Wilderness Medicine Case Study 53

You are on a late summer rafting trip in the Grand Canyon when one of your rafts pins at Bedrock rapid spilling two passengers, John and Tory, into the river leaving the guide and one passenger struggling to stay in the raft. John, is caught in the rigging and held underwater by the current. It takes the guide a few minutes to fully grasp the situation and cut him free. Once free, John flushes to the right side of the rocky island face down and unresponsive in the water. Your gear raft picks him up below the island while others rush to stabilize the pinned raft and help those on board to shore. Reaching John, you quickly determine he is not breathing and has no pulse. You initiate CPR as your two passengers struggle to get the heavy raft to shore. After what feels like hours but must have been only minutes, John spontaneously regains both his pulse and breathing. By this time you are safely tied to the lower end of the island. Roughly fifteen minutes later John is awake with no memory of the event. Your physical exam reveals bruising and minimal swelling around his right ankle where he was caught in the rigging. His right ankle is tender with minimal impairment; John believes he can stand and walk on it. The rest of his exam is unremarkable and John's helmet is free of scratches; it appears that he did not hit his head during the event. Some 30 minutes after the event, John's pulse is 68 and regular; his respiratory rate is 16 and easy, his skin is normal, and he is fully awake and alert. His focused spine exam is also unremarkable with no spine pain, no spine tenderness, no shooting or electric-like pain, and normal motor and sensory exams.

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