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Kin 2236 Athletic Injuries > (3) Lecture 19: Neck Injuries and On-field Assessment > Flashcards

(3) Lecture 19: Neck Injuries and On-field Assessment Flashcards

1
Q

Goals of an Emergency Field Assessment

A

Primary
- ABC, Roll, Equipment removal, spinal board

Secondary
- history/subjective
- field assessment
- transport
- sideline assessment (what’s wrong? can they play?)
- return to game

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2
Q

What should you be thinking while you are sprinting onto the field?

A

Is the athlete at risk?
- life vs limb (activate EAP/load + go)

Is the area stable?

Can they continue w/o significant risk (safely + effectively)

How do I get the athlete off the field?
- walk, assist, non-weight bearing? immobilized/boarded

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3
Q

On-Field Assessment

A

Unconscious vs Conscious

Unconscious - activate EAP immediately

Then primary assessment
- poor result = activate EAP

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4
Q

Primary Survey

A

Determine existence of potentially life-threatening situations

UABC
U - Responsiveness (Unresponsive? alert? verbal?
Airway
Breathing
Circulation

Check for spinal injury if suspected mechanism

YES to any of those things - “load + go”, activate EAP
NO: secondary Ax (assessment)

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5
Q

Spinal Injury

A

Supine (on back) - ensure ABC’s and stabilize
Prone (on belly) - may need to reposition to ensure ABC’s

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6
Q

Athlete with suspected neck injury

A
  1. Stabilize the C-spine (until neck injury is ruled out)
  2. Assure athlete and tell them not to move - be firm + assertive
  3. Get brief history + subjective report
  4. Begin your palpation + assessment
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7
Q

Subjective spinal

A

Use 8 questions to help decide course of action

  1. Can you tell me what happened (MOI)
  2. Do you have pain in your head?
  3. Do you have pain in your neck?
  4. Do you have pain in your back?
  5. Do you have tingling or numbness in any of your arms or legs? - get specifics
  6. Do you have pain anywhere else?
  7. Can you wiggle your toes? - check both sides
  8. Can you wiggle your fingers? - check both sides
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8
Q

Stinger/Burner Mechanism

A

best case scenario; risk of injuring brachial plexus
- hits FRONT of player

Mechanism
- nerve traction or compression especially involving C5 and C6
1. Shoulder distracted down from head and neck = stretch
2. Blow to supraclavicular fossa (ex. getting hit by stick/ball) = lax
3. Forced neck extension and rotation to injured side = pinch

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9
Q

Stinger/Burner Signs + Symptoms

A
  • RARELY neck pain (down middle of spinal processes)
  • UNILATERAL symptoms
  • can be transient (short time)
  • SENSORY CHANGES (C5/6) distribution
  • motor changes C5/6 (shoulder abduction/external rotation + elbow flexion

Heals quickly often by time they reach the sideline

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10
Q

Neck pain

A

NOT pain on side of the neck

usually pain down middle of spinal processes

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11
Q

Return to Play for Stinger/Burner

A

Same game return to play IF
- quick resolution of symptoms (<5mins)
- full ROM
- full strength - able to protect themselves
- ability to complete sport specific skills
- mentally ready

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12
Q

C- spine injury MOI

A

usually one of two mechanisms:

  1. Axial load = vertical compression
    - burst fracture = everything lined straight up
  2. Compression = flexion injury
    - anterior portion compresses and posterior portion elongates
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13
Q

C- spine injury on-field findings

A
  • neck pain
  • pain on CENTRAL palpation (spinous process)
  • bilateral neural findings (myotomes/dermatomes)
  • upper + lower extremity findings
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14
Q

To board or not to board neck injuries

A

Practice is shifting from blanket immobilisation to a selective approach

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15
Q

Palpation of the injured C-spine athlete

A
  • need to palpate upper back, neck, shoulder, clavicle and sternum
  • failure to do this means paralysis or death
  • know the order
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16
Q

Dermatomes

A

go through them

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17
Q

Myotomes

A

go through them

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18
Q

Canadian C spine Rules

A
  1. High-risk factors that mandate RADIOGRAPHY (Yes = X-Ray; No = #2)
    - Age > 65 years
    - Dangerous mechanism or paraesthesis (tingling) in extremities
  2. Low-risk factors that allow safe assessment of ROM (Yes = #3; No = X-Ray)
    - NO midline C-spine tenderness
    - Delayed onset of neck pain
    - Ambulatory at any time
    - Sitting position
    - Simple rearend MVC
  3. Able to actively rotate neck? → 45° left and right (able = no X-Ray, unable = X-Ray)

Dangerous mechanisms: fall from elevation, axial load to head (diving). MVC high speed

19
Q

Stinger/Burner vs Spinal Cord Injury

A

Stinger/Burner
- unilateral
- rarely involve lower extremities b/c brachial plexus doesn’t innervate there
- transient (can heal quickly)
- sensory (C5/6 dermatome)
- weakness

Spinal cord/C-spine injury
- bilateral
- upper AND lower extremities
- transient or prolonged/permanent
- sensory w/ possible total loss of sensation
- weakness/paralysis

20
Q

Log Roll

A

Prior to roll
- make sure helmet is stable
- need to use CROSS ARM technique so arms unwind as roll is performed

Leader uses commands: “PREPARE TO ROLL” and “ROLL” - assistants follow

21
Q

C- spine immobilization clinical recommendation

A

when a C-spine injury is suspected, the spine should be immobilized in NEUTRAL position
- can reduce spinal cord compromise
- may facilitate airway management

there are 3 contraindications to moving C-spine to neutral

22
Q

Contraindications to moving C-spine to neutral

A
  1. Movement causes or increases pain, neurologic symptoms or muscle spasm compromising the airway
  2. there is RESISTANCE to movement
  3. patient expresses apprehension
23
Q

Helmet Facemask Removal Tools

A

Study 1: cordless screwdriver is more efficient than FM extractor

Study 2: cordless screwdriver should be used as primary tool for face mask removal + should have a backup tool

24
Q

“Don’t Lose Your Head”

A

Keep them in as much equipment as possible as long as they’re safe and secure

25
Q

Hockey Helmet Study

A

looking at alignment of C- spine w/ no equipment, full and partial equipment

  • increase of lordosis in sub axial cervical spine alignment

Recommendation: stable ice hockey helmets should NOT be removed from injured players (to eliminate unnecessary motion of the C-spine)

26
Q

Football Helmet Studies

A

Study 1
- looked at groups of cadavers using radiograph
- HP had no significant change in cervical lordosis compared to N.
- H v. N - flexion (- degrees); S v. N - extension (+ degrees)
Recommondeation: removal of helmet and pads should be “ALL OR NONE”

Study 2
- looked at live subjects on spine board w/ HP or N via CT
- no significant diff. btwn N and HP
- P only = increased cervical extension
Recommendation: players w/ suspected C-spine be transported w/ helmet and shoulder pads left in place

27
Q

Lacrosse Study

A
  • assessment of live subjects on spine board wearing personal helmets and shoulder pads (HP) or P only via CT

Results
- HP has greater extension
- P vs. HP = more cervical flexion
- P vs. N = more flexion

Recommendation: players w/ suspected C-spine injury be transported w/ helmet and shoulder pads left in place

28
Q

Helmet protocol for football and hockey

A

Helmets must be STABLE
- hockey MUST have chin strap done up tight

29
Q

Helmet Removal Protocol

A

Remember to KEEP YOUR HEAD ON - only continue if necessary

  1. Partner 1 stabilizes helmet w/ ELBOWS ON THE GROUND. Partner 2 (leader) CUTS chin straps - don’t undo
  2. # 1 maintains grip. #2 unscrews/cuts lateral clip on both sides
  3. # 1 maintains grip. #2 spreads facemask to release cage from clips and flips facemask toward top of helmet
  4. # 1 continues grip. #2 removes cheek pads w/ straight edged appliance - AIRWAY ACCESS now achieved
  5. # 1 attempt to spread sides of helmet. #2 does VICE/ALLIGATOR GRIP to maintain cervical alignment
  6. # 1 rolls helmet forward on patient’s head towards the chest. #2 maintains vice grip/alligator

if you need airway, take off facemask first and try to keep helmet on
IF HELMET COMES OFF, SHOULDER PADS COME OFF TOO

30
Q

Helmet and Shoulder pad removal relationship

A

IF HELMET COMES OFF, SHOULDER PADS COME OFF TOO

31
Q

Shoulder Pad Removal

A
  1. Partner 1 stabilizes patient’s head as before. Partner 2 cuts patient’s jersey up the front, across shoulders and out arms
  2. # 1 maintains grip. #2 cuts all straps and laces
  3. # 2 does vice/alligator grip UNDER SHOULDER PADS to achieve cervical stability. #1 grasps both sides of shoulder pad breast plate and bends them bwd. towards patient’s head and slides pad from under patient
  4. # 1 reestablishes control of head. #2 applies cervical collar to patient
32
Q

Equipment Removal Guidelines

A

Helmet should be removed:
- If face mask cannot be removed to gain airway access
- If airway cannot be controlled after removal of facemask due to design
- If helmet and chin straps do NOT hold the head securely
- If helmet prevents immobilization for transport
ALWAYS IF SHOULDER PADS ARE REMOVED

Shoulder pad should be removed in the following situations:
- Multiple injuries requiring full access to shoulder area
- Ill-fitting shoulder pads lead to inability to maintain spinal immobilization
- CPR needs access to thorax
ALWAYS IF HELMET IS REMOVED

33
Q

Transport to Spine Board

A

Log Roll vs Vertical Lift
- minimal difference in flexion/ext. btwn LR and VL
- greater axial rotation + lateral flexion w/ log roll

Recommendation: use VERTICAL LIFT when able

34
Q

Transport to Spinal Board

Vertical Lift

A

need 8 ppl
- 1 leader immobilizes head + neck)
- 1 person moves board
- 3 ppl on each side at shoulders, hips + knees

Slowly lift vertically together then board is slid under. Then slowly lower athlete

35
Q

Transport to Spinal Board

Log Roll

A
  • immobilize the head
  • use AT LEAST 3 ppl - always roll TOWARDS
  • leader/charge always coordinates (head)
  • place board against back at 45 degree angle
  • may require Z position (slide over + up on an angle) - no straight traction or compression
36
Q

Securing the athlete with spine board transport

A
  • once on the spine baord, leader must continue to stabilize the head and neck
  • assistants secure athlete to the board

BEGIN W/ THORAX, THEN HEAD THEN LOWER BODY

37
Q

Secondary Ax Goals

A

non-emergent or extremity

  1. what is wrong?
  2. if the sport allows: do they need a more detailed assessment?
  3. determine if athlete can play or if it is safe to remove from field
  4. how to transport from the field
38
Q

Sports rules for assessments

A

wrestling: 90s

rugby: game keeps going - limited subs; watch your back

football: 2 mins for blood 0 3 plays out for player (make sure they won’t get uo before you go on the field)

soccer: ref calls therapist on field - yellow card

Speed and accuracy are essential

39
Q

History (Secondary Ax)

A

Evaluate athlete’s injury
- unique b/c you often see MOI, so pay attention to game/event
- what happened?
- where does it hurt?
- did you hear of feel any pops/grinding?
- have you injured this or the other side before? - comparing to a normal jt?

40
Q

On-field Secondary Ax

A

First the 3 questions
1. Life or limb
2. Is area stable? Clear ABCs

THEN
1. clear above and below - squeeze test
2. palpate
3. special tests for stability of bones and joints

Anything grade 2 or above is UNSTABLE

41
Q

What grade of injury is stable? Unstable?

A

Anything Grade 2 or above is UNSTABLE

Grade is technically stable

42
Q

Return to Play after Secondary Ax

A

Look at ROM, STRENGTH AND FUNCTION
- can athlete participate in the sport safely?
- can athlete play effectively?
- can athlete perform relatively pain free?

Options:
- observe on sideline w/ possible return to play
- removal from play + referral for follow-up
- send to hospital

43
Q

What do coaches want to know?

A

During the game
- can they play? yes or no
- are they 100% (if not, what %)
- will they be available this game? minutes, period?

After game
- how are they? what is injured? - LAYMAN’S TERMS
- how long are they out for?
- when will we know about next game?

Kin 2236 Athletic Injuries (20 decks)

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