Assessment of the Unconscious Athlete ATTR 322 Krzyzanowicz- Spring 13

Definition The inability to respond to any sensory stimuli, with the possible exception of those causing deep pain Determining the level of consciousness is one of the most reliable mechanisms for determining the neurologic status of an athlete

Levels of Consciousness Alert Lethargic Seems drowsy, but can be awakened easily Stuporous Partially unconscious; ↓responsiveness; falls asleep but can be awakened for short periods by verbal/ physical stimuli Unconscious – cannot be aroused; may pull away from painful stimuli Coma – cannot be aroused even by a painful stimuli

Causes of Unconsciousness Traumatic head injury Heat Stroke Diabetes Epilepsy Cerebral or cardiac malfunctions NOTE: will need to develop a systematic approach to evaluation because you probably will not know the causes

Seizures Periods of unconsciousness that must be managed before assessment can begin; result from abnormal discharges within in the brain; trauma to head is most common cause Epilepsy Disorder of the brain characterized by a tendency for recurrent seizures which can cause disturbances in movement, unconsciousness, and/or behavior Grand mal seizure Management

Primary Survey Airway – technique to open? Breathing Circulation Is head gear on? Facemask? Etc. Circulation Do you have to remove equipment? Cervical immobilization Always assume head and neck injury

Secondary Survey Reconstruct events and circumstances of the injury Assess, treat, care, transport Record vital signs frequently and write them down Determine level of consciousness Is it stable? Improving? Declining? How quickly? Can athlete be aroused? Is he responsive to pain? Is he aware of the surroundings? Can he answer questions accurately and quickly? Changes must be recognized and recorded

Secondary Survey (continued) History Since athlete is unconscious, what must you do? Are you familiar with athlete’s medical hx? Determine how the injury occurred and what happened (witnessed) If you did not see the injury, refer to bystanders for mechanism of injury If patient is unconscious, determine what signs may have existed while athlete was conscious Learn if bystanders know anything about the patient’s medical history

Secondary Survey (continued) Observation Examples of an observable sign that may indicate a life- threatening condition? What is the alignment and position of the athlete? Check positions of the head, neck, and extremities Check for deformity, unusual position, or body posturing Determine rate, depth, and rhythm of pulse and respirations Check skin for color, moisture, and temperature Inspect for deformity, discoloration, swelling, and fluid drainage Hemorrhaging vs. Cerebrospinal fluid? PEARLA Other signs of trauma?

Secondary Survey (continued) Palpation Confirm the presence and strength of palpable vital signs Pulse – rate? Strength? Rhythm? Blood pressure Pulse pressure Skin temperature Check for evidence of trauma through head-to- toe examination Reaction to pain? Stress tests

Secondary Survey (continued) Determine level of consciousness Alert? Lethargic? Stuporous? Unconscious? Coma? Is athlete improving or worsening? Use verbal or painful stimulus to arouse the patient Know when to refer Patient fails to regain consciousness within a few minutes Cause for unconsciousness unknown Abnormal vital signs present Any sign of serious or life-threatening injury or illness