You are the trip leader on a day rafting trip on the Penobscot River in Northern Maine. One of the rafts in your trip flips in Exterminator hole at the top of the Staircase rapid (Class IV) shortly after putting-in at the power station. One of the guests, a 52 year-old man, was trapped under the raft and only released at the bottom of the rapid. James was pulled onto the top of his raft by the guide weak and coughing. After a few minutes, the coughing subsided and, aside from numerous scrapes on his lower legs from contact with the rocks in the rapid, your physical xam is normal and he says he feels okay. He is currently alert with no spine pain or tenderness and normal motor and sensory exams. His history is also unremarkable and after resting for ten minutes, he wants continue with the trip.
What do you think is wrong with James and what should you do about it? 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.
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