Rock Jock Doc – You and a friend are climbing at a local crag. As you take a break to eat some lunch another friend who was climbing a couple of routes over, and who knows you took this cool WFR class, comes running up and, out of breath, manages to spit out that a young “kid” just took a bad fall while bouldering. You grab your pack with its small first kid and your buddy leads you back to the patient. You look over the scene, decide it’s safe, and approach the young man, who you are relieved to see is sitting up.
Scene and Primary Assessment: Scene safe, one patient, fall to ground from about 6 up. Rapid, shallow respirations; patient is speaking. Nothing else of note.
Secondary Physical: You introduce yourself and ask to help, getting a grimace and a nod yes. His partner tells you that the guy’s name is Terry. Upon examination you hear some moaning and see a very slow stretch of one leg. Terry, who says he is 19, complains of a really sore left side. You gently lift back his shirt to see scrapes around the lower ribs, with a little blood oozing from the scrapes. He won’t lie down for an exam and claims no other symptoms, refusing your request to conduct a full physical. He was not wearing a helmet but claims he didn’t hit his head or lose consciousness and he denies any pain around the back or neck.
SAMPLE: Symptoms as described; Terry claims no allergies and no medications, but you smell the sweet pungent odor of some good weed—this is Colorado after all—thoroughly embedded in Terry’s clothes, he denies smoking recently but his red eyes make you wonder; he says he never fell as hard as this one, or hurt his side as bad; last ins and outs normal; Terry’s climbing partner said he was only 6 or 7 feet up, but trying to do a heel hook, when he peeled; no “crash pad” just an embedded boulder where he landed.
Vitals: Terry let you get one set of vitals before he declined further care. HR 88, RR 18, AOx4. Before you leave you watch him talking to his buddy, and notice what seems like increasingly rapid and what sounds like shallow breathing. As you walk away, shaking your head, you see his buddy try to get him to stand, which he is barely able to do, and only with assistance.
Setting: The crag is a half mile from a National Forest parking lot, on an easy trail. The gravel road is ~1 hr from the nearest town. You are at ~6,000 feet, on a late spring afternoon, mostly blue sky and about 50 F, but big boomers growing overhead. There are a dozen or so climbers in the vicinity.
Even though you are not treating Terry, provide an assessment, list of anticipated problems, and plan. What information about Terry do you wish you could get?
Assessment: 19 year old male fell approximately 6 feet, landing on side, while bouldering. Possible respiratory difficulty.
Anticipated Problems: Spinal injury (Terry’s head and neck should have probably been keep hand stable until a spine assessment could be conducted). Respiratory difficulty. Bruised or broken ribs. Hemo- or Pneumothorax. Altered mental status due to cannabis? Possibly developing thunderstorm.
Plan: It might not hurt to notify the County Sheriff’s office that there is a potential injury at the site. It might not hurt to talk to the buddy one more time, if he seemed more willing to take the injury seriously. Other than that, not much you can do, as long as the patient is refusing treatment.
Other Information Desired: A full physical on Terry could be very helpful, especially palpating ribs. A second and possibly third set of vitals could also be very telling.