Chapter 12 - On-the-Field Acute Care and Emergency Procedures Flashcards
Parts of an EAP
personnel and corresponding roles
available emergency equipment
procedures involving removal of equipment
phone numbers
keys should be accessible
inform members of the EAP
assign roles
carry contact info
EAP should include procedures for spectator injury
good relationship with local EMT’s
obtain consent form minor’s paretns
emergency call information given:
type of emergency situtation
type of suspected injury
present condition of athlete
current tx being applied
location of telephone being used
exact location of emergency
primary survey
assesses life-threatening injuries (CAB)
check, call, care
administering supplemental oxygen
bag-valve mask, pressurized cylinder of oxygen (10-15 L/min)
Venous hemorrhage
deep red with continuous flow
capillary hemorrhage
reddish, exudes from tissue
arterial hemorrhage
bright red, spurting
signs of shock
low blood pressure (systolic
secondary survey
pulse, respiration, blood pressure, temp, skin color, pupils, level of consciousness, movement, abnormal nerve response
pulse
(80-100 bpm) rapid/weak may mean shock bleeding heat exhaustion rapid/strong - heatstroke or fear
respiration
(12-20 breaths per minute)
blood pressure
(120/80 mm Hg) - high is 140/90
temperature
98.6 degrees
hot, dry (disease, infection, overexposure to heat); cool, clammy (trauma, shock, heat exhaustion)
skin color
flushed/red (heat stroke, sunburn, allergic reaction),
pale/ashen/white (insufficient circulation, fear, shock, hemorrhage, heat exhaustion, or insulin shock);
bluish/cyanotic (airway obstruction or respiratory insufficiency);
yellow/jaundice (liver disease or dysfunction)
pupils
one/both dilated (head injury, shock, heatstroke, hemorrhage);
unequal response to light (brain injury, alcohol/drug poisoning)
level of consciousness
alert, confused, drowsy, unresponsive
movement
bilateral deficits in UE (cervical injury) or lower extremity (injury below spine)
abnormal nerve response
numbness/tingling (nerve or cold damage)
blocking of main artery (severe pain, loss of sensation, lack of pulse in a limb)
complete lack of pain/awareness (shock, hysteria, drug usage, spinal cord injury)
crutch fitting
place tip 6 in anteriorly, 2 in laterally
2-3 finger widths under arm
arm flexion of 30 deg
place crutch 12-15 inch ahead and swing through
one crutch: hold truth on uninjured side and move crutch simultaneously with injured leg
Rules of every EAP (4)
- every org that sponsors athletic events should have a written, structured EAP
- ) coordinate it with local EMS,s school public safety officials, onsite first responders, medical staff, school administrators
- ) specific to each venue
- ) px annually with all those involved
EAP should focus on these guidelines (3)
- ) instruction, preparation, expectations of all involved
- ) health care profs who will provide med care during px and games and supervise the execution of the EAP with respect to med care
- ) precise prevention, recognition, and tx and RTP policies for the common causes of sudden death in ahtletes
common causes of sudden death in athletes
Asthma Catastrophic brain injury cervical spine injury diabetes exertional heat stroke exertional hypothermia exertional sickling head down contact in football lighting sudden cardiac arrest
Prevention and screening of ashtma
- thorough med history and exam
- structured warmup protocols
educate athlete about use of asthma meds, spirometry devices, triggers, s/sx, compliance
recognition of asthma
confusion, sweating, drowsy, forced expiratory volume in the first second of less than 40%, low o2 saturation, use of accessory muscles for breathing, wheezing, cyanosis, coughing, hypotension, bradycardia or tachycardia, mental status change, LOC, cannot lie supine, cannot speak properly
tx for acute asthma exacerbation
short-acting B2-agonist to relieve Sx
offer supplemental oxygen if available
severe cases (rapid sequential administrations may be needed)
for acute asthma, 3 administrations of short acting B2 agonist did not help, what should you do
refer to appropriate health care facility
Prophylactic asthma control tx
inhaled corticosteroids, and leukotriene inhibitors can be used
or long acting B2-agonist can be combined with other meds to control
after an asthma attack, when may an athlete return to play?
monitor lungs with peak flow meter,
values should be compared with baseline lung volume values and should be 80% of predicted values before the athlete may participate in activiteis
Prevention of catastrophic brain injuries
- ) AT coordinate informational meeting with athletes and coaches
- ) AT should enforce the use of standard certified helmets, and make all aware helmets do not prevent cerebral concussions
normal breathing rate
12 breaths per minute
normal end tidal carbon dioxide partial pressure
35-45 mm Hg
cerebral herniation care/tx
prepare for transport, elevate head to 30 degrees, IV may be needed if trained professional is available
Prevention of cervical spine injuries
- ) AT’s familiar with sport specific MOI
- ) educate coaches and athletes
- ) corrosion-resistant hardware should be used in helmets. helmets should be regularly maintained throughout a season. should be recertified.
- ) emergency personnel should be up to date on techniques of transport to minimize motion
what s/sx require the initiation of the spine injury management protocol:
unconsciousness, altered level of consciousness, bilateral neurologic findings or complaints, significant midline spine pain with or without palpation, obvious spinal column deformity
tx and management of cervical spine injury
neutral position, manual stabilization applied immediately
do not apply traction
expose the airway
one who has the most training and experience should establish the airway and begin giving rescue breaths
convert stabilization to external device, but continue manual stabilization
immobilized with long spine board or other full body immobilization device
contraindications to re-alignment of the cervical spine
pain caused by movement, neurologic symptoms, muscle spasm, airway compromise, physical difficulty repositioning the spine, encountered resistance, apprehension expressed by the pt.
according to the position statement for the equipment laden athlete, should equipment be removed?
no, defer unless the helmet is not providing stabilization, equipment prevents neutral alignment, or prevents airway or chest access.
when should the face mask be removed?
once the decision has been made to immobilize and transport
Prevention of Diabetes
blood glucose monitoring, carb supplementation, guidelines for hyper/hypo-glycemia, insulin adjustments, urine testing for ketone bodies,
Hypoglycemia recognition
tachycardia, sweating, palpitations, hunger, nervousness, headache, trembling or dizziness; LOC or death can occur
hyperglycemia recognition
w/ or w/out ketosis.
if w/out ketosis look for: nausea, dehydration, reduced cognitive performance, feelings of sluggishness, and fatigue
hyperglycemia recognition with ketoacidosis
nausea, dehydration, reduced cognitive performance, feelings of sluggishness, and fatigue, Kussmaul breathing, fruity odor of breath, unusual fatigue, sleepiness, loss of appetite, increased thirst, frequent urination
Kussmaul breathing
abnormally deep, ver rapid sighing respirations, characteristic of diabetic ketoacidosis
tx of mild hypoglycemia
athlete should be conscious and able to follow directions
administer 10-15 g of carbs (4-8 glucose tablets or 2 tbsp of honey), assess blood glucose levels every 10-15 min
(activate EMS after 2 doses of carb and waiting 10-15 min)
if blood glucose levels return, provide substantial snack
tx of severe hypoglycemia
athlete is unconscious or unable to swallow or follow directions
medical emergency, activate EMS, administer glucagon if trained
RTP of athlete following mild hyper/hypo-glycemia
physician should determine a safe blood glucose range
when is blood glucose too low
below 70 mg/dL or (3.9 mmol/L)
Exertional heat stroke prevention
look for history of heat illness
7-14 days to acclimatize to heat
free access to water at all times
consistently replace water during px and games
sports med staff should educate coaches about heat illness
exertional heat stroke recognition
core body temp of greater than 104-105 taken via rectal thermometer after collapse
CNS dysfunction (disorientation, confusion, dizziness, vomiting, diarrhea, loss of balance, staggering, irritable, irrational, unusual behavior, LOC, delirium, hysteria, coma,
generally athlete will have hot sweaty skin, hypotension, or hyperventilation
tx of heat stroke
reduce core body temp to 102 ASAP.
cold water immersion (best option) (35-59 degrees F)
cool first then transport
Exertional hyponatremia prevention
- individualized hydration protocols
- consume adequate dietary sodium
- post exercise rehydration should aim to correct fluid loss accumulated during activity
- body weight changes, urine color, and thirst offer cues to the need for rehydration
- generally happens in athletes who drink too much water
-
exertional hyponatremia prevention recognition
- AT should recognize EH s/sx during and after exercise: over drinking, nausea, vomiting, dizziness, muscular twitching, peripheral tingling or swelling, headache, disorientation, altered mental status, physical exhaustion, pulmonary edema, seizures, and a decreased level of consciousness
include EH in DiffDx until proven otherwise
Tx and Management of exertional hyponatremia (severe)
IV hypertonic saline (3-5%) is indicated
transport to an advanced medical facility during or after tx
Tx and Management of exertional hyponatremia (mild)
restrict fluids and consume salty foods or a small volume of oral hypertonic solution
normal blood sodium levels
135-145 mEq/L
Exertional sickling prevention
- educate
- educate those with SCT and create tailored precautions for them
- those with SCT should be given longer periods of rest and recovery, be excluded from participation in performance tests (mile runs, springs, work-rest cycles in heat), emphasize hydration, control any asthma, have supplemental oxygen available when new to a high-altitude environment
Exertional sickling recognition
screen for SCT in PPE, testing for SCT to confirm
s/sx of exertional sickling
muscle cramping, pain, swelling, weakness, and tenderness; inability to catch one’s breath; and fatigue, and be able to differentiate exertional sickling from other causes of collapse
know usual settings and app terns of exertional sickling
Exertional sickling tx
immediate withdrawal from activity
high-flow oxygen at 15 L/min w/ a non-breather face mask
monitor vitals, prepare to activate EAP if vitals decline
treat as a medical emergency
AT has duty to notify physicians of the presence of SCT and make sure they are prepared to treat the metabolic complications of explosive rhabdomyolysis
HEAD DOWN contact in football prevention
-head down contact is the only technique that causes axial loading
spearing
intentional use of head down contact technique.
do football helmets cause or prevent axial loading?
no
safest technique to avoid head down?
make contact with shoulder or chest while keeping head up. must be learned, practiced in px
lightning safety prevention
hear it, see it, flea it. remain indoors when lighting is close.
Establish EAP or policy specific to lighting
identify unsafe “shelters” - dugouts, picnic shelters, tents, storage sheds etc.
buses and cars that are fully enclosed can be safe
30 min should pass after the last lighting or sound of thunder
lightning tx
victims are safe to touch, must ensure one’s own safety first
triage first lightning victims appear to be dead
apply AED, perform CPR
treat for concussive injuries, fractures, dislocations, and shock
Sudden Cardiac Arrest prevention
access to early d-frib is essential. (3-5 min after initial collapse)
PPE - include thorough history and complete record of exertional syncope or pre syncope, chest pain, personal or family history of sudden cardiac arrest, or family history of sudden death
Sudden cardiac arrest recognition
myoclonic jerking or seizure like activity after collapse. agonal gasping. sudden collapse. unconscious.
lightning watch
issued when the risk of a hazardous weather even is significantly increased but it’s presence, location, or timing is unclear
lighting warning
issued when hazardous weather is occurring and is imminent, or has very high probability of occurring
Grand Mal seizure
generalized tonic clonic
s/sx grand mal seizure
sudden cry or moan fainting rigidity muscle jerks frothy saliva shallow breathing bluish skin lasts 2-5 min
phases of grand mal seizure
aura tonic phase hypertonic tonic clonic autonomic discharge post-seizure phase postictal phase
aura
peculiar warning sensation
tonic phase
one continuous muscular contraction, victim stops breathing
hypertonic phase
extreme muscular rigidity
tonic clonic phase
rigidity and relaxation alternate rapidly, frothy saliva, may lose bladder/bowel control
autonomic discharge
hyperventilation, salivation, rapid heartbeat, victim may lose bladder or bowel control
post-seizure phase
victim lapses into a coma
postictal phase
recovery phase, all muscles relax, victim slowly becomes responsive, remains exhausted
petit mal s/sx
blank stare, rapid blinking, chewing movements, lasts only a few seconds
simple partial seizure s/sx
jerking in fingers and toes, victim stays awake, jerking may progress up hand, arm, then to whole body and becomes a convulsive seizure
perfusion
circulation of oxygen rich blood to the cells
hypovolemic shock
loss of blood (trauma, burns, diarrhea, vomiting, etc)
cariogenic shock
heart does not pump enough to circulate throughout the body (injury, heart attack, heart disease)
distributive shock
extreme blood vessel dilation - due to loss of nervous control associated with spinal cord injury or release of chemicals
obstructive shock
blockage of the forward movement of blood through the arteries in the body (associated with large clot in the vessel in the lung, trapped air in one side of chest, compression of the heart)
Hemorrhagic shock
loss of fluids/blood
Anaphylactic shock
severe allergic reaction, medical emergency
septic shock
widespread infection that causes organ failure
flushed/red skin color means:
(heat stroke, sunburn, allergic reaction),
pale/ashen/white skin color means:
(insufficient circulation, fear, shock, hemorrhage, heat exhaustion, or insulin shock);
bluish/cyanotic skin color means:
(airway obstruction or respiratory insufficiency);
yellow/jaundice skin color means:
(liver disease or dysfunction)
