Test Your Wilderness First Responder Skills: Patient Case Study #1, Feeling Ill
Today is the second day of your backpacking trip with four friends up the Hoh River Trail in the temperate rainforest of Washington. The plan is to get to Glacier Meadows at the end of the trail – another 8 or so miles from where you camped – and you all already hiked in almost 10 yesterday when you stopped to camp for the night.
It’s a beautiful rainforest so you’ve had your phone out on occasion taking pictures. For the most part you haven’t had any service and when you have it has been very spotty. But who needs to get notifications on a hike?
Your friend Jerry woke up this morning feeling pretty groggy and tired and you didn’t see him eat breakfast. You approach him to try and see how he’s doing and check on him. You are a Wilderness First Responder and think back to your training as you consider how to approach the conversation.
The scene is safe, you’re keeping your personal protection in mind, and the temperature is 58 degrees, partly cloudy and pretty humid at 8:30 am.
Your patient Jerry is a 28 year old male whose chief complaint is, “I feel exhausted and my stomach is upset about something.”
He appears a bit pale and tired. He tells you he has ‘blood sugar problems’ sometimes but hasn’t really kept on an eye on it with a doctor because it’s never been an issue. He was really stoked for this trip but and wasn’t feeling well the night before we were supposed to leave to go on it. He didn’t mention anything to you beforehand about not feeling well. He had some stomach cramps and diarrhea the night before the trip but says it wasn’t a big deal and wasn’t bad enough to stop him from coming.
He’s wearing his heaviest puffy jacket even though it’s not very cold this morning and he seems to be shivering a few times a minute. He generally just seems ‘off’ from his normal demeanor. He absolutely loves to hike and be outdoors and was looking forward to the trip but doesn’t seem to be having a great time this morning. He’s not the kind of guy to complain about much so you have to really ask a lot of questions to get him to tell you how he’s feeling.
He mentions that in order not to upset his stomach more he didn’t really eat anything yesterday besides half a sleeve of saltines and a protein bar for dinner last night. He says he hasn’t eaten breakfast this morning and was too tired to even try.
He says he hasn’t injured himself on the trip or recently and brushes off a head-to-toe exam. When you ask where his stomach hurts he gestures diffusely to his abdominal area. He lets you check his pulse for quality and when you grab his wrist you notice his hand is clammy.
His vital signs at 8:38 am:
LOR: A&Ox4
HR: 112
RR: 22 and slightly labored
SCTM: Pale, hands are clammy and cool but not cold to the touch
Pupils: PERRL
BP: 128/92
After taking a set of vitals, you ask him questions about his medical history and learn the following:
Signs/symptoms: Generalized abdominal discomfort and occasional cramping, 4/10, about the same since it started the day before the hike, feeling progressively more tired and out of energy and mentally foggy.
Onset: about 36 hours ago
Provoked/Palliated: Food makes things feel unsettled and uncomfortable, not eating has kept the discomfort pretty mild
Quality: Occasional cramping
Region: diffuse abdominal
Severity: 5/10 when it started and about a 3/10 since then
Time: cramping lasts about 20 minutes at a time and was more frequent when it first started and less since
Allergies/asthma: He denies having any.
Medications: He “popped a few tums when my stomach first started hurting before and a few yesterday too.” He states that he took a couple as directed by the bottle.
Past medical history: He says the last time he went to the doctor something was ‘off’ with his blood sugar levels but hasn’t noticed it really been an issue and never followed up.
Last ins/outs: Had several bouts of diarrhea 36 hours ago and hasn’t had a bowel movement since. Yellow urine a few times yesterday and once this morning; doesn’t endorse any kind or odor or anything else unusual. States he has tried to stay hydrated the best he can while they were hiking and had a bottle of Gatorade after the diarrhea and another yesterday.
Events leading up to: “I think I ate something weird that made me sick before the trip” and hasn’t been feeling really well since he started having abdominal discomfort and diarrhea the day before the trip. He says that sometimes he feels low on energy before eating in the morning but then perks up after eating and drinking some coffee.
Questions:
What is your problem list for this patient?
What treatment would you provide?
Can this patient stay in the field or does he need to be evacuated? If he requires evacuation, how urgent?
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Published on October 10, 2024