Lecture 19 - Neck Injuries and On-field Assessment Flashcards
what 3 things should you be thinking when running on field?
- is the athlete at risk (life/limb) –> activate EAP
- is the area stable (safety and effectiveness) –> should the game continue
- how do i get the athlete off the field –> walk, assist, non-weight bearing, boarded/immobilized
what is the first thing you should do during an on-field assessment?
- ensure the c-spine is stabilized (if at risk of injury)
- check if athlete is conscious or unconscious
- then start primary care (active EAP after if necessary)
what is the primary survey assessment?
- looking for potentially life-threatening situations
- UABC’s (unresponsiveness, airway, breathing and circulation)
- look for spinal injury
- also consider significant deformity (fracture), profuse bleeding or shock
- activate EAP if yes, if no, continue with a secondary assessment
what are the 4 steps for caring for an athlete with a suspected neck injury?
- stabilize the c-spine (and keep stabilized)
- keep athlete still (tell them, if they try to move, hold down by chest)
- get a brief history (body positioning, numbness and tingling, etc.)
- palpation and assessment (pain, weakness, deformation, dermatomes and myotomes)
what are the 8 questions of subjective spinal survey?
- can you tell me what happened (MOI)
- do you have pain in your head?
- neck
- back
- do you have numbness in your arms or legs (get specific)
- pain anywhere else?
- can you wiggle your toes (or roll ankles if in boots/skates)
- can you wiggle your fingers
what is a stinger-burner injury?
- hit/disturb the brachial plexus
- 3 possible MOI’s (stretch, whack or pinch)
- unilateral pain (not in neck), motor changes to shoulder abduction, external rotation and elbow flexion
- heals quick/transient –> feeling may be back by the time they reach the sidelines
what is the return-to-play protocol for a stinger-burner injury?
- can return if symptoms are gone within 5 minutes
- if they have full ROM and strength (need to be able to protect themselves)
- if they can complete sport-specific skills (on the sidelines, without symptoms)
- if they mentally feel ready
what are the two usual types of C-spine injuries?
- burst fracture (caused by axial load-vertical compression)
- compression fracture (compression-flexion injury)
how would you determine a c-spine injury?
- neck pain
- pain on central palpation
- bilateral findings
- myotomes and dermatomes
- upper and lower extremity findings (anything below site of injury)
what key structures do you need to palpate with a suspected c-spine injury?
- upper back
- neck
- shoulder
- clavicle
- sternum
how do you test for sensation?
- dermatomes
- pinprick for pain, cotton for pressure
how do you test for innervation?
- myotomes
- reflexes and movements
what is the canadian c-spine rule?
*stabilize the c-spine first then check…
send for radiography if…
- dangerous mechanism, or numbness/tingling in >1 extremity
- midline c-spine tenderness
- unable to rotate the neck
*if in doubt, get them checked out
how/why would you perform a log roll on an athlete?
- if an airway is not present
- firm grip on stable helmet, cross arm technique to roll over athlete, using commands “prepare to roll” and “roll” all 4 people will roll athlete as one unit
- avoid twisting
what position should the spine be immobilized in with a suspected c-spine injury?
- neutral
- so no compromise to the airway or spinal cord
when should you not force the cervical spine into neutral?
- movement causes/increases pain, neurological symptoms or muscle spasms compromise the airway
- resistance to movement is encountered
- patient expresses apprehension
what should you do after the primary survey/evaluation?
- roll the patient if necessary
- reassess primary
- support the head (especially if wearing shoulder pads)
- secondary survey
why must equipment be removed from an injured athlete?
- EMS will not transfer a person without airway access
what removal tools should you have?
- cordless screwdriver
- cutting tool (as a backup if screws/nuts are stripped/rusted)
- depends on the sport and the equipment
what does the term “don’t lose your head” imply?
- keep as much equipment on as possible as long as they are safe and secure
- ensure airway
- reduce movement as much as possible
what does the term “all or nothing removal” imply?
- if equipment must be removed (airway, etc.) remove all equipment (helmet, shoulder pads, etc.) to reduce the movement of the c-spine
what are the steps to removing a helmet and equipment?
- remove mask (cut straps/unscrew) –> partner 1 keeps head still, partner 2 deals with the mask
- remove cheekpads (cut/snap out) –> partner 1 keeps head still, partner 2 deals with cheek straps
- remove helmet –> partner 1 removes helmet, partner 2 has vice grip/alligator grip to maintain cervical alignment
- cut jersey, cut straps/laces on shoulder pads –> partner 1 keeps head still, partner 2 cuts
- remove shoulder pads –> partner 1 removes pads, partner 2 has alligator grip
- cervical collar –> partner 1 keeps head stable, partner 2 applied collar
which method of transport to the spine board is better?
- vertical lift > log roll
- will have less movement
- log roll if patient is already on their stomach or if not enough people (only need 3-4)
how do you perform the vertical lift?
- 8 people necessary
- 1 at head, 1 to move board and 6 on sides (shoulder, hip and knee)
how do you secure someone to transport on the spine board?
- secure athlete to the board with straps
- start with the thorax (heaviest in case of vomiting)
- then strap head
- then strap lower body
what are the steps of an on-field assessment if it obviously not a c-spine injury?
- injury
- conscious vs unconscious (only unconscious if in shock)
- primary survey
- secondary survey (vital signs, history, msk evaluation, treatment options and transportation) –> follow-up
* may have to wait for ref to call you to field or for play to stop, depends on sport rules)
*safety is the most important, speed and accuracy are essential
how do you determine history in non-emergent cases?
- ask them about it (what happened, where does it hurt, did you hear anything, have you injured this or the other side before)
what must you do in an on-field primary examination for non-emergent injuries?
- clear above and below (no weight bearing until cleared)
- palpate
- special tests for stability of bones and joints –> (grade 1 = stable, grade2/3 = unstable so don’t weight bear)
what is the treatment/transportation for non-emergent cases?
- severity determines medical management
- take time to do a sideline assessment if not urgent (STTT, primary and secondary again)
- look at ROM, strength and function (if good can return after doing some sideline observation)
- remove from play = ice and immobilize, follow-up at dr/hospital
- follow-up with them the next day
what should you tell the coaches after an injury?
- can they play
- are they 100% (/what % are they at)
- suspected time until they can play again (that game?)
- how they are/what they injured
- time off/when you will know (after the follow-up)
what should you check for in the follow-up?
- ice
- immobilization
- treatment plan
- clinical assessment (if necessary)
