You are skiing in the backcountry when one of your friends, Jane, catches an edge and crashes into a tree hitting her head—she is wearing a helmet—and upper chest. She is awake, struggling to breathe, and holding her head when you reach her. Her helmet is cracked. After catching her breath, she is confused, has a throbbing headache (6), and doesn't remember her fall, hitting the tree, or the events immediately preceding it. While the left side of her upper chest hurts as you examine her, she is able to take a deep breath without pain. While it is difficult for her to focus during your spinal assessment, she has no spine pain, no mid-line spine tenderness, and normal motor and sensory exams. The rest of her physical exam is unremarkable. Jane plays lacrosse for her college and was hospitalized for a brief period after a concussion three years ago. Her pulse roughly fifteen minutes after the accident was 58 and regular; her respiratory rate 16 and easy; she reports her normal pulse rate is 56. It's a few hours ski to your vehicles, the nearest hospital or clinic is another two hours beyond that, and your cell phone has no bars. There are a total of three people in your party, including Jane.
What is wrong with Jane 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.
Our public YouTube channel has educational and reference videos for many of the skills taught during our courses. Check it out!