Case Study 1

The Answer

Assessment

This patient has an injury to his right ankle. He also has abrasions to his right lower leg and a laceration to his right thigh. Based on the MOI this patient is an unlikely candidate for spine injury.

The Plan

  • A usability test was performed and the patient is able to bear weight. The minor bleeding was controlled with direct pressure. The wounds will be further assessed in camp where there are more materials for wound care. 
  • Once in camp we will irrigate and clean the abrasion and dress the abrasion in a clean dry gauze dressing. The laceration is not gaping and appears clean. It will be irrigated with water, then closed with “steri strips” and dressed with a “micro thin” dressing. 
  • Additionally, we will RICE the ankle injury and, if needed, support with tape.

Anticipated Problems

  • Possible wound infections. 
  • Inability to bear weight on the ankle develops.

Comments

A thorough assessment is the standard for any patient. This patient presented with a couple of injuries that could be treated differently based on what exactly the assessment revealed.

The ankle: 
A usability test can help to determine the extent of the musculoskeletal injury. We don’t try to diagnose the injury or grade a sprain or the strain. We decide if an injury is usable or not. If usable, we use RICE therapy and may tape for support. If unusable we immobilize and evacuate.

The RICE treatment is: 
Rest: allow time for healing 
Ice: 20 to 40 minutes every two to four hours for 24 to 48 hours 
Compression: elastic bandage to reduce swelling 
Elevation: to reduce swelling

For this patient and single rescuer the usability test may help determine whether this patient will self-evacuate to camp or if the rescuer will need to go for help to evacuate. A good thorough assessment can help determine whether this is a trip-ending injury or one that can be taken care of with some diligence in camp. The patient may not be climbing, but they could certainly sit and enjoy a sunset while the dishes are being done!

The soft tissue wounds: 
A review of our wilderness protocols regarding laceration closure shows that this wound can indeed be effectively closed. A laceration wider than a half inch would need to be “packed open” and eventually assessed by a physician. Paying particular attention to the prevention of infection will go a long way to ensure this wound heals without incident in the field.

Cleaning Wounds

  • Wash your hands with soap and water
  • Put on protective gloves
  • Scrub and irrigate the wound
  • Scrub the area around the wound
  • Use sterilized tweezers to remove debris
  • Use pressure irrigation
  • Rinse thoroughly with disinfected water
  • Dress and bandage the wound
  • Check circulation, sensation, and movement
  • Monitoring for early signs of infection you’ll look for:
    • Redness and swelling
    • Pus, heat, pain

End of the Tale

You and your partner make the decision to continue car camping. The soft tissue injuries seem to be healing without complication. The ankle injury, moving into shades of burgundy and taupe, is still painful but with decreased swelling. RICE treatment in the evening and a supportive tape wrap during the day works to keep you both active. Although his mobility keeps him from climbing, he is able to belay you on a 5.10 off-width from which lesser individuals have been spit like so many watermelon seeds at the county fair.


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