Wilderness and Rescue Medicine 8th Edition

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Section II: Critical Body Systems

A: 1. Respiratory distress due to infection with lower airway constriction and fluid in the alveoli.

A’: Respiratory failure A’: Systemic infection 2. Compensated volume shock from dehydration A’: Decompensated shock A’: Hypoglycemia 3. Remote location, high-risk evacuation P:

1. Non-penicillin antibiotics 2. Monitor respiratory status 3. Minimize activity

4. Encourage oral electrolyte drink. Monitor urine output. Consider hypodermoclysis . 5. Change course for land to improve access to evacuation. Advise Coast Guard of the situation and plan. Discussion: This patient’s condition is serious but not yet an emergency in this remote setting. Shortness of breath on exertion is early respiratory distress and the problem seems to be progressing quickly. However, because the likely cause is infection, it is reasonable to start antibiotics and look for improvement while sailing toward land. Emergency evacuation could be initiated if the patient’s condition worsens, with due consideration of the risks associated with a helicopter at the limits of its flight range. The respiratory structures affected suggest pneumonia, which causes fluid to accumulate in the alveoli. The generic treatment for respiratory failure in this case would be PPV. The captain’s plan is certainly contrary to the goal of the voyage. It would be very tempting to hope for the best and continue on course with fair wind and good boat speed. The presence of respiratory failure, decompensated shock, and systemic infection on the anticipated problem list, however, demand decreasing rather than increasing the distance to definitive care.