non-HIPPA related med report

1/23/2010
26 y/o male c/o finger laceration secondary to a speed ice climbing competition event:
The patient was able to rip the protective leather finger off the third digit of the glove and still create a full thickness laceration. The finger of the glove was still on the ice pick what the subject was lowered to the ground.
Mild hemorrhage was immediately controlled by the patient and then myself since I was present and witnessed the event (have it on video).
The patient was prepped and draped in a non-sterile fashion in a Swiss climbing bar with a dirt floor in Saas-Fee only 20 paces from the ice climbing event. No local anesthesia was used, but the patient enjoyed general anesthesia effect from the multiple alcoholic beverages that were given him by the locals who insisted he partake in the festivities at the time of being provided acute medical care.
The patient was taken to a Red Bull table in the bar where the best light was. Hemostatis was achieved by using a finger tourniquet. Irrigation of the would using the tap water out of my Camelback in my Avalung backpack was the only water available. Power irrigation was achieved using a 10cc spring loaded syringe and 18ga angiocather from my trauma kit in my backpack. My First Assist, Malcolm Kent (another athlete) was able to maintain control of the water supply.
The 1cm x 0.5 cm 90 degree angular full thickness laceration to the 3rd digit on the medial side of the right hand is located between the DID and PIP. Exploration showed no deeper structure involvement and the patient had good motor and sensory distally. No tendinous involvement.



Multiple photographs from by-standers were being taken but the flashes did not interrupt or hinder care. Red Bull and Vodka and Rum and Coke drinks had to be removed from the table several times throughout the procedure.
No gloves were able to be used and no drapes were available. So, I used sterile 4x4 gauze as a drape and sprayed my fingers down with the water irrigation solution.
5.0 Prolene was used to place three interrupted sutures and close the wound. The tourniquet was released and a sterile bandage was placed over the wound site. The last suture was difficult to place since the bar lowered the lights and the band started to play rock and roll with the speakers being right next to the table.
No splint was available besides bar straws, so I just advised the patient to try and keep the finger straight and refrain from flexing.
The crowd cheered when we were finished and the Americans stayed at the party.
I will be following the patient since he is my roommate and I’ll be skiing with him for the next 3 days and ice climbing with him for the next two weeks at the World Competition circuit throughout Europe. I will make sure that the stitches stay in longer if he is placing more force on them than necessary while ice climbing/skiing.

1/26/2010
Day three after the incident, the patient shows me his wound and it appears to be weeping with subsequent sticking to the bandage. I placed a small amount of Neosporin ointment near the wound and re-bandaged with an American Flex-fabric Band-Aid. The wound looks good and there’s no sign of infection.
Will consider taking out the stitches after the Rabenstien Ice Fight competition in northern Italy.

NOW THAT's what friends are for !

Saas-Fee to Zermatt Ski Tour

1/20/2010
Saas-Fee to Zermatt, Switzerland ski tour
Ski touring in the Swiss Alps is a spectacular adventure and experience. It’s a big day to go from Saas-Fee to Zermatt on skis, especially on-sight. I needed to rack up a little more mock guiding time for my upcoming AMGA exam, so Justin helped be a great bro and helped me out as an acting client.
We rented our gear in Saas-Fee and the local guide’s office helped me out with a loaner shovel since I didn’t bring one to Europe. Other than that, we had the rest of the requisite equipment except for a map. The Swiss maps are among the best in the world. We went back to our hotel room and planned the route, AMGA style and no skimpy plans.
Boarding the tram and then jumping onto the Alpine Train, we were excited to get going on our journey. They stopped the train at the half-way point and we jumped off. Several other people tried to get off the train and everyone else yelled “no” to them, and they promptly got back on board since this definitely was their stop. The tunnel runs through some culverts to an electronic door. We stopped there and got geared up.
We emerged from the culverts and it was a very bright bluebird day. Looking at my log book I got our bearings and figured out which direction we needed to go. I did a quick assessment of the snowpack to ski down the first couple hundred feet that ran out onto the glacier. It was good and stable, so we made our first turns. Once on the glacier we went into roped glacier mode. The local UIAGM guide, Peter, told us that the snow bridges were not obvious and were also weak and that it was easy to punch through into a crevasse.
Justin and I split the rope into equal amounts and we space ourselves out. The snow was completely untouched. There were no tracks whatsoever and the distances were large. The peaks were beautiful and there were no sounds except for a light breeze. The sun was strong, but a storm was coming in and would be enshrouded soon, so we soaked it up as much as we could.
We snuck around the corner of a ridge and found ourselves looking at the final skin up the next 1000m to Adler Pass. I knew we needed to stay a couple hundred meters away from the right since there was a large rock escarpment and we could be hit with a spontaneous rock volley, even though it didn’t seem likely since there was no active rock fall. However, I’ve seen large rock faces slough off several times in the past while in Chamonix. So, I started heading up a nice graded slope and promptly punched through the snow into a small crevasse. My skis were not parallel to the crevasse and I popped though easily. I yelled out to Justin, “heads up” and I fell into my armpits. Being able to lean back while falling in I was able to pretty much catch myself with my left arm on top of the snow and stem my knees against the walls of the slot to prevent going in any further. I told Justin, “take, take” meaning to tension the rope. He was already lying down in hockey stop position, so it wasn’t like I was going anywhere. He snapped off a couple of photos and I pulled myself out and we continued on.
We got out into the middle of the glacier where 10,000 soccer fields could be placed and made sure of our next bearing. We cruised up the Adler Pass though incandescent bled glacier fields. The last 20m to gain the saddle were a bit taxing since the wind was cold and biting. We also had to kick out of our skis and boot up that last section since the wind slab was so hard.
We stopped near the rocks at the saddle, put on another jacket layer, took the skins off our skis, got some hot tea from our thermoses, ate some food and looked out over the 3100m descent that fell away into the Zermatt valley far below the Matterhorn. The clouds were now building and the forecast was for a fresh 3-5cm of snow. We had good bearings and map coverage until we reached the Zermatt ski area(s), and made a horrible assumption, but I’ll get to that later.
From Adler Pass the first few hundred meters were icy and then gave way to a breakable crust on about a 46 degree slope until it ran out to lower angle terrain and higher quality of skiing. Another few hundred feet below that, the cash box lay waiting. The snow became stupendous and we were able to carve out great turns for 1500m on the glacier. Monster hanging glacier rose above and sat idly on top stone yet uncovered from the last ice age.
We dodged through intermittent moraine rock fields, and then finally, the snow turned into worsening conditions at about the halfway mark. We were able to follow our route for the most part, but the glacier became increasingly dry and would not only be poor skiing on ice, but would also be a potential fall hazard. We deviated slightly and the angle was too shallow to ski in the fetches where the snow was deeper. We would up skinning downhill a bit, then ran into a cliff band. We navigated it as the sun went down and wound up in the valley floor that a small creek ran down and into the ski area that we were aiming for.
Once we finally reached the ski area we were dumbfounded to find out that the only way to get from our location within the ski area to Zermatt was by train. We found a restaurant and an old man answered the door. In his broken Swiss English he was able to tell us to follow an old trail that would take us into a small village.
By headlamp we skied this trail and gained the village. From there we could only find a footpath that was located on the opposite side of the ski area. The sign for the footpath said “CLOSED.” We hiked back up hill and found a bar that was closed to ask for directions. A lady and two men opened their electronic digital locking doors and told us by really broken English that “no ski to Zermatt…trail…yes.”
We skied back to the “CLOSED” sign and made our way into Zermatt! We stopped at a restaurant and grabbed a Hot Bailey’s and Hot Chocolate and some dinner. Then we took a taxi back to Saas-Fee!
I was so psyched to be able to get in a route like this. It was a big day and well worth the trip out here in and of itself, let alone to be able to compete in one of the World's biggest and best ice competitions.

Arrival in Saas-Fee, Switzerland

1/18/2010 - 1/19/2010
Milan, Italy to Saas-Fee, Switzerland
Up and at ‘em ! Moving on to the next competition venue on a cold and foggy morning in Milan, we caught a ride by shuttle bus to the train station. We must be headed to Switzerland because all the transfers ran like clockwork. No waiting around. The train out of Milan was fast and smooth and only made a few short stops. Waterfall ice and climbing crags littered landscape when we got into the mountains. I was able to get some studying done by reading some of my textbook for the spring semester at UNM that hasn’t started yet.
Malcolm Kent from the UK had given us some food when he dropped us off from our trip out of Valle di Daone, and I carried it in a bag with two bottles of champaign that Emilo, the owner of Zamberlan boot company had given to Justin and I at the last competition. We ate the food, but left the bubbly for another time, likely in Saas-Fee.
Gordon McArthur is supposed to show up from Canada today/tonight. This will be his first World Competition and I’m sure he’s super excited. We all have a flat in Saas-Fee, and as you can imagine, it’s pretty nice. A quaint chalet with a bomb shelter serving as the game room downstairs comes complete with incredible views of some of our ski tour lines that we’ll be doing later this week.
We strolled through the town after getting settled in. The 1:25,000 maps are available at the local gift shop and the magnetic declination is about 0, so that makes navigation a bit easier in whiteout terrain. I’m pretty psyched to get some big days on skis here, especially since I’ll be taking my AMGA Ski Mountain Guides Exam in Alaska in a couple months.
The Swiss take the Euro, but give change in Franks. They don’t take Euro coins however, and so we’ll be stuck with buying trinkets with our leftover Franks when it’s all said and done. Pretty good scheming, I’d say. The exchange rate is nearly 1:1 with the US dollar, but they don’t take US that money. They nail you on currency exchange, so the best bet is to use the evil Visa card.
Ryan Nelson, a hard mixed climber who pushed the limits early on in mixed climbing history has been sending me information on Facebook about what to do and where to go! He’s becoming the best tour guide and single best information point for the entire trip so far. Really, Ryan should be climbing with us at this competition. I remember seeing him and Jarrod Ogden putting up hard mixed lines in Ouray when I was still coming to grips that what they were doing was even possible. I’m sure Ryan could train up and get on the podium. Yes, this is a call to arms. Not only Ryan – you know who you are out there. Answer the call, push your limits, and train hard. Hope to see your name on the docket for the World Ice Comps someday!
We took a quick peek at the venue for the competition here is Saas-Fee as well. It didn’t appear that anyone was working on it or was in shape for competition, so we took a closer look. Holy crap, they would never allow this in the USA (something cool and fun). The structure is fixed inside a 10 story parking garage in middle of the spiral drive! The wall is bolted on, fixed with cable and manipulated with a monster-sized winch on the -5th floor. Yes, the minus 5th floor. The parking garage is built on the side of a cliff as there are no high-rise buildings in Saas-Fee to ruin the viewscape. Ice runs down the semi-symmetrical looking climbing structure. The holds look like real rock holds and are mounted on extremely overhanging terrain. Large blocks of ice have been hoisted up and fixed speckling the structure with volumous opportunities for outlandish mixed climbing terrain. I can only hope that I have the drive to get up this thing and have as good a time as it promises to be.