Week 8- Sports Flashcards
on-field assessment
determine
- nature of injury
- provide direction in decision making process concerning the emergency care that must be rendered
subdivided into primary and secondary survey
what is the primary survey for
determines existence of potentially life-threatening situations including problems with - airway -breathing - circulation -severe bleeding -shock
what does the primary survey include
if they're unconscious : assume serious neck injury until proven otherwise A=alert V=respond to verbal stimuli P= responds to painful stimuli U= unresponsive
GCS - score made up by adding (i) eye opening response, (ii) verbal response and (iii) motor response
alert other medical personnel and call for an ambulance
the unconscious athlete, what to do
- Do not move until they regain consciousness
- Monitor ABCs
- If prone and breathing –leave
- If supine and breathing-leave
- Do not awaken with noxious substance – Smelling salts etc
- Be prepared to stabilise spine when they “awaken”
The unconscious athlete, what to do #2
- support head to stabilise neck: use assistants.
- log-roll method to turn patient supine onto a spine board
- open airway with jaw-thrust method
- stabilize head and neck
- CPR: ABC
- stop bleeding
When to urgently refer to hospital
- prolonged loss of consciousness (> 5 min)
- increasing headache, nausea, vomiting
- unequal pupil size
- gradual increase in BP and decrease in pulse rate
- convulsion
- changing neurological signs
life threatening injuries
– TBI (Concussion) – neck injuries – unconscious patient – chest and abdominal injuries – heatstroke, de/over- hydration
non-life threatening injury
– joint injuries – muscle and soft tissue injuries – fractures/dislocations – cramps – skin injuries – wounds & bleeding – nose bleed
the conscious athlete: regional physical examination
– check for deformity swelling, bleeding, tenderness, active ROM
The conscious athlete : postural symptoms
– allow athlete to sit up on their own, resist helping
– re-assess dizziness, nausea and pain
the conscious athlete
regional physical examination
postural symptoms
move to sidelines
the conscious athlete -rule out neck injury
shouldnotsituporwalkunless:
– 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 ankle, bend knee, lift leg
• ClinicalDecisionRules– NEXUS group: (National X-Radiography Utilization Study Group)
• lowriskcriteria(nomidlineC-spinepain,nofocalneurologicaldeficit, normal alertness, no intoxication, no painful distracting injury)
– Canadian C-spine Rule (CCR)
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.
• mentalstatus: – orientation
– anterograde amnesia – retrograde amnesia – concentration
• symptoms:
– headache, blurring vision, numbness, tingling – any pain or symptoms elsewhere.
secondary survey
• a basic-condensed musculoskeletal assessment
• determine: – mechanism of injury
– events leading up to injury – audible sounds heard – degree of pain
aim of the secondary survey
Determine – severity of the injury – type of management (immobilisation) – ability to resume play Look -visual observation Listen - auditory observation Feel - palpation Move - ROM-quantity and quality
TOTAPS abbreviation
T alk O bserve T ouch A ctive Movement P assive movement S kills
on sidelines/locker room
• obtain more detailed history and PE
• mild injuries: RICE
• decide on return to play: graduated functional assessment
NB: you must be able to assess all joints/soft tissue!
considerations in returning the athlete to the field
- obvious severe injuries such as fractures
- after any joint dislocation
- any joint instability
- concussion
- blood and infectious diseases
- 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!
spinal cord injuries
- Spinal injuries are a unwelcome consequence of participation in contact, collision and high velocity sports
- Spinal cord trauma is damage to the spinal cord. It may result from direct injury to the cord itself or indirectly from damage to surrounding bones, soft tissues, and blood vessels.
- Most spinal cord trauma occurs to young, healthy individuals. Males between ages 15 and 35 are most commonly affected.
Spinal cord symptoms
• Symptoms vary depending on the location of the injury. Spinal cord injury results in varying degrees of weakness and sensory loss at and below the injury. The pattern depends on whether the entire cord is injured (complete) or only partially (incomplete).
signs and symptoms of SCI
- Weakness, paralysis
- Breathing difficulties (from paralysis of the breathing muscles)
- Spasticity (increased muscle tone)
- Sensory changes
- Numbness
- Loss of normal bowel and bladder control
- Pain
C spine rules
slide 29
