BASIC MEDICAL CARE - Medicine for Mountaineering and Other Wilderness Activities - page 15

ated. The combination of cardiac arrest and severe hemorrhage is essentially always lethal.
(These problems are discussed in greater detail in Chapter 3: Life-Threatening Problems . )
Other Injuries
All injuries should be treated as completely as possible before any person is moved.
Open wounds are always contaminated to some extent; further contamination should be
avoided. Soft-tissue wounds should be covered with voluminous dressings that apply pres-
suretocontrolbleeding,provideimmobilization, minimize swelling, andcontrolinfection.
Even when no fractures are present, severely injured extremities should be immobilized
and elevated slightly to aid blood circulation. If the lower extremities are injured and evac-
uation requires walking or climbing, the person should stop periodically to lie down and
elevate the feet. Splinting fractures before the person is moved is particularly important.
“Splint 'em where they lie” is a timeproven adage.
Theequipmentnecessaryforthetreatmentofsomeinjuries,suchasinjuriesofthechest,
isnotavailableonmostshortoutings.However,thisequipmentshouldalwaysbeavailable
in popular wilderness recreation areas and should be part of the emergency gear of all wil-
derness rescue organizations.
FEVER AND CHILLS
Fever and chills are signs of infections but can be signs of other disorders.
Fever
Normal body temperature averages 98.6°F (37°C) when measured orally, ranges from
96.5°F(35.8°C)to100°F(37.8°C),andusuallyvaries1.25°to3.75°F(0.7°to2.1°C)daily.
Thelowesttemperature occursbetween 3:00and5:00 A.M .andthehighestinthelate after-
noon or early evening in individuals who are active during the day and sleep at night. The
temperatures of women of childbearing age rise about 1.0°F (0.5°C) at the time of ovula-
tion and remain elevated until menstruation begins. During vigorous exercise, a healthy,
well-conditioned athlete's temperature can climb to 104°F (40°C) or higher if he is gener-
ating heat faster than it can be lost.
Ina moderate orhot wilderness environment, a person should not be considered to have
afeveruntilthetemperatureatrestexceeds100°F(38°C)orallyor101°F(38.5°C)rectally.
In a cold environment, hypothermia can mask a fever—sometimes a very high fever—by
reducing the body's temperature to normal or subnormal levels.
Oral temperatures are easier to measure but are affected by recently consumed food or
beverages,smoking,ormouthbreathingandtalking.Oraltemperaturesshouldnotbetaken
for at least ten minutes after eating or smoking, and the person should preferably have
been sitting or lying quietly. Rectal temperatures are more reliable and usually are about
1°F (0.5°C) higher than the oral temperature. If rectal measurements are necessary, a rectal