While attempting a beach landing in heavy surf, one of your friends, Jane Turner, turned over, failed to roll, and bailed out of her kayak. She managed to make it to shore without assistance but collapsed once she reached the beach. Jane is awake, coughing, and struggling to catch her breath. After a few minutes her breathing normalizes and she is able to speak. She says her leg got caught and she inhaled some water when she was exiting her kayak. She is not exhibiting any respiratory distress. She feels a little bruised but thinks she is okay. Her history, physical exam, and vital signs are unremarkable and she passes a focused spine assessment.
What is wrong with Jane and what should you do? What is Jane's prognosis? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course. Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available.
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You are on a two-week canoe trip in the boundary waters in late April with an insulin-dependent diabetic friend, Amy. After four glorious fall days, the weather turns. At the end of a day filled with intermittent rain and head winds, you notice that during Amy is acting a bit lethargic as you pull into camp for the evening.
What's wrong and what should you do? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course. Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. Your friend is leading a chossy traverse on the third pitch of a new route on Heavy Runner just outside Glacier National Park. She is about forty-five feet out with poor protection when a section of the wall breaks loose and she falls. Her protection pops and she swings into the left-facing wall below you. Fortunately your belay is secure and you are able to arrest her fall. Looking down, she appears to be unresponsive, hanging in her harness against the wall. When you finally reach her some fifteen minutes later, she is awake and complaining of a mild pain in her left side. Her helmet is damaged and there is a shallow cut on her cheek that has stopped bleeding. Two rappels and an hour and a half later, you are both safely on the ground.
Once on the ground, Tiana—26, athletic, and in good health—reports sharp pain when she tries to take a deep breath. She is nauseous, with a mild headache and a sore, stiff neck; she cannot remember her fall. The ribs on her lower left side are very tender; Tiana winces and has trouble catching her breath when you touch them. Her pulse rate is 88 and regular, her respiratory rate is 22 and easy and her skin is slightly pale underneath her tan. What is wrong with Tiana and what should you do about it? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course. Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. You are partway through the morning of the third consecutive day in a snow cave at 8,000 feet in the Central Cascades waiting out a surprise spring storm. Your skis and poles are inside with you yearning for fresh powder. At last count, you owe your friend a few hundred dollars from losing too-many-to-count hands of nickel poker and your supply of peanut M&M "poker" chips is almost gone. The atmosphere inside the cave is cold but bearable and you are down to your last candle. Both you and Jim have mild but steadily worsening headaches. Drifting and falling snow covered the most of the entrance to the cave during the night.
What's wrong and what should you do about it? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course. Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. You and a friend are descending a fairly steep, single track trail on your mountain bikes when you round a corner and see a middle-aged man crouching over a teenager who appears to have fallen off his bike. You stop to render assistance. A young man—his father says Jeff just turned 19—is lying on his back with his shoulders and head against rock roughly fifteen feet downhill from the trail; is bike is slightly uphill and on top of him. His father reports that he ran off the edge of the trail and fell head first off his bike into the rock; he says he hasn’t moved him. On exam, Jeff is pain responsive and breathing easily; his helmet is shattered where it hit the rock. Jeff groans as you palpate his shoulders and neck, and his right knee. You have no bars on your cell phone; the trail head and your vehicle is roughly four miles away; the nearest hospital is another two hours further. It’s mid-afternoon and the sun sets at five o’clock. The temperature is in the low 60’s now and is forecast to drop into the upper 30’s this evening. You have camping gear in your truck.
What is wrong with Jeff and what should you do about it? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course. Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. You are a new administrator for a municipal outdoor recreation program. After assuming the position and reviewing the trip calendar, you decide to accompany a kayak touring trip to a local lake as an observer and assistant trip leader (the scheduled assistant canceled the previous day). While not an advanced paddler, you have led numerous multi-day kayak tours and the trip is marketed for beginning/new paddlers. It's early April and while the previous week has been unseasonably warm, the day of the trip is cool with a storm threatening. On arrival at the put-in you see the lake, long and narrow, stretch out before you. There is a light wind blowing down the lake at your back; you can see white caps on the horizon. The air temperature is 42º F; the water is 38º F. The lake is beautiful with vertical rock walls falling into the water on both sides. The clients arrive dressed—as requested in the pre-course literature—in long underwear, pile jackets, rain gear, wool beanies, and sneakers. After unloading the kayaks, the guide, a young man in his early twenties, pulled a drysuit over a light pile layer and donned neoprene booties. There were three doubles and three singles for nine people, including the guide; no spray skirts were provided. After a brief safety talk that focused on keeping the group together, everyone put on lifejackets, picked up paddles, chose their boat, and in six cases, their partners. The plan was to paddle down the length of the nine-mile lake, eat lunch, and return by 3 pm; it was no 10:30 am.
Watching launch preparations for the trip unfold at the put-in, you are extremely uncomfortable. While you are in overall charge of the tripping program, you are not the guide's immediate supervisor and you are here as an observer only. What are your concerns and what should you do? Click here to find out. Don't know where to begin or what to do? Take our Effective Outdoor Program Design & Management workshop and one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course. Looking for a reliable medical field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. You are a trip leader for a winter ski program. It's the second day of a week long (7-day) tour. Your route is point-to-point through rolling, heavily forested terrain where dead wood is readily available and fires are permitted. The entire route follows old forest service roads with excellent camping along the way; there is no avalanche danger. Halfway through the dinner on the second day it begins to snow heavily. The flakes are HUGE and very wet. Snow accumulates quickly at a rate of 2-3 inches per hour. It's necessary to wake every few hours throughout the night to knock snow from your tents to keep them from collapsing. By morning the snow has stopped and your campsite is buried beneath three feet of new snow. It seems to take forever to make breakfast and get out of camp. Breaking trail in the deep snow is hard work. By mid-afternoon everyone is wet from a combination of falling down and sweating. You decide to stop at the next available spot to dry out and camp for the night. A couple of your students are completely exhausted by the time camp is set-up. One, Katie, disappears into her tent and sleeping bag as other prepare dinner, look for wood, and start a fire. When dinner is ready, you send one of the students to wake Katie. The student returns saying she is in her bag and wants to sleep. You let her.
The temperature drops to -15º F during the night and everyone is slow to wake again the following day. Katie does not appear for breakfast. You go to check on her and can't fully awaken her. In the process, you notice that she appears to have slept in her wet clothes and much of her sleeping bag is frozen. What is Katie's current problem, what should you do about it, and how could you have prevented it? Click here to find out. Don't know where to begin or what to do? Take our Effective Outdoor Program Design & Management workshop and one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course. Looking for a reliable medical field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. You are part of a Search & Rescue team looking for a missing fisherman, Jim Hicks, on a Moosehead Lake in northern Maine. You find him roughly a half mile from his upside down skiff floating unresponsive with his face out of the water in three-foot waves roughly 500 yards from open shore on Mt. Kineo. You estimate he has been in the water more than an hour. The water temperature is 74ºF and he is wearing lightweight cotton pants and a insulated shell under his lifejacket. He has no pulse or respirations. Once on board, you begin CPR. A small amount of foam appears in his mouth as you compress his chest. HIs pulse and respirations spontaneously return after a few minutes and you place him in a full hypothermia package. Twentyfive minutes later, as you are in the process of transferring him to a waiting ambulance, Jim awakens with no memory of getting in his skiff or leaving the Rockwood dock. Aside from still being quite cold and some lingering but mild respiratory distress, his history, physical exam, and vital signs are unremarkable and he passes a focused spine assessment. He thanks you profusely for rescuing him, says he doesn't want to go to the hospital, and asks you to drop him off at his vehicle so he can go home and rest.
What is wrong with Jim and what should you do? What is Jim's prognosis? Click here top find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course. Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. You are part of a mountain rescue team responding to an out of bounds avalanche that reputedly buried three skiers. Two victims have been recovered; one is alive, awake, and curled in a fetal position in a sleeping bag, moaning. Aside from low back pain Jim's SAMPLE history is unremarkable. He reports that any movement sends a severe, shooting pain down his right leg. A physical exam reveals tenderness at L-3 and L-4. His pulse is 68 and regular, his respiratory rate is 18 and easy, and his skin is normal. Jim's blood pressure and O2 sat were not taken.
What is wrong with Jim and what should you do about it? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course. Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available.
Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. |
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Our public YouTube channel has educational and reference videos for many of the skills taught during our courses. Check it out!
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