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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