Case Study 21

The Scenario: Fighting Fatigue on the Trail

The Setting

Two search and rescue (SAR) volunteers have been sweeping a trail into the central Rocky Mountains in response to a vague cell phone report of a person somewhere on the trail. Eight miles from the trailhead at 8,800ft (2680m) they find two adult males, sitting on a log and not in any obvious distress.

After introducing themselves the SAR team learns that one of these guys is the person they've been looking for, and with the patient's permission, they begin an assessment.

SOAP Report


The patient is a 38-year-old male with a chief complaint of weakness and fatigue. He states that he thinks he has the flu, has been walking very slowly, and can get to the trailhead if he can ride a horse. He has only been able to walk four miles over eight hours today on a level or downhill trail with a light pack. 


Patient Exam:

Patient denied recent injury, fainting, dizziness, or falls. There were no findings on the head-to-toe assessment. There are rales throughout his lungs by stethoscope, but no audible abnormal breathing noises. He is not coughing, although he said he had coughed a lot over the past few days. The patient was sitting comfortably, not in any apparent distress, speaking in sentences. He is able to stand and walk a line in the dirt without ataxia.


Vital Signs





100, regular, strong


24, regular, unlabored


pale, warm, dry


radial pulse present



99°F (37.2°C) oral






Weakness, fatigue at present. Headache, nausea, no appetite, lethargy the past 48 hours.




Acetaminophen 500mg 3 times a day for the past two days for headache.  Denies any other regular medications.

Pertinent Hx:

Pt states he has hiked at this and higher altitude several times previously without illness. He denies any significant medical history or breathing problems.  He reports he is very physically fit and cannot understand his fatigue. 

Last in/out:

Patient has been drinking 4 liters a day with clear urine and normal bowel movements. He has been nauseous with poor appetite for 48 hours and has eaten some food, but less than normal.


The patient states that this is his fifth day in the mountains. On the first day he traveled from his home at 3000' (915m) to the trailhead at 8000' (2400m). On day two they backpacked 8 miles to 10,200' (3100m). On day three they backpacked 7 miles to 10,400' (3200m) and that evening he began to feel ill with headache, nausea, weakness, and coughing.  He slept poorly that night and stayed in camp the next day. His symptoms did not improve and as the group had an aggressive itinerary he decided to leave the mountains today, the fifth day. He and his companion left this morning for the 12-mile hike to the road. By noon he was clearly weaker and concerned with his lack of progress.  He called a friend at home who apparently called the local SAR unit.

Stop ...

What is your Assessment and Plan?

DO NOT click/peek at the next page without answering this first.