While you’re at the movies, a person in front of you stands up clutching their throat, and they can’t speak. They have been eating popcorn.

24yo female fell down a flight of stairs and she is c/o left shoulder pain, she cannot move her shoulder and her arm is stuck in extension over her head.

After a long day of hiking a 36yo male is c/o a headache, mild nausea, increased heart rate, and mucous membranes are dry.

While working in the desert southwest a client comes to you c/o a very painful sting on the back of their hand. The area of the sting is pale and cool to the touch. “The bug that bite me looked like a little lobster.”

You see a person collapse and lay perfectly still for about 30 seconds and then they start to flail their arms and legs.

A 12yo female fell off her bicycle and is now c/o left lateral chest wall pain that is worse with deep breathing. Positive for point tenderness over the left lateral ribs. Breath sounds are normal.

36yo male is sitting in a coffee shop enjoying a hot cup of java when the cup fails and he dumps the contents of the hot coffee into his lap. He is c/o pain in the area of the genitals.

44yo female is found wandering on a hiking trail. She is mildly disoriented, awake and oriented x 1, she has uncontrollable shivering, and she is cold to the touch.

On the second week of a 3-week horse packing trip in Wyoming, a client shows you a 2cm ulceration on the left upper leg that is slowly enlarging over the past few days. They deny any injuries or bites, it is not painful.

68yo female is having difficulty speaking and is unable to walk because her left arm and leg will not move.

FACE – Ask the person to smile. Does one side of the face droop?
ARMS – Ask the person to raise both arms. Does one arm drift downward?
SPEECH – A

13yo male is c/o difficulty breathing and increasing shortness of breath for about 1 hour. As he breathes, you can hear wheezing as he exhales. He does have an albuterol rescue inhaler with him, but he has not used it.

A climber is found at the bottom of an ice climb, he is conscious. Before doing a physical
exam you take his vital signs and they are:
Respiratory Rate is 30 and shallow
Heart Rate is 110 and weak. No radial pulse, has a femoral and carotid pulse.
BP

23yo male, is on a backcountry ski trip in Yellowstone. At a rest stop, he complains that the fingers on his right hand are cold, white, numb, and stiff. Upon examination they are hard to the touch and cannot be bent.

While on a cave expedition trip in Tennessee, after spending the day in the Grindstaff Cave, a 26yo female presents to you c/o abdominal pain, cramping, and a headache. Her BP is elevated as indicated by a bounding radial pulse.

52yo male is c/o chest tightness and shortness of breath with exertion for about 4 hours. Symptoms improve with rest. Vital signs are normal.

43yo female is c/o a sensation of shortness of breath for the past 2 hours. She states that it came on while she was watching TV. She denies any injuries. On physical exam you discover that she does not have breath sounds on the right. Negative for JVD or

76yo female, victim of a hit and run, she was a pedestrian. She is unconscious, on PE there are 2 or more ribs broken in 2 or more places, positive for paradoxical chest wall motion with breathing.

35yo female is on a mountain trek in Nepal, started out the day at 8,000’ and they are now at 11,000’. She is c/o a headache, nausea, and dyspnea on exertion.

A 22yo female emerges from a bathroom in Botswana c/o a snake bite. There are obvious bite marks on her left ankle. She is c/o increasing difficulty breathing, headache, and chest pain.

48yo female is c/o chest pressure, nausea, and a dull ache in the left side of her jaw and left upper arm. She gets no relief of symptoms with rest. She does have dyspnea on exertion and chest pain worsens with exertion.

56yo female who is c/o shortness of breath. She fell on her front steps 3 day ago and has a large bruise on her left upper leg. This happened the day after she flew home from overseas, the flight was 7 hours long. PE – breath sounds are normal.

A 44yo male fell while climbing and he hit his head, he was wearing a helmet. He is conscious and c/o a severe headache. His vital signs are:
LOC – decreasing level of consciousness, he appears angry
Respiratory Rate – 30 and deep
Heart Rate – 44 an

A 30yo has been hiking most of the day in the Sonoran Desert in Arizona. When you come upon him he is hallucinating, seeing snakes all over the ground, refuses care, appears agitated and angry, and his skin is red, hot, and dry to the touch.

While hiking in Costa Rica, a dog suddenly appears on the trail, growling and barking. The dog is quite aggressive and bites your co-leader on the leg before running off into the bush. The dog heads for a ranch about ¼ mile up the trail.

18yo male c/o intense thirst, increased urination, has a fruity smell on his breath, this has been coming on slowly over the past several days. Hx of IDDM.