Wilderness Medicine Case Study 12

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:

1. If your resuscitation efforts remain unsuccessful how long do you continue CPR? 
2. If your resuscitation efforts are successful but he remains pain responsive and shivering with bruising and tenderness on his lower right ribs, slightly elevated pulse and respirations, and wet lung sounds, what are his problems, his anticipated problems, your field treatment and your evacuation level? 
3. If your resuscitation efforts are successful and your patient becomes awake and alert with no memory of the event, bruising and tenderness on his lower right ribs (he can take a deep breath without pain and he appears to be breathing easily), and passes your focused spine assessment (reliable with no spine pain, no spine tenderness, normal sensory & motor exams), what are his problems, his anticipated problems, your field treatment and your evacuation level?

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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.

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