You and two friends are riding an old mountain bike race course when you reach a gnarly downhill section. You elect to slide down the section with your bike and take photos. One of your friends manages to successfully ride down. Unfortunately Jack hits his front breaks too hard, flies over the handlebars landing on his head, neck, and shoulders, then slides with his bike another 50 feet to an open, dry wash at the bottom of the slope.
When you reach him, he is sitting up holding his side and having difficulty catching his breath. After a few minutes, he calms down and is able to breath as long as he doesn't try to take a deep breath and breathes with his diaphragm. Jack's helmet is intact and he is able to recall his entire fall. He says he landed hard on his handlebars and thinks he broke a rib low on his left side. Road rash covers most of his back where his jacket slid up during his slide and small pieces of gravel is embedded under portions of his skin; it looks nasty but Jack said it doesn't really hurt. Jack's pulse rate is 88 and regular; his respiratory rate is 22 and easy; he reports that his normal pulse rate is in the low 50s.
It's 3 pm, overcast and cool, about 50 degrees F; the sun sets about 7:30 pm. You have a small first aid kit, some water, food bars, but no additional clothing. Nighttime temperatures have been in the low 40s. You are roughly six miles from your vehicles over challenging terrain and another two hours to the nearest clinic. You have cell phone reception.
What is wrong with Jack 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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