Wilderness Medicine Case Study 75

Returning to the snowmobile you left parked on WA Route 20, you stop to watch a pack of snowmobilers highmarking on a bowl above and to the south of your route. Just as you finish your break, one rider and sled reach the apex of their attempt, roll over, and release an avalanche. Both the rider and his machine disappear. As the snow settles, you see a portion of his sled sticking out of the snow; you turn your transceiver to receive, and you join the rest of the pack to begin a search for the buried rider. One rescuer gets a signal near the machine, and the digging begins.

Roughly ten minutes later, you uncover Sam's face. There was a small sickle-shaped air pocket around his mouth and nose. He is unresponsive, not breathing, and he has no pulse. Elapsed time is less than twenty minutes. You give a couple of quick rescue breaths as others free his chest and begin chest compressions.

During the second round of compressions, Sam abruptly starts breathing and awakens shortly afterward with no memory of the event. Once Sam is completely free of the snow, you do a complete patient assessment. Sam is 42 years old and appears to be in good physical health; his SAMPLE history is unremarkable. He complains of a mild headache (3), a slightly sore chest (2), severe pain in his right knee (8), mild pain in his lower left ribs (2), and a sore neck (2). Your physical exam reveals an angulated, swollen, and extremely tender right knee with no range of motion and good distal CSM, and tender lower-left ribs; he is able to take a deep breath without pain. His focused spine assessment shows a tender neck C-3 through C-7 with normal motor and sensory exams. At 2:35 pm, Sam's pulse rate is 82 and regular and his respiratory rate is 20 and easy; both within his normal self-reported range. His temperature was not taken; oxygen saturation and blood pressure were also not taken. He is wearing an insulated snowmobile suit and says he is warm.

What is wrong with Sam 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.

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