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
spinal injuries guidelines
- Spinal cord injury is a medical emergency requiring immediate attention.
- The time between the injury and treatment is a critical factor affecting the eventual outcome.
- The athletes head and neck must be immobilised
- Semi-rigid collar with secure lateral support is applied and the patient not moved until specialist assistance arrives e.g. paramedics/ambulance.
3 types of head injuries
skull fractures
localised trauma
diffuse head injury
Skull fractures
with or without brain injury
localised trauma
internal injury to cerebral cortex & other brain tissue
diffuse head injury
widespread physiological disruption of neurological structures
skull fracture causes
• small, high velocity projectiles (balls, bats, pucks)
• rapid deceleration during a fall on to hard surface (skiing, cycling)
– infection needs to be considered – medical referral and x-ray essential
localised trauma causes
• Intracranialhemorrhage
– most common cause of death from head injury
– Extradural haematoma
• bleed between skull & duramater
– Subdural haematoma
• bleed between brain & duramater • most common intracranial injury
– Intercerebral haemorrhage
• bleed within the brain-severe injury & deterioration
– Subarachnoid Haemorrhage
• more pathological than other bleeds-serious headache
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
neurometabolic cascade
Release of neurotransmitters ^ glutamate (cell toxicity)
Efflux K+ /Influx Ca++
Decrease in cerebral blood flow ^ Na+/K+ pump (^ demand for glucOse)
^ Hyperglycolyis
^ lactate accumulation ..decrease ATP production
Brain energy crisis
what to do if you suspect a concussion
• Athletes who are suspected of being concussed need to be screened by sideline sports medicine personnel (e.g. sport medics, physiotherapists, doctors) in order to determine appropriate referral and management
Zurich consensus
Consensus Statement on Concussion in
Sport: the 3rd International Conference on Concussion in Sport held in Zurich,
November 2008 P McCrory et al
return to play
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.
infectious disease transmission in sport
- All sports physiotherapists should be familiar with the potential for the spread of infectious diseases
- Contact and collision sports increase the risk of spread of certain infections
- Demands a responsible, preventive approach
causes of infectious disease transmission in sport
- virus reproduction
- bloodborne pathogens
-hep B/C
HIV
virus reproduction
• Submicroscopic parasitic organisms
• Dependent on the nutrients within cells
– Metabolism – Reproduction
virus transmission
• infected person sneezes/coughs
• You inhale the virus particle
– it attaches to cells lining the sinuses in your nose.
• The virus attacks the cells lining the sinuses – rapidly reproduces new viruses.
• The host cells break
– new viruses spread into your bloodstream and also into your
lungs.
• Viruses in the fluid drip down your throat
– attack cells lining your throat (=sore throat)
• Viruses in your bloodstream
– attack muscle cells (=muscle aches)
prevention
• Personal health and hygiene habits
– hand washing
– avoiding spitting
– covering the nose and mouth when sneezing or coughing
• Surface sanitizing may help prevent some infections
– alcohol
– ammonium compounds – diluted chlorine bleach
• Face masks might prevent transmission – beneficial effects is mixed in the community
FACEMASKS
bloodborne pathogens
• Good personal hygiene
– Hep B can survive for at least a week
• Dried blood/contaminated surfaces – Cover cuts, grazes, wounds
– Vacinate
• Avoid contact with any blood or fluid – Gloves
– Handwashing
– No player is permitted to play with;
• Uncontrolled bleeding, inadequate wound care.
• There is no evidence that sweat, tears or urine will transmit Hep or HIV
medical risks in endurance sports
- heatstroke
- dehydration
- postural hypotension • hyponatremia
- hypothermia
- hyperthermia
- hypoglycemia
traumatic causes of exercise associated collapse
Head injury severe minor Spinal cord cervical thoracic lumbar Thoracic injury fail chest haemothorax tension pneumothorax cardiac tamponade cardiac contusion Abdominal injury ruptured viscus (e.g. liver/spleen) Blood loss
non traumatic causes of exercise associated collapse
Cardiac
coronary artery disease arrhythmia
congenital abnormality hypertrophic cardiomyopathy Hyperthermia
hypothermia
Cerebrovascular accident Hypoglycemia Hyponatremia Respiratory
asthma
spontaneous pneumothorax pulmonary embolism
Allergic anaphylaxis Drugs
Other
fainting
blood pooling post exercise hyperventilation
hysteria
Heat stroke
– hot, humid conditions
– front runners i.e. competing at high %high VO2Max – elevated heart rate but BP low
– rectal temp > 41°
heat stroke treatment
– re-hydration with electrolyte drinks
– ICE packs in groin, axilla, neck, or Torso in small tub filled with ice and water with arms and legs hanging out for 5 – 10 min (avoid hypothermia)
– 1-1.5L of 0.5%saline solution drip only when
• severedehydration:unabletospit,sunkeneyeballs,skin
turgor
• cardiovascularinstability
• oralhydrationdoesnotcorrect
dehydration
– hot, humid conditions – drip only when • severe dehydration: unable to spit, sunken eyeballs, skin turgor • cardiovascular instability • oral hydration does not correct • front runners
Postural hypotension
– collapsing after the finishing line: pooling of blood
– body temp not elevated – major difference to heat stroke
– reverse by lying down, hips and legs slightly elevated
– should recover 10-30 min
Hyponatraemia (over-hydration
– slower runners (> 4 hour marathon)
– aetiology – excessive replacement of sweat by large quantities of dilute fluid
– serum sodium concentrations below 129mmol/L (i.e. over- hydration by between 2-6L)
– swelling (hands and fingers – watches)
– cerebral symptoms: confusion, disorientation, bizarre
behaviour
hyponatraemia treatment
– Mild: nothing, provided adequate flow of very dilute urine. Recovers within 10-24 hours.
– Severe: seizures, coma, death. EVACUATE immediately and NO FLUIDS
hypothermia
– marshalls, swimmers, triathlons, skiing, water sports, adventure sports , injured athlete
– mild: cold extremities, shivering
– moderate: Low core temperatures ( 32- 34°C), fatigue, incoordination, reduced shivering, apathy, dehydration
– severe: loss of shiver, inappropriate behaviour, muscle rigidity, pulmonary edema
Hypothermia treatment
– treat with insulation, re-warming, fluids
Hypoglycaemia
– blood glucose level <3.6mmol/L
– main concern with athletes with type I diabetes
– after exercise there is an increased insulin sensitivity and reduced glycogen stores and excess insulin will increase the risk of post- exercise hypoglycemia (can occur 4-24 hrs post exercise)
– early signs and symptoms include sweating, headache, confusion, tremor and hunger
– if hypoglycemia is not corrected the athlete symptoms may progress to confusion, abnormal behavior, loss of consciousness and convulsions may occur
Hypoglycaemia treatment
– Ingestion of oral quickly digestible forms of carbohydrate (solid or
liquid) e.g. Barley sugar or glucose tablets
– semi or unconscious athlete requires urgent intravenous glucose administration
ottawa ankle rules
slide 62
Splinting
• Rigid materials. A board, metal strip, folded magazine or newspaper, or other rigid item.
• Anatomical splints may also be created by securing a
fractured bone to an adjacent un-fractured bone.
• Anatomical splints are usually reserved for fingers and toes but, in an emergency, legs may also be splinted together.
Guidelines for splinting
- Support the injured area above and below the site of the injury, including the joints.
- If possible, splint the injury in the position that you find it.
- Don’t try to realign bones or joints.
- After splinting, check for proper circulation (warmth, feeling, and color).
- Immobilize above and below the injury.
Splinting - soft materials
Towels, blankets, or pillows, tied with bandaging materials or soft cloths.
