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

2. 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.

3. Recognition of Injuries

4. 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.

5. 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

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

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

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

9. 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

10. 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

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

12. 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)

13. 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.

14. 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

15. 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.

16. 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.

17. 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.

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

19. 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?)

20. 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

21. 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.

22. 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.

23. 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)

24. 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.

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

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

27. 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”

28. 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

29. 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.

30. 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

31. 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

32. 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

33. 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.

34. 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.

35. 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)

36. 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.

37. 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.

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