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Principles of Examination Core Concepts in Athletic Training and Therapy Susan Kay Hillman.

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Presentation on theme: "Principles of Examination Core Concepts in Athletic Training and Therapy Susan Kay Hillman."— Presentation transcript:


2 Principles of Examination Core Concepts in Athletic Training and Therapy Susan Kay Hillman

3  Explain the difference between the primary survey and the secondary survey in the evaluation of an injured person.  List the main steps in performing a complete on-site examina­tion.  List the main steps in performing a complete acute injury examination.  Explain the term “SINS” as used in acute and clinical examinations.  Explain the difference between the subjective and the objective segments of the examination.  List the elements one should include in the objective component of the clinical examination.  Explain the importance of documenting an examination. Objectives

4  Examination Components  Before making a diagnosis must thoroughly examine the injury  Sequentially performing tasks involved in specific examination components  Dictated by location and timing of examination  Three different environments  On field (onsite  On sideline (acute)  Athletic training facility (clinical)  Each demands different examination, but all should begin with evaluation to eliminate any critical or life threatening concerns Introduction

5  Primary Survey  Determine status of life threatening or limb threatening conditions  Life threatening conditions (ABC’s or CAB’s)  Other vital signs and severe bleeding  Treat emergency conditions or move on to secondary survey depending on your findings  Secondary Survey  Occurs when primary survey is concluded or deemed unnecessary  No life threatening conditions, patient is breathing and any bleeding is under control  Examination to determine presence of other injuries  Rapid examination to determine seriousness of injury and if and how patient should be moved  Determine nature of injury or illness and identify positive findings for referral to medical professional Examination Components

6  SIDEBAR: When to Refer for Further Evaluation (Emergency Room or Physician)  Patient fails to regain consciousness within few minutes  Cannot determine cause of unconsciousness, even if consciousness is regained  Observe abnormal vital signs  Note any signs of serious or limb threatening or life threatening injury or illness Examination Components



9  Goals and Purposes  Rule out life threatening and serious injuries  Determine severity of injury  Determine most appropriate method of transporting patient  Perform a quick accurate examination and treat injury to minimize effects  Initial decisions among most critical  Incorrect decision can have dire or even deadly consequences On-Site Examination

10  Determine conscious vs. unconscious  Unconscious serious situation  Trauma or general medical condition  Rapid decision making  Stay calm  Take your time  Be focused and efficient  Good examination skills, knowledge and experience are essential  Err on the side of caution  Stay within the scope of your practice and training  Make all decisions with persons safety in mind Goals and Purposes

11  Determine mechanism, location and severity of injury  On site history: investigate chief complaint and problems that are readily apparent and in need of attention  Always watch to observe for mechanism but also ask patient what happened  Also ask bystanders if patient unconscious or mechanism is unclear  Ask questions regarding exact location of pain and severity of pain and other symptoms  Pain scale 1 to 10  More detailed history can be obtained during acute and clinical examination Obtain a History

12  Observe patient movement ability and patterns  Check for abnormal positioning of head, neck or extremities  Observe discoloration, deformity, swelling, patients reaction, movement  If suspect spinal injury, stabilize patients head and neck and examine peripheral nerves for sensory and motor function  Head injury: Alert and Oriented x 4 Observe and screen

13  Observe for bony injury  Deformity  Palpation (feel) for fracture or dislocation  Observe for muscular and or ligament injury  Palpation for defect  ROM test  Strength test  Stress Test  Special Test Observe and screen

14  Patients with severe pain, first time injury of any severity, or poor tolerance for any injury observe for signs and symptoms of shock  Pale, cool, clammy skin  Rapid, shallow breathing  Weak, rapid pulse  Nausea, falling blood pressure  Treat immediately and transport to emergency medical facility Monitor for Shock

15  If determine life threatening or serious injury refer patient for further examination and treatment  Follow your emergency operating plan (EOP)  If immediate transport not necessary determine transport method off playing surface  More detailed examination can occur on sideline or in AT Room  Rehearse and practice methods of transport and implementation of emergency operating plan Implement Immediate Action Plan

16  Communicate findings with staff, coaches, officials and other healthcare professionals  Provide detailed information to allow for appropriate care for athlete Communicate in Site Examination Results

17  Follows the on-site examination  SINS: severity, irritability, nature, and stage of an injury  Determine more precisely the nature and severity so you can administer appropriate treatment, provide referral, or return athlete to participation Acute Examination

18  History  Observation  Palpation  Special Test  ROM Test  Strength Test  Stress Test  Neurological and circulatory tests  Functional tests  Other Special Tests Acute Examination

19  Subjective Segment  How does the patient feel  Patients opportunity to describe injury or illness  More detailed history from on site examination  Questions should not be leading  Athlete may be able to recall information they could not during on site eval.  Athlete has calmed down and is less agitated  All pertinent medical information  Past and present injuries Acute Examination

20  Objective Segment  What you can see or evaluate  Swelling, discoloration, deformity  Be careful not to perform test that may cause more injury or pain  Use common sense and information gathered during subjective testing  Best time to evaluate is immediately after injury  A.T. get the most accurate testing in first 10 minutes after injury before pain and swelling have developed Acute Examination


22  General Principles of the Clinical Examination  If injury not witnessed or is chronic, examination may be broader and more detailed  Continuation of on site or acute exam or first encounter with athlete  Subjective Segment Clinical Examination

23  Objective Segment  Comparable sign  Negative response if tissue is not injured  Positive response if tissue is injured  Reproduction of patients symptoms is called comparable sign  Bilateral Comparison  Always perform all test bilaterally  Understand purpose of the test and what is normal for the patient Clinical Examination

24  Observation  Posture, movement patterns, Contour, alignment, discoloration and symmetry  Palpation  Feel anatomical structures for pain, swelling, deformity, spasm, tissue thickening, crepitus  Superficial to deeper structures  Bony to Soft tissue  Range of Motion  AROM, PROM, RROM  Quality and quantity of physiological and accessory movement  End feels: abnormal end feels may be indicative of injury  Strength  Isometric or Break test  Strength test through ROM  Grading scale of 0 to 5 Clinical Examination

25  Stress Tests  Special Tests  Neurological Tests  Rule out brain, spinal, or peripheral nerve pathology  Performed if you suspect nerve injury or if patient symptoms include sensory deficits (radiating pain, tingling, burning, numbness, etc.,)  Sensory, motor and reflex responses  Unilateral changes=nerve root or peripheral nerve lesion  Bilateral changes-central cord or brain pathology Clinical Examination

26  Vascular Tests  Examine integrity of vascular system  Palpate pulses  Check capillary refill distal to injury  If absent, weakness or disappears=medical emergency  Functional Tests  Used only to when patient is ready to return to former participation levels  Determine patients ability to return safely and fully resume all activities  Increase patients confidence and readiness to return  Sidebar Page 198 Clinical Examination



29  Accurate and thorough documentation of your findings  Legal standpoint  Continuity of care  Re-examining of injury  Follow HIPAA (Health Insurance Portability and Accountability Act) guidelines Documenting the Examination

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