Wilderness and Rescue Medicine 8th Edition

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Wilderness and Rescue Medicine

O: At 18:30: An alert, responsive, but uncomfortable man is found sitting on a rock holding his right arm. He is cool and wet but inadequately dressed. His right wrist is deformed and tender to touch; he is unable to move it. He can wiggle his fingers and feel the light touch of the examiner’s hand. His skin color is pale. There is no other obvious injury. Vital signs: P: 80; R: 18, easy; BP: 122 systolic; O 2 : 99%; S: cool and pale; T: 37.1°C; C: awake and oriented.

anticipated problem of hypothermia, for example, we are reminded to take measures to prevent it. In more complicated cases where a patient may have more than one problem, the format remains the same. Under A (Assessment), we would list the problems in order of priority, and be sure that we have a plan for each one. By checking each problem for a plan and each plan for a problem, we can avoid missing anything. We can also avoid the common mistake of making plans for prob- lems that don’t exist. As our patient’s condition and evacuation logis- tics change, our problem list and plans will need to be revised. Backcountry rescue is rarely straight- forward and predictable. Monitoring the condi- tion of the patient and crew is essential. SOAP is a dynamic process. Patients with anticipated critical body system problems should be reassessed most often, at least every 15 minutes, if possible. The status of injured extremities in a reliable patient can be checked less frequently, at 1- to 2-hour intervals. Conditions that develop slowly, such as wound infection, might be adequately monitored every 6 hours. Our problems list also becomes a useful commu- nication tool. “The problem list is as follows: One, unstable right wrist. Two, cold response” gives the relevant information in just a few words in a text message, brief radio transmission, or while updat- ing rescuers arriving on scene. This format can be especially useful in a multiple-casualty incident or other high-stress operation. When time and technology allow, more complete information can be relayed. Still, the practitioner should keep the message concise. The essential points can be lost in too much information. Try to paint a picture of your situation, including your problem list and plan: “This is Search and Rescue on the scene of a mountain bike accident mile 42, White Rim Trail. One male patient: Problems are unstable right wrist and cold response. Current weather is cold rain and wind. We will stay here tonight and evacuate in the morning.” In this case, relaying specific exam findings and vital signs is unnecessary. The receiving station knows your location, situation, problem list, and plan.

A: 1. Unstable injury; right wrist A’: Swelling and ischemia A’: Pain 2. Cold response A’: Hypothermia 3. Dark, wet, unsafe riding or hiking conditions. P: 1. Wrist splint. Elevation and rest. Acetaminophen. Monitor distal CSM. 2. Dry clothes, food, and shelter from the rain and wind. 3. Stay on scene tonight, walk out tomorrow. We have expanded SOAP to include environ- mental and logistical factors. Sometimes these are more of a threat than the original injury or illness. In long-term care, we also add a list of anticipated problems (A’), which could be com- plications of the injury itself or the result of expo- sure to environmental conditions. By listing the