Injury Assessment & Evaluation Procedures Primary Survey -ABCs Secondary Survey - HOPS

Step One: SAFETY Does the scene appear to be safe? Is practice still going on? What are others in the area doing? Is there a shooter on the roof? Or what may have caused the player to drop down? Look carefully around the scene!

Step Two: Primary Survey Goal  recognize and evaluate all injuries for each individual patient. This is systematic and follows a specific procedure. A – Check LOC (level of consciousness) Call the patient to elicit a response Is the patient awake or unconscious? If responsive, ask their name, what happened, the location, and what hurts. If no response, “tap and shout” If no response, pinch finger webs. If nothing, they are unconscious.

Step Two: Primary Survey B – Check Airway, Breathing and Circulation (ABCs) Airway – check for obstruction Breathing – Look for the chest to rise Listen for breath sounds from the nose & mouth Feel for the air on your cheek Circulation – check for pulse gently on the side of the throat with first & second finger

Step Three: Secondary Survey The “Evaluation” Done once it has been established that the pt. does not have any life-threatening injuries There are 3 different formats: HOPS HIPS SOAP

Step Three: Secondary Survey H.O.P.S.=  History, Observation, Palpation/Physical Exam, Special Tests, which will be focus of today's lesson. H.I.P.S. = History, Inspection, Palpation/Physical Exam, Special Tests S.O.A.P.= Subjective information, Objective Information, Assessment, Plan is used to assist in documentation of injuries, daily treatments, weekly / Bi-weekly summaries PRN(as needed)** * We will focus on the HOPS Format for assessing injuries ** We will discuss S.O.A.P. notes in a later section.

H = HISTORY In this portion of the evaluation the information comes mostly from the patient. It includes medical history (hx) of the patient and Sign & Symptoms (S/S). What to find out: Who they are? ………..Patient’s Name What Happened?........How did injury occur Where did it happen?.........Did it happen on a field, court, locker room etc Any Previous Medical History (Hx)?....Has the body part ever been injured before What is your primary Complaint?..... What is the worst thing about the injury

H = HISTORY cont. Type / quality of Pain they are having?....Is it sharp, achy, throbbing etc Location of pain?.....Have patient point to location of pain!; Pain Scale 0 to 10. Have patient state a number giving a level of pain he/she is in: 0 = no pain ,  10 = Worse pain ever!!!; Does pain increase with activity, if so what? What has the patient done in the past to address his/her pain. Any snapping/cracking/ popping sensations (this is called crepitus) ACTIVITY- Pair up and ask your partner about an injury he/she sustained in the past. Have them answer the History questions.

O= OBSERVATION O: Observation= Visually looking at the injury. This refers to physical signs of injury that are recognized by the ATC or other medical Professionals. Why do you think that the athletic trainer still has not touched the injured athlete? Looking for: Swelling (type, location, amount) Discoloration Deformities Gait/weight-bearing Posture Scars from previous injuries Bleeding What should you do if you see bleeding?

O = OBSERVATION cont. Discoloration/Ecchymosis: Black & Blue skin Yellowing in later stages Position  / Posture of an Athlete Holding / Guarding (protecting) a body part Grasping a body part “SCREAMING USUALLY” Decorticate, Decerebrate ALWAYS Compare Involved side with Uninvolved (CONTRALATERAL) side whenever possible. Why is this necessary?

O = OBSERVATION Cont. Bicep - partial tear Scapula Winging

What do you notice in the above pictures? O = OBSERVATION cont. What do you notice in the above pictures?

P = PALPATION This is the first time you actually touch the athlete You use the information you gained during the history and inspection to guide you Now you are FEELING for clues about the injury You always palpate the uninjured side first Why? Then you palpate the injured side starting away from the area of most pain.

P = PALPATION cont. Remember to observe universal precautions if your observation revealed blood or body fluids Things you are looking for during palpation Temperature changes: hot or cold Deformities Point tenderness Crepitus Swelling (wet diaper vs. water balloon) Rule out fractures

P = PALPATION cont.

S = SPECIAL TESTS The tests used in this section will be different for each body part that we cover Remember to perform each test bilaterally In general the tests are used to determine Joint range of motion Muscle strength and function Ligament stability Nervous function/integrity

S = SPECIAL TESTS cont. ROM & Muscle Testing Used to determine if the range of motion of a joint is within normal limits Always test bilaterally Three ways to test range of motion– test them in this order Active—the athlete move the joint themselves Passive– the athlete is relaxed and you move the joint through the ROM Resistive-- you apply resistance while the athlete moves the joint

ROM/Special Testing cont.

Ligament Testing Tests used to determine the integrity of specific ligaments We will learn specific tests during future units Results of these tests, along with the history, inspection and palpation will allow you to “grade” sprains

Grades of Sprains Grade I Ligament testing reveals solid endpoint (rope) Little to no swelling/loss of function Grade II Ligament testing reveals soft endpoint (bungee) Grade III Ligament testing reveals no endpoint (nothing)

Grades of Sprains cont.