Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

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Section VI: Backcountry Medicine

reducing infarction and preserving heart function. A helicopter evacuation would be ideal but would be a high-risk operation in the mountains with the current weather. Allowing the patient to rest to reduce oxygen demand would be ideal as well but would significantly delay evacuation. It would take at least a day for a mountain rescue team to access the patient by foot and perform a 9-kilometer carry-out on a rough single-track trail. A horse can cover the distance in a few hours. The benefit of time saved would be worth the risk associated with the increased exertion required to ride. If you wondered about possible carbon monoxide poisoning because of the wood stove in the tent, you should look for similar symptoms in the other people staying there. It would be unusual for only one person to show symptoms of such exposure. Another clue to CO inhalation would be an unusually high reading on a pulse oximeter. At 3200 meters elevation you would expect a reading of somewhere between 86 and 93%. A reading of 99 or 100 could indicate that the color of the carboxyhemoglobin molecule in the blood could be fooling the meter.

Case Study 13: Remote Canoe Trip Scene

S: The most uncomfortable of the ill students reports the onset of pain two days ago with swallowing inhibited by the discomfort. He also reports a runny nose and intermittent mild ear pain and thinks he might have a fever. He gives no complaint of difficulty breathing, nausea, or dizziness. His tent mate has similar symptoms but not as severe. His last meal was at 1230 but “hurt a lot to eat.” He has been able to drink well and reports that cold water makes his throat feel better. He has no other complaints and is normally healthy. He denies allergies and is not taking medication. O: Alert, oriented, and appears mildly uncomfortable. No evidence of respiratory distress, shock from dehydration, or altered mental status. The throat looks inflamed but not swollen and there are no white patches visible. The patient’s neck is mobile with mildly swollen glands. Clear nasal drainage is noted. The chest is clear to auscultation and the abdomen is not tender to palpation. Vital signs: Pulse: 64 and regular, Resp: 16 and easy, Temp: 37°C, Skin: warm, pink, and dry, O2: 98%, C/MS: Awake and oriented. A: 1. Sore throat, not serious A’: Discomfort when eating A’: Airway obstruction (unlikely) 2. Contagious illness spreading through the group At 1430 on day 5 of a month-long canoe trip in central Quebec, several students begin to complain of severe sore throat and pain on swallowing. One student admits to arriving with the illness on day one, but now seems to be improving. The group is now 75 kilometers downriver from the launch- ing point. The only evacuation route is by float plane. The weather is overcast with light rain with a temperature of 12°C and light winds.