DIAGNOSIS - Medicine for Mountaineering and Other Wilderness Activities - page 6

the individual is lying on his or her stomach, the back should be examined before turning
the person over so as to ensure the absence of bleeding or other evidence of injury—unless
suspected fractures of the vertebral column dictate that such an examination be postponed.
A systematic routine must be followed so that no areas of the body are overlooked.
Chestinjuriesareunquestionablymorethreateningthanhandinjuriesanddeserveattention
first,butfailuretorecognizeandcareforahandinjurycanresultinapermanentdeformity.
“Manyerrorsincareareduetoincompletediagnosisortooverlookingsomeseriousinjury
while concentrating on the obvious. Systematic examination decreases the likelihood of
making such errors.” 3
If evacuation requires more than one day, examinations must be repeated to monitor the
individual's condition and to ensure that all injuries have been found. Any individual who
isunconsciousatthetimeoftheinitialexaminationmustbereexaminedimmediately upon
regaining consciousness.
MEDICAL RECORD
Fordisablingdiseasesorinjuries,awrittenaccountofthehistoryandexaminationfindings
is an essential element in the person's medical care, particularly when a physician's help
is more than a few hours away. In the confusion associated with an accident and subse-
quent evacuation, a medical attendant may be unable to remember whether a symptom
was present or physical changes were detectable, even a few hours after the examination.
Memory is not a dependable record of numerical data, such as pulse and respiratory rates,
temperature, and blood pressure. If any medications have been administered, a written ac-
count of the doses and times they were given is essential. All treatment must be recorded.
Forindividualswithnontraumaticillnesses,awrittenrecordallowstheexaminertosys-
tematically review his findings while trying to arrive at a diagnosis. Written records help
ensure no details are forgotten when trying to obtain help by such means as radio or cellu-
lar telephone.
Written records of vital signs (pulse, respiratory rate, blood pressure, and temperature)
andotherfeaturesoftheperson'sillnessmakedetectingsmallchangesinthesesignseasier.
Such changes usually precede more obvious indications that the individual's condition is
worsening and allow treatment to be instituted earlier, when it often is more effective.
These changes may also indicate a response to treatment and presage more obvious im-
provement in the person's overall condition, perhaps allowing a difficult evacuation to be
delayed until circumstances are more favorable.
When evacuation is prolonged, written records allow more than one person to share in
the individual's care. Because all can determine what the signs or symptoms were at any
time, all can recognize changes and initiate any therapy that is needed. Written records are
also essential for preventing omission or duplication of doses when administering medica-
tions.