Case Study 30

The Scenario: Colder Than Expected

The Setting

You’re on a backcountry ski trip with five friends, presently a four-hour ski from the nearest road. The weather over the last 24 hours has been challenging with unanticipated daily highs of 9F (-12C) and nighttime lows of -20F (-28C). When you stopped to camp one of your companions revealed that he may have frostbite on his fingers. As a Wilderness First Responder (WFR) you asked if you could look at his hands. You were struck by how white they looked, especially the fingers on the right hand.

SOAP Report

Subjective/Summary/Story

The patient is a 24-year-old male with possible frostbite to his right fingers.

Objective/Observations

Patient Exam: The patient’s distal joints of the fingers of his right hand are white, numb, and hard. The remainder of his hand is cool, pale, and soft. There is no injury to his right thumb, left hand/fingers, or to his feet. He is not hypothermic.

Vital Signs
TIME

1600 hrs

LOR

A+O x4

HR

92, strong, regular

RR

16, easy, regular

SCTM

pink, warm, dry (except right hand)

BP

radial pulses present

Pupils

PERRL

99°F(37.2°C) oral

History

Symptoms:

Denies.

Allergies:

None.

Medications:

Ibuprofen 400mg three times today for muscle aches.

Pertinent Hx:

No previous cold injury history, no relevant medical history.

Last in/out:

Patient is well-hydrated, has been eating throughout the day; normal urine and bowel function.

Events:

Patient was skiing in cold weather and had trouble keeping his hands warm.

Stop ...

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