The Setting
Two friends are on a long run in the foothills of the Wind River Range in Wyoming in August. It’s a hot day. Four hours into the run your companion stumbles, slows, staggers, and sits on a log. He says he “feels awful.”
SOAP Report
Subjective/Story/Summary
The patient is a 34-year-old male. His chief complaint is “feeling awful.” We are four hours into a planned 24-mile trail run at elevations ranging from 6000-8000’ (1800-2400m).
Objective
Patient Exam:
There is no mechanism of injury. Nothing unusual found on head-to-toe assessment. No edema, rashes, swelling, bruises.
Vital Signs
| TIME | 1000 |
| LOR | A+Ox4 |
| HR | 76, strong, regular |
| RR | 20, easy, regular |
| SCTM | Pink, warm, flushed (seems appropriate amount of sweat for this run) |
| B.P. | Strong radial pulse |
| Pupils | PERRL |
| T° | Not taken, skin not warm to touch |
History
| Symptoms: | The patient complains of feeling dizzy, shaky, “weird,” anxious, nauseous, and having a dull headache. |
| Allergies: | Denies |
| Medications: | Ibuprofen 800mg at 0500, 400mg at 1000 |
| Pertinent Hx: | None |
| Last in/out: | The patient has been drinking water. He drained his 2L hydration backpack twice today. He has not urinated since the start of the run. He has eaten two energy bars (200mg sodium each) and one salt tablet (215 mg sodium). He denies thirst. |
| Events: | The patient has been trail running for four hours (20 miles) through the Wind River Range. It’s hotter than expected under a blazing sun. The patient has a visor sun shade, sunglasses, light synthetic clothing, and a very light pack. |
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