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The Ice Hockey Injury

A Case Study in Physiology


Philip J. Stephens
Department of Biology
Villanova University


The high school ice hockey team is playing the last of three games in one day. The game gets rough and Rick, the star player, is slammed against the boards. Injured, he has to be  escorted from the ice. This interrupted case study follows Ricks health as it deteriorates over the next few hours. Students are presented with Rick’s symptoms and use their knowledge of anatomy and physiology to diagnose the problem. The case was developed for a one-semester animal physiology course taken mostly by sophomore and junior biology or general science majors. It could also be used in a freshman general biology course, anatomy and physiology course, or human physiology course for non-science majors.


  • To understand the function of the pleural cavity during breathing.
  • To appreciate that each lung has its own pleural cavity.
  • To understand the effects of hemorrhaging on blood pressure and orientation.
  • To use deductive reasoning to determine a physiological problem.


Pleural cavity; hemothorax; hemorrhaging; sports injury; ice hockey

Topical Areas


Educational Level

High school, Undergraduate lower division, Undergraduate upper division



Type / Methods




Subject Headings

Anatomy  |   Physiology  |   Sports Science  |  

Date Posted


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Thomas Fleetwood
Science Department
Charter School of Wilmington
Wilmington, DE
First, I want to thank you all tremendously for the use of this excellent site and material. I have no doubt that this is one of the best ways for students to learn to actually understand and remember the material and be able to apply it to real life situations.

Regarding this case — mine is a high school anatomy class consisting of 11th & 12th grade students. They were excited to receive the case and related to the individual in the case and his circumstance. As we started they were full of ideas. As they completed each part I questioned the group members and asked for explanations/clarifications, etc., before they received the next part. The students started to get frustrated at the process when they weren’t "told" the answers and needed to do more research. But then they were quite proud when they finally got the answers and could explain why. So, in all, they seemed to go through the cycle of excitement, frustration, excitement, frustration, excitement.... Sort of like real life.

They did have particular problems with the CT scan. This wasn’t because they had never read one - they actually did a very nice job figuring that part out. (In fact, I gave most of them the CT scan before the blood work so they weren’t quite as sure of the answer yet.) Their difficulty rather resulted from the fact that the upper GI image seems to be flipped backwards from the Chest image. In other words, the right and left side of the body are reversed in the images.

Outside of patient history I’m not sure there is any reasonable way for them to know it is the patient’s “left” lung. And even with the patient history it could actually be that he damaged his "right" lung when he was smashed against the boards even though he was hit with the stick on his left side. So, as a suggestion, I would like to see that image flipped. I also believe, although I am not certain, that these CT scan images are typically viewed as if you are looking up from the patients feet, thus putting the patient’s left on the viewing right. If that is in fact the case both images should reflect that. [Editor’s Note: The relevant portion of the case has been revised as a result of this comment.]

As a fun follow-up activity I had the students write an “Ode to Rick” where they wrote a poem summarizing the story, the test results and their meaning, the treatment and prognosis. They really enjoyed it and it helped me see what they understood and still needed some help with. If you would like to see these "poems" for a little chuckle they can be found on my website at

Again, this case was done beautifully and I highly appreciate the time and effort put into it.

Darlene McLeish, Teacher
Health Science
Wilson Central High
Lebanon, TN
I used this case in my A&P class made up of 11th and 12th graders. I loved it since it really made them think. They analyzed it to death, trying to figure out the diagnosis. It was great! Thanks!