rock fall 2.0

 
 
 
Canonigo, Altar - Ecuador

Canonigo, Altar - Ecuador

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Setting:  western ridge, canonigo, Altar - Ecuador

Three climbers go into the western ridge of the Canonigo peak in the Altar Volcano - Ecuador to complete a first ascent. This is the third time they are in this place, which is why they already have a bivouac place. They have had constant rain and cloudy days. They decide to go for the climb but eventually reach a place where the rock is too poor so they decide to turn around. The first climber descends through the first rappel with no problems and awaits for the second climber. The second climber starts the rappel and reaches the first climber. As the second climber is taking off her rappelling device, she feels a huge hit on her helmet. She immediately starts feeling warm blood down her neck. The first climber helps her take the devices off and sits the patient down, starting the patient assessment. The third climber descends and they start discussing the evacuation options. Everyone is wearing a helmet. 

Subjective:

The patient is a 29-year-old female. She was hit in the head by a boulder (size unknown), causing significant bleeding. Patient does not lose consciousness, she is alert and oriented. She complains of pain in her jaw.

Objective:

Patient exam: Reveals that the patient has severe pain in her neck and jaw, she cannot open her mouth much. On a skin level, there is no visible depression in the skull, then again there is a lot of blood. Patient has good CSMs. Patient is alert and oriented, with pain, but collaborating with her fellow climbers on her rescue.

Vital Signs:*

Time: 16h00

LOR A+Ox4

HR 76 Strong, Regular

RR 18 Regular, Easy

Skin Pink, Warm and Dry 

Symptoms: Pain and tenderness in neck and jaw

Allergies: None

Medications: None

Pertinent Medical Hx: None

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

Events: The rock fall was not caused by fainting but rather from poor quality rock.

 

WHAT IS YOUR ASSESSMENT AND PLAN?

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

 

Assessment:

  • Potential skull fracture

  • Potential jaw fracture

  • There is a MOI for possible spine injury

  • Mild concussion

Plan:

  • Stop bleeding

  • Monitor bleeding

  • Monitor CSMs

  • Monitor head injury and level of responsiveness 

  • Descend 

  • Evac

Anticipated Problems:

  • Dehydration 

  • In case they don’t reach the base camp, spending the night up there can lead to hypothermia

  • The weather can deteriorate again

  • If the bleeding doesn’t stop it can lead to hypovolemic shock

  • Head injury can worsen, leading to a moderate-severe concussion

The tale continues:

Between the two climbers they decide to descend to the base camp. The patient descends with complete support from the other climbers, using the rope systems to get down. They call porters and horse packers to come first thing in the morning to take them out the next day. They continue to descend to the base camp and make it there with no problems. They monitor the patient’s head injury all night. The next day the horse packers come and take everyone down. Once in the hospital a skull fracture is confirmed as well as a mild concussion, a jaw fracture is ruled out.  

Take away points:

  • The climbers knew the area and the terrain, they could make a good decision to evacuate amongst themselves. 

  • The rock quality is poor in the area.

  • The climbers decided to leave some gear behind, to make their descent more efficient, allowing them to get to the horse packers on time.

  • Everyone remained calm throughout the whole time.

Case study by: Juliana Garcia

*Vital Signs Parameters

*Vital Signs Parameters