Limb threatening injuries Flashcards
A player is brought to see you in the medical room an hour after the game. You recall he was involved in a multiple player tackle where he landed awkwardly on an opponent players’ knee. However, he was able to play on for a while before requiring replacement. When you see him, he is in severe respiratory distress with a respiratory rate of 36bpm. His pulse rate is 120 radial and thready, and his capillary refill time is greater than two seconds. His neck veins are not distended, his trachea is central, and the chest wall movements are outward on inspiration. Breath sounds are absent in the left chest, and the percussion note over the left chest wall is dull. Breath sounds are normal on the right side.
The player may have which of the following injuries?
Haemothorax
Whilst acting as pitchside medic in a cup game, you see a 50/50 tackle between two players on the far side of the pitch. The referee is urgently waving you onto the field. Your player has not moved, and the surrounding players look concerned. His medical history records an old injury to his right knee.
On approach, you see that his right foot is malaligned at 90 degrees to the leg. After safe approach, you complete an initial assessment (where the player is A on AVPU, RR 22bpm, HR 100bpm, and no other injuries). Help is already supporting the limb in situ.
What is your next immediate action?
Check for foot and ankle pulses, making note of presence or absence.
Whilst acting as pitchside medic in a game, you witness a high-speed collision between two players. The referee and players are urgently waving you onto the pitch. Your player has not moved, and the surrounding players look concerned.
On approach, you see that his left foot is malaligned at 90 degrees to the leg. After completing a safe approach and initial assessment (where the player is A on AVPU, RR is 22rpm, and HR is 110bpm), there are no other obvious signs of bleeding. You diagnose a closed fracture-dislocation of the left ankle joint with compromised distal circulation. The foot is mottled after removing the boot, and the dorsal pulse is extremely weak in comparison to the right foot.
You make the decision to re-align the limb to the neutral position before placing into a splint. An ambulance is called, and you have several helpers present to assist.
What is the correct course of action to take? (step by step)
Reassure player,
pain relief,
distract/align,
recheck neurovascular status,
apply a splint,
recheck neurovascular status,
fasten the splint,
recheck neurovascular status,
extricate
During a training session, you are attending a player with an open fracture-dislocation to their right ankle.
They are in obvious pain. Both distal pulses are present, but you are concerned with the degree of tenting over the malleoli and have been informed that the ambulance may be up to two hours (as this is a non-medical emergency).
Your player is in severe stress due to the pain so, after discussion with your team, you provide Entonox. A gauze swab is used to stem the bleeding with direct pressure as able.
Due to the degree of tenting, the risk of neurovascular compromise and your now nearly empty Entonox cylinder, you make the decision to realign the limb into the neutral position. This is so you can extricate the player to the medical room, where they can wait for the ambulance in comfort and warmth.
Following a controlled reduction to normal alignment, both the tibialis posterior and dorsal pedis pulses have disappeared.
What is your next immediate action?
You may have overcorrected in your alignment. Release your realignment in gentle increments until the pulses return. Then splint in this position, rechecking pulses post splint application
During a competitive match, a player suffers an obvious fracture-dislocation of their lower leg. ABCD is established, and an ambulance is on the way but will be another 30 minutes.
What is your next immediate action?
‘Steady and support the limb, remove the boot and sock and check for the presence of a distal pulse. Suitably splint the limb, placing into neutral alignment first if required (rechecking distal circulation before and after splint application).
Remove the player safely (on a suitable stretcher) from the field of play and take to the medical room
You are the first person from the medical team to arrive in the morning to the training ground. The cleaner rushes over to you. She has called 999 after finding one of the senior players, who came in early to train, on the floor in the gym. You approach the player, who is lying on the floor in supine with free weights scattered around him. He looks unwell with pale and clammy skin but responds to your voice. His airway is clear with a respiratory rate of 28rpm and he has a thready pulse of 120bpm. He has pain on palpating his pelvis and upper right leg.
What can be done to support the player
Apply compression with dressings if there is an open wound
Apply a Kendrick splint if there is a suspected femoral shaft fracture
Apply a pelvic binder if there is a suspected pelvic fracture
Give oxygen at 15LPM
In a suspected fracture, what is the purpose of applying a splint?
Immobilise the limb, reduce pain, prevent further damage, reduce bleeding
If you were in a position to manage a penetrating chest wound after an outdoor preseason training session where a player collided with an old wooden fence, which one of the following statements would be the most appropriate action until help arrived?
Cover using a vented Russell or Asherman seal
You suspect your goalkeeper has a dislocated shoulder on the field of play. The radial pulse is present and the player is standing and talking to you, advising you that they are in pain. What is your next immediate action?
Allow them (or you) to support the arm in the most comfortable position as you escort them from the field of play
You have been asked to prepare the travelling medication for an away game in Scotland. The airline is not allowing travel with medical gases, so you decide to take Penthrox for pitchside pain relief. Which of the following statements about its use in the United Kingdom are correct?
You may select multiple answers.
It can be used to treat pain associated with fractures and dislocations in adults
It can be used to treat the pain associated with rib fractures
Compartment syndrome can occur as a consequence of acute limb trauma. In the late stages, it is characterised by the presence of a multitude of clinical signs/symptoms.
Which one of the following should be cause for concern?
- Pain disproportionate to the injury
- Pulselessness
- Paraesthesia
- Mottled, shiny but pale limb
- Increased pain on movement
