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Suspension Trauma Scenario

Suspension Trauma Scenario

You are called to a 59-year-old male who has fallen while climbing and is now suspended from a cliff at a well-known climbing area. On arrival, you see the patient is still hanging 15 ft from the ground, his climbing rope is twisted tightly around his right leg.

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Question 1 of 15

1. Question

What are your first actions to aid management of the scene and patient?

Request technical rescue through HART or the Fire Service
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Make verbal contact with the patient
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Clear the scene as best as possible for further resources and rescue
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Gain a history of the incident from bystanders or, if possible, the patient himself
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Question 2 of 15

2. Question

You learn that the Fire Service technical rescue team is nearby to assist. The patient is confused, so you cannot gain information from him directly, but bystanders report he has been hanging for over an hour. You suspect the patient is showing pre-syncopal symptoms. What might these include?

Dizziness
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Confusion
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Clamminess
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Nausea
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Visual changes
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Question 3 of 15

3. Question

As the Fire Service arrives, the patient collapses in the harness. Current research suggests that syncope due to suspension occurs because…

Of provoking factors such as pain, chest compression, or discomfort, similar to a usual vasovagal event
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Of venous pooling and resultant cerebral hypoperfusion
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Of chest tightness reducing lung capacity and causing hypoxia
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Of reduced cardiac output caused by vagus nerve–mediated bradycardia
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Question 4 of 15

4. Question

The patient collapses in his harness and remains in a near-vertical position. Why is this problematic?

Venous pooling and resultant cerebral hypoperfusion means the patient will not recover from syncope
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Neck hyperextension or flexion may cause airway compromise
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Provoking factors such as pain, chest compression, or discomfort are not relieved
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Chest tightness reducing lung capacity and causing hypoxia may worsen
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Reduced cardiac output caused by vagus nerve–mediated bradycardia may worsen
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Question 5 of 15

5. Question

The Fire Service recognises the urgency and begins rescue immediately. Once the patient is lowered, what do current recommendations suggest regarding positioning?

Place the patient supine as quickly as possible
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Slowly move the patient to a supine position, sitting them first if possible, to reduce the sudden release of toxins into the circulation from the area distal to compression
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Keep the patient head-elevated to reduce the chance of toxins entering systemic circulation
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Question 6 of 15

6. Question

The patient is still breathing as he reaches the ground but is unconscious and snoring. What should be your first action?

Protect the airway using an OPA or manual manoeuvre
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Protect the C-spine due to the fall
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Untangle the rope from around his legs
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Complete a set of observations
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Question 7 of 15

7. Question

You should apply a tourniquet above the site of compression, similar to crush syndrome management, to stop toxins entering the circulation before releasing the rope?

False
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True
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Question 8 of 15

8. Question

You insert an airway and begin observations. The rope has been released, leaving his legs slack. Observations are: HR 129, RR 30, BP 80/45, SpO₂ 93% on air, Temp 36.0, BM 5.1. What treatment or management would you initiate?

Oxygen administration
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IV access
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IV fluid bolus
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12-lead ECG
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Sitting and standing blood pressure readings
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IV paracetamol
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Question 9 of 15

9. Question

Compression syndrome has the same physiological effects as crush syndrome, so fluid management should be similar if suspected?

True
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False
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Question 10 of 15

10. Question

What complication of compression syndrome can cause deterioration after the incident?

Hyperkalaemia
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Rhabdomyolysis
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Hypokalaemia
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Sepsis
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Question 11 of 15

11. Question

Pulmonary embolism can also occur because of compression syndrome due to venous pooling?

True
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False
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Question 12 of 15

12. Question

If the patient arrests in this situation, standard ALS resuscitation guidelines should be followed?

True
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False
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Question 13 of 15

13. Question

The likelihood of rhabdomyolysis and/or hyperkalaemia increases significantly when suspension is prolonged. What timeframe do current recommendations suggest?

2 hours
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1 hour
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6 hours
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10 minutes
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Question 14 of 15

14. Question

What factors may cause compression syndrome to progress more quickly?

Limited harness padding
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Location of the harness pinch point
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Inability to move the legs
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Existing comorbidities
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Obesity
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Patient consciousness level
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Question 15 of 15

15. Question

Compression syndrome is now rare in industry due to…

Increased training
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Better designed, more comfortable harnesses
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Improved self-rescue capabilities
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