Going for the Gold – It is a beautiful September afternoon and the aspen are aglow. You and three friends (the “over the hill” gang of 50-somethings) are mountain biking down an old mining road up near Telluride. The brilliant fall foliage ignites your spirits and you and let ‘er rip. You are doing Mach 3 or 4 when you hit a large loose rock and get thrown over your handlebars.
Scene and Primary Assessment: Scene is safe; your friends find nothing on primary assessment; environment is dry and warm.
Secondary Physical: Upon examination you are V on the AVPU scale with bleeding and unstable ankle injury. Your LOC steadily improves and within 5-10 minutes you are A on AVPU and soon AOx4. There is a scratch on your helmet but on exam your head appears as normal as it ever does. Your leg really hurts as your LOC improves.
SAMPLE: No other symptoms besides those described. No allergies. You are on a daily aspirin (81 mg) and Viagra (for the “altitude”). You blew out your ACL on that same leg 15 years ago, but you have never broken anything before, if that is what is going on. Last ins and outs normal. You were feeling great until you went flying.
Vitals: Round 1 – HR 96, RR 24, V on AVPU scale. Round 2 – HR and RR 88 and 20, and AOx4.
Setting: Old mining road (only accessible by foot, horse, bike, and probably ATV), 5 miles from trailhead and your parked car. Weather sunny, and warm, except in the shade where it is starting to get a bit chilly. Trail dry. No cell phone coverage where you are, but you did have it at the pass, about a mile away and 500 feet above you.
What do you do? What is your assessment, anticipated problems, and plan?