alone in the mountain

Setting: Obispo Peak, Altar Volcano - Ecuador

Two climbers set off to climb Obispo, the highest peak of the Altar Volcano in Ecuador. They are hunkering down at the base camp due to bad weather for a couple of days. A small window in the weather finally opens up and they move to their advanced base camp at the foot of the glacier. After 24 hours of continuous snow, they decide to go up to the summit. They notice that the snow conditions are not optimal, but still decide to attempt their climb to the summit, which they are able to  achieve a few hours later. On the way back, they start rappelling down to the advanced base camp. The climbers face some difficulties with the ropes getting stuck, which makes them lose time getting off the wall. On one of the rappels they decide to put a deadman anchor to continue descending. The first climber reaches down and yells back at the climber that was still on top “there’s a crevasse at the end of the rappel, watch out!” The second climber starts descending and mid rappel sees the dead man come out of the snow. He plunges down towards the crevasse and as he falls, the climber extends the hand holding the ice axe to break his fall. He feels a sharp pain in his shoulder but eventually the ice axe stops his fall right before reaching the crevasse.  

Subjective:

The patient is a 22 year-old-male, who fell 25 meters and managed to self-arrest. The patient doesn’t lose consciousness, he is alert and oriented. His chief complaint is severe pain on his right shoulder.

Objective:

Patient exam revealed that there is severe pain on his right shoulder, on his acromion (on top of the shoulder). There is no deformity on the clavicle. When exposing the shoulder, there is some bruising present. The patient has good CSMs in all of his extremities, but diminished range of motion on his right arm. The patient is alert and oriented, is aware of his situation, and despite the pain he is collaborating with his climbing partner to descend. 

Vital Signs:*

Time: 12h00

LOR A+Ox4

HR 76 Strong, regular

RR 18 Regular, easy

Skin Pink, warm and dry 

Symptoms: Pain and tenderness in right shoulder. 

Allergies: None

Medications: None

Pertinent Medical Hx: None

Last ins/outs: 2 liters of water throughout the day, normal peeing

Events: The fall was not caused by fainting but rather from a fail in the protection placed.

WHAT IS YOUR ASSESSMENT AND PLAN?

DO NOT peek at the next section without answering this first.

Assessment:

Potential fractured clavicle, we have a mechanism of injury as well as pain and tenderness. 

Plan:

• Stabilize the right arm to limit motion

• Monitor CSM’s

• Descend

• Evac

Anticipated Problems:

• Dehydration 

• If unable to reach the advanced base camp, spending the night up there can lead to hypothermia. Weather can deteriorate again. 

• Loss of CSM’s

The tale continues:

The other climber takes all the weight, leaving the patient with a light backpack and both climbers continue to rappel down to the advanced base camp. While the patient had some support, the pain was considerably reduced. They knew that a horse packer was coming up to the base camp early next morning, so the climbers decided to keep pushing to base camp which they were able to reach safely some hours later. The next morning they met the horse packer and the climber was evacuated via horse. Once they reach the hospital, they get confirmation that ligaments on the right shoulder are torn and that the acromion is out of place. There is no fracture to the clavicle or collarbone. 

Take away points:

• Snow and weather conditions had deteriorated as they progressed the climb, this should have been a point of decision whether to continue the climb or not. 

• The placement of the deadman anchor was wrong, it was placed in the opposite direction, when weight was applied it flew out of the snow.

• The climbers decided to leave gear to make the descent more efficient, and that way make it in time to meet the horse packer. 

• The rescuer remained calm throughout the whole time, making it safe for both climbers to get off the mountain.