Case Study 6

The Scenario: A Rattlesnake Strikes

The Setting

You and your partner are sampling some of the new north-facing overhanging limestone outside the famed Wild Iris climbing area in Wyoming. This steep pocketed little gem has yet to be discovered by the general public so the approach to the crag is steep with little or no trail. It takes 45 min. to drive to the pullout from Lander, with an additional 15 min. of walking along an old two-track road to get to the crag.

While walking along the base of the cliff, a dry buzzing noise fills your ears. You react without thinking and somehow avoid stepping on the rattlesnake coiled at your feet. Your partner, distracted by the sheer cliff band, walks right into you and you both tumble to the ground. After scrambling back to your feet you watch the beautiful snake with its triangular head and diamond pattern quickly slide around the corner. Then you notice your partner still on the ground wailing that he is “too young to die.”

SOAP Report

Subjective/Summary/Story:

The patient is a 25-year-old male whose chief complaint is a possible snakebite to the right forearm. Patient states, indeed insists, he was struck when he tripped and fell with outstretched arms to the ground while hiking.

Objective/Observations/Findings:

Patient was found lying on the ground clutching right forearm.

Patient Exam:

Head-to-toe exam revealed two puncture wounds approximately 3/4” apart on the right forearm. One puncture weeping clear fluid tinged with blood. Patient complains of persistent ache in right elbow, and states this was present prior to this event. No other injuries were found. Patient denies head, neck, and back pain and he did not lose consciousness. There is no bruising or swelling at the bite site, no tingling or numbness in the arm, and good CSM in the right hand.

Vital Signs:

TIME 

15:40

16:00

LOC

A&O x 4

A&O x 4

HR

100 strong and reg.

72 strong and reg.

RR

22 shallow and reg

16 shallow and reg.

SCTM

P/C/C

P/W/D

BP

Strong Radial Pulse

Strong Radial Pulse

Pupils

PERRL

PERRL

Temp

N/T

N/T

 

History:

Symptoms:

Nausea, Anxiety

Allergies:

Penicillin, seansonal allergies not presently a problem

Medications:

Ibuprofen 400mg for elbow pain

Pertinent Hx:

Ache in right elbow for last two weeks. Belived to be climbing overuse injury

Last in/out:

Energy bar @13:00, 2 L H2O today, bowel normal, urine pale yellow

Events:

Unremarkable

Stop ...

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