Emergency Action Steps

Below are various emergency medical protocols, checklists, questions, and MAMAs (Medical Acronym Memory Aids) – that I have found useful while caring for and teaching others. Some of what is below is well-known. Some I created myself.

Emergency Action Steps: [3CN2D]

  • CHECK: Scene, Individual(s), Resources, Time
    [SAFETY/HAZARDS, ACCESS, EQUIPMENT, ASSISTANCE]
  • CALL: (9)9-1-1 (NATURE & LOCATION of Emergency)
    [Police, Fire, Ambulance, Coast Guard, Search & Rescue, Utility Company]
    or Poison Control (CA: 1-800-8-POISON: age, weight, amount)
  • CARE: “Are you OK?” Identify yourself, your training, your intentions “How may I help (you)?”
    *Ensure you have CONSENT (Expressed, Implied, Parental) ~ Honor/Document Refusal of Care
  • NOTIFY (those responsible/affected)
  • DEBRIEF (everyone involved/concerned)
  • DOCUMENT (all known/pertinent facts)
  • If you are alone:
    CALL FIRST when victim is unconscious and over 8 years of age
    (or possible cardiac emergencies)
    CALL FAST (after 1 minute of care) when victim is under 8 years of age
    (or probable respiratory emergency)
    and for victim(s) of submersion/drowning; arrest associated with trauma; drug overdose

    Assessing Level of Consciousness (LOC): Responsiveness and Competence
    If Conscious: “A/O times four”? (“A and O” = “Alert and Oriented” to I-LET)
    1. Identity/Name: “What’s your (full) name?” or “Who are you?”
    2. Location/Place: “Do you know where you are?” or “How’d you get here?”
    3. Event/Others: “What happened?” or “Do you recognize anyone (else)?”
    4. Time: “What/when do you remember last?” or “What time/day is it now?”

    AVPU Response: Alert, Verbal, Pain, or Unresponsive

    Glasgow Coma Scale: Eye Opening (1-4) + Verbal Response (1-5) + Motor Response (1-6)
    Glascow Coma Scale: Eye Opening: 4 eyes; Verbal: Jackson 5; Motor: 6-cylinder engine
    [Best GCS Score = 15, Worst = 3]

    Especially if/when someone is Unconscious/Unresponsive:
    Look for MedicAlert bracelet and/or other ID/med info
    Perform Rapid Physical/Trauma Exam & reassess frequently
    Check Pupils for size, shape, equality & reactivity (PEARL?)
    Check for contact lenses, glasses, hearing aids, dentures, etc.
    Estimate age, height, and weight (preferably in Kg)
    Ask family/witness/bystanders for known info/medical history
    If female, consider possibility/complications of pregnancy
    Honor valid DNR/advance directives/DPAC decisions
    If dead or dying, preserve body as possible organ donor

    Consider possible AEIOU TIPS:
    Alcohol or Allergies?
    Epilepsy or Endocrine?
    Infection?
    Overdose?
    Under-dose or Uremia?
    Trauma or Temperature?
    Insulin?
    Psychological Disorder?
    Stroke, Seizure, or Shock?

    Assessment/Treatment/Response Priorities:
    ABC/(D)
    Airway
    Breathing
    Circulation
    Defibrillate?

    ABCHs
    Airway open?
    Breathing?
    Circulation?
    Hemorrhage?
    spinal cord injury?

    ABCDEFs
    Airway & Cervical Spine
    Breathing
    Circulation / Bleeding (RED)
    Disability (LOC, DOTS)
    Expose & Examine
    Freezing (Cold Injury)
    shock / splint

    RED (Blood)
    Rest
    Elevation
    Direct Pressure

    RED (Help)
    Request
    Encourage/Enlist
    Demand

    THREE ABC’s (ABC123)
    A1: Assess scene/situation
    A2: Airway (ensure patency)
    A3: Alert Others (Call 9-1-1)
    B1: Barriers (gloves, mask)
    B2: Breathing (interventions)
    B3: Bleeding (assess/control)
    C1: CPR / AED?
    C2: Cervical Spine / Collar?
    C3: Cover, Protect / Carry?

    Comfort, Calm, Reassure
    Administer Oxygen (and/or appropriate fluids/meds) if trained and available
    Attempt to contact/notify a child’s parent/guardian if not present
    Make patient priority and transport decision(s)
    Physical Examination and Documentation

    CH2ECK (AFTER addressing any obvious Life Threatening Conditions (ABCs):
    Chief Complaint: “What’s wrong?” or “Where do you hurt?”
    (Assess Extent/Degree of Distress/Urgency)
    History:
    1. What caused injury or condition (MOI: Mechanism of Injury or NOI: Nature of Illness)
    2. (SAMPLE) Information about allergies, medications, previous personal/family health problems
    Exact Location: LAF / IAPP (estimate percentage of body surface area (BSA) burned/affected: Rule of Nines; Palm)
    Compare: with other/uninjured side (and/or self) DOTS / DCAP-BTLS
    Keep Checking: condition for change(s), CSM
    (Stable: check each 15 minutes ~ Unstable: check in 5 minutes)

    LAF:
    Look for DOTS / DCAP-BTLS / Disease / Disability (and/or any missing body parts)
    Ask about pain (OPQST); pregnancy (CCLUE) + months/due? pregnancy #? last delivery? pre-natal care?)
    Feel for DOTS / DCAP-BTLS (note/differentiate any abdominal findings by quadrant/region)

    IAPP:
    Inspection
    Auscultation
    Palpation
    Percussion

    CSM:
    Circulation
    Sensation
    Movement

    DOTS:
    Deformity
    Open wounds
    Tenderness
    Swelling

    DCAP-BTLS:
    Deformities
    Contusions
    Abrasions
    Punctures (or Penetration)
    Burns
    Tenderness
    Lacerations
    Swelling

    CCLUE:
    Contractions
    Complications
    Leaking
    Urge (to push)
    Expected Date

    SOAP Notes:
    Subjective (Symptoms/History)
    Objective (Signs/Base Findings)
    Assessment (MOI/NOI/Status)
    Plan (Care/Treatment)

    SAMPLE History:
    Signs and Symptoms: “What seems to be the problem?”
    Allergies: “Are you allergic to anything (that you know of)?”
    Medications: “Are you taking anything (Rx, OTC, recreational)?”
    Past History: “Has anything like this ever happened to you before?”
    Last Meal/Oral Intake: “What/when did you last eat/drink?” “Hungry?” “Need to vomit (or void)?”
    Events Leading up to Illness/Injury: “How did it happen?” “What led up to this?” “Anything else?”

    PAIN:
    “Describe the pain / discomfort for me?” “Where does it hurt?” “Point to where it hurts.”

    OPQRST:
    Onset/Origin: “When/how/where did it start?”
    Provocative: “What makes it better/worse?”
    Quality: “What does it feel like?””Has it changed?”
    Radiate/Region: “Do you feel it anywhere else?”
    Severity: “How much does it hurt (Scale from 1-10)?”
    Timing: “How often?” “Better/worse in AM or PM?”

    ABCs of (Radio) Communication
    Accuracy
    Brevity
    Clarity

    First Responder/Ambulance RADIO Destination and Closest Facility Requests:
    Age, Sex, Weight
    C/C, Hx of events leading up to Cx
    BRIM & OPQRST (expanding on them if needed)
    V/S
    Hx, Meds, ALG
    Rx
    Update pertinent V/S and changes following Rx
    ETA
    BSI: Body Substance Isolation
    PCR: Patient Care Report
    ???

    MCI: Mass/Multi-Casualty Incident Priorities:
    Adults START: Resp Rate <10 or >30; Capillary Refill >2 seconds; GCS <13
    Children JumpSTART: Resp Rate <15 or >45: No Distal/Peripheral Pulses; GCS <13

    Simple Triage And Rapid Treatment (START)
    0: Dead/Nonsalvageable – Black/Gray
    I: Immediate – Red (Rabbit) – (P)U
    II: Delay – Yellow (Turtle) – AV(P)
    III: Minor – Green (No Ambulance)

    Walking wounded = Minor
    Immobile but able to follow instructions = Delayed
    AVPU: AV(P) = DELAYED (P)U = IMMEDIATE

    START where you stand: with “Walking Wounded” then RPM (Respiration ~> Perfusion ~> Mental Status)
    Priority-1: Airway/respiratory/cardiac problem; uncontrolled hemorrhage; open chest/abdomen; severe head injury; shock; burn; medical
    Priority-2: Spinal cord injury; multiple/major fractures; moderate burns; uncomplicated head injury
    Priority-3: All minor/ uncomplicated fractures, wounds, other injuries, burns; psychological problems

    RPM:
    Respiration: over 30/min (or obstructed airway) = Immediate/Priority 1 [NO breathing = deceased]
    Perfusion: absent radial pulse and capillary refill over 2 seconds = Immediate/Priority 1
    Mental Status: Can’t follow simple commands = Immediate/Priority 1

    0: Dead/Nonsalvageable – Not breathing (without assistance); [Children get 2 breaths]
    I: Immediate – Difficulty with maintaining (adequate) breathing, circulation or thinking
    II: Delay – Responsive/mentally aware but unable to move or improve (without support)
    III: Minor – Able to walk, talk, (whine or wait) and help (care for themselves/others)

    WNL: Within Normal Limits – or We Never Looked?

    ADULT | CHILD | INFANT TPR “Norms”
    Temperature (Oral/Rectal/Axillary/Tympanic;C/F) 97-99F (36.1-37.2C) [Rectal: +1F,Axillary: -1F]
    Pulse (Location, Rate, Rhythm, Quality, Perfusion) 60-80BPM | 80-100BPM | 100-140BPM (at rest)
    Respiration (Rate, Volume/Depth, Effort/Quality) 12-20RPM | 15 – 30RPM | 20 – 50RPM (at rest)
    Blood Pressure (Systolic/Diastolic/Palpated) 100-140/60-90mmHg | 60-120/40-76mmHg (child)
    *Skin (Color, Temperature, Moisture; Turgidity) Related TPR Changes: +/- 1F = +/- 10BPM = +/- 1-2RPM
    “Average Adult” T: 98.6F/37C P: 70 R: 16 BP: 120/80 Minimum Palpable BP: 60 Carotid, 70 Femoral, 80 Radial

    Pediatric Assessment Triangle:
    Appearance: Alertness, Distractability, Consolability, Eye Contact, Speech/Cry, Spontaneous Motor Activity, Color
    Breathing Effort: Audible Abnormal Breathing Sounds, Retractions, Nasal Flaring
    Circulation to Skin: Skin Temperature, Pulse, Capillary Refill Time

    Breath Sounds:
    Stridor = Upper Airway Obstruction
    Wheezing = Lower Airway Obstruction
    Expiratory Grunting = Inadequate Oxygenation
    Inspiratory Crackles = Fluid/Mucus/Blood in the Airway
    Absent Breath Sounds = Complete Airway Obstruction, Pleural Fluid, Consolidation, or Pneumothorax

    5 Ps of Circulatory Checks: Pain, Pallor, Paralysis, Paralysis, Pulse
    7 Ps of Planning: Proper Prior Preparation Prevents Piss Poor Performance

    The 7 Bs (Priorities for Managing Emergencies):
    Breathing
    Beating (Pulse, Pressure)
    Bleeding
    Brain
    Bowel (Abdominal Injuries)
    Bladder (Pelvic Injuries)
    Bone

    The 4 Bs of (Military) Logistics:
    Beans
    Bandages
    Bullets
    Badguys

    Trauma Criteria:
    Physiologic Factors
    Anatomic Factors
    Mechanisms of Injury
    Additional Factors
    Age and Co-Morbid Factors

    “VITAL SIGNS”
    LOC/Responsiveness (AVPU; Glascow Coma Scale: 4-5-6)
    Pulse (Rate, Rhythm, Quality)
    Respiration (Rate, Rhythm, Quality)
    Blood Pressure (Systolic/Diastolic/Palpated; Pulse/Mean; Site/Location/Position)
    Temperature (Oral, Rectal/Core, Axillary, Tympanic; Skin/Surface)(F, C)
    +Pain/Discomfort (Level/Intensity, Location, Quality/Characteristics/Changes)
    +Pulse Oxymetry (O2 SAT)
    +End Tidal Capnography (ETCO2)
    *Skin (Color/Appearance, Temperature/Texture, Moisture/Turgidity)
    *Pupils (Size, Shape, Equality, Reactivity)
    *Perfusion/Capillary Refill Time (+/- 2 seconds)
    *(Peripheral) CSM (Circulation, Sensation, Movement)

    Peripheral pulses should be compared for rate, rhythm, and quality.
    Pulses are graded as:
    0 Absent
    +1 Weak and thready
    +2 Normal
    +3 Full
    +4 Bounding

    5 Ps of Vascular Insufficiency: Pain, Paralysis, Parasethesia, Pallor, Pulselessness

    Questions to ask/factors to consider regarding Chief Complaint:

    OPQRST:
    Onset
    Palliative/Provocative
    Quality
    Region/Radiation
    Severity
    Time

    OLD CART:
    Onset
    Location
    Duration
    Characteristics
    Aggravating Factors
    Relieving Factors
    Treatment

    PASTMED:
    Provocation
    Associated Chest Pain
    Sputum Production
    Temperature
    Medications
    Exertion/Exercise Tolerance
    Diagnosis (Previous)

    Resulting from AEIOU TIPS?
    Alcohol or Allergies
    Epilepsy or Endocrine Problems
    Infection
    Overdose
    Under-dose or Uremia
    Trauma or Temperature
    Insulin
    Psychological disorder
    Stroke, Seizure, or Shock

    CC: Chief Complaint/Present Injury/Illness
    PH: Personal/Past Medical History
    FH: Family History
    SH: Social History

    Orthostatic/positional changes (BP & Pulse): Supine-Sitting-Standing (-Walking – Running)

    Variance(s) when:
    Asleep/Upon Waking/At Rest
    Active/Under Stress
    After Exercise/Exertion
    Eating/Drinking/Voiding/Showering/Bathing

    History of present illness
    How do you feel?
    What’s wrong?
    Where does it hurt?
    Since when?
    When did your illness/pain begin?
    How often?
    How long does it last?
    What makes it better/worse?
    Has it happened before?
    What have you eaten today?
    What have you swallowed?
    Have you thrown up?
    Did you have an accident?
    Where did it happen?
    When did it happen?
    What happened?

    Past medical history
    Have you ever had….?
    What diseases have you had in your family/youth?
    Have you ever had an operation?
    Have you ever been hospitalized?
    Are you taking any medications?
    Are you allergic to any medicines?

    Allergies/Anaphylaxis
    Are you allergic to anything?
    What are you allergic to?
    What are your symptoms?
    Are you allergic to penicillin/certain foods/insect stings?
    Where you stung by a bee?
    Have you inhaled anything unusual?
    Have you ingested anything unusual?
    Does your skin itch?
    Do you have asthma?

    Breathing Problems
    Do you have…
    a cold?
    asthma?
    chronic bronchitis?
    a (dry) cough?
    difficulty breathing (at night)?
    emphysema?
    expiration?
    the flu?
    heart disease?
    heart failure?
    phlegm?
    pneumonia?
    sore throat?
    (pain or problem) with inspiration?
    has this ever happened before?
    Do take any medications?

    Chest pain
    Do you have chest pain?
    Where does it hurt?
    When did it start?
    Does the pain radiate?
    Have you ever had a heart attack (or stroke)?
    History of heart problems?
    Do you have…
    palpitations?
    a murmur?
    shortness of breath?
    hypertension?
    Has this ever happened before?

    Neurologic?/Neuralgic Disorders:
    Do you have blurred vision?
    convulsion
    epilepsy
    fainting spell
    headache
    hypertension
    numbness
    paralysis
    stroke
    tremors
    Did you receive a blow to the head?
    Move your arms/legs
    What day is today?
    Squeeze my fingers

    Gastrointestinal/abdominal/genitourinary complaints
    Does it hurt when I press here?
    Has this ever happened before?
    Do you have…
    constipation?
    diarrhea?
    heartburn?
    hemorrhoids?
    indigestion?
    stomach ache?
    ulcers?
    vomiting?
    hepatitis?
    jaundice?
    nausea?
    regular bowels?
    dysuria?
    gallstones?
    blood in the urine?
    venereal disease?
    syphilis?
    gonorrhea?

    Burns:
    Body Surface Area (BSA)

    Stop further burning
    Drop temperature
    Roll protective covering around site

    Earthquakes: Seek/Create “Triangle of Life”
    Do NOT “duck & cover” or hide under anything; lie next to it!

    Burning stopped
    Breathing maintained
    Body examined
    Cool
    Cover
    Carry

    Physical Examination / Injury Evaluation:

    HOPS:
    History
    Observation
    Physical Exam/Palpation
    Special Tests

    FACTS:
    Function
    Arterial pulse
    Capillary Refill
    Temperature – skin
    Sensation

    (Newborn) APGAR:
    Appearance (color)
    Pulse (heart rate)
    Grimmace (reflex, irritability)
    Activity (muscle tone)
    Respiratory (effort)

    ASC LAST: let patient talk first, then ask specific questions
    Aggravating and Alleviating Factors
    Severity
    Character, Quality
    Location
    Associated Symptoms
    Setting
    Timing

    VARIATIONS WHEN:
    Adult
    Male
    Female
    Child
    Infant
    Upon Awaking
    Asleep/At Rest
    Under Stress
    After Exercise/Exertion
    Sitting / Supported
    Standing / Walking / Running
    Laying Down
    Eating/Drinking/Voiding/Showering/Bathing

    various animals?

    Blood Vessels
    Checking Pulse / Circulatory Pressure Points
    Controlling Bleeding (Internal & External)
    Bones & Joints (Ligaments)
    Movement
    Reducing Dislocations
    Setting Breaks (Traction), Splinting & Wrapping
    Muscles & Tendons (Origins & Insertions)
    Movements, Posture, Balance
    Testing (Strength, Function, Range of Motion)
    Stretching
    Strengthening
    Organs

    Medicine
    Food
    Herbs & Flowers
    Homeopathic Remedies
    Pharmaceuticals

    Intake/Administration:
    Oral (Tablet, Capsule, Liquid, Inhalant)
    Topical (Liquid, Cream, Gel, Aerosol)
    Intradermal/Subcutaneous (ID), Intramuscular (IM), Intravenous (IV), Intraoseos (IO)

    Human Reflexology:
    Body
    Face
    Eye (Pupil, Sclera)
    Ear
    Tongue
    Hand
    Feet

    Wound Closure
    Butterfly Bandages, Steristrips, Coverslip Enclosures, Duct Tape
    Sutures, Needle & Thread
    New Skin, Crazy Glue

    Suctioning
    Electric
    Manual
    Syringe
    Bulb (Turkey Baster)
    Tube (Hose, Straw)

    Supplemental Oxygen

    blood pressure:
    the bladder of BP cuff must be equal to at least 80% of the circumference of patients arm.

    hypertension:
    vascular diseases (artherosclerosis)
    kidney disease
    sodium retention
    metabolic disturbances

    blood clots
    stroke
    myocardial infarction/heart attack
    ruptured aneurysm
    hemorrhage

    hypotension:
    decreased circulation in blood volume (bleeding/hemorrhage)
    change in diameter of blood vessels (neurogenic shock)
    cardiac tamponade
    head trauma/brain injury

    shock
    cardiac failure
    toxins/poison in the blood

    Vital Sign Reassessment:
    At least every 15 minutes in a stable patient
    At least every 5 minutes in an unstable patient
    After every significant intervention you provide
    When requested by advanced life support personnel

    Inadequate ventilation (air hunger):
    retractions
    nasal flaring
    irregular rhythm
    unequal or inadequate chest expansion
    shallow tidal volume (shallow breathing)
    abnormal, diminished or absent breath sounds
    pale, cool, and clammy skin
    hypoxia/cyanosis

    Assisted Artificial Ventilation:
    Inadequate tidal volume
    Respiration rate that is too slow or too fast
    Signs of respiratory compromise
    An altered level of consciousness

    “VITAL SIGNS” ADULT-CHILD-INFANT “Norms”
    Temperature (Oral? Rectal? Axillary? Tympanic?) 97-99F (36.1-37.2C) [R:+1F, A:-1F]
    Pulse (Rate, Rhythm, Quality) 60-80BPM 80-100BPM 100-140BPM
    Respiration (Rate, Rhythm, Depth) 12-20RPM 15-30RPM 20-50RPM
    Blood Pressure (Systolic/Diastolic) 100-140/60-90mmHg 60-120/40-76mmHg
    *Skin (Color, Temperature, Moisture) Average T: 98.6F P: 70 R: 16 BP: 120/80
    *Pupils, *Pain, *Capillary Refill, *Turgidity

    Four Disease processes:
    Traumatic (Injury)
    Infections
    Metabolic
    Psychological

    Pathogens: Viruses, Bacteria, Fungi, Protozoa, Rickettsia
    Pathogen, Quantity, Susceptibility, Entry Site
    Direct Contact, Indirect Contact, Airborne, Vector-borne

    Grief/Loss/Stress Emotions:
    ADABDA:
    Anxiety
    Denial
    Anger
    Bargaining
    Depression
    Acceptance

    7 Stages:
    Confusion
    Denial
    Anger-Guilt
    Hope
    Depression
    Acceptance
    Understanding

    6 Ds / Warning Signs
    Defensiveness
    Depression
    Disorganization
    Defiance
    Dependency
    Decision-Making Difficulties

    Soft Tissue Injuries
    Open Soft Tissue Injuries:
    abrasions, lacerations, avulsions, pentrations/puncture wounds, amputations, crush injuries

    Closed Soft Tissue Injuries:
    contusions (bruises), hematomas, crush injuries

    Bruises:

    Phases of Bruise Discoloration:
    Color Age
    Red = 1-2 days
    Purple/Blue = 2-5 days
    Green = 5-7 days
    Yellow = 7-10 days
    Brown = 10-14 days

    Stop the Burning
    Drop the Temperature
    Cover with Protective Bandaging

    Muscle and Bone Injuries

    Mechanical Injuries: Direct, Indirect, Twisting, Contracting
    Fracture, Dislocation, Sprain, Strain,
    dislocation, subluxation
    grade 1,2,3 sprain (ligament)/strain (muscle/tendon)
    muscle cramps, muscle guarding, muscle soreness,
    contusions (bruises), nerve injuries
    tendonitis, tenosynovitis, bursitis, osteoarthritis
    myofascial trigger points

    Healing process: inflammatory response, fibroblastic repair, maturation remodeling

    Acute injuries = Trauma
    Chronic injuries = Overuse

    long bones: diaphysis, epiphysis, articular cartilage, periosteum
    osteoblasts (bone-forming cells), callus, oestoclasts

    Fractures: closed/simple, open/compound; comminuted/shattered
    Comminuted fractures
    Depressed fractures
    Greenstick fractures
    Impacted fractures
    Longitudinal fractures
    Oblique fractures
    Serrated fractures
    Spiral fractures
    Transverse fractures
    Contrecoup fractures
    Avulsion fractures
    Blow-out fractures

    stressors: tension, compression, bending, twisting (torsion), shear

    mechanisms/pattern:
    bending => transverse
    torsion => spiral
    compression plus bending/oblique => transverse
    compression plus bending plus torsion => oblique
    variable => comminuted
    compression => metaphyseal compression

    Seizure Classifications:
    Partial Seizures: 60%
    Simple partial seizure
    Complex partial seizure
    Partial seizures with secondary generalization
    Generalized Seizures: 30%
    Absence seizures (petit mal)
    Tonic-clonic seizures (grand mal)
    Tonic seizures (rigidity)
    Clonic seizures (rhythmic jerking)
    Atonic seizures
    Febrile seizures
    Unclassified Seizures: 10%
    Neonatal seizures
    Infantile spasms
    Epilepsy
    Idiopathic

    Epilepogenic

    Prodrome, Premonitory, Aura (associated with partial seizures)

    Clonus
    Flaccidity
    Conjugate gaze
    Syncope

    Primary motor cortex
    Primary sensory cortex
    autonomic function, visual cortex, auditory, olfactory
    Frontal lobe, Temporal lobe

    Postictal

    Expressive Aphasia
    Receptive Aphasia

    Benzodiazepines:
    Diazapam (IV)
    Lorazepam (IV)
    Midazolam (IM)

    Medical and Behavioral Emergencies:
    Diabetes:
    Type I
    Type II
    Syndrome X

    Diabetic Emergencies:
    Hypoglycemia
    Hyperglycemia

    Behavioral Emergencies:

    Stroke:

    Frostbite:

    Medical and Behavioral Emergencies:

    Organophosphate Poisoning (SLUDGE):
    Salivation
    Lacrimation (Excessive Tearing)
    Urination
    Diaphoresis
    Gastrointestinal Motility
    Emesis

    Drugs:
    Stimulants, Hallucinogens, Depressants, Narcotics, Inhalants, Cannabis Products, Other
    “420” = Marijuana

    Temperature, Climate & Environment:
    Altitude Sickness:
    HACE: High Altitude Cerebral Edema
    HAPE: High Altitude Pulmonary Edema
    (Nitrogen Narcosis)
    (Bends)
    Hyperthermia:
    Miliaria / Prickly Heat
    Sun glare (UV A, B, C)
    Heat Cramps
    Heat Fatigue / Heat Exhaustion
    Heatstroke / Sunstroke
    Hypothermia:
    Immersion Foot / Trench Foot
    Frost Nip
    Frost Bite
    Snow Blindness

    Temperature Extremes:
    Heat:
    Al-Aziziyah, Libya (Africa) 57.7C (136F)
    Death Valley, California (North America) 56.7C (134F)
    Tirat Zevi, Israel (Asia) 53.9C (129F)
    Cloncurry, Queensland (Australia) 53.1C (127.5F)
    Seville, Spain (Europe) 50C (122F)
    Rivadavia, Argentina (South America) 48.9C (120F)
    Luzon, Philippines (Pacific Islands) 40.5C (105F)

    Cold:
    Vostok (Antartica) -89.2C (-128.6F)
    Oymyakon, Russia (Asia) -67.7C (-89.9F)
    Snag, Yukon (North America) -62.8 (-81F)
    Ust-Shchuger, Russia (Europe) -55C (-67F)
    Colonia, Argentina (South America) -33C (-27F)
    Ifrane, Morrocco (Africa) -23.9C (-11F)

    World’s Most Venemous Land Snakes by Region:
    Europe: Adder
    North & South America: Rattlesnakes
    Copperhead
    Fer de Lance
    Cottonmouth
    Bushmaster
    Coral snake
    Africa & Asia: Cobras
    Kraits
    Boomslang
    Mambas
    Russell’s Viper
    Puff Adder
    Saw-Scaled Viper
    Malay Pit Viper
    Australasia: Death Adder
    Australian Black Snake
    Taipan
    Tiger Snake
    Australian Brown Snake

    Poisonous Sea Creatures
    Poisonous Spines:
    Stingrays
    Sea Urchins
    Neatocysts:
    Jellyfish
    Anemones
    Octopi
    Bites:
    Sea Snakes

    Insects
    Bees
    Mosquitos
    Ants
    Spiders

    Ticks
    Leeches
    Internal Parasites
    Roundworm
    Hookworm
    Threadworm
    Tapeworm
    Amoeba
    Blood Flukes

    Appendicitis / Peritonitis
    Cholera
    Diarrhea
    Haemorrhoids (Piles)
    Hepatitis (A,B,C,D,G)
    Hernia
    Malaria / Dengue
    Cramp
    Poliomyelitis
    Meningitis
    Rabies
    Swollen Feet
    Tuberculosis
    Typhoid
    Typhus
    Urinary Tract Infection
    Vaginal Disorders
    Yellow Fever