Case Study 29

The Scenario: Search & Rescue in the Winds

The Setting

You are on a SAR team of Wilderness First Responders (WFR) hiking the Bear’s Ears Trail into the Wind River Range looking into a vague report of a “very sick person” camped “near the trail near tree line." The report came in at midnight. Your team’s role is to sweep this trail in the dark in the hopes of finding out exactly what is going on. A second group is gathering to hike up later in support. 

After eight miles of fast uphill walking you see a poorly pitched tent off the trail at 11,300 ft. The first rosy fingers of dawn reach across the Wind River basin from the east.

 “Hello, is anyone in the tent?”  “This is search and rescue. We have a report of someone who needs assistance?”

The silence and a distinct smell of vomit prompt you to look into the tent. You see a woman curled in a sleeping bag, appearing pale and sickly. She opens her eyes when you ask, “Ma’am, can I help?”

SOAP Report

Subjective/Summary/Story

We found a 52-year-old female who is lethargic with altered mental status. She apparently hiked up here yesterday afternoon and was too ill and fatigued to continue. Her companions continued on with a vague plan to return if she did not arrive at their planned destination lake.

Objective/Observations/Findings

Patient Exam: The patient denies any recent trauma. Head-to-toe findings are negative other than some minor scrapes and bruises on her lower legs. Listening with a stethoscope her lungs are clear bilaterally. She can stand with assistance and walk slowly and wobbly.

Vital Signs
TIME

0500

LOR

A+Ox2 .

HR

90, strong, regular

RR

22, regular, easy

SCTM

Pale, warm, dry

B.P.

150/94

Pupils

PERRL

99°F (37.2°C) oral

 

Blood Sugar

“high” reading on  glucometer.

 

History

Symptoms:

Weakness, lethargy, nausea. She denies headache, shortness of breath or chest pain. She is not consistently oriented to place and time and requires multiple questions to elicit her medical history and recent events. 

Allergies:

Denies

Medications:

We found multiple medications prescribed to this patient; simvastatin (for cholesterol), captopril (for blood pressure), and insulin. We are unable to determine when she last took any of these. She states she needs to take insulin and try to eat. 

Pertinent Hx:

This is unclear and unreliable. Patient does report a history of diabetes and high blood pressure. 

Last in/out:

She says she has been drinking water; however, there is no water at this location and her water bottles are empty. It appears she has vomited several times. Patient denies diarrhea and there is no evidence of diarrhea. She urinated dark smelly urine once in our presence.

Events:

We think this patient, who apparently lives at sea level, hiked eight miles and 3000’ to this location yesterday. She became fatigued and decided to stop for the night. Her companions continued on. 

Stop ...

What is your Assessment and Plan?

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