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Case Study 7 October 2008
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Case Study 7 October 2008

The Setting

The smell of the morning coffee your co-instructor is brewing wakes you from a great sleep. This is immediately followed by a loud scream from one of the student camps.  It’s a fall morning in the Gila Wilderness in New Mexico, and you’re about to earn your pay.


You bolt out of your sleeping bag, stumble and fall in the process, and curse your clumsiness.  Your co-leader runs to the sound of the howls and commotion.  You grab the first aid kit, pull on your shoes and a layer of clothes.   While walking to the scene you keep your breathing under control and your head up while your eyes scan the camp.  You mentally review the scene size-up and initial assessment.  


You find one of your students, 25 year old Daniel, howling in pain and trying to pull off his polypro long johns. Another student is pouring water onto the student on the ground.  At the same time one of the students is standing to the side sobbing “I’m sorry.  It was an accident.”  Apparently, he tripped while carrying a pot of hot water and spilled the water into the patient’s boot.


You quickly figure out that this is a spilled hot water burn and continue the cool water irrigation and help the patient to pull off polypro, socks and shoes.  After 20 minutes of water irrigation, which required several relays of people back and forth to the stream (which of course was more than 200 meters from the camp) you decide it’s time for a complete patient assessment. burn spilled water salmon 06(3).jpg


SOAP Report

Subjective/Summary/Story

The patient is a 25 year old male who had a pot of boiling water spilled on the back of his left lower leg and foot.  


Objective/Observations/Findings

Patient Exam

The patient has 5% superficial burns to the back of the left lower leg and a 2” x3” partial thickness burn to the heel of the left foot. The burn is not circumferential.  The blister has ruptured.  CSM is good in the left toes. No other injuries found.  



Vital Signs

TIME       0700 hrs                         0730 hrs

LOR        A+Ox4                            A+Ox4

HR          72, strong, regular          68, strong, regular

RR          12, regular, unlabored    12, regular, unlabored

SCTM     Pink, warm, dry              Pink, warm, dry

B.P.         Radial pulse present       Radial pulse present

Pupils     PERRL                            PERRL

T°           Not taken                         Not taken


History


Symptoms:    None other than the pain from the burn

Allergies:    Reacts strongly to poison ivy.  No exposure.

Medications:    No regular medications.  We have started the patient on ibuprofen 600 mg every 6 hours for pain.

Pertinent Hx:    Patient has no relevant medical history.

Last in/out:    Patient is well hydrated.  He has not eaten breakfast yet today nor has he had a bowel movement.  Urine is clear.

Events:    Patient was cooking and had hot water spilled on his leg.


What is your Assessment and Plan?  DO NOT click/peek at the next page without answering this first.



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