1. Assessment of the Unconscious Athlete
ATTR 322
Krzyzanowicz- Spring 13

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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?

10. 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

11. 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