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.

You and a few friends just returned from a hot, weekend backpacking trip in the Superstition Mountains outside Phoenix, AZ. It was the first trip for one of his friends, Alan, who is slightly overweight and unfit, had a difficult time with the heat, distance, and elevation changes. Monday morning, the day after the trip, Alan called you complaining of very sore leg and back muscles; he said he could hardly get out of bed and taking 600 mg of ibuprofen didn't help. 

What do you think might be wrong with Alan, how do you find out, and what should you do? Click here to find out.

You are part of a search and rescue team looking for two lost climbers on Mount Washington. The search is entering its third day when, with the help of rescue dogs, the climbers are both located in a snow cave that was hidden from view by a fresh layer of snow from a storm the previous night. The climbers are both unresponsive with no pulse or respirations. They are huddled together and wearing parkas. One of the climbers, James Standing, has an angulated lower right leg; the other climber, Asa Cochran, appears to be uninjured. The average temperatures on the mountain ranged from a daytime high of 16º F to a nighttime low of -4º F. The day is clear with a light wind, and a helicopter is on standby at the Appalachian Mountain Club lodge on Route 2 at the base of the mountain. You are in communication with the lodge and Incident Command via satellite phone.

What is wrong with James and Asa and what should you do? Click here to find out.

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.

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.

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.