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Case Study 13 November 2009
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Case Study 13 November 2009
Page 2

The Setting

You’re the trip leader for a group of teenagers on a 9 day trip in the Bitterroot Mountain of Montana.  It’s late June and winter hasn’t wanted to loosen it’s grip.  There has been a lot of snow on the ground, which turns to slush on the warm days.  The rivers are up and every crossing has been wet.  Then, to punctuate the challenge, 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.  snowstreamcross.jpg


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


The patient is an 18 yr old male complaining that his feet hurt.



Patient Exam:

The patient’s feet are pink, cool to the touch. Capillary refill does not appear diminished.  They are not swollen 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. immersion_foot_sm.jpg


Vital Signs





72, strong, regular


14, regular, easy




Strong radial pulse



Not taken




Pt complains that his feet ache and throb.  He states is a 6 on a 1-10 scale.




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.


Pt has been hiking in wet cool conditions.  Although he has been diligent with foot care he stated that yesterday his feet became very cold and he didn’t do anything about it until he went to bed, and that they 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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