Case Study 19

The Scenario: Stomach Cramps on a Kayaking Trip

The Setting

Five days into sea kayaking with friends in Prince William Sound, Alaska, you feel lousy; some diarrhea, some vague abdominal cramping, not much appetite. You assume it's a touch of the flu and don't say anything. The next day you feel better and paddle all day.

That night you wake with the worse abdominal pain you have ever experienced. You endure it quietly and it subsides after 30 minutes. At breakfast you tell your companions about it. The Wilderness First Responder (WFR) in the group begins a series of questions, which he writes into a document he calls a SOAP report. You don't think you're very ill, but he's your friend, so you allow him the chance to do his "patient assessment."

SOAP Report

Patient is a 26-year-old male whose chief complaint is, "I don't feel great, but I've felt worse." He appears pale, with normal mental status, and can walk. He states he has been feeling poor for the past two days with occasional diarrhea. He has been able to paddle his sea kayak on several long days. Last night he had 30 minutes of the "worst hard cramping pain he has ever experienced." "I have a new 10 on a 1-10 scale." He also reported his "belly was hard as a rock". The episode subsided and the patient was able to sleep the remainder of the night. 
Patient Exam: Patient denies any recent injury and we have been together and have not witnessed any injury. He refuses a head-to toe exam, but agrees to an abdominal exam. He has some tenderness throughout his abdomen, no localized pain, but sharp pain in his lower right belly upon a tap on his right foot. 

Vital Signs

Vital Signs

7/23 8:30 AM

7/23 9:30AM





90 strong, regular

94 strong, regular


15 regular, easy

15 regular, easy


pale, warm, dry

pale, warm, dry


strong radial pulse

strong radial pulse


not taken

not taken

98.4°F (36.8°C) oral

not taken




At present he has constant and dull generalized abdominal pain that is a 2 compared to last night's 10. States he has general feeling of being "sick".




Has been taking 400mg ibuprofen 4x a day for the past week for shoulder aches.

Pertinent Hx:

None.  Patient has his appendix.

Last in/out:

Has been well-hydrated with clear yellow urine past several days. Drank several cups of water this morning, no BM. He ate a light breakfast.


Feeling ill past several days.

Stop ...

What is your Assessment and Plan?

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