You are leading the eighth pitch of a 12-pitch climb on chossy rock when your rope dislodges a small pillar of loose rock. Your belayer is hit on her helmet by a chunk of the falling rock the size of a baseball; the remaining fragments shatter into small shards. Janey is initially unresponsive but awakens quickly. Despite the generally poor quality of the rock on this pitch, you are able to construct a solid anchor and within a few minutes Janey is able to give you enough rope to rappel down to her belay stance. Careful not to dislodge any more rock, you head down. When you reach the belay station she is awake and alert with a cracked helmet; she cannot remember the rockfall or being hit. During the focused spine assessment she reports both pain (4/10) and tenderness in her neck around C-3, says her entire neck is stiff, and she doesn't want to move it; she passes all the motor and sensory exams. Aside from a few superficial scratches from small rock shards and a headache (3/10), she has no additional injuries. From the base of the climb it is an hour hike over third and fourth class terrain to your vehicle and another three hours to the hospital. There is no cell coverage and there is roughly four hours of light left. It's cool on the route, and you need a thin insulated shell to stay warm while climbing. Nighttime temperatures are expected to drop below freezing and a front is expected to arrive sometime tomorrow morning bringing wind, rain, and perhaps some snow. What's wrong with Janey and what do you do? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available.
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You are holed up in a snow cave waiting out a heavy winter storm at 10,500 feet in the Colorado Rockies. Your sleeping area is raised a few feet above your entrance. You have been cooking outside with your stove sheltered from the wind by strategically placed snow blocks. A ski pole poked through the roof of the cave provides much needed ventilation. To save batteries, you have been using two candle lanterns to provide enough light to read and play cards. After a day, the air inside the cave is slightly stuffy and both you and your partner have a slight headache. What's wrong and what can you do about it? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. While mountain biking down a steep single track your friend catches his front wheel and is thrown forward with his bike. During the fall the handlebars smash into the left side of his chest. Asa has difficulty sitting up and catching his breath, and appears to have injured his left wrist. After assisting him to a sitting position and coaching him to breathe with his abdomen, his respiratory distress appears to resolve. During your physical exam, he reports a sharp pain (7) in the ribs on his lower left chest when he tries to take a deep breath. While his left wrist hurts (4) and has a slightly decreased ROM with good distal CSM, it appears weak: Asa is unable to easily hold and lift a full 1-liter water bottle. His helmet is cracked, he reports feeling a bit woozy, and has a headache (4); the remainder of his physical exam is unremarkable. With abdominal breathing, the pain in his ribs is manageable (3). 20 minutes after his accident his pulse is 94 and regular and his respiratory rate is 22 and remarkably easy; he reports his normal pulse rate is in the mid-60's and he doesn't know his normal respiratory rate. While awake, he still feels a bit "out of it." A focused spine assessment reveals cervical pain and tenderness at C-7 with no shooting pain and normal motor and sensory exams. What is wrong with Asa and what should you do? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. While skiing back to your vehicle after a day of touring in the backcountry, your friend skis directly into a 10-inch lodgepole pine at a moderate rate of speed. When you reach her, she is out of breath and struggling to sit up. You carefully assist her to a sitting position and begin your assessment. Jenny's breathing quickly returns to normal. She tells you she got the wind knocked out of her and the right side of her chest is sore (2); on exam, her chest is slightly tender. She did not hit her head. Her pulse and respiratory rates are normal. A focused spine assessment reveals no spine pain, tenderness, or shooting pain and normal motor and sensory exams. Jenny doesn't think she is badly injured and is ready to continue skiing, albeit slightly slower and under better control. What is wrong with Jenny and what should you do? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. You are the trip leader for a two-week high school snowshoe trip in the Adirondack mountains of New York state. It's day four. There was six inches of new snow on the forest road at the beginning of the trip. Last night it snowed three feet and it is still snowing hard. Looking closely at your map you realize that your original route crosses a few potential avalanche paths. After talking it over with your co-leader and considering the ever-increasing snowfall, you decide to reverse your route and head back. You have no satellite or cell phone reception during the storm. After a day of struggling through the deepening snow, everyone is exhausted and wet from either sweat or snow when you reach your evening camp. You notice that two 16 year-old girls are particularly tired and shivering. What are your concerns and what should you do? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. You are a trip leader on a five-day winter break backpacking trip in Linville Gorge, NC. It's day three of the trip when the gorge is hit unexpectedly with 14 hours of freezing rain. The rocks, trails, and trees are covered with an inch of ice; numerous trees have fallen, leaving the trails littered with trees and tree limbs, further increasing the difficulty of foot travel. You are camped at the bottom of the gorge and scheduled to be picked up at 10 AM on the fifth day. To reach the pick-up at the scheduled time, you need to hike most, if not all, of the day. What are your concerns and what should you do? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. A 35 year-old man hits a tree while skiing out of bounds. Bill is awake, alert, and reliable but fails your focused spine assessment due to cervical pain (8) and tenderness with no neurological deficit. Ski patrol is available to assist with transport via a Cascade toboggan and snow mobile. Estimated arrival to scene is 45 minutes and transport to an ambulance is expected to take another two hours with arrival at a local hospital in another hour. Total response and transport time to the hospital is estimated at roughly ± 4 hours. The outside temperature is 22º F and the patient has additional thermal layers in his pack. His remaining injuries are compatible with self-evacuation. Should you keep him quite and immobile and wait for help or begin a self-evacuation. Click here to find out. Click here to read a blog article on current spine management guidelines. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. Geoff Jones, 52, is swept away in a medium sized soft snow avalanche while skiing in the backcountry. He travels approximately 400 feet and is recovered partially buried. He is awake, alert, and reliable with cervical spine pain and tenderness. He reports a tingling, electric-like pain in his right arm when his neck moves; he cannot distinguish between pinprick pain and light touch on his right hand; and, there is noticeable weakness on his right side when executing the motor exams on his hands. His remaining injuries are compatible with self-evacuation. There is no cell service and no one in the group is carrying bivy equipment with them or on their snowmobiles six miles away. Help is roughly twelve hours away. It's 3:30 pm in mid-January; sunset is within the next hour. The current air temperature is 21º F. Clouds are moving in, the wind is picking up, and it looks like it's going to snow. Should you keep Geoff quiet and immobile and go for help or begin a self-evacuation? Click here for answers. Click here to read a blog article on current spine management guidelines.
Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course. Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. You are leading a week-long backpacking trip for a local high school. During the night a cold front with high winds passed through breaking tree limbs and blowing down trees. A six-inch limb split off an overhead tree and landed on a student tent, hitting one of the students a glancing blow on his head while in his sleeping bag. When questioned, James said the storm had just woken him up when something hit the tent, collapsed it, and hit him in the head through his sleeping bag. The commotion woke his tent mate and together they managed to push the branch off the tent. They came to get you because James said he had a headache and a big lump on his head. Other than the lump and a headache (3), James says he feels okay. He has no spine pain or mid-line spinal tenderness, normal motor and sensory exams on his hands and feet, and no tingling or electric shooting pain in his arms or legs. His skull feels intact beneath the swelling. What is wrong with James and what should you do? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. You and your climbing partner are six pitches up on Goat Wall in Mazama, WA when a sudden lightning storm moves in with heavy rain and lightning. Abandoning the climb you begin to simultaneously rappell off (an advanced—and somewhat risky—climbing technique where two climbers rappel at the same time on the same rope counterbalancing one another). On the last rappell, you neglected to tie a knot on your side of the rope and misjudged the distance to the ground, and rappelled of the end of the rope a few feet above the ground. Unfortunately, your climbing partner, Jessie was roughly 20 feet above you when you fell. With the loss of your counterbalanced weight, the rope pulled through the anchor and Jessie fell to the ground landing on her right side and head in the talus. When you reach her, Jessie is unresponsive and bleeding from her nose and ears; some of the fluid appears to be a light yellow and her helmet is cracked. A quick physical exam reveals a soft spot on her skull behind her right ear and crepitus in multiple ribs on her right side. Her pulse rate is 168 and regular; her respiratory rate is 26 and slightly irregular; her skin is pale. What is wrong with Jessie and what should you do? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. |
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