Ed note: This is a longer case. To avoid lots of scrolling, answers are in line with the questions. Scroll slowly and answer the questions yourself before moving to the answer.
It’s February and you’re settled into your mid-season routine. It’s been snowing lightly for a few days and crowds are visiting the resort for President’s day weekend. After completing setup, you’re sitting with your coffee in the patrol shack and waiting for something to happen.
As usual, it doesn’t take long. Your radio sounds off, “Attention patrollers, I have a reports of a guest in need of assistance at the summit restaurant, caller reports a 35-year-old male who is short of breath.”
You’re dispatched to this call as a first responder. As you ski from the patrol shack to the restaurant, you consider what you might find.
Answer: While the potential causes are many, generally speaking, our guest population is somewhat healthier than the general population. Still, anything can happen. Thinking in terms of worst-first, this patient could have shortness of breath caused by a heart attack (ACS, acute coronary syndrome), spontaneous pneumothorax, choking or aspiration, anaphylaxis, asthma attack, or a pulmonary embolism (blood clot in the lungs). Other common causes include acute mountain sickness (AMS), anxiety or panic attack, dehydration, viral illness, pneumonia, and exertion at altitude. Uncommon medical causes in the skiing population anlso include acute blood loss anemia, gastrointestinal bleeding, pleural effusion (fluid around the lungs), and heart failure exacerbation.
You arrive at the scene and find a small crowd gathered around a thin man who is seated on a chair in the restaurant. He is leaning forward with his hands on his knees and he appears to be focused on his breathing. You introduce yourself, obtain permission to help, and put on a pair of gloves and a surgical mask for BSI. You perform your primary survey, revealing:
A. The patient appears to have a patent airway. His mouth is open and upper airway appears clear.
B. He is tachypneic, breathing around 18 times a minute. He has faint breath sounds on both sides, with a quiet, high-pitched wheezing heard as he breathes out. C. He has a strong radial pulse and he’s tachycardia, with a rate of about 130 bpm. He appears slightly pale and diaphoretic (sweaty).
Answer: Based on the patient’s appearance of respiratory distress with wheezing and tachycardia, choking or aspiration, anaphylaxis, and asthma attack are most likely. Pneumothorax, ACS, pulmonary embolism, and panic attack remain possible. This is less likely acute mountain sickness, simple viral illness, pneumonia, dehydration, or normal dyspnea due to altitude.