The Setting
You’ve been searching on foot for the past two days in a wet snowstorm for a lost hunter. Last night the skies cleared and the bottom dropped out of the thermometer. It’s a 0 ° F dawn. The snow is knee deep. Your hunter has now spent two nights out.
The radio crackles with a report that the subject has been found and is being evacuated by sled to the search base, a large nearby log cabin. You head over in time to see the patient, in a sleeping bag, being carried into the cabin. They found the hunter face down in the snow. He had apparently fallen into a creek sometime during the early morning hours (the ice had not re-frozen).
Your initial assessment finds the patient responsive to pain with a barely audible moan. You cannot find a pulse and there is no apparent respiratory effort. With a stethoscope you find a heart rate of 30 and a respiratory rate of 6. In order to do the head-to-toe you need to cut through 2-3 layers of frozen cotton garments.
SOAP Report
Subjective/Story/Summary
The patient is a 30-year-old male who has been missing for 36 hours over two nights. He is presumed to be suffering from hypothermia.
Objective
Patient Exam:
White, waxy, hard tissue is present on all fingers, all toes (proximal onto the forefoot), the nose, ears, and on an 8″ diameter section of the left upper abdominal quadrant (his clothing was pulled up here apparently exposing his belly). He has several small bruises on his lower legs. No other injuries found. Skin is cold to the touch.
Vital Signs
| TIME | 0915 |
| LOR | responsive to pain with a moan |
| HR | undetectable pulse, auscultated rate of 30 |
| RR | auscultated at 6 |
| SCTM | pale, cold, dry |
| B.P. | undetectable |
| Pupils | equal and slow |
| T° | unable to measure |
History
| Symptoms: | not available |
| Allergies: | not available |
| Medications: | not available |
| Pertinent Hx: | not available |
| Last in/out: | not available |
| Events: | patient has been lost in the mountains in cold (single digit lows) temperatures and wet snow for 36 hours over two nights |
Stop...
What is your Assessment and Plan?
Take a few minutes to figure out your own assessment and make a plan.
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