Sports Injury Assessment Procedures

Primary and Secondary Surveys It is important to perform a Primary and Secondary survey. Primary Survey (make sure you are safe before you treat) –Detect and treat Life Threatening conditions –“Treat as you go” – ABCDE’s  “A” Airway  “B” Breathing  “C” Circulation  “D” Disability  “E” Expose

“A”IRWAY An obstructed airway may quickly lead to respiratory arrest and death. Assess responsiveness and, if necessary, open the airway.

“B”REATHING Respiratory arrest will quickly lead to cardiac arrest. Assess breathing, and, if necessary, provide rescue breathing. Look for and treat conditions that may compromise breathing, such as penetrating trauma to the chest.

“C”IRCULATION If the patient’s heart has stopped, blood and oxygen are not being sent to the brain. Irreversible changes will begin to occur in the brain in 4 to 6 minutes; cell death will usually occur within 10 minutes. Assess circulation, and, if necessary, provide cardiopulmonary resuscitation (CPR). Also check for profuse bleeding that can be controlled. Assess and begin treatment for severe shock or the potential for severe shock.

“D”ISABILITY Serious central nervous system injuries can lead to death. Assess the patient’s level of consciousness and, if you suspect a head or neck injury, apply a rigid neck collar. Observe the neck before you cover it up. Also do a quick assessment of the patient’s ability to move all extremities.

“E”XPOSE You cannot treat conditions you have not discovered. Remove clothing– especially if the patient is not alert or communicating with you–to see if you missed any life-threatening injuries. Protect the patient’s privacy, and keep the patient warm with a blanket if necessary.

Primary Survey Continued As soon as the ABCDE process is completed, you will need to make what is referred to as a status decision of the patient’s condition. A status decision is a judgment about the severity of the patient’s condition and whether the patient requires immediate transport to a medical facility without a secondary survey at the scene. Ideally, the ABCDE steps, status, and transport decision should be completed within 10 minutes of your arrival on the scene.

Secondary Survey The object of a secondary survey is to detect medical and injury-related problems that do not pose an immediate threat to survival but that, if left untreated, may do so. Usually the trauma assessment is about 20 percent patient interview and 80 percent physical exam. On the other hand, the medical assessment is 80 percent patient interview and 20 percent physical exam. Both the physical exam and patient interview should always be done for all medical and trauma patients. H.O.P.S.

HOPS- History History: Attitude, mental condition, and perceived physical state. –Stated by the athlete. –Primary Complaint –Mechanism of Injury –Characteristics of the Symptoms –Limitations –Past History

HOPS - History Initial and most important step in the evaluation process. In many instances, the history alone describes the illness or injury. Physical exam only confirms it.

HOPS -HISTORY CONT. 1.Look at the athlete. Anxious Posture Walk freely or limp Guarding 2.Identify the chief complaint Why is the athlete there to see you. 3.Review previous medical history Acute or Chronic Any previous injury or surgery

HOPS - History Cont. 4.Review Symptoms Athlete’s interpretation of injury or illness When asking about pain use the following PQRST –Provocation »What causes the pain. –Quality »What type of pain »Sharp, aching, dull, burning, etc…. –Region/Radiating »Location of pain, Radiating pain –Severity »Scale of 1 to 10 –Time »When does it hurt, how long, »What makes it better or worse

HOPS - History cont. –At conclusion of History ask yourself was the history AMPLE? A = Allergies (Bee sting, Penicillin) M = Medicine P = Previous Illness or Injury L = Last thing taken by mouth E = Events leading up to injury or illness

HOPS- Observation and Inspection Observation: Measurable objective signs. –Appearance –Symmetry –General Motor Function –Posture and Gait –Deformity, swelling, discoloration, scars, and general skin condition

HOPS- Palpation  Rule out FX (fracture)  Skin temperature  Swelling  Point tenderness  Crepitus  Deformity  Muscle spasm  Cutaneous Sensation (nail bed refill)  Pulse

HOPS- Special Tests Functional Tests –A–Active Range of Motion (AROM) –P–Passive Range of Motion (PROM) –R–Resisted Manual Muscle Testing (RROM) Stress Tests –L–Ligamentous Instability Tests –S–Special Tests

Neurologic Tests –Dermatomes –Myotomes –Reflexes –Peripheral Nerve Testing Sport-Specific Functional Testing –Proprioception and Motor Coordination

HOPS- Special Tests Sport-Specific Skill Performance –Throw the football, baseball, softball, javelin... –Kick the soccer ball, football, opponent…

S.O.A.P. Notes S=Subjective information gathered from the patient O=Objective A=Assessment P=Plan

SOAP- Subjective History: Attitude, mental condition, and perceived physical state. –Stated by the athlete. –Primary Complaint –Mechanism of Injury –Characteristics of the Symptoms –Limitations –Past History

SOAP- Objective: Observation: Measurable objective signs. –Appearance –Symmetry –General Motor Function –Posture and Gait –Deformity, swelling, discoloration, scars, and general skin condition

SOAP- Objective  Rule out FX (fracture)Cutaneous Sens.  Skin temperaturePulse  Swelling  Point tenderness  Crepitus  Deformity  Muscle spasm

SOAP- Objective Functional Tests –Active Range of Motion (AROM) –Passive Range of Motion (PROM) –Resisted Manual Muscle Testing (RROM) Stress Tests –Ligamentous Instability Tests –Special Tests

SOAP- Objective Neurologic Tests –Dermatomes –Myotomes –Reflexes –Peripheral Nerve Testing Sport-Specific Functional Testing –Proprioception and Motor Coordination

SOAP- Objective Sport-Specific Skill Performance –Throw the football, baseball, softball, javelin... –Kick the soccer ball, football, opponent… –Macarena, Cabbage Patch, Mash Potato

SOAP- Assessment Analyze and assess the individual’s status and prognosis Suspected injury Site Damaged Structures Involved Severity of Injury Progress Notes

SOAP- Plan 1.Immediate treatment given 2.Frequency and duration of treatments and modalities and evaluation 3.On-going patient education 4.Criteria for discharge/return to play

On Field Assessment

On The Field Assessment History: –Location of Pain –Presence of abnormal neurological signs –Mechanism of Injury –Associated sounds (snap, crack, pop)

On The Field Assessment cont. Observation: –Check the surrounding area –Body positioning –Movement of the athlete –Level of responsiveness –Primary survey –Inspection for head or neck trauma –Inspection of the injured body part

On The Field Assessment cont. Palpation –Joints –Bones –Soft tissue –Skin temperature

On The Field Assessment cont. Functional Testing –Active Range of Motion (AROM) –Passive Range of Motion (PROM) –Resistive Range of Motion (RROM) –Weight Bearing

On The Field Assessment cont. Stress Testing –Ligamentous stability Neurological Testing –Cutaneous –Motor

On The Field Assessment cont. Vital Signs –Pulse –Respiratory Rate –Blood Pressure –Temperature –Skin Color –Pupils –Disposition

On The Field Assessment cont. Moving the Athlete –Ambulatory Assist –Manual Conveyance –Spine Board –Pool Extraction

Physician Ordered Tests Blood Test Radiographs (X-Ray) Computed Tomography (CT) Magnetic Resonance Imaging (MRI) Radionuclide Scintigraph (Bone Scan) Ultrasonic Imaging Electromyography (EMG)

Special Tests X-rayMRI

Special Test cont. CT scanBone Scan

Special Tests cont. UltrasoundElectromyography - EMG