Rangers Lecture Flashcards
on field assessment can be divided into
primary and secondary surveys
primary - unconscious athlete
Secondary - conscious athlete
Responsiveness
talk to athlete “open your eyes”, “squeeze my hand”
Primary survey
assume neck injury until proven otherwise A: alert V: responds to verbal stimuli P: Responds to verbal stimuli U: Unresponsive
Alert other medical personnel and call for an ambulance
The unconscious athlete
do not move until they regain consciousness
Monitor ABC’s
If prone and breathing - leave
If supine and breathing - leave
Do not awaken with noxious substance
be prepared to stabilise spine when they awaken
How to handle unconscious athlete
support head to stabilise neck: use assistants
Log roll method to turn patient supine onto a spine board
open airway with jaw thrust
stabilise head and neck
CPR: ABC (airway, breathing, circ)
Stop bleeding
When to urgently refer to hospital
prolonged loss of consciousness (>5mins)
Increasing headache, nausea, vomiting
Unequal pupil size
gradual incr in BP and decr in pulse rate
convulsion
changing neurological signs
Sporting emergencies vs injuries
life threatening - TBI (concussion) - neck injuries - Unconscious pt chest and abdominal injuries heatstroke, de/over hydration
non-threatening joint injuries muscle and soft tissue injuries #'s/dislocations Cramps Skin injuries- wounds and bleeding Nose bleed
The conscious athlete
regional physical exam
- check for deformity, swelling, bleeding, tenderness, active ROM
Postural symptoms
- allow athlete to sit up on their own, resist helping
- re-assess dizziness, nausea and pain
move to sidelines
Rule out neck injury (the conscious athlete
should not sit up or walk unless
- no neck pain or tenderness
no pain, tingling, numbness in legs/arms
normal sensation to touch to chest, arms, hands, legs, feet
Normal bilateral motor function: make fist, bend elbow, lift arm, move toes, move ankles, bend knee, lift leg
Canadian C-SPine rules
Evaluation of the conscious athlete
only allowed to sit up once neck injury ruled out and can do so by themselves. If athlete decides not to get up, assume serious injury Mental status - orientation anterograde amnesia retrograde amnesia Concentration
Symptoms
- Headache, blurring vision, numbness, tingling
- any pain or symptoms elsewhere
Secondary survey
a basic condensed MSK assessment to determine
- MOI
- Events leading up to injury
- Audible sounds heard
- Degree of pain
to determine
- severity of injury
- type of mgmt
- ability to resume play
Look - visual observation
Listen- auditory observation
Feel - Palpation
Move - ROM quantity and quality
TOTAPS
Talk Observe Touch Active ROM Passive ROM Skills
on sidelines/locker room
- obtain more detailed Hx and PE
Mild injuries: RICE
decie on RTP: graduated functional assessment
considerations in returning the athlete to the field
obvious severe injuries such as #’s
after any joint dislocation
any joint instability
concussion
blood and infectious disease
muscle injuries which limit speed or function
If return carries a high risk of significant aggravation and long term consequences
err on the side of non-participation
consideration must be the welfare of the player, not the result of the game
concussion
“A complex pathological process affecting the brain, induced by traumatic biomechanical
forces” • Direct or indirect blow..
• Rapid onset of a short-lived impairment
• Functional not structural injury (-ve imaging) • May/may not involve loss of consciousness
• Resolution follows a sequential pathway
Suspect a concussion?
athlete who are suspected of being concussed need to be screened by sideline sports medicine personnel (eg, sports medics, physios, Drs) in order to determine appropriate referral and management
SCAT 3
42
RTP
Athletes should not be returned to play the same day of injury.
When returning athletes to play, they should follow a stepwise symptom-limited program, with stages of progression. For example:
1. Rest until asymptomatic (physical and mental rest)
2. Light aerobic exercise (eg, stationary cycling)
3. Sport-specific exercise
4. Non-contact training drills (start light resistance training) 5. Full contact training after medical clearance
6. Return to competition (game play)
There should be approximately 24 hours (or longer) for each stage, and the athlete should return to stage 1 if symptoms recur. Resistance training should only be added in the later stages. Medical clearance should be given before return to play.
COncussion video
caused by brain moving around in the cranium, caused by bump to head or body less than 1 in 10 people lose consciousness symptoms - confusion - headache - dizziness - nausea - fatigue - foggy feeling
Rx - rest - nil activity, nil mental activity, nil screens(movies, games, texting)
