OEC Case Analysis & Practical Application 3 — Questions and Answers
Question 1: A mountain biker crashes and has an open chest wound that makes a sucking sound with each breath. After sealing it with a vented chest seal, his breathing worsens and neck veins become distended. What has likely occurred?
- The chest seal was placed incorrectly and needs to be repositioned
- A tension pneumothorax is developing and the seal should be briefly lifted (Correct answer)
- He has developed cardiac tamponade from blunt trauma
- His airway is obstructed and needs suctioning
Correct answer: A tension pneumothorax is developing and the seal should be briefly lifted
Worsening respiratory distress with JVD after sealing an open chest wound suggests tension pneumothorax; briefly lifting the vented seal or burping a non-vented seal can relieve the pressure.
Question 2: During a backcountry ski patrol assessment, you find a patient with suspected hypothermia. Core temperature is estimated at 30°C (86°F). Which rewarming strategy is most appropriate?
- Aggressive active external rewarming with hot water immersion
- Passive rewarming only — remove wet clothing and insulate
- Active external rewarming to the core areas (axilla, groin, neck) with gentle handling (Correct answer)
- Vigorous exercise to generate internal heat
Correct answer: Active external rewarming to the core areas (axilla, groin, neck) with gentle handling
Moderate hypothermia (28–32°C) warrants active external rewarming to core heat transfer areas with extremely gentle handling to prevent afterdrop and cardiac arrhythmia.
Question 3: A hiker is bitten on the hand by a rattlesnake. Which intervention should you prioritize in the field?
- Apply a tourniquet proximal to the bite to limit venom spread
- Incise the bite and attempt to suction out venom
- Immobilize the extremity at heart level and arrange rapid evacuation (Correct answer)
- Wrap the entire arm tightly with an elastic bandage
Correct answer: Immobilize the extremity at heart level and arrange rapid evacuation
Immobilizing the limb at heart level reduces venom spread while rapid evacuation to a facility with antivenom is the definitive treatment for pit viper envenomation.
Question 4: A patient is found in a frozen lake after breaking through ice. She is pulseless and not breathing. Water temperature was near 0°C. What does OEC guidance say about resuscitation attempts?
- Do not attempt resuscitation — cold water drowning is uniformly fatal
- Begin CPR only if the patient has been submerged less than 5 minutes
- Begin CPR; cold water submersion patients may survive prolonged arrest due to hypothermic protection (Correct answer)
- Attempt 2 rescue breaths only, then focus on rewarming before CPR
Correct answer: Begin CPR; cold water submersion patients may survive prolonged arrest due to hypothermic protection
Cold water dramatically slows metabolism and can protect the brain; patients should receive full resuscitation efforts as survival after prolonged cold water submersion is possible.
Question 5: A trail runner develops sudden severe headache, photophobia, and neck stiffness at altitude. She has no fever. Which condition should you consider first given this presentation?
- Acute mountain sickness (AMS)
- High Altitude Cerebral Edema (HACE)
- Subarachnoid hemorrhage (Correct answer)
- Tension headache from dehydration
Correct answer: Subarachnoid hemorrhage
The classic triad of sudden severe headache, photophobia, and nuchal rigidity without fever at altitude should raise concern for subarachnoid hemorrhage requiring emergency evacuation.
Question 6: A patient fell from a horse and complains of left flank pain with hematuria (blood in urine). Vital signs are BP 100/70, HR 108, RR 20. What organ injury does this presentation suggest?
- Spleen laceration
- Renal (kidney) injury (Correct answer)
- Colon perforation
- Lumbar spine fracture
Correct answer: Renal (kidney) injury
Flank pain combined with hematuria after blunt trauma is the classic presentation of renal injury; associated hemodynamic instability indicates significant hemorrhage.
Question 7: You are treating a patient with a suspected pelvic fracture after a high-speed ATV crash. Which intervention is most appropriate in the field?
- Log-roll the patient to check for posterior bleeding
- Apply a pelvic binder or improvised sheet wrap at the level of the greater trochanters (Correct answer)
- Elevate the legs to 45 degrees to reduce internal bleeding
- Compress the iliac wings laterally to stabilize the pelvis
Correct answer: Apply a pelvic binder or improvised sheet wrap at the level of the greater trochanters
A pelvic binder applied at the greater trochanters reduces pelvic volume and tamponades life-threatening internal hemorrhage from an unstable pelvic fracture.
OEC Case Analysis & Practical Application 3
A mountain biker crashes and has an open chest wound that makes a sucking sound with each breath.
After sealing it with a vented chest seal, his breathing worsens and neck veins become distended.
What has likely occurred?