Case Analysis & Practical Application Flashcards

A ski patroller responds to a collision between two skiers. Patient A is alert with a deformed femur. Patient B appears unresponsive. Using the START triage system, which patient receives the immediate (red) tag?

Answer: Patient B because unresponsiveness indicates a critical airway or circulation problem

START triage categorizes patients by respirations, perfusion, and mental status; an unresponsive patient fails the mental status check and is triaged immediate (red) pending airway assessment.

A patient involved in an avalanche burial of 45 minutes is excavated in full cardiac arrest. Which factor most significantly affects the decision to attempt resuscitation versus withhold it?

Answer: Presence of a packed snow airway (snow in the airway) suggesting asphyxial rather than hypothermic arrest

A packed snow airway indicates the patient died from asphyxia before hypothermia could provide neuroprotection, making survival unlikely; without airway packing, hypothermic arrest warrants full resuscitation.

You are 6 hours from the trailhead with a patient who has an isolated closed tibia-fibula fracture. After splinting and PMS checks, the patient begins complaining of increasing pain, tightness, and paresthesias in the foot that is unrelieved by pain medication. What do you suspect?

Answer: Compartment syndrome developing within the leg

The 5 Ps of compartment syndrome (Pain out of proportion, Pressure, Paresthesias, Paralysis, Pallor) developing after fracture splinting indicate emergent fasciotomy is needed — accelerate evacuation.

A patient with a penetrating abdominal wound from a tree branch has eviscerated bowel protruding through the wound. What is the correct field management of the eviscerated organs?

Answer: Cover with a moist, non-adherent dressing and do not attempt to replace the bowel

Eviscerated abdominal organs must be covered with moist, non-adherent material (saline-moistened dressing) and never replaced in the field, as this introduces contamination and can cause further injury.

A 60-year-old hiker with a history of heart disease develops sudden crushing chest pain radiating to the left arm, diaphoresis, and nausea at 8,000 feet elevation. Which treatment takes first priority in the field?

Answer: Supplemental oxygen, aspirin (325 mg chewed), and immediate descent/evacuation

Suspected acute MI requires aspirin (antiplatelet effect) and supplemental oxygen immediately, with rapid evacuation as the definitive intervention — delays increase myocardial damage.

A patient in the backcountry has a laceration on the scalp that is bleeding profusely. After applying direct pressure for 10 minutes, bleeding continues. What is the most appropriate next step?

Answer: Increase pressure with a pressure dressing or wound packing, and consider wound closure with closure strips

Scalp lacerations bleed extensively due to rich vascularity; if direct pressure fails, a compression dressing with wound packing or closure strips helps control hemorrhage while evacuation is arranged.

During a ski patrol shift, you respond to a patient with suspected spinal injury who is supine and vomiting. What is the safest technique to manage this airway emergency?

Answer: Log-roll the patient as a unit onto the side while maintaining manual in-line spinal stabilization

A vomiting patient with suspected spinal injury should be log-rolled as a unit onto the side by the team to allow drainage while maintaining manual in-line cervical stabilization.