Medical Issues Flashcards
Epistaxis that has clear fluid out of nose
and OR patient reports a sweet post nasal drip
-indicates CSF LEAKAGE
-clear fluid out of nose
-reports a sweet post nasal drip
-can be caused by nasal or cribiform fractures
-PATIENT AT RISK FOR MENINGITIS- NEEDS ANTIBIOTICS
Cribiform Plate Fracture
Thin bone- part of ethmoid bone above nasal cavity and under olfactory bulb
associated w/
-septal hematoma
-oflactory dysfuxn
-CSF leakage
-infection- meningitis
Epistaxis
nosebleed
Rupture to spleen presents:
- can refer to shoulder- Kehr’s sign
-Left UQ TTP
-abd guarding and rebound tenderness
-systemic symptoms
What kind of force poses greatest risk for serious brain injury
Rotational
What kind of head injury presents with a lucid interval followed by declined mental status
Epidural hematoma- where the blood is
-typically involves an artery
-progresses rapidly
Care for knocked out tooth
- rinse and re-implant tooth ASAP and send to dentis
- if can’t place in saline and send to dentist
What is the 1st step when encountering a conscious football player with likely concussion?
Assess for ligamentous or structural disruption or instabilty by testing PROM for bony block or instability
What does SAMPLE stand for?
Signs & symptoms,
Allergies,
Medications,
Past Medical History,
Last Food or Drink
Events leading up to the present injury
Describe Epidural Hematoma
-blood between dura mater and skull–inr pressure in intercranial space
-LOC follwed by lucidity and then gradual progression of symptoms
-decrease visual field
-dizziness/nausea
-dec conciousness
-neck rigidity
-decr pulse and breathing
- deadly and rare
- care: urgent neuro surgery- CT or will be deadly
Describe Subdural Hematoma
Blood in outermost meningeal layer
-tear in venous vessels
-incr pressure
-LOC
dialation of pupils
-HA, dizziness, Nausea, sleepiness
-care- immediate medical care CT/MRI
-can be delayed in onset
Care for trauma to head
-
-PALPATE- check for underlying fracture
-clean with antiseptic soap and water and remove debris
-cut away hair prn
-firm pressure to decr bleeding
-wounds > 1/2 inch- refer
-smaller- cover w pad and gauze
Tongue lacerations
-Refer for
flap, bisection or >1 cm, 30% or more of tongue, U shape or deformity
-
care for chipped tooth
return to play- see dentist after
Crown fracture
-can be complicated
-bleeding and sig pain
-if uncomplicated- - put remainder of tooth in bag of saline, control bleeding w gauze
-can return to play and f/u dentist
Tooth luxation
loose or dislodged- refer in 48 hours
-if tooth out of cavity- replace and refer immediately
Tooth knocked out of cavity
-attempt re-implantation w/in 20 min
-save tooth in saline/saliva/milk
-refer immediately
DONOT
wash tooth
hold by root or wait more than 20 min
Auricular Hematoma
Cauliflower Ear
-caused by compression or shear force
-subcutaneous bleeding
-ear protection prevents
-apply ice
- prevent fluid solidification- pack ear w/ guaze tight in and behind ear
- keep compression on it
- may need to refer to drain
Tympanic Membrain Rupture
-caused by fall or slap to ear (water polo)
- loud pop, intense pain, vommiting dizziness
-sig hearing loss
-can see rupture thru otoscope
-small perferations can heal 1-2 weeks
-monitor for infection
-no flying until sx’s resolved
Otitis Externa
Swimmers Ear
-infected ear canal from trapped water
-can have vestibular sx’s, pain, discharge, partial hearing loss
care: prevention- dry ears, ear drops- asorbic acid and alcohol, avoid overexposure to cold wind
- may need antibiotics
-
Ototitis Media
Middle Ear infection
-local and systemic infection
-sxs: fluid drainage, intense pain, transient hearing loss, fever, HA’s nausea
Care: can be drained
analgesics and antibiotics 24-72 hours
Eipstaxis
nose bleed
causes: high humidity, allergies, trauma
Care: sit upright w/ cold compress over nose w/ pressure on nostril
gauze between upper lip and gum- limits blood supply
- NEVER TIP HEAD BACK
-if bleeding more than 5 min- apply astringent/gauze, nose plug
-don’t blow nose for 2 hours
-wrestles can play
Nasal Fracture
-direct blow
sx: separation of whole frontal process of maxilla
-separation of lateral cartilage
-or both above
-profuse bleeding
-immediate SWELLING
-control bleeding, xray, can be back in 1 week with splint
Deviated Septum
- can accompnay frx
-septum pushed laterally
-if don’t see from front- look superiorly at nostrils
-profuse bleeding
-hematoma
-Care- control bleeding and refer to GP
Closeline Injury
At throat
-laryngeal injury
-severe pain
-spasmodic coughing
- difficulty speaking and swalling
- if frx of cartilage- frothing blooding coughing, inabiilty to breath, cynanosis
-ABC’s!! if airway and circ intact, may need to apply cold
Carotid Artery Dissection
- constant pressure and get to ER
DO NOT STAND UP!!!!!
Mandibular fracture
-trauma/direct blow
-generally at frontal bone
-deformity
-parasthesias of lower lip
- pain biting, bleeding
-Care: temporary immobilization w/ wrap then refer to MD for Sx
Orbital Fracture
blow to eyeball
pushes it posteriorly into orbital area
usually from a baseball
sxs: diplopia
DOWNWARD displacement of eye- pupils may point up in socket
- swelling and bruise
-numbness
-ER and xray
treated w/ antibiotics 2/2 close to sinus- usually surgery
Zygomatic Fracture
sunken face
-sig epistaxis
-diplopia
-CHECK FOR N/T
Care: apply cold, refer to MD
8 weeks to heal, may need 1 year for RTS
Maxillary Fracture
cheekbone
-elongated face
-epistaxis
-may require Airway Management!!!
ruptured globe
damage to outermembrane of ye
blunt trauma or penetration
opthamologic emergency ER
damage to posterior eye
Corneal Abrasion
- scratch on cornea- can be from rubbing
-sudden onset of pain
-watering, photophobia,
-blinking (use patch)
-treated with topical antibiotics
-see opathomolgist
hyphema
SERIOUS
- blunt blow to eye
-collection of blood anterior chamber of eye
- red tinge or pea green in lower iris
-partial vision loss
-usually bed rest / incline to 30-40 degrees
-send to MDx
detached retina
blow or atraumatic
PAINLESS
sx’: specs or flashes of light in vision
-“curtain” falling over field of vision
-immediate referal to opthamologist
conjunctivitis
pink eye
-bracteria, allergens, smoke
-eyelid swelling
-discharge
- can be highly infectious
refer to MD
Eye Hordeolum
Sty
acute infection of eyelid
blocked gland - oil gets backed up
- pain
can have infection
nodule
periorbital lacerations
common
usually at eyebrows
refer if >1/2 inch 2/2 may need sutures and risk of infection
Foreign bodies in eye- what to do?
AVOID RUBBING
flush with saline, eyedrops or blink
which eye injuries need ER
globe ruptures
periorbital fractures
hyphema
Iritis
Detached Retina
MD persistent visual disturbance
corneal abrasion
List the Canadian C SPINE rules
- high risk factor- YES xray
-dangerous mechanism- parasthesisas in extremities
- 65 or older
- Low Risk Factors that allow evaluation of ROM -if none- no xray
if any YES xray- simple rear end MVA
-sitting position in ED
-ambulatory at anytime since injury
-delayed onset neck pain
-abscence of midline TTP
- simple rear end MVA
- Patient able to actively rotate 45 dg bilaterally? if yes- don’t need xray
organ damage
Blunt trauma
can result in internal bleeding or organ failure
can hemorrhage slowly sometimes over weeks before any signs/sx’s
Bladder trauma
hematuria
difficulty urinating
abd rigidity
Kidney injury
mm guarding
back/flank pain
N/V or shock
can affect intestines bloating
changes in bowel fxn
BP changes
Liver trauma
high abdominal- especially R side
rapid HR
low BP
abd pain
N/V,
blood in vomit, feces or urine
Splenic Trauma
systemic illness (mono)
shock, cool pale skin
weak rapid pulse
possibly Kehr’s sign- referred pain to LEFT SHOULDER andn arm
Describe assessment for Abdominal Injuries
- Check rebound tenderness- fingers of one hand over other- pressure and quick release
- check vital signs
if these are abnormal- transport to ER
if unsafe to transport- put in comfortable position-
NO LIQUIDS
if shock- elevate legs for blood flow to head and heart
Heat Acclimitization
14 days of consecutive practice, 1 day of complete rest at least every 6 days
days of rest do not count towards 14
practice no more than 3 hours
Playing in Heat
MATCH PLAY HYDRATION BREAKS: WBGT OF 89.6°F
Provide hydration breaks of 4 minutes for each 30 minutes of
continuous play (i.e., minute 30 and 75 of 90 minute match)
Playing in cold
NATA: if below 30degr- keep watch
if < 15 1 hour practice 20 min at least warming up inside
if 7 degrs 30 min practice and 20 at least warm up
0 degrees cancel practice
athlete hygeine
shower after every practice
avoid body cosmetic shaving
all cothing and gear washed everyday
braces disinfected daily
MRSA
bacterial
community aquired methicillin resistant stphylococous aureus
crusty
higly contagious
can be fatal if untreated
2/2 close contact
red, yellow small scabs, furuncles/carbuncles underskin
Impetigo
Bacterial
streptococcus
raised blisters on nose/mouth; skin- rupture easily
honey colored crust, raw surface
highly contagious
risk hospitization
carbuncles/foruncules
bacterial
areas of high friction or sweat (shoulder pads)
do not pop
Herpes simplex (HSV)
viral
incubation of 3-10 dyas
single vesicle or cluster
flu like sxs, burning
contagious
white bubbles
RTSport- free of systemic sx’s
no new lesion in 72 hors
min 5 days of antivirals
molluscum contagiosum
bubble with flat top or looks like ring on top
dimpled and flesh colored
RTSport- lesions must be removed or curretted
localized lesions can be covered w/ gas permeable dressing, underwrap and stretch tape
Tinea
fungal
Tinea capitus
scalp
gray scaly patches
mild hair loss
topical antifungal
Tinea corporus
Ring worm
well defined scale7 lump on skin
patches, circles, red , raised borders
can be irregular
RX keep skin clean and dry
wash sheets and clothes daily
topical antifungal