Case Study 18

The Scenario: Numb Toes

The Setting

You are the trip leader for a group of college-aged outdoor education students. You’ve been teaching a course on outdoor skills through the fall, most of it taught indoors. The group’s weekend trips have been day hikes. Today is the culminating trip, an overnight ski trip where you plan to sleep in snow shelters.

The skiing portion went according to plan; you arrived at the snow shelter site at the time anticipated. Everyone appeared weary, happy, and healthy. You note that it is much colder than any previous trip, with temperatures hovering in the single digits Fahrenheit.

Shelter digging is strenuous, and the dry snow needs time to set up before it can be excavated into a quinzhee. You use this time to check how everyone is doing; it’s obvious some people have gotten sweaty and are tired from the hard work. You decide to be a good model. You sit on a pad, pull off your boots, and look at your toes, asking everyone to do the same. Lo and behold, one of the students has toes that are white. He comments that they were “cold and numb, but I thought I could get by until I got into my sleeping bag.” 

SOAP Report


The patient is a 20-year-old male with a local cold injury. The mechanism for injury is one day of exposure to cold temperatures.


Patient Exam:

The patient is warm and resting in our camp. All ten toes are reported numb and are white and cold to the touch. His fingers are warm with normal CSM. There is a good pedal pulse and he can move his ankle and his toes. The big toe on his right foot is cold, white, and hard. His other toes appear white and cold, but soft. No other injury noted.

Vital Signs

1600 hrs




72, strong, regular


10, regular, easy




Strong radial pulse



98F oral




Numb toes.





Pertinent Hx:

Pt reports several previous episodes where his toes got cold and very painful when warmed. He denies having frostbite or any blisters secondary to the cold exposure.

Last in/out:

Pt is well hydrated with 4 liters today and clear urine. He has eaten throughout the day and had a normal bowel movement this morning. 


Snowshoe hike of 3 miles and shoveling snow for shelters.

Stop ...

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