Wilderness and Rescue Medicine 8th Edition

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Section II: Critical Body Systems

Case Study 3: Snow Machine Accident SCENE

S: A 42-year-old man is found awake and responsive lying on a tent fly and foam pad. There is a bandage around his head. The guide reports that the patient was “out” for a few minutes after striking the tree, then woke up and kept asking the same questions over and over for another 15 minutes. Mountain Rescue responds to a snow machine accident 15 kilometers from the trailhead at 3300 meters elevation. The guide reports that a middle-aged male client was thrown from a machine, striking a tree. At 1500 hours the weather is partly cloudy with east winds at 12 knots and the tem- perature is -6°C. The forecast calls for increasing winds and blowing snow. The trail is rough. The team required 45 minutes to reach the scene. Ground evacuation to an ambulance will take an hour. The ambulance transport will take 30 minutes to a small community hospital. Air evacuation will require a 45-minute response to the scene and 45-minute return to a Level II trauma center.

The patient now complains of a moderate headache and nausea, which seems to be getting worse. He denies neck or back pain and distal numbness or weakness. He is aware of being on a snowmachine tour but does not remember who he is with or anything about the ride or the accident. He denies allergies. He takes one aspirin a day. He reports one previous TBI requiring hospitalization several years ago. His last meal was at 1200. O: The patient is subdued but awake and cooperative. Moderate deformity of the face with superficial lacerations and abrasion. No

skull deformity. Bleeding controlled by direct pressure. No spine tenderness. Distal CSM intact. Mild shivering. Vital Signs: Pulse: 80, Resp: 18, Temp: normal, Skin: cool, dry, pale, C: awake but subdued with significant memory loss, BP: 138/88. A: 1. TBI with nausea and headache A’: Elevated ICP A’: Vomiting with airway obstruction and aspiration 2. Cold response A’: Hypothermia 3. Facial lacerations and deformity

A’: Infection A’: Bleeding 4. Decaying weather

P: 1. Recovery position in medic trailer. Oxygen. Suction device ready. Close monitoring. 2. Sugar and fluids as tolerated. Insulation. 3. Clean and dress scalp wound. 4. Evacuate to the trailhead while conditions permit. 5. Request helicopter response to the trail head.