Emergency Medical Response Flashcards
Rules for lightning
-wait at least 30
minutes after the last sound of thunder or lightning
flash before resuming an activity or returning out-
doors
-By
the time the flash-to-bang count approaches 30 seconds (or
is less than 30 seconds), all individuals should already be
inside or should immediately seek a safe structure or
location
What is the flash-to-bang method?
the observer begins counting when a lightning flash is sighted.
Counting is stopped when the associated bang (thunder) is
heard. Divide this count by 5 to determine the distance to
the lightning flash (in miles). For example, a flash-to-bang
count of 30 seconds equates to a distance of 6 miles
Lightning-safe position
crouched on the ground, weight on the balls of the
feet, feet together, head lowered, and ears covered
According to NATA, which of the following signs and symptoms require immediate transport of an athlete with a potential spine injury?
Severely painful neck ROM or a significant decrease in ROM
Which nerve innervates motor of the face?
Facial Nerve
Describe axillary nerve and axillary nerve injury
The Axillary nerve winds around the surgical neck of the humerus after passing to the posterior aspect of the arm through the quadrangular space. A traction injury can occur with a traumatic anterior dislocation. (about 30% experience mostly mild neuropraxic lesions with less than 5% experiencing significant damage.
Weakness in shoulder abduction and external rotation along with decreased sensation over the lateral side of the proximal part of the arm. The patient may have already recovered full neurological function at 4 weeks.
What is the most common initial presentation of an athlete post anterior shoulder dislocation.
The player holds his arm in slight external rotation and abduction. Sulcus sign is evident.
How is an anterior shoulder dislocation managed?
often requiring surgical intervention to prevent recurrence. - rarely (20%) can be treated conservatively
Describe zygomatic fracture
The zygomatic bone is the second most commonly fractured structure in the face. Common cause is usually blunt trauma to the cheek. Signs and symptoms include numbness to the cheek, infraorbital region and upper teeth on the injured side; eyelid swelling; inability to close mouth properly; swelling and ecchymosis, flattened cheekbone.
What imaging modality is most appropriate for use with an athlete with acute concussive symptoms?
A CT scan is indicated if a focal injury such as an acute subdural or epidural bleed is suspected; this study easily demonstrates acute blood collection and skull fracture. While this would be a rarity, if is the image of choice in this population.
decerebrate posture
neurological brain injury posture- all 4 extremities in extension
Decorticate Rigidity
neurological brain injury posture- UE flexed and LE’s extended
Fencing Posture
Can indicate concussion- 1 arm flexed, I arm extended
If helmet- what to do when assessing airway?
Remove facemask-
DONOT removed shoulder pads or chin strap
How many minutes before brain damage possible after heart stops beating?
4-6 min possible
6-10 min likely
10+ min irreversible brain damage
Explain CAB sequence for cardiopulmonary emergency
If no pulse- always perform 30 compressions 1st and then A and B
Describe shock symptoms
-pale, clammy skin
-irregular or difficulty breathing
-tachycardia
-dizziness
-altered mental status
1st step in emergency always
Survey the scene for safety
PE of head: looking for
-open wounds
-depressions/ asymmetries
-CSF- clear/ maybe yellow, out of nose/ears, halo sign -yellow around red blood- may report sweet taste in mouth
-pupil size and if symmetrical
PE of chest: looking for
- paradoxical breathing- abdomen pushes out during exhale- indicates fractured ribs or sternum- flail chest
-bruising
-trachial deviation- may indicate pneumothorax, pleural effusion , neck injury, bleeding
how much fluid to replace to prevent dehydration?
drink 17-20oz (500 mil) before event
-drink 3-4 oz (100ml) every 20 min
Signs of Exertional Sickling
-MM WEAKNESS
-SOB
-NO VISIBLE OR PALPABLE CRAMPING- (biggest diff from ex assoc mm cramps)
-SLUMPS TO A STOP
-IS AN EMERGENCY!
exercise associated mm cramps vs exertional sickling
Exercise assoc muslce cramps- visible and palpable cramping
NO SOB
“hobbles” to stop doesn’t “slump” to stop
Signs, Symptoms of heat syncope
dehydration
hypotension
venous pooling
dizziness
paleness
bradycardia
Rectal temp < 102.2
RX: place in shaded area, legs elevated, rehydrate, monitor vitals
- don’t typically go back to play that day
Heat Exhaustion
sweating
dehydration
possible fainting
fatigue, headache
confusion/vomiting, nausea
hypotension, impaired mm coordination
Rectal temp <105
RX: assess vitals, place in cool area, legs elevated, lower body temp, rehydrate,
monitor rectal temp every 10 min
Head Stroke
MEDICAL EMERGENCY- have a 30 minute window
CNS dysfunction AND rectal temp >105
collapse, confusion
seizures, altered consciousness
no longer sweating
RX : immediate cold water immersion until temp 101.5
monitor vitals
administer fluids IV- CANNOT DRINK
transport to medical facility after DECR temp
Cold water immersion
Gold standard- ice water immersion 2 degrees celsius 35.6 F
(if don’t have bath- ice packs in armpits and groin but doesn’t work well)
Frost Nip
skin cold, red painful
Mild frostbite
red, pale, stinging, burning, swelling
severe frostbite
white, blue, grey, numbness
RX : avoid friction and keep blisters intact
do not allow tissue to refreeze!!
Non-freezing- Chilblain
inflammatory response to cold
red, siny, swelling, itching, numbness, burning-
Non - freezing Immersion foot
Trench foot- prolonged exposure to cold but usually not freezing, damp, and sometimes unsanitary conditions.
-burning, tingling, decreased sensation, maceration- softening of skin with exudate
Altitude Illness
- incr risk with rapid accent or poor acclimatization
-barometric pressure decreased at high altitudes– leads to decrease in partial pressure of arterial blood- can’t get 02 in body
-acute hypoxic changes leads to incr respiratory rate, tachycardia, and incr blood pressure
Acute mountain Sickness
HA, nausea, vomiting, dizziness
-usually over 8202 ft (2500meters)
Pulmonary Edema
altitude related illesss
dyspnea at rest
coughing
wheezing, chest tightness
cyanosis
tachycardia, tachypnea
-> 3000 meters 9800 ft
High altitude Cerebral Edema
change in mental status
ataxia
management: supp o2
slow decent, medication- can use meds propholacticly
Injuries to mid cervical spine can affect which cranial nerve?
Phrenic- 3,4,5 keeps us alive- cardiopulmonary fxn-motor supply to diaphragm
C/S injuries- When to immobilize the spine
- LOSS OF CONCIOUSNESS
-BILATERAL NEURO SXS
-SIG SPINE PAIN W/ OR W/O PALPATION
-OBVIOUS SPINAL DEFORMITY
Describe hip dislocations
- medical emergency
-6 hour window for reduction
-posterior most common
Presentation: ADD, IR and Flexion of LE- looks like short leg, pain, limited ROM
-high risk for assoc injuries- labrum, frx, sciatic nerve
Femoral head AVN can result
Describe Tibiofemoral Knee dislocations
high energy trauma or cutting on LE
-Multi- lig injury common
-high risk for neuromuscular compromise
-can self reduce
-ACTIVATE EMS IMMOBILIZE AND TRANSPORT
Fractures
- gross deformity, crepitus, point tenderness, UA to WB
can be displaced, non-displaced, open or closed
-IF open- risk of hypovolemic shock and infection
-if closed- risk compartment syndrome - NEED TO CHECK DISTAL PULSES
- Ottawa rules for X-ray
Ottawa Knee Rules
> 55 years
UA to WB 4 steps immediately or in ER
isolated point tenderness patella
point tenderness fib head
UA to flex knee past 90
Ottawa Ankle Rules
IF any pain in malleolar zone AND
any one of
-UA to WB 4 steps immediately or in ER or
-TTP along 6 cm posterior edge of the tibia or tip of the medial malleolus OR
-TTP along 6 cm posterior edge of the tibia or tip of the lateral malleolus
Ottawa Foot Rules
If any pain in mid foot zone AND
-TTP navicular
-TTP base of 5th metatarsal
-UA to WB 4 steps immediate or in ER
Keys for management of dislocations and fractures
-remove restrictive equip or clothing prior to immobilization
-cover wounds w/ moist, sterile dressing
-assess NV status distal to injury site (pulse, motor, sensation and capillary refill)
-immobilize above and below
-REASSESS NV status after immobilization
Difference in swelling presentation between ACL and meniscal tears
ACL swells much faster than meniscus
ACL- immediate to ~6 hours
Meniscus- ~ >6 hours
Describe ankle syndesmosis Sprain
- forced ER in DF- drives talus up into syndesmosis
- incr fxnl limitations vs later ankle sprain
-pain at anterior ankle
-difficulty/inability to WB
-minimal swelling
-need X-ray to R/O fracture
Describe Burnes/stingers
Traction or compression at neck/shouler region causing immediate neuro sis
-burning, stinging, numbness in arm/hand
- weakness of arm/hand
-MUST HAVE FULL ROM AND STRENGTH to return to play (must do pushups)
-recurrent stingers should be referred for imaging
-if 2nd stinger- stay out of game
7 factors to Return to Play in same game after extremity injuries
- minimal to no pain
- full ROM
- Full Strength
- normal balance
- ability to peform sport specific fxs- jump sprint
- willingness and desire
- if minor- must have parent consent
Sickle cell Trait symptoms
Typically none
DOMS symptoms
-dull, diffuse pain and tenderness;
-stiffness;
-swelling;
-decreased strength of the exercised muscle.
These signs and symptoms typically last 1 to 4 days after the exercise bout.
What causes Acute Exertional rhabdomyolysis
caused by a skeletal muscle injury that results in the release of myoglobin and other cellular contents into the circulatory system
Describe Trigeminal Nerve
fifth cranial nerve (CN V) and the largest of the cranial nerves. Its primary function is to provide sensory innervation to the face and is divided into three main branches. The different branches are the ophthalmic (V1), maxillary (V2), and mandibular (V3) nerves
Describe Facial Nerve
7th cranial nerve and
- control facial movement and expression.
-involved in taste to the anterior 2/3 of the tongue and producing tears (lacrimal gland)
What should people with sickle cell trait avoid?
people with sickle cell disease should be active, but intense activities that cause you to become seriously out of breath are best avoided. avoid alcohol and smoking – alcohol can cause you to become dehydrated and smoking can trigger a serious lung condition called acute chest syndrome.
Symptoms of acute exertion rhabdomyolysis
-Muscle aches and pains out of proportion with the amount of exercise.
-Muscle cramping, swelling, and/or weakness.
-Stiffness and decreased range of motion.
-Rapid heart rate.
-Nausea or vomiting.
-Headache.
-Confusion and disorientation.
-Tea or Coca-Cola colored urine.
-intense workout (particularly with eccentrics),
–bilateral pain,
-marked point tenderness.
Acute exertion rhabdomyolysis prevention
-hydration, drinking plenty of fluids especially in preparation for exercise. By consuming plenty of fluids, it will dilute the concentration of myoglobin to aid the kidney in clearing the bloodstream
-heat acclimatization
What is the recommended mode and frequency of exercise for individuals with Type I and II diabetes?
Patients with diabetes mellitus should have 5 or more days (a minimum of 150 minutes) of aerobic exercise weekly and 3 days of resistance training weekly. Evidence for optimal frequency continues to evolve.
recent studies show that resistance exercise improves insulin sensitivity similar to that of aerobic exercise
Sickle Cell Collapse presentation:
-often occurs within the first half hour onfield, as during initial windsprints.
Core temperature is not greatly elevated.
-The athlete initially will still be conscious and able to talk
-complains of muscular pain, however this is not to be confused with muscle cramping.
Exertional sickling is a medical emergency and requires immediate treatment.
TREATMENT administration of oxygen (151 pm) is the gold standard, as well as calling 911 if vital signs are declining
Primary source of articular cartilage
Type 2
What test is best to test anterior drawer of ACL?
anterior bundle test: Performing this test at 90 degrees of knee flexion will stress the anteriomedialbundle, which is most taut in this range.
most common type of arrhythmia preceding death
V fib
Sickle Cell Trait treatment
Stopping when athlete has cramping, fatigue, or dyspnea
Signs of Sickle Cell Trait Collapse
Exercise collapse with sickle cell
most common w/all-out exertion
Often occurs within 30 min of workout
Collapse is medical emergency, administer O2 if necessary
How athlete with Marfan;s managed?
Echo every 6 months monitor size of aorta, preventing complications such as decreasing BP to
prevent enlargement of aorta
No collision sports or strenuous exercises ex. NO weight lifting
What does Marfan’s syndrome affect
Disorder of connective tissue
aortic arch dilation (can rupture
aorta)
