OEC Case Analysis & Practical Application 2 — Questions and Answers
Question 1: A skier collides with a tree and is found unconscious with gurgling respirations. After opening the airway with a jaw thrust, the gurgling persists. What is your next action?
- Begin rescue breathing immediately
- Suction the airway to clear secretions (Correct answer)
- Apply a cervical collar and monitor
- Roll patient to recovery position and call for evacuation
Correct answer: Suction the airway to clear secretions
Gurgling respirations indicate fluid in the upper airway; suctioning is required to clear the obstruction before effective ventilation can occur.
Question 2: During a wilderness trip, a patient with a known bee allergy is stung and begins showing hives, throat tightness, and hypotension. Epinephrine has been administered. What is the next priority?
- Administer diphenhydramine and monitor
- Prepare for a second epinephrine dose and arrange rapid evacuation (Correct answer)
- Place patient supine and elevate legs only
- Apply ice to sting site and observe for 30 minutes
Correct answer: Prepare for a second epinephrine dose and arrange rapid evacuation
Anaphylaxis can be biphasic; after epinephrine the patient must be evacuated rapidly and a second dose prepared because effects may wear off before definitive care is reached.
Question 3: A snowboarder reports severe knee pain after a fall with a twisting mechanism. The knee is swollen and he cannot bear weight. Which assessment finding would most suggest a ligamentous injury versus a fracture?
- Point tenderness directly over the tibial plateau
- Rapid effusion developing within 2 hours
- Audible pop heard at time of injury with instability on valgus stress (Correct answer)
- Pain with passive range of motion only
Correct answer: Audible pop heard at time of injury with instability on valgus stress
An audible pop followed by joint instability on stress testing is a classic presentation of ligamentous rupture, particularly the ACL.
Question 4: A hiker is found alert but confused after a long summer hike in 95°F heat with minimal water intake. Skin is hot and dry, HR 120, BP 90/60. What condition does this presentation most likely represent?
- Heat exhaustion with dehydration
- Classic heat stroke
- Exertional heat stroke (Correct answer)
- Severe dehydration without heat illness
Correct answer: Exertional heat stroke
Hot dry skin with altered mental status, tachycardia, and hypotension after exertion in heat indicates exertional heat stroke, a life-threatening emergency requiring immediate cooling.
Question 5: You are assessing a rock climber who fell 15 feet onto a ledge. He is ambulatory and denies back pain but has a small scalp laceration. Under what circumstance should you still apply spinal precautions?
- Scalp lacerations always require spinal precautions
- He is ambulatory so spinal precautions are not needed
- Mechanism alone (significant fall) warrants precautions even without symptoms (Correct answer)
- Only if he loses consciousness during your assessment
Correct answer: Mechanism alone (significant fall) warrants precautions even without symptoms
A fall of significant height is a high-risk mechanism; OEC protocols recommend applying spinal precautions based on mechanism even when initial symptoms are absent.
Question 6: A cross-country skier presents with a white, waxy, hard patch of skin on her cheek that does not blanch with pressure. She reports no sensation in the area. What stage of frostbite is this most consistent with?
- Frostnip
- Superficial frostbite
- Deep frostbite (Correct answer)
- Immersion foot
Correct answer: Deep frostbite
White, waxy, hard skin with absent sensation and failure to blanch indicates deep frostbite involving full skin thickness and underlying tissues.
Question 7: A patient in a remote canyon has a femur fracture from a rockfall. Before splinting, you assess PMS distally. What does PMS stand for and why is it critical in this scenario?
- Pain, Movement, Strength — to grade the fracture severity
- Pulse, Motor function, Sensation — to detect neurovascular compromise (Correct answer)
- Pressure, Movement, Swelling — to guide splint tightness
- Pulse, Muscle tone, Skin color — to assess bleeding
Correct answer: Pulse, Motor function, Sensation — to detect neurovascular compromise
PMS (Pulse, Motor, Sensation) assessment detects neurovascular compromise from the fracture or splint, which can lead to permanent limb damage if unrecognized.
OEC Case Analysis & Practical Application 2
A skier collides with a tree and is found unconscious with gurgling respirations.
After opening the airway with a jaw thrust, the gurgling persists.
What is your next action?