Case Study 13

The Scenario: Soggy Socks

The Setting

You’re the trip leader for a group of teenagers on a nine-day trip in the Bitterroot Mountains of Montana. It’s June. Winter hasn’t loosened its grip. The rivers are up and every crossing has been wet. A late spring snowstorm dropped several inches of new snow and brought cooler temperatures. This has kept the mosquitoes at bay, but at the expense of being generally wet for most of the trip.

You’ve encouraged daily foot checks, changing socks, and staying as warm and dry as possible – all relative to the reality of these conditions. At today’s midday rest break you realize that no one has dry socks and one of the participants says his feet hurt. 

SOAP Report

The 18-year-old patient is complaining that his feet hurt.

Patient Exam: The patient’s feet are pink and cool to the touch. Capillary refill does not appear diminished.  The feet are not swollen, not cyanotic, and there are no blisters or other soft tissue wounds or rash. The patient can feel light touch on the ends of all the toes, wiggle his toes, and push against resistance without increasing the pain. He denies itching, numbness, or pins and needles sensations. There is a white soft patch on the underside of his right big toe. 

Vital Signs
TIME         1230
LOR            A+Ox4
HR            72, strong, regular
RR            14, regular, easy
SCTM         pink, warm dry
B.P.            strong radial pulse
Pupils        PERRL
T°            Not taken

Symptoms: Pt complains that his feet ache and throb at a 6 on a 1-10 scale.
Allergies: Denies.
Medications: Denies regular medications. Pt has been taking ibuprofen 400mg every six hours for this pain. 
Pertinent Hx: No history of local cold injury to his feet.
Last in/out: Pt is well-hydrated and ate lunch today.
Events: Pt has been hiking in wet cool conditions. Although he has been diligent with foot care, yesterday his feet became very cold. He didn’t do anything about it until he went to bed. His feet stayed cool most of the night.

Stop ...

What is your Assessment and Plan?

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