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 1: Fall While Climbing Scene

S: The patient is found sitting upright on a steep scree slope. He complains of a mild headache and severe right ankle pain on attempted movement and weight bearing. He reports full memory for the event. He denies neck or back pain, difficulty breathing, abdominal pain, or distal numbness or weak- ness. His history is remarkable only for infrequent exercise-induced asthma. He describes himself as otherwise healthy and using no medication. His last meal was lunch at 1300. He last drank 500 ml of water just before the fall. He reports his normal resting pulse rate as 64. He lives at 3000 meters. O: Awake and calmwith normal mental status. Scalp with several superficial lacerations and contusions. Other superficial abrasions and contusions noted over trunk and extremities. Right ankle is markedly swollen and tender. Distal circulation, sensation is intact. There is no respiratory distress. There is no significant chest wall, abdominal, or pelvic tenderness. There is no tenderness to firm palpation of the spine, and the distal motor and sensory exam is fully intact (exception for R ankle motor exam). Vital signs at 1915: P: 106, R: 16 and easy, O2: 93%, BP: 126 systolic, S: normal, T: normal, C: awake and oriented. A: 1. High risk MOI with elevated pulse; concern for volume shock. A ’ : Decompensated volume shock 2. Unstable right ankle injury. A ’ : Ischemia 3. Numerous superficial abrasions, lacerations, and contusions A ’ : Infection 4. Difficult and dangerous evacuation. A ’ : Delayed transport, rescuer fatigue and injury. P: 1. Proceed with urgent evacuation. Bolus of 500 mL IV fluid. Monitor vital signs. 2. Ankle splint, litter evacuation. Monitor distal CSM. Pain medication. 3. Wounds irrigated with water, deeper wounds dressed. 4. Mutual aid for more technical rescuers and logistical support. Discussion: This was an arduous and hazardous night evacuation. Mountain Rescue transferred the patient to EMS at the trailhead at 0300 the following day. Fortunately, only minor injuries were experienced by the rescuers during the process. The patient’s pulse rate remained between 106 and 120 throughout. No critical system problem was ever identified. Amountain rescue team responds to the scene of a climbing accident. A 24-year-old man has fallen 5 meters off a cliff, impacting and rolling 30 meters down a steep scree slope. The report was called in by cell phone at 1700 hours by his climbing partner. Mountain Rescue arrives on scene at 1900 hours. The weather is clear and calmwith a temperature of 18°C. The scene is at the base of a granite cliff at an elevation of 3300 meters. The evacuation will require a the decent of a 35% slope of loose scree and trees to the valley floor at 2750 meters.