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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.
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While mountain biking down a steep single track your friend catches his front wheel and is thrown forward with his bike. During the fall the handlebars smash into the left side of his chest. Asa has difficulty sitting up and catching his breath, and appears to have injured his left wrist. After assisting him to a sitting position and coaching him to breathe with his abdomen, his respiratory distress appears to resolve. During your physical exam, he reports a sharp pain (7) in the ribs on his lower left chest when he tries to take a deep breath. While his left wrist hurts (4) and has a slightly decreased ROM with good distal CSM, it appears weak: Asa is unable to easily hold and lift a full 1-liter water bottle. His helmet is cracked, he reports feeling a bit woozy, and has a headache (4); the remainder of his physical exam is unremarkable. With abdominal breathing, the pain in his ribs is manageable (3). 20 minutes after his accident his pulse is 94 and regular and his respiratory rate is 22 and remarkably easy; he reports his normal pulse rate is in the mid-60's and he doesn't know his normal respiratory rate. While awake, he still feels a bit "out of it." A focused spine assessment reveals cervical pain and tenderness at C-7 with no shooting pain and normal motor and sensory exams. What is wrong with 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. 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. You are on a three-week canoe expedition in the boundary waters. One of your students, Ximena, approaches you before breakfast complaining of pain and swelling in her ankles; she thinks it's a reaction to the black fly bites she received a couple of days ago when she forgot to reapply DEET after swimming. Yesterday the bite sites were slightly red and itchy. This morning, upon awakening, both her ankles are swollen with red streaks moving up her lower legs. She is tired and feels sick. Her core temperature is 101º F (38.3º C). It's day 14. What is wrong with Ximena 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 Forest Service wildland firefighter supervisor and trainer. You have a strenuous field exercise planned for tomorrow for a new cadre. Unfortunately, an unseasonable heat wave is in place and the high temperature predicted for the day is in excess of 110 degrees F. What are your concerns and how should you address them? 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 your partner are planning a two or three day backpacking trip near your home in Boone, NC with your seven year-old daughter and six year-old son. They have been car camping with you for the past three years, taken short day hikes, and enjoyed both. Your daughter is severely allergic to wasps and poison oak; she was hospitalized at four after being stung by a yellow jacket in your backyard. How should you plan your trip? 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 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 paddling with two friends on the Farmlands section (Class VI-V) of the White Salmon River in Washington state. The day is sunny and 65 degrees F but the water temperature is quite cold at 45 degrees. Most of the river is behind you when one of your friends Jessie, gets offline and runs the slot. Her kayak completely disappears for a few seconds before popping up downstream upside down. There is no sign of Jessie. Chasing her, you see her get scraped out of her boat as it drags over a submerged rock. It takes another 3-5 minutes (?) to rescue her. Once on shore, she is unresponsive, not breathing, and does not have a pulse. You pull her onto a flattish rock and begin CPR. During the second round of chest compressions, a small amount of foam issues from her mouth and nose. You breathe through it. Roughly three minutes later she spontaneously begins breathing. Ten minutes later she is awake and confused with no memory of the event. Her helmet is cracked and her physical exam is unremarkable. She is shivering even though the rock she is on is in the sun; she is wearing a drysuit. Her pulse rate is 52 and regular; her respiratory rate is 16 and easy; her lungs appear dry with no rales, gurgling, or coughing. The Green Truss bridge take out is just downstream and requires ropes to haul your kayaks to the rim. Once at the rim, a clinic is about an hour away and a small hospital an hour further. Jessie wants to get off the water and go home. You have cell coverage. What is wrong with Jessie and what should you do? Click here to find out. Click here to read a blog article on drowning. 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 father/son day hike for a local camp. The father's ages range between 35 and 54 with various levels of fitness; their sons are 11 or 12 years old. The hike is a point-to-point hike covering a total of five miles. You are currently a hiking up a rather steep grade to a prominent overlook; there is only a few hundred feet to the top and just over a mile remaining to your pick-up spot. The day is sunny and hot with an ambient temperature of 88º F. One father, Bill, an overweight man in his early 50s, repeatedly stops to catch his breath on the hill. After his second rest stop you move him to the front of the group in an effort to keep the group together and slow the pace. Upon reaching the top at 3 PM he is clearly exhausted, slightly pale, sweating heavily, and complaining of the heat; the slight breeze at the overlook is clearly welcome. While resting, he admits he "is more out of shape than he thought" and relates that he is otherwise healthy with no personal or family history of heart disease; although, his physician has been trying to get him to start statins to lower his cholesterol. He can't remember the last time he urinated or the color of his urine at the time; he thinks it was when he woke up this morning. He reports drinking about a quart of water on the hike thus far but not snacking; he is very thirsty now. His color returns and after 10 minutes, his pulse is 86 and regular, his respirations are 20 and easy, and his oral temperature is 102º F.
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 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. |
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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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