Answers
A young man crashes into a tree while skiing. He quickly develops shallow and rapid breathing
and complains of pain on the side of his chest that was hit. Upon exposure of the chest wall,
you visualize an open wound with minimal bleeding but hear a sucking sound upon inhalation.
He is alert and did not hit his head, but is profusely sweating and pale. His breathing seems to
become more labored as you talk with him. His chest expands more on the right than the left.
What should you do? - ANS Place an occlusive dressing around the wound and evacuate
You are hiking in a deep forest when you hear some screaming. You come across a man
clutching his abdomen. He has been mauled by a bear and his shirt is stained with blood. You
control all of the bleeding and examine his abdominal region. You find sections of intestine
protruding through one of the lacerations from the bear.
What should be done for this injury? - ANS Rinse intestines and cover with moist cloth
You are hiking in the woods with a group of people when you hear some shouts further up the
trail. You find a man pinned under a tree that has fallen. The tree is laying over the man's waist.
As a group, you carefully move the tree off the man. You find that he has significant bruising on
his hips and he confirms they feel very tender.
What is your plan? - ANS Bind the hips with a sweatshirt
You are bouldering on some low level cliffs when you see a man fall and hit his chest on a rock.
Upon examining him, you find bruising and tenderness over the right side of his chest. There is
no bleeding and his chest is expanding equally as he breaths. The man is experiencing difficult
and painful breathing, and starts to cough. After some time, bloody mucus comes up with each
cough.
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,What is this patient likely experiencing? - ANS Pulmonary contusion or hemothorax
A man hiking alone is struck in the back by a falling rock and knocked off the trail. He is hurt but
ends up walking back to his camp. The next morning, he wakes up and finds that he has some
blood in his urine. He also has new, bluish bruising on the side of his lower back.
What is the likely diagnosis? - ANS Retroperitoneal/renal bleeding
You are camping in the mountains when you hear a woman scream. When you get to her, you
notice that she has fallen from a large rock, landing on a small stick. She is complaining of
abdominal pain and is holding her abdomen. On exam, you find that she has a stick penetrating
upwards in her left upper quadrant.
Which of these structure is she most at risk of damaging? - ANS Diaphragm
You and some friends are mountain biking on a forest trail. One friend crashes into a tree, falls
off his bike, and lands on his back. He does not lose consciousness but immediately has trouble
breathing. You open his shirt to find part of the chest wall dropping inward as he takes a breath,
while the rest of his chest is expanding.
What is this condition and how do you treat it? - ANS Flail chest. Pad the area with a bulky
dressing, wrap the area and evacuate
You and a friend are hiking near some cliffs. Your friend gets too close and part of the cliff gives
way. She falls about 20 feet, landing on the right side of her body. You quickly get to her and
find that she has injured the right side of her chest. She is having some trouble breathing, but
she seems to be stable despite this. You make the diagnosis of broken ribs and a possible
pneumothorax and call for help on your cell phone. She suddenly has more trouble breathing.
She starts to lose consciousness and the veins in her neck have now enlarged and are bulging
out of the skin. The trachea has shifted to the left.
What has happened? - ANS She had developed a tension pneumothorax
An 18-year-old runner trips while training and lands such that her abdomen hits a rock. You are
quickly on the scene. She has significant abdominal pain in both the upper left and upper right
quadrants of her abdomen, and says it feels very tender. You recognize this as blunt trauma to
the abdomen, and you call 911.
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,What is the likely mechanism of injury and the organ(s) injured? - ANS Compression injury to
the liver and spleen
A 22-year-old female on a car camping trip comes to you in the early morning complaining of
pain that started right around her navel. The pain came on rapidly through the night and is
getting worse. She says that she did not fall, has not vomited, and does not have diarrhea. She
says that she does not want to eat at all. She also says that motion makes the pain worse. You
decide to drive her to the hospital. She is given the diagnosis of appendicitis and her appendix
was removed. Why was the pain at the navel? - ANS Pain in the abdomen and chest can
often refer to other parts of the body
You are whitewater kayaking, wearing a helmet, and come upon one of the more technical
rapids of the run. Partway through the run your head hits a rock.
Besides any external protection, which provides the most protection against injury to the brain?
- ANS Cerebrospinal fluid
Which part of the spine is fused within adults? - ANS Sacral vertebrae
You are rock climbing when you hear someone shout followed by another person's scream. You
find that a Belayer lower on the wall, who was not wearing a helmet, was struck by a falling
rock. Luckily, the rock only cut his head and he did not lose consciousness. You assess the
patient for a skull fracture. There is none, so you prepare to take care of the wound. The
bleeding is well controlled.
What is the next step for managing the patient's hair? - ANS Trim the hair around the wound
You are mountain biking down some backcountry single track in the summer with friends. One
friend goes off a jump and crashes. When you get to him, he is conscious, lightheaded, has a
headache, is acting uncharacteristically emotional, and does not remember the crash.
Which is an indication for immediate evacuation? - ANS Temporary loss of consciousness
You are working ski patrol at a remote resort when you receive a call that a skier has crashed.
When you arrive at the scene, you find that the patient rolled several times during the crash
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, before their head hit a tree. You stabilize the patient and immediately suspect a basilar skull
fracture.
What physical sign indicates a basilar skull fracture? - ANS All
You are ice climbing on a steep wall when a large chunk of ice breaks off. It hits a bystander on
top of her helmet knocking her to the ground. She is unconscious as you evaluate her for a
closed head injury.
Which is true about a closed head injury? - ANS Severity depends on the duration and depth
of unconsciousness
You are camping in a national forest when you hear shouts from up the road. When you arrive
on the scene, you find an overturned all-terrain vehicle with two patients lying on the ground.
One patient is shouting, but the other appears to be unconscious. The unconscious person
wakes up and begins to talk. You suspect an epidural hematoma.
What is true of an epidural hematoma? - ANS Outside dura
You are mountain biking down some backcountry runs in the summer with friends. One friend
goes off a jump and crashes. When you get to him, he is conscious but does not remember the
crash. Your friend was a rugby player in high school and suffered from a few concussions during
games.
What is the correct management for his momentary loss of consciousness? - ANS Evacuate
You are ice climbing on a steep wall when a large chunk of ice breaks off. It hits a bystander on
top of her helmet knocking her to the ground. During your primary assessment, you find that
the patient is unresponsive.
Which of the following should you not do? - ANS Give ibuprofen
You are working ski patrol at a remote resort when you receive a call that a skier has crashed.
When you arrive at the scene, you find that the patient rolled several times during the crash
before their head hit a tree.
Following a traumatic head injury, what vital signs would you expect to present in the patient? -
ANS Erratic respiratory rate, slow heart rate, rising blood pressure
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