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You are on a multi-day backpacking trip in the southwestern canyons with a friend and her partner. You haven't seen your friend Janey for a number of years, and this is the first time you spent any time with her partner, Jon. The temperatures on the trip have been in the mid 70s until today when they unexpectedly climbed to over 90º F by noon. You are in a fairly open part of the canyon and exposed to the direct sun. Everyone is sweating heavily and looking forward to reaching camp and water. By mid-afternoon Jon is noticeably tired and feeling nauseated. You are almost out of water, but camp is within a half mile. You stop, pull out a SOAP note and complete a full patient assessment. During your SAMPLE history, Jon tells you he just started taking lithium for a mild bipolar disorder; the last time he urinated was before lunch. The remainder of his history is unremarkable; however, both his pulse and respiratory rates are a little higher than normal. What do you think is wrong with Jon 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.
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You are part of a hotshot crew responding to a wildfire in northern California. Temperatures are well into the triple digits close to the handline they were tasked with holding. James, one of the crew members, is complaining of the heat and it's difficult to keep him cool. During your patient assessment, you find that he has recently started taking Benadryl® for a newly developed allergy to juniper pollen. What do your think is wrong with James 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. You are leading an interpretive day hike down the Bright Angel Trail of Grand Canyon National Park for a local concessionaire. People sign up for the hike online or at the concessionaire's Flagstaff office; they do not complete a medical form. It is a 9-mile out-and-back hike; water, shade and bathrooms are available at Indian Garden, which is the turn-around point. There is also water and a resthouse at 1.5 and 3 miles. It's mid-August and the temperature is expected to reach triple digits by early afternoon; the hike is scheduled to leave the Backcountry Information Center at 7 am. Participants are asked to arrive at 6:30 am with a day pack that includes snacks, lunch, water (at least two liters, one bottle should be frozen), and sunscreen. They are also instructed to wear light-colored clothing, a wide-brimmed hat, and sun glasses. During your pre-hike safety talk, no one responds when you ask if anyone has any medical conditions you should be aware of. The day heats up quickly and it's close to 90º F by 10 am and travel has been slower than expected. You are close—a quarter mile—from Indian Garden when one client, a 62-year-old man, begins to complain of the heat. You stop, cool him off using a combination of mist from your spray bottle and fanning. Once he is cool, you continue to Indian Garden, where once again, he complains about the heat. You break out the spray bottle as he sits in the shade. Once he is cool, you take out a SOAP note and do a full patient assessment. During your SAMPLE history you discover that he was hospitalized four years ago for a heart attack and currently taking a beta blocker and a diuretic to help prevent a second heart attack. The client, Tyrone, reports that he has been athletic with no health issues for the past two years. What do you think is wrong with Tyrone 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. You are a paddle raft guide on the Salmon River during high water; the air temperature is 72º F and water temperature is 54º F. You are at the put-in waiting for your clients to arrive. The bus pulls up and the clients disembark in wetsuits and life-jackets and move to their assigned guides for a safety talk. Your clients all know one another, joined the trip after seeing a brochure during a planned holiday to celebrate the 70th birthdays of two group members, and have never been whitewater rafting before. The entire group is retired, in their late 60s or early 70s, and appear to be in good health for their age. After your safety talk, two of the men, Paul and Andrew, tell you they are each taking a beta blocker for a heart condition. The day run from Riggins to Lucille contains two large rapids where a paddle raft guide needs to rely on the strength and ability of the clients to get the raft to the right place in each rapid; the raft could flip or throw one or more clients in the rapid if in the wrong spot. What are your concerns, if any, 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.  You and a couple of friends rented a backcountry yurt and are out on a day tour. As one friend, Tyler, triggers a soft-snow sluff that carries him 75 feet into the trees where he stops, partially buried against a large Ponderosa pine. He is unresponsive and bleeding slightly from a small cut above his left eyebrow and from abrasions below his left eye. He slowly awakens and is fully alert as you finish digging him out of the snow. Tyler is a healthy 26-year-old male with a history of multiple mild concussions. He is complaining of a mild headache (3) and a sore neck (2). He exhibits limited movement in his left eye when asked to follow your finger as you move it upward (refer to photo); the remainder of his physical exam is unremarkable. During the focused spine assessment his spine is non-tender with normal motor and sensory exams; his neck is still sore. His resting pulse and respiratory rates are normal; his oxygen saturation level, blood pressure, and core temperature were not taken. You have no cell reception and are about two miles from the yurt where there is an emergency satellite phone. What is wrong with Tyler 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.  You are part of a search and rescue team looking for two lost climbers on Mount Washington. The search is entering its third day when, with the help of rescue dogs, the climbers are both located in a snow cave that was hidden from view by a fresh layer of snow from a storm the previous night. The climbers are both unresponsive with no pulse or respirations. They are huddled together and wearing parkas. One of the climbers, James Standing, has an angulated lower right leg; the other climber, Asa Cochran, appears to be uninjured. The average temperatures on the mountain ranged from a daytime high of 16º F to a nighttime low of -4º F. The day is clear with a light wind, and a helicopter is on standby at the Appalachian Mountain Club lodge on Route 2 at the base of the mountain. You are in communication with the lodge and Incident Command via satellite phone. What is wrong with James and Asa 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.
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 search and rescue team looking for survivors a day after a devastating wildfire passed through your town. It's been raining non-stop for the past 12 hours making your task more difficult. Mud slides have closed a number of roads slowing evacuation and exacerbating the entire situation. As you walk the shoreline of one of the nearby lakes, you see someone waving in an attempt to attract your attention from an island roughly half a mile from shore. Borrowing an aluminum rowboat from one of the burned-out cabins, you and your partner row to the island. Once there, you are confronted by a 32-year-old mother who is wet, shivering, and seeking help for her six-year-old daughter, Jolene. Jolene is huddled in a leaky, make-shift shelter, swathed in a wet blanket. She responds to your questions with short, mumbled phrases. Her mother, Trish, reports that they fled the fire by swimming to the island yesterday, that both she and Jolene are uninjured, and that they have had no food since early yesterday. Trish said she had to swim with Jolene most of the way. The water temperature is in the mid-60s F. It's now 4:30 pm and the rain is not letting up. You are in communication with Incident Command via satellite phone. What is wrong with Jolene 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.  You are leading a three-week summer backpacking trip for 18-21 year-old college students. While on a day hike to a local summit on day 13 of the trip, one of your students, Geoff, falls and cuts his leg on a sharp rock. There is not much bleeding and he can bear weight and walk with minimal pain. You are roughly a mile from your campsite with two days left until your next resupply. 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. You are on a 6-day preseason guide training trip for a commercial river company operating on the Colorado River in the Grand Canyon. There is a party on the 3rd evening of the trip and many of the guides are drinking. When you head for bed around 10 pm there are still a few souls by the fire. An hour and a half later you are awakened by a drunken guide and asked to examine a 28 year-old male trainee who they cannot arouse. You find Jim lying on his side on a sleeping pad near the fire. He is unresponsive with slow, irregular breathing; his pulse rate is 36 and regular, his skin is pale and his nail beds are blue-tinged. The night is slightly cool, likely in the mid-60s °F but it's warm by the fire where Jim is lying. You remember seeing Jim with a beer in hand but no one can remember how much he drank or if he had some of the whisky that had been passed around. Going through Jim's personal belongings reveals a bottle with a number of unidentified tablets. What is wrong with Jim 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. |
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