Burn Out Case Study – It’s late January and it’s been a long couple of weeks at work; you’re feeling a bit crispy after lots of holiday family visits and way too much overtime. You decide to head out for a weekend ski tour to a “secret” old mining cabin up above Breckenridge that you’ve been wanting to check out for years. You and your three mid-twenties Denver buddies arrive to the one room primitive cabin after a long and tiring climb, ecstatic to find the cabin at the end of a long and very cold day. After a quick snort from the flask passed around, and putting your sleeping bags in the rustic bunks, Pete breaks out his backpacking stove and tries to start it. Nothing – he curses an empty gas cartridge and throws another one on the stove and lights it. A few moments later there is a blinding flash and a big “WHUMP” as a flash fire engulfs the room. You and your buddies grab your sleeping bags and beat out the flames around the stove. You see Pete on the floor looking dazed, but amazingly he seems okay, at least at first glance.
Scene and Primary Assessment: The fire is out and there is surprisingly little smoke. Everyone is accounted for. Other than a bit of wheezing by Pete, he has good ABCs and no apparent other primary issues.
Physical: On exam Pete complains of a very sore left ankle. Apparently he badly twisted it when he stumbled from the flames. He has a blister on the back of his right hand about the size of a silver dollar that is super painful. He voice is bit raspy and he says his throat is kind of sore so you look more closely at his face. You laugh as you see that his long bangs are singed, as is his part of his scraggly beard. He is shivering a bit in the cold cabin, otherwise nothing else of note.
SAMPLE: Symptoms as described; Pete is allergic to cats and dogs and pollen. He is on some kind of anti-allergen medicine, but doesn’t know what it is (he took his daily dose today). No relevant history. He had lunch 5 hours earlier and probably got a liter of water down over the day—it was too cold to drink much. In terms of E, Pete was starting to put a pan of water on the stove when there was the big “whump.” You figure that maybe the “empty” stove canister wasn’t really empty and that it leaked and the gas ignited from the stove flame.
Vitals: Round 1 – HR 88, RR 24 and “wheezy,” AOx4. Round 2, 10 minutes later – HR 92, RR 28 and “wheezy,” AOx4, but a bit anxious.
Setting: About 11,500 feet, it’s now 6 pm. Calm and clear skies, but cold—about 5 degrees F. below. You are 3.5 miles from, and maybe 1500 feet, above the trailhead. It is a moderate ski down through trees on a broken trail. While you are a beginner backcountry skier, the other three of you are competent and experienced skiers. You have a cell phone but there is no cell service, at least at the cabin; there was at the trailhead.
What do you do? What is your assessment, anticipated problems, and plan?