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Case Study 13 December 2015
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Case Study 13 December 2015
Page 2

 

 

 

 

The Setting  snowstreamcross.jpg

You’re the trip leader for a group of teenagers on a 9 day trip in the Bitterroot Mountain of Montana.  It’s June.  Winter hasn’t loosened it’s 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 no one has dry socks and one of the participants says his feet hurt. 

 

SOAP Report

Subjective 

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


Objective

Patient Exam: The patient’s feet are pink, 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

Not taken


History

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 6 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.


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

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