wasps & off-widths

 
 
 
Lower Cathedrals - Yosemite, California

Lower Cathedrals - Yosemite, California

 

Setting:  Lower cathedrals, Yosemite - california, united states

Two Ecuadorian climbers are in Yosemite, planning to go up the Salathe Wall of El Capitan. This route has a lot of offwidth (something they don't have a lot of experience with). A local climber recommends they try a route in the Lower Cathedrals to practice, without knowing their climbing level. The two Ecuadorian climbers head over to the Lower Cathedrals and start the 450 meter climb. At 3 pm, the climber that is leading the pitch starts screaming: “wasps, wasps!” The second climber belays him down to safety and finds his friend’s face and hands covered in wasp stings. They decided that the fastest way out is to finish the climb. The second climber picks up the heavy rack and starts leading the same pitch in the same direction. The second climber places some protection but the climb is pretty challenging. Human factor starts to play a role and the belayer tells the lead climber to come down so they can rappel down to the valley. The lead climber ignores this request and keeps going up when suddenly he pitches off the wall and falls. The protection holding the lead climber fails, and due to the weight of the rack, the climber falls face down and impacts his side on a ledge.

Subjective:

The patient is a 32 year-old-male. He doesn't lose consciousness, is alert and oriented. His chief complaint is severe pain in his right ribs, radiating towards his spine. Patient claims he has pain when breathing.

Objective:

Patient exam revealed that there is severe pain on palpation to the right ribs, radiating to the spine. There is no deformity on the ribs or the spine. Some bruising is present in the lower left side of the ribs. The patient has good CSMs in all of his extremities. The patient is alert and oriented, is aware of his situation, and despite the pain he is collaborating with his climbing partner to descend.

Vital Signs:*

Time: 16h00

LOR A+Ox4

HR 76 Strong, regular

RR 18 Regular, laboured

Skin Pink, warm and dry 

Symptoms: Pain and tenderness in right ribs, pain on breathing. 

Allergies: None

Medications: None

Pertinent Medical Hx: None

Last ins/outs: Small amounts of water throughout the day.

Events: The fall was not caused by fainting but rather from a fail in the protection placed. 

 

WHAT IS YOUR ASSESSMENT AND PLAN?

DO NOT peek at the next section without answering this first.

 

Assessment:

  • Potential fractured ribs, unstable chest wall. 

  • Potential injury to the spine

Plan:

  • Stabilize the right arm to provide protection to the ribs

  • Monitor other climber for possibility of allergic reaction to wasps

  • Descend

  • Evac

Anticipated Problems:

  • Dehydration 

  • If unable to reach the base of the wall, spending the night up there can lead to hypothermia

  • Unstable chest wall can worsen, leading to a pneumothorax

  • Hypovolemic Shock

  • Allergic reaction to wasps can worsen and lead to an anaphylactic shock

The tale continues:

It's 5 pm, the climbers are completely alone on the wall and with no equipment to spend the night. They look for the best rappelling route that will lead them down efficiently. The patient is lowered by his partner, meeting up on a ledge and repeating the process. It gets dark but they still continue to descend until 10 pm when they reach the base of the wall. The patient laid down due to the pain but his partner motivated him to get up and walk to the road where they were able to find a ride to the hospital. Once in the hospital they get confirmation of two fractured ribs and fortunately the spine of the patient is in good shape.

Take away points:

  • The climbers had little experience and knowledge of the type of climb they were attempting. They should have learned the techniques before starting the route. 

  • The event with the wasps was the first warning they had to retreat, but they decided to continue climbing. 

  • They didn’t have a first aid kit or anything for allergies. 

  • They didn't have any equipment to spend the night, they only had the necessary gear, food, and water for the day. 

  • They didn’t have helmets. 

  • No one knew where they were. 

  • The climbers looked for a good way to descend in an efficient manner.

*Vital Signs Parameters

*Vital Signs Parameters