Chapter 2 Recognition, Evaluation & Management of Athletic Injuries Recognition of Injuries

Recognition of Injuries Primary function of an athletic trainer are to recognize when an injury has occurred, determine the severity of the injury, and apply proper evaluation/treatment procedures and protocols.

Recognition of Injuries

Recognition of Injuries Two Major Considerations in Emergency Evaluation: Control Life Threatening conditions and activation of Emergency Medical Service. Management of non-life threatening Injuries.

Recognition of Injuries Refer to a Physician When: Loss of respiratory function (breathing) Severe bleeding Suspicion of intracranial bleeding and/or bleeding from the ears, mouth and/or nose Unconsciousness Paralysis Circulations or neurological impairment Shock Obvious deformity Suspected Fracture Pain, tenderness, or deformity along the vertebral column Significant swelling and pain Loss of sensation (motor or sensory) Loss of Motion Doubt about the severity of the injury

First Aid / Emergency Care The athletic trainer must maintain certification in Professional Rescuer. Which includes: (CPR) AED Training First Aid

Emergency Transportation Procedures 2 main Points to Consider: 1st – the availability of emergency ambulance service. 2nd – the severity of the injury

Emergency Transportation Procedures Never transport an athlete in a private vehicle because of liability issues.

Evaluation of Life Threatening Injuries When a serious Injury is suspected: Survey the Scene A irway B reathing C irculation Note: Unless you see the injury assume ALWAYS it is Life Threatening

Evaluation of Life Threatening Injuries Primary Survey: Approach athlete in a calm & reassuring manner Maintain a clear & open airway free of potential obstructions such as blood, vomitus, and foreign matter Position patient in the most comfortable position for breathing Be prepared for Rescue Breathing &/or CPR

Evaluation of Life Threatening Injuries Secondary Survey Once determined the athlete’s condition is non-life threatening History: Examiner Questions the Athlete

History Mechanism of Injury Onset of Symptoms Location of Injury Quantity and Quality of pain Type and location of any abnormal sensations Progression of signs and symptoms Activities that make the symptoms better or worse Nausea Weakness Dyspnea (shortness of breath)

Evaluation of Non-Life Threatening Injuries Physical Examination is the next step. Note: findings may vary tremendously from athlete to athlete Factors such as physical activity & exercise may account for this variance Examples that may vary are: respiratory rate, moistness, color and temperature of skin, & pulse rate.

Evaluation of Non-Life Threatening Injuries Physical Examination cont. Essential to evaluate & monitor VITALS: Abnormal Nerve Response Blood Pressure Movement Pulse Respiration Skin color State of Consciousness Temperature

Evaluation of Non-Life Threatening Injuries Once a life threatening injury has been r/o, medical evaluation of the injury must be comprehensive. In Athletic Training 2 formats of evaluation are commonly utilized: H.O.P.S. S.O.A.P.

H.O.P.S. History, Observation, Palpation, Special Test (Stress) The 1st purpose of an evaluation is to determine if a serious injury has occurred. Initially a fx should always be suspected.

H.O.P.S. Signs of Fracture: Direct or Indirect Pain Deformity Grating sound at injury site Some fx are NOT accompanied by swelling or pain. If a fx is suspected extremity should be splinted for transport.

H.O.P.S. Note: Young athletes are especially susceptible to fractures Often Ligaments and Tendons/Muscles are stronger than the bones

H.O.P.S. (H) History Involves questioning the athlete to determine Mechanism of Injury. Mechanism of Injury (How did it Happen?) Location of Pain (Where does it Hurt?) Sensations Experienced (Did you hear a “pop” or a snap?) Previous Injury (Have you been hurt here before?)

H.O.P.S. (O) Observation The athletic trainer should compare the uninvolved to the involved anatomical structure Look for Trauma Bleeding, deformity, swelling, discoloration, scars, and other signs of trauma

H.O.P.S. (P) Palpation The physical inspection of the injury. Palpate the anatomical structures/joints above and below the injured site. Palpate the affected area. The entire area around the injury may be sore but the ATC should try to pinpoint the site of severe pain.

H.O.P.S. (P) Palpation Knowledge of the anatomy and injury mechanism, the type and extent of the injury can be evaluated. Involve the athlete in the evaluation as much as possible.

H.O.P.S. (P) Palpation Use bi-Lateral comparison: Neurological Stability (motor/sensory) Circulation Function (pulse and Capillary Refill) Anatomical Structures (palpate) Fracture Test (Palpation, compression, and distraction)

H.O.P.S. (S) Special Test With a all special test, the ATC is looking for joint instability, and pain. It is possible to further damage an injury through manipulation To determine if damage has been done to the anatomical structures, the ATC use special test and functions test to access disability.

H.O.P.S. (S) Special Test These Test Include: Joint Stability Muscle/Tendon Accessory Anatomical Structures Inflammatory Conditions

S.O.A.P. S ubjective O bjective A ssessment P lan

S.O.A.P. Subjective Assessment (History) Requires the athletic trainer to ask detailed questions of pre-existing or existing injuries. Previous Injury How it Happened When did it happened What did you feel Types of pain Where does it hurt Sounds/noises “pop”

S.O.A.P. Objective Assessment Involves visual, physical, and functional inspections. Items to assess are: Swelling Deformity Ecchymosis Symmetry Gait/walk Scars Facial expressions Circulation Neurological test Bone Soft Tissue ROM Sport Specific Movements

S.O.A.P. Assessment Reviews the probable cause and mechanism of the injury, impression of the injury site, severity of injury, and treatment goals.

S.O.A.P. Plan Should outline appropriate action that should be taken to care for the injury. Initial Actions Include: Immediate Action Referral Modalities Utilized Preventative Techniques (Bracing/Tape) Rehab Considerations Criteria for Return

Basic Treatment Protocol Followed by referral to a physician when necessary all treatment protocol should follow the Acronym PRICES P rotection R rest I ce C ompression E levaltion S upport

PRICES Protection After the injury Protect injury from further damage by removing the athlete from participation Rest After the evaluation, rest the injury. Depends on severity

PRICES Ice Apply Cold to the injured area. This will aid in controlling bleeding/swelling. Two Methods: Ice Packs (ice bag, gel pack) 15 to 20 min. at least 1 to 2 hours apart. Cold Water Immersion Bath (Whirlpool, bucket, tub) H2O Temperature between 50 – 60 degrees. Same protocol as Ice Packs Careful with patients with circulation issues, sucha as diabetics & elderly.

PRICES Compression Using a compression wrap to control swelling. When possible wrap site distal to proximal. Always check circulation (signs of poor circulation are?) Do not sleep with wrap. Elevation Keep the injured body part elevated higher than the heart. Allows the use of gravity to aid in swelling prevention.

PRICES Support To include splinting and/or crutches or slings. Splints are intended to protect an injury from further damage. Splinting Equipment Fixation Splints Most common (board, SAM, pillow, blankets) Vacuum Splints Most common usage is for dislocations, deformed or misaligned fx Traction Splints Used for long bones like the Humerus/Femur Prevent lfx ends from touching (major arteries are protected) Medical Training required (EMS personnel)

10 Key Points to Consider When Splinting Inspect injury for open wounds, deformity, swelling, and ecchymosis. Check – Pulse, Motor, Sensations (PMS) and capillary refill of the injured site distal to the injury. Cover all wounds with a dry sterile dressing before applying a splint Do not move the athlete before splinting extremities unless there is an immediate hazard to the athlete or you. Select proper splint in which length and size should cover the immediate injured area, along with all joint structures above and below.

10 Key Points to Consider When Splinting Place splint beside the injured extremity and then smooth out the contents of the splint. The larger end of splint should be placed proximal to the injury. When applying the splint, use your hands to minimize movement. Also, support the injury above and below when applying the splint on the extremity. For stabilization purposes, apply gentle traction to the limb. Secure splint with straps by applying firm compression/ Again, check PMS, and capillary refill at a point distal to the site of injury. Apply cold to the injured area and document time. X-rays can be taken withour removing MOST splints.

In all injury management protocols, make sure that you know the proper techniques and work within your knowledge base.