Wilderness Medicine Case Study 8

You and a three kayaking friends are taking turns playing in a rather large hole on a popular day run. The take out is four miles downstream. The day is sunny and 74º F and the clean blue-green water is a cool 52º F and every one is wearing a dry top if not a full dry suit. It's a weekend so there is some raft traffic on the river. You are keeping an eye out for approaching rafts as they sometimes run the hole you are playing in and can't see a kayaker in the hole until it's too late. You have been at the play spot for a while and everyone is getting a bit tired. One of your friends, Sue, enters the hole for what she says is "the final time". Unfortunately she's a bit too tired and is unable to exit the hole before a raft lands on top of her; however, she did have the presence of mind to turn upside down before the raft landed on her. The raft exits the hole with her upside down kayak pinned under its floor. The bow of her kayak is sticking out the from under the side of the raft and members of the raft crew together with a couple of the kayakers attempt to free it. As they are working on the kayak your friend pops up slightly upstream of the raft coughing and gasping for air. She is quickly pulled into the raft by an attentive paddler.

It takes her about five minutes to stop coughing and speak normally. Although she is wearing a full drysuit she is actively shivering even after sitting in the sun for five minutes. As she is catching her breath she is cradling and supporting her right arm. After she regains her breath she is able to relate details of the entire event. She tells you that she turned over just the raft hit the bottom of her boat. She felt something in her shoulder tear and she couldn't use her right arm. With the raft on top of her kayak and her right shoulder not working properly, it took her a while to get out of her boat. She remembers breathing in some water as she surfaced. She says her shoulder hurts a lot (8); she is supporting the arm on her injured side with her elbow held about eight inches from that side and she unable to touch her opposite shoulder with the hand on her injured side.

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