API – Case Study – Ch. 7: Skeleton Week 9 – Fall 2004
The Case of the Unlucky Hiker
Emily, a 24-year-old Asian-American graduate student in animal behavior, spends her free time
hiking in the mountains around her home observing the behavior of various animals in
preparation for her graduate work. One afternoon, Emily decides to spend her time hiking on less
frequented trails in hopes of working on walking quietly while carefully observing the area
around her. As usual, she lets her housemates know where she is planning to go. After parking
her car and checking her equipment and supplies, she signs in at the trailhead. The day is warm
and Emily is careful to drink frequently to minimize her chances of becoming dehydrated. Also,
she snacks while hiking to maintain adequate blood glucose. As she rounds a bend in the trail,
Emily notices a small herd of deer in the ravine below her and decides to try to move closer to
them. After carefully checking the wind she starts to slowly move down the slope toward an
overhanging ledge she noticed about halfway down. As she approaches the ledge, Emily loses
her footing and begins to slide down the side of the ravine. She tries to catch herself at the ledge,
but falls over the side of the ledge twisting her left knee and landing awkwardly on her left side.
She continues to slide down the slope and finally comes to a stop at the edge of a grove of fir
trees. While she does not lose consciousness, Emily is stunned and it takes her a few minutes to
regain her composure. The first thing she notices is that her left leg is at an awkward angle and
her left knee is very painful. When she tries to get up, she experiences pain in her left knee.
Remembering that human anatomy is not that different from the anatomy of most mammals and
the minimal experience she has from a mandatory first aid course she feels fairly certain that she
can draw some conclusions about her condition. Emily remains seated and uses her hands and a
camping mirror from her daypack to evaluate her condition. Other than some minor scrapes and
scratches Emily feels certain that she has not sustained any injuries to her arms, shoulders, ribs or
abdominal organs. While she cannot be certain, she also believes that she has not sustained any
injuries to her head, although she may have a mild concussion. Emily also cannot detect any
extreme tenderness or swelling in her abdominal region or ribs. Her right leg and shin seem to be
"normal", however her left knee appears to be injured and is swelling quite rapidly. Emily
arranges her daypack so she can elevate left leg and begins to think about the best way to
progress. As she is thinking, Emily hears what sounds like voices coming from above her. She
uses her whistle to signal to the people she hears. When they respond she yells to tell them where
she left the trail and what happened to her. The people on the trail above her tell her that they
will mark the location and return to the ranger station to send some help back. Emily replies that
she thinks she may have injured her left knee and she will wait until help arrives.
While waiting for help, Emily continues to monitor her situation. She begins to feel chilled, so
she puts her jacket on and has something to eat and drink. She also tries to remain alert by
counting the number of bird species she notices. Approximately 90 minutes later she hears
voices calling to her from above. She attempts to direct the rescue team to her position and
within 30 minutes they arrive and complete a field evaluation. Their diagnosis concurs with
Emily's and they transport her to the trail and then to the regional hospital. At the hospital Emily
receives a thorough physical examination by an emergency room physician. She tells the
emergency room physician that she thought she heard a "popping" sound when she twisted her
knee as she started to fall. The results of this examination indicate that Emily has not suffered
any major injuries other than torn knee ligaments in her left knee. The emergency room
physician immobilizes the leg and calls for an orthopedic consultation regarding her knee. The
results of the magnetic resonance image (MRI) of her knee indicate a torn anterior cruciate
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