Case Study 9

The Scenario: Struggling with Steep Terrain

The Setting

You’re leading a college spring break backpacking trip in the Arizona desert. On today’s agenda is an afternoon of rappelling practice to prepare for an anticipated technical canyon section later on this route. A hot wind rises out of the south every afternoon bringing with it a dust that coats the inside of your mouth, making everything taste the same.

Katie is a 19-year-old female who has demonstrated anxiety on steep terrain. She has needed a lot of coaching to get through a few of the steep descents. Now she is 15’ below the edge on a rappel. She got this far after you spent 20 minutes coaching her over the edge. It is mid-afternoon and right on schedule, the wind starts blowing dust in her face. She is crying and says she is dizzy and is going to pass out. You engage the belay line and try to get her to release her brake hand so she can be lowered. This generates a bit of drama, but eventually she lets go and you lower her to the ground. Unfortunately, this does not seem to fix the problem. There are shouts from below of heat stroke, “can’t breathe,” and seizure. You take a deep breath and a long pull from your water bottle. It tastes like dust.

SOAP Report

The patient, a 19-year-old female, complains of dizziness, headache, numb and painful hands, and tingling around her mouth. She says she “can’t breathe.” Patient was lowered to the ground on belay after failing to rappel a section of steep terrain. There is no mechanism for injury.

Patient Exam
Head-to-toe exam reveals tingling and numbness in hands and lips, with cramping in right hand. Spine is non-tender. CSMs in feet are normal. Circulation is good to her extremities. No wheezes or coughing while breathing.

Vital Signs

Vital Signs

1530 hrs




104, strong, regular


28, regular, deep, unlabored


Flushed, warm, moist


Radial pulses present



Not taken




Patient is emotionally anxious and crying. Light-headed and dizzy.


She denies allergies, but says she “may have asthma”.


She does not take any medications. She never has used an inhaler.

Pertinent Hx:

Patient has been anxious on steep terrain.

Last in/out:

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


Patient developed symptoms while rappelling.

Stop ...

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