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

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Wilderness and Rescue Medicine

Case Study 8: Mountaineering

S: A 17-year-old girl caught her right index finger between loose rocks. She was able to dislodge herself but complained of immediate pain. Shortly afterward, she became dizzy and nauseous, then unresponsive for at least a minute. When the instructor arrived on scene at 0920 hours he was told that the patient did not fall and was not struck by anything. She has no allergies, is not on medication, and has no significant past medical history. She had breakfast 1 hour ago. She had been walking without difficulty prior to the accident and was well rested and hydrated. The rock was stable, but the weather was cool and windy. O: The patient was found lying against a large rock. She was pale and sweaty, but oriented and responsive. The right index finger was very tender with obvious deformity at the proximal interphalangeal joint. The patient was unable to demonstrate any range of motion. There was no other injury. Vital signs at 0930: BP: unknown, P: 64, R: 24, Skin: pale, cool, moist, T: feels cool, C: A on AVPU with confusion and disorientation, improving. A: 1. No critical system injury. Unnecessary beacon activation. 2. Dislocation right index finger A’: Ischemia to infarction A’: Pain and disability 3. Acute stress reaction now resolved P: 1. Deactivate beacon. 2. Reduce finger dislocation, buddy splint. Monitor CSM. 3. Reassurance. Discussion: The finger was immersed in a cold stream to relieve pain. The joint was reduced with minimal traction. She was encouraged to lie in a sleeping bag and calm down. Her vital signs rechecked at 1000 were normal. The finger was splinted by taping it to the third finger with a gauze pad between the fingers. The girl was instructed to keep the finger elevated as much as possible and to use cool soaks for swelling and pain relief during rest stops. She was cautioned to check circulation and sensation at the fingertip frequently. She would be referred to medical care when the group reached town in three days. Although this patient was displaying very frightening signs and symptoms immediately after the injury, there was no mechanism to explain it, except acute stress reaction (ASR). The changes in mental status rapidly resolved with rest, reassurance, treatment, and pain relief, leaving only an unhappy girl with a sore finger. Activation of the beacon was inappropriate and could have caused an unnecessary, expensive, and risky rescue response. Scene A group mountaineering course in the Torres del Paine National Park. A student suffers a hand injury during the descent of a talus slope 8 kilometers from the trailhead. The group is on an inde- pendent route-finding exercise, trailed at a distance by their instructor. Alarmed by the response of the patient to the injury, the group has activated their emergency beacon. At 0910 hours the weather is partly cloudy with light winds and a temperature of 12°C.