Basic Athletic Training Chapter 2 Recognition, Evaluation, and Management of Athletic Injuries Edited by Gurchiek PE 282 Introduction to Athletic Training

Chapter Objectives Recognize the signs of life-threatening injuries Identify the protocol in first aid emergency care Identify the steps in emergency transportation Describe the components of the injury evaluation formats Identify types of first-aid splinting equipment Describe the basic treatment protocol for athletic injuries

Recognition 0f Athletic Injuries

Recognition of Injuries Certified Athletic Trainers are trained to recognize when an injury has occurred. They are responsible for: Determining the severity of the injury Applying proper evaluation/treatment procedures and protocols

Evaluation of Injuries Control life-threatening conditions and activate emergency medical services (EMS) Management of non-life-threatening injuries

First-Aid Emergency Care American Heart Association www.americanheart.org American Red Cross www.redcross.org CERTIFICATION American Heart Association BLS for health care providers Cardiopulmonary resuscitation (CPR) Automated external defibrillator (AED) American Red Cross Sport Safety Training (SST)

First-Aid Emergency Care Proper evaluation Certified in cardiopulmonary resuscitation (CPR) Access to automated external defibrillator (AED) Use standing orders for emergency action plan (drafted by Certified Athletic Trainer and team physician)

See Handouts For Emergency Action Plans And Guidelines

Emergency Transportation Procedures Points to consider Availability of emergency ambulance service Severity of injury Athletic training staff or coaches should never transport injured athletes in a private vehicle because of liability issues Emergency ambulance services need to be present at events or competitions

Evaluation of Injuries Following a written statement (standing orders and emergency action plan) drafted and approved by your team physician and organization, the proper steps in the evaluation of injury can occur. When serious injury is suspected, begin your evaluation with a survey of the scene and then primary survey.

Evaluation of Life-Threatening Injuries Perform Primary Survey Airway Breathing Circulation Severe Bleeding other life-threatening conditions Perform Secondary Survey History Physical examination (Head to Toe)

More on Primary and Secondary Survey 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

Evaluation of Non-Life-Threatening Injuries History, Observation, Palpation, Special Test (HOPS) History How did it happen? (mechanism of injury) Where does it hurt? (location of pain) What did you hear? (did you hear a pop or snap?) Previous injury? (have you had injuries in this anatomical structure before or injured the opposite limb?)

History, Observation, Palpation, Special Test (HOPS) Look for bleeding, swelling, discoloration, deformity and compare anatomical structures

History, Observation, Palpation, Special Test (HOPS) Palpate anatomical structures above and below injured site Palpate affected area Bones, Ligaments, & Muscles

History, Observation, Palpation, Special Test (HOPS) Special Tests Joint stability Muscle/tendon Range of Motion Strength

Subjective, Objective, Assessment, Plan (SOAP Format) Subjective Findings Ask detailed questions like when conducting an injury history Objective Exam Examination and Findings Measureable visual, physical, and functional findings Assessment Review the probable cause and mechanism of injury based on subjective a objective finding Plan Outline appropriate action plan for care & rehab.

First-Aid Splinting Equipment Fixation Splints Most common adaptable (board, wire ladder, pillow, blankets) Vacuum Splints Appropriate for dislocations or misaligned fractures and adaptable to limb angulations Pneumatic (air) Splints Suited for nondisplaced fractures, air splints are easy to apply Traction Splints Used for long bone injuries (humerus and femur)

Key Points When Splinting Always splint if player needs to be moved when a fracture or joint instability is suspected. Stabilize the joint above and below the fracture site or the bones above and below the unstable joint. Check circulation before and after splint application. Continue to monitor circulation with distal pulse check and check for normal sensation

Basic Treatment Protocol Protection, Rest, Ice, Compression, Elevation, Support (PRICES) Once an injury has occurred, protect from further damage by removing athlete from participation Rest Resting the injury is dependent on the severity of the injury. Set the injury at rest

Basic Treatment Protocol Protection, Rest, Ice, Compression, Elevation, Support (PRICES) Apply cold (ice pack 20 minutes every 2 hours) (Make change in text book on page 20)

What is the Purpose of the Cold? Decreases the death of healthy cells by slowing down cellular metabolism Decreases pain and spasm

Basic Treatment Protocol - PRICES Compression Using compression wrap to control swelling. Begin elastic wrap (farthest from heart) and spiral wrap toward heart on the involved extremity. Wraps too tight could interfere with circulation/nerves. Ice and Compression are more effective in controlling swelling than if used independently Remove wrap if too tight and reapply – check every 4 hours

Basic Treatment Protocol - PRICES Compression Using compression wrap to control swelling. Begin elastic wrap (farthest from heart) and spiral wrap toward heart on the involved extremity. Wraps too tight could interfere with circulation/nerves. Remove wrap every 4 hours.

What is the Purpose of Compression Compression equalizes the pressures inside and outside the cells Pressure equalization helps prevent the death of healthy cells

Basic Treatment Protocol - PRICES Elevation Keep injured body part elevated higher than the heart.

What is the Purpose of Elevation? Keeps fluid from being pulled down by gravity to settle around the injury site. Elevation helps the lymphatic system pull the fluid away from the injury site.

Basic Treatment Protocol - PRICES Support If necessary, place injured extremity in splint, brace, or some type of support. If injury is lower extremity, crutches may be needed. This prevents further injury This decreases movement which causes pain – which causes spasm- which causes more pain. Alienation may cause long term disuse and atrophy

Cycle of Injury Pain Spasm Pain

Questions ?