Case Study 27

The Scenario: Over the Edge

The Setting

You're leading a group of business people in the Arizona desert. Their agenda is team-building. Today's plan includes rappelling practice. 

Charlie was a reluctant participant. He doesn't like exposure, nor does he relish camping. He thinks water skiing on Lake Mead is a better bonding environment. It took cajoling from his co-workers to get him on the rappel. Charlie is now 15’ below the lip and looks awful. The bantering that pushed him over the edge pushed him over the edge. He's red, sweating, breathing hard, and says he is going to pass out. You engage the belay line and try to get him to release his brake hand death grip. This triggers drama, invectives, and a two-handed grip on the main line above his friction device. Eventually he lets go and you lower him to the ground. 

SOAP Report


The patient is a 49-year-old male lowered to the ground after failing to rappel a short cliff. There is no mechanism for spine injury. He complains of dizziness, numb and painful hands, and thinks he's going to vomit. He says he “can’t breathe.” He is pacing rapidly and won't be still. 

Patient Exam: He has a superficial abrasion on his hands that looks like a rope burn. He has tingling and numbness in hands and lips. CSMs in feet are normal. Circulation is good to his hands. No wheezes or coughing while breathing. He denies chest pain.

Vital Signs

Vital Signs


1030 hrs




100, strong, regular


40, regular, deep, unlabored


flushed, warm, moist


radial pulses present



Not taken




Patient is emotionally agitated, light-headed, and dizzy. Patient states he feels "wired" and that his heart is racing/pounding in his chest and his "stomach is a mess."


He denies allergies.


He apparently takes several medications but is unwilling to discuss details.

Pertinent Hx:

He is unwilling to discuss his medical history.

Last in/out:

Patient ate breakfast today, is well-hydrated; urine has been clear and bowel movements normal.


Patient developed symptoms while rappelling.

Stop ...

What is your Assessment and Plan?

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