 It’s late summer in Icicle Creek: the air is dry, a light breeze flows through the canyon, and the shaded gray granite feels cool to the touch. You and your partner, Beth Sanson, are halfway up a three-pitch 5.9 crack climb. Beth is leading. On the second pitch, Beth places a small cam in a shallow, flared crack, steps up, but slips on dusty crystals. The next piece holds, but she drops about twenty feet, swinging violently into the wall. Her right hip hits the wall first, followed almost immediately by her head. She is wearing a helmet. Beth is initially unresponsive as you lower her to your belay. She regains consciousness at the belay before being lowered to the ground. Once on the ground, you help Beth sit down. She is favoring her right leg, but talking and breathing normally. Her helmet is chipped above the left temple. She says she feels a bit dazed. She is slightly pale and complains of pain in her right hip. A bruise is forming high on her right thigh with some swelling. When she tries to stand, her face tightens, and she quickly sits back down. She keeps one hand over her right hip as you help her settle into a jacket for padding. When asked, Beth says she is starting to feel cold and has a headache. She also mentions feeling a bit nauseous. What’s wrong with Beth, and what should you do? Interested in learning more about wilderness medicine? 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 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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 It’s a hot Saturday in July on the Lower Yough, the seven-plus mile Class III/III+ drop-and-pool run below Ohiopyle Falls. The river is crowded with rental rafts and commercial trips. At the entrance to Dimple Rapid, the raft caught a strong eddy line, and the bow dove. Two of the guests lose their balance, stop paddling, and fall into the water. One swimmer—Elena Márquez—flushes toward Dimple Rock’s undercut. She disappears in the aerated water, then surfaces coughing and gasping. A guide’s throw bag reaches her, and she is pulled to shore. You eddy out on river right. Elena sits upright on a riverside boulder, soaked and shivering. She coughs repeatedly, bringing up small amounts of river water. Her breathing is fast, and she pauses between sentences to catch her breath. She says it feels hard to take a deep breath. Her skin is cool and damp, and she leans forward, resting her forearms on her knees. There are scrapes on her right shoulder and forearm. She says she did not hit her head and remembers everything. Her chest discomfort is mild at rest but increases when she tries to take a deeper breath. What’s wrong with Elena, and what should you do? Interested in learning more about wilderness medicine? 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 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. 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. |
