You are on the 5th pitch of a new route on Elephant's Perch in the Sawtooth Wilderness in Idaho when you climbing partner, Jonna, takes a forty-foot lead fall. During the fall, she made contact with the rock a couple of times. Hanging from her harness immediately after the fall, she is awake and alert, complaining of severe pain in her left arm near her elbow. There is enough rope for you to lower her to your belay stance on a micro-ledge. Once on the ledge, you examine her arm and find it tender, slightly deformed, with no range-of-motion, and painful (6 out of 10) with good distal CSM. Her right knee also hurts (2 out of 10) and is slightly tender with some minor abrasions, but has complete range-of-motion and she is able to bear weight. Jonna reports that she did not hit her head or trunk during the fall; however, her helmet is scratched, her neck is sore (2 out of 10), and she has a mild headache (3 out of 10).
What do you think is wrong and what can you do about it? Click here for answers. 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 at a friend’s cabin cutting firewood for the upcoming winter, when the chainsaw slips and cuts deeply into your Ron’s right leg just above his knee. The saw stalls on the canvas of his pants and his tissue; dark blood immediately begins to well out of the wound quickly saturating the material and flowing down his leg. You quickly grab his sweatshirt and attempt to stop the bleeding with direct pressure as you yell to your brother to grab the first aid kit. Blood is seeping from under the shirt when the first aid kit arrives. Opening it, your brother finds two CAT tourniquets, 3-4 rolls of sterile gauze, two Chito-SAM dressings, Trauma shears, and a couple of 2-inch elastic wraps. You are at least six hours from the nearest hospital.
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 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. 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 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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