ERA Course Flashcards
Airway and breathing steps?
- If unresponsive, open airway and check 5-10 seconds
- Check pulse and look for breathing
- Perform rescue breaths vs. CPR
Types of shock
Cardiogenic, neurogenic, anaphylactic, psychological
Signs/Symptoms of hypoperfusion/shock
- Pale, cool grey skin
- Dizzy/lightheaded
- Decreased BP
- Increased HR
- Anxiety
- Loss of consciousness
- Shallow breathing
What is hypoperfusion/shock
Lack of blood flow to vital organs. Your body tries to compensate by shunting of blood from extremities to organs
Treatment for Shock/hypoperfusion
- Keep patient temperate
- No oral fluids
- Elevate legs
- Emergency oxygen
- Treat injuries (bleeding/fractures)
- Monitor vitals
- Advanced care
Ask these questions during secondary assessment?
SAMPLE
1. Signs/symptoms
2. Allergies
3. Medications (including OTC’s)
4. Pertinent medical history
5. Last oral intake
6. Events leading up to incident
Vitals needing taken?
At a minimum: pulse and RR. Want BP and O2 if possible.
What is in the head to toe exam?
DCAPBLTS
1. Deformity
2. Contusion
3. Avulsion
4. Penetration
5. Burn
6. Tenderness
7. Laceration
8. Swelling
Areas of concern during secondary exam?
- Head/Skull: CSF, bleeding, skull fracture
- Neck: point tenderness, pain with movement
- Chest: Bruising, deformity, asymmetry
- Abdomen: 4 quadrants
- Back: Tenderness
- Pelvis: Tenderness
- Genitals: Swelling, incontinence
- Extremities: Soft tissue or skeletal injury
When to assess Cranial Nerves and How?
If athlete sustained head injury, blow to face, or neuro signs.
Olfactory: Smell
Optic: Vision
Oculomotor: Pupil reaction
Trochlear: Lateral and inferior eye movement
Trigeminal: Mastication and facial sensation
Abducens: Lateral eye movement
Facial: Taste, expression
Vestibulocochlear: Hearing, equilibrium
Glossopharyngeal: Swallow, gag, tongue sensation
Vagus: Speech, swallowing
Accessory: Trap/SCM innervation
Hypoglossal: tongue movement
How often should you reassess athletes?
5 minutes or less for unstable athlete, 15 minutes if stable
Potential symptoms of asthma
Labored breathing, audible wheezing (may be on inspiration and expiration or expiration alone), chest tightness, and persistent coughing. Low systolic BP and rapid breathing. Respiratory distress can occur (O2 Sat <90%)
O2 sat levels that are concerning? What is O2 sat measuring?
Anything below 95. Measures the percentage of oxyhemoglobin in blood pulsating through capillaries.
How much oxygen do you give?
15 L/min tolerated well by most athletes unless by nasal cannula, then only 6 L/min.
How will athlete hold arm with shoulder injuries?
Anterior dislocation = holding arm in abd and ER
Clavicular fracture = holding arm across body.
AC separation = supporting arm under the elbow.
Guidelines for Splinting
- Splint for pain relief or to move an athlete
- Remove jewelry or restrictive clothing
- Clean and bandage any open wounds before splinting
- Do not cause more pain
- Check pulse and sensation before and after splinting
- If joint injured, immobilize bone proximal and distal to joint
- If bone is injured immobilize joints proximal and distal to bone
- Pad areas of bony prominences before tying on splint
- Do not tie any securing straps directly over the fracture site
Physeal closure during development
Growth centers close beginning at the distal extremities and moving proximally. Clavicle last to close in early 20’s. Complete closure of growth plates occur about 18-24 months after start of menarche. Appearance of beard/mustache in males indicative of joint closure.
Diagnostics for Young Patients With Back Pain
Most spinal disorders in skelletaly immature should have plain radiographs.
Grades of spondylolisthesis and when to stop participating in sports?
1 = 0-25%
2 = 25-50%
3 = 50-75%
4 = >75%
Shouldn’t participate in sports with grades 3-4.
Little league shoulder
Stress reaction or fracture of the proximal humeral physis (salter type 1). Overuse injury. Clinical exam shows painful physis and plain films may be negative.
Treatment of little league shoulder
Minimum 6 weeks without throwing. Start with gentle stretching to posterior shoulder and core strength. After 2-3 weeks and pain-free ROM, begin RTC strengthening.
Recommended ages for pitches
Pitchers should not throw breaking pitches in competition until bones have matured (typically 13)
Supracondylar fracture
Most common seen in ED for children 3-14. About 1/2 need surgery. Commonly the anterior interosseous branch of median nerve becomes compromised (inability to flex thumb at IP join and give OK sign)
Immobilization after elbow dislocation
Cast immobilization for 2-3 weeks
Types of forearm fractures
Monteggia - fracture of ulna with dislocation of radial head
Nightstick - transverse fractures of ulna
Galeazzi - fracture of distal radius with disruption of distal radioulnar joint
Smith Fracture: Radius goes towards palm
Collies Fracture: Distal radius goes dorsal
Barton Fracture: collies fracture plus dislocation of radiocarpal joint
Signs/Symptoms With Medial Epicondyle Apophysitis
Usually 8-14 and pitchers or tennis players. May have up to 15 degrees flexion contracture of elbow. Pain with wrist flexion and pronation.
Osteochondritis Dessicans vs AVN vs Osteochondrosis.
OCD is where a piece of cartilage, along with a thin layer of bone separates from end of bone because of inadequate blood supply. AVN is where bone dies due to decreased blood supply. Osteochondrosis is derangement of normal bone growth where there is interruption of blood supply to epiphysis in adolescents.
Panner’s Disease Progression Down the Road and Prognosis
Blood supply returns and capitellum reshapes after 1-2 years. Early detection is key, surgery usually not indicated. Full return to sports the next season.
Buckle (Torus) Fracture
From FOOSH. Occurs at diaphyseal-metaphyseal junction where stronger diaphysis compress metaphysis. Treatment usually 3 weeks in cast. Radiograph shows bump on edge of bone.
X-rays needed for hip in youth athlete
AP, lateral, and frog.
Major sites for apophysitis in hip/pelvis.
6 sites:
1. Iliac crest (common and pain with rotation due to obliques)
2. ASIS
3. AIIS
4. Ischial physis
5. GT
6. Lesser Trochanter
Diagnosis and prognosis for LQ avulsion?
Diagnose with radiographs. Need surgery for displacement >3 cm.