wallet in the patient's mouth to prevent them from biting their tongue.
During a seizure, the primary goal is to protect the patient from harm. This involves clearing the area of dangerous objects and cushioning their head. However, you should never force anything into the patient's mouth. This can cause broken teeth, jaw injuries, or an airway obstruction. Timing the seizure and placing them in a recovery position afterward to manage the airway are both appropriate and important actions.
Question 5: Which of the following scenarios is the clearest indication for immediate evacuation for a patient experiencing a sudden illness in the wilderness?
- A hiker with a known seizure disorder has a single, 2-minute seizure and returns to their normal baseline mental status within 15 minutes.
- A patient with a bee sting develops a large, localized swelling and redness at the sting site but has no trouble breathing.
- A diabetic patient feels weak, but after eating a granola bar, their symptoms resolve completely.
- A patient complains of crushing chest pain that is not relieved by rest and radiates to their left arm. (Correct answer)
Correct answer: A patient complains of crushing chest pain that is not relieved by rest and radiates to their left arm.
Crushing chest pain unrelieved by rest and radiating to the arm are classic signs of a myocardial infarction (heart attack). This is a time-sensitive medical emergency that requires immediate definitive care that is unavailable in the wilderness. The other scenarios, while requiring monitoring, do not represent the same level of immediate life threat requiring urgent evacuation. A patient returning to baseline after a typical seizure, a localized allergic reaction, and a resolved hypoglycemic event can often be managed in the field while assessing the overall situation.
Question 6: You are treating a patient for anaphylaxis and have administered a dose of epinephrine via an auto-injector. Their symptoms initially improve, but 15 minutes later, their breathing becomes difficult again and the hives return. What is the correct course of action?
- Administer a large dose of an oral antihistamine.
- Immediately begin CPR.
- Administer a second dose of epinephrine. (Correct answer)
- Assume the first dose was ineffective and begin rapid evacuation only.
Correct answer: Administer a second dose of epinephrine.
Anaphylaxis can have a biphasic or rebound reaction, where symptoms recur after initially improving. The treatment for this rebound reaction is the same as the initial treatment: administer another dose of epinephrine. WFR protocols allow for repeating epinephrine doses every 5-15 minutes if symptoms persist or return. While antihistamines are part of the treatment, epinephrine is the primary life-saving medication. CPR is only indicated if the patient is pulseless and not breathing.
WFR - Wilderness First Responder Sudden and Severe Illnesses Questions and Answers
A member of your hiking party, a known diabetic, becomes confused, irritable, and starts stumbling.
Their skin is pale and sweaty.
Which of the following is the most appropriate immediate action?