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.
0 Comments
You and two friends from the northeast are on a road trip after your college graduation and decide to do a quick day hike in Arches National Park as you pass through Moab, UT. It's mid-June, it's everyone's first time to the desert southwest. When you leave for your two hour hike each of you are carrying a liter of water, some GORP, and a couple of food bars. Six hours later you get back to the visitor's station and your vehicle. Everyone is hot, tired, thirsty, and complaining of headaches. One friend, Jenny, with a normally pale complexion is badly sunburned on her legs, lower arms, and face even though she was was wearing SPF 15 water resistant sunscreen. The sunburn covers about 45% of her total body surface area. After consuming quite a bit of water and hanging out in the air conditioned visitor's center to cool off, you head out to look for a campsite; your sunburned friend is still a bit hot.
Later that evening, the friend with the bad sunburn is bundled up and shivering even though the night temperature is 78º F. She has a headache (6 on a scale of 1-10), is nauseous, and eventually vomits once. The last time she urinated was on the hike; she doesn't remember the color. Her core temperature is 100.2º F, her pulse is 88 and regular, and she is breathing easily at 22 breaths per minute. Her normal pulse is 62 and regular. What do you think is wrong and what can 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 paddle raft guide on the Penobscot River in Northern Maine. Due to high snow levels in the Northeast the river is running close to 3000 cfs and the Cribworks, a challenging Class V is quite pushy. Having successfully run the rapid you eddied out downstream and river left of the main drop prepared to rescue any swimmers. The next raft is captained by a first year guide who misses his line in the rapid and bounces through the rocky center of the rapid losing two passengers in the process. One passenger disappears in the rapid, the second surges ahead of the raft and is picked up by a downstream safety boat. After a few anxious minutes you see the first passenger entangled in a loose throw rope just below the surface of the dark water. You quickly cut the rope and pull him into your raft unresponsive with no pulse or respirations. There is a deep laceration on the back of Joe's head below his helmet. After a few minutes of CPR his pulse and respirations return and he awakens with no memory of the event ten minutes later. Bleeding from his head laceration was controlled with direct pressure when his pulse returned and has now clotted. At 10:55 AM Joe is awake and alert, his pulse is 76 and regular, and his respirations are 16 and easy. He says he has a headache (6) and feels nauseous; his normal pulse is 72 and regular. He is stiff, sore, and bruised in numerous spots from contact with the rocks. His neck hurts and is tender at C-4. His right knee is painful (3), tender, and slightly swollen with good ROM and CSM; he thinks he can walk. Joe recalls peeing before launching about an hour or so ago but not the color of his urine. You have three bars on your cell phone. The hospital in Millinocket is at least an hour away assuming you can find a vehicle and drive fast on the gravel road.
What do you think is wrong and what can 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 leading a two week backpacking and canyoneering trip in the desert canyons of southwestern Utah for a Seattle-based youth group. The weather in the pacific northwest has been cool and the desert heat challenging with relief coming mainly at night. While most students are slowly acclimatizing, one of the teachers, an overweight 53 year-old man named Carl, has been struggling since day one. During the first week of the trip the temperatures hovered in the low 90s. Yesterday it jumped to 105º F and last night was unusually warm. During the afternoon siesta at a small sheltered seep, Carl seems lethargic and out of it. He is unable to respond coherently to your questions. At 3 PM in the afternoon Carl's pulse is 92 and regular, his respiratory rate is 26 and slightly labored, and his oral temperature is 104.2º F. You are carrying a satellite phone. What is Carl's problem and what should you do about it?
What do you think is wrong and what can 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 leading a week-long spring break backpacking trip in the Southeastern US. It's been raining hard for the past few days and your gear is wet. In order to reach your trip vehicle, you must cross a swollen stream with rapid, and apparently waist, deep current. Rather than attempt a crossing you decide to camp and wait for the water to recede. While the constant rain slows overnight, it doesn't stop and the water in the stream is not appreciably lower the next morning. Resigned to waiting another day (or two) you are surprised to see a solo hiker attempt to cross the stream from the other side around noon using his treking poles for support. The water is approaching waist height when he reaches the main current and is swept off his feet and carried quickly downstream. He appears to be struggling to remove is pack when you lose sight of him as he goes around a bend in the stream.
Grabbing your first aid kit you and a couple of students rush downstream to see if you can help. After a few minutes you spot some color and what may be his body pinned underwater against a debris pile on your side of the stream. It takes another few minutes to confirm that it is indeed the lost hiker and rescue him. He is unresponsive with no pulse or respirations so you start CPR. The water temperature is about 52º F, the air temperature is roughly 60ºF with a slight wind from the south, and the constant rain has become an intermittent drizzle. Answer the following questions:
Don't know or want to check your answers? Click here. 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. It's been rainy, cold, and downright miserable thus far on your annual four day hiking trip on the Pacific Crest Trail in the North Cascades. Last night it snowed 15 inches. Everything wet from the past few days of rain has frozen during the night. After hiking through a morning of wet snow, one friend wants to skip lunch and continue onward to the car three miles ahead. She is shivering, acting out of character, and is difficult to convince to stop, layer-up, and eat.
What do you think is wrong and what can 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 trip leader for an outdoor adventure company. On day 4 of a two week fall backpacking trip in the Appalachians one of your students, a 27 y/o women approaches you complaining of mild abdominal pain (3), cramping, and spotting. Sharon reports that she has been feeling nauseous for the past week on awakening and considered not coming on the trip. She says the pain and spotting started the day before yesterday. Her period is almost two months overdue but says that's normal for her when she plays sports or exercises; however, she never has cramps. She has been sexually active in the three months prior to the trip and regularly uses a diaphragm; she reports that intercourse has been painful during the week prior to the trip. Since yesterday she has soaked three maxi-pads. Her lower pelvic region is soft, non-tender with no rebound pain. Her pulse is 84 & regular, respirations are 20 and easy, her skin is pink, warm, & dry, oral temperature is 97.8º F, and her BP and O2 Sat were not taken.
Six hours later she reports that the pain has increased (6) and localized to her lower right quadrant and she has soaked three more pads. Her lower right quadrant is slightly tender. Her pulse is 92 & regular, respirations are 26 and easy, her skin is pale, cool, & moist, oral temperature is 97.4º F, and her BP and O2 Sat were not taken. What do you think is wrong and what can 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 three kayaking friends are taking turns playing in a rather large hole on a popular day run. The take out is four miles downstream. The day is sunny and 74º F and the clean blue-green water is a cool 52º F and every one is wearing a dry top if not a full dry suit. It's a weekend so there is some raft traffic on the river. You are keeping an eye out for approaching rafts as they sometimes run the hole you are playing in and can't see a kayaker in the hole until it's too late. You have been at the play spot for a while and everyone is getting a bit tired. One of your friends, Sue, enters the hole for what she says is "the final time". Unfortunately she's a bit too tired and is unable to exit the hole before a raft lands on top of her; however, she did have the presence of mind to turn upside down before the raft landed on her. The raft exits the hole with her upside down kayak pinned under its floor. The bow of her kayak is sticking out the from under the side of the raft and members of the raft crew together with a couple of the kayakers attempt to free it. As they are working on the kayak your friend pops up slightly upstream of the raft coughing and gasping for air. She is quickly pulled into the raft by an attentive paddler.
It takes her about five minutes to stop coughing and speak normally. Although she is wearing a full drysuit she is actively shivering even after sitting in the sun for five minutes. As she is catching her breath she is cradling and supporting her right arm. After she regains her breath she is able to relate details of the entire event. She tells you that she turned over just the raft hit the bottom of her boat. She felt something in her shoulder tear and she couldn't use her right arm. With the raft on top of her kayak and her right shoulder not working properly, it took her a while to get out of her boat. She remembers breathing in some water as she surfaced. She says her shoulder hurts a lot (8); she is supporting the arm on her injured side with her elbow held about eight inches from that side and she unable to touch her opposite shoulder with the hand on her injured side. What do you think is wrong and what can 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. Spring came early and warm temperatures precipitated an early run-off. Streams and rivers in the program area rose quickly. An instructor team with 10 college-age students were en route to their course end pick-up and were unexpectedly stopped by a flooded stream. The instructors were new to the course area and had no training in Swiftwater Rescue or high-water stream crossings; no emergency communication is available. After spending the night next to the swollen stream, they noticed that, although still quite high, the water level had fallen somewhat during the night and elected to attempt a crossing. During the attempt, one student was swept off her feet, into a fallen tree, and trapped under water against its branches. The rescue, although poorly conceived and extremely risky, was ultimately successful; however, the victim was recovered unresponsive with no pulse or respirations; and, her gear was lost. CPR was initiated and also successful; the patient recovered consciousness after 15 minutes with no memory of the event. One hour after the event she was warm, awake and alert with normal pulse and respiratory ratess, no spine pain or tenderness, and normal motor and sensor exams.
What were the administrative and site management errors, if any, that contributed to this incident? What are the patient's current and anticipated problems and what level of evacuation, if any, should be initiated? 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 field reference for expedition medical problems? 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 snowboarding in the backcountry with one of your close friends, Joe, in roughly two feet of new powder on a 35º timbered slope. The trees are Lodgepole Pines with trunk diameters varying between six and ten inches. Some are closely spaced. Your friend chooses a rather tight line and takes off. Unfortunately it's a bit too tight, and he crashes into an eight-inch tree hitting his head—he's not wearing a helmet—and injuring his arm. When you finally reach him, he is partially buried upsidedown in a tree well and struggling to release his bindings with his left arm. He has a two inch gash across his forehead over his left eye that, while not deep, is bleeding freely.
As you approach, you ask him to stop struggling and then free him from his board, and help him into a sitting position. After asking him to hold a trauma dressing to his forehead to stop the bleeding and then move forward with his assessment. Joe tells you he feels sick and might vomit, can't move his right arm, and that both his right shoulder and wrist hurt. He estimates the pain in his shoulder is a three and his forearm a six. He confirms that he has no allergies, is not taking any medications, has indeed been drinking water and is not dehydrated (his urine was light yellow at the top of the run). He admits to having been hospitalized for a concussion a few years ago when he totaled his car. He tells you he didn't "black out" when he hit the tree and proceeds to describe his fall in detail. Upon exam, his right forearm is tender and while he can move the fingers of his right hand, it hurts quite a lot and he is unable to hold onto a one liter water bottle due to the pain in his forearm. The laceration on his forehead has stopped bleeding and upon close inspection is more a scratch than a serious wound. His right shoulder is sore but he can move it without pain. By now, twenty minutes have passed and his arm, although throbbing, doesn't hurt quite a much (3 on the 10 scale) as long as he supports it against his chest. He also says his nausea is gone and he feels better. His pulse is 68 and regular, his respirations 16 and easy, the skin on his face and hands is a bit pale and cool (it is cold out after all), and he is able to easily carry on a discussion with you regarding his injuries. He says his back doesn't hurt. While he is able to resist pressure applied to his ring and index finger equally on both hands, the fingers of his right hand are significantly weaker than those on his left even with his hand supported. His feet show no weakness when asked to push down or pull up. He has a no spine tenderness and no shooting or electric-like pain. What are his current problems, anticipated problems, and your treatment plan? You and Joe are about two miles from your vehicle. 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. |
Categories
All
Our public YouTube channel has educational and reference videos for many of the skills taught during our courses. Check it out!
|