Recognition, Evaluation and Management Chapter 2 Recognition of Injuries Primary function of athletic trainers is to recognize an injury when it happens, determine its severity, and apply proper evaluation. Two major considerations: Control life threatening conditions Management of non-life threatening injuries Question A gymnast slipped off the springboard on an approach to a vault and collided full force into the horse. As the on-site athletic trainer, you observe the gymnast lying motionless on the floor. Based on this information, is it appropriate to activate 911? While the condition of the gymnast may eventually warrant activation of the institution’s emergency medical plan, there is not sufficient information at this point to activate the plan. It is important that the athletic trainer assess the athlete’s condition to determine whether activation of the emergency medical plan is necessary. Referral to a Physician No breathing Suspected fracture or Severe bleeding Suspicion of intracranial bleeding Unconscious Paralysis Circulation and neurological impairment Shock Obvious deformity dislocations Pain, tenderness, or deformity on spine Significant swelling or pain, Loss of sensation Loss of motion Doubt about the severity of the injury. Student Athletic Trainers in Emergency Situations Becoming aware of the causes of serious injuries Making sure equipment and the playing area is safe. Alerting the athletic trainer and coach of potential dangers Recognizing serious injuries Assisting in EMS activation, splint use, crowd control. First Aid Emergency Care Follow the American Red Cross standards that will be taught to you in this class. All coaches and athletic trainers are certified in CPR and First Aid. Emergency Transportation Procedures Two points to consider: Availability of ambulance services Severity of an injury EMTs are skilled, practiced, professionals who routinely handle medical emergencies. They have the proper equipment to handle the medical emergencies. Questions In assessing the condition of the injured gymnast, what sequential process can be used to determine if the central nervous system(brain/spinal cord) and/or cardiorespiratory systems are critically injured? What conditions warrant activation of the emergency medical plan, including summoning EMS? Evaluation of Life Threatening Injuries When a serious injury is suspected, begin an evaluation with the primary survey Airway Breathing Circulation Make sure you are calm during this. Once the primary survey is complete, a secondary survey is doing including a history and physical exam of the injury. Evaluation of Non-Life Threatening Injuries Once a life- threatening injury is ruled out, medical evaluation of the injury should be more involved. There are several commonly used abbreviations to help remember all the important aspects of the evaluation: HOPS: History, Observation, Palpation, Special Tests SOAP: Subjective, Objective, Assessment, and Plan HOPS History: How did it happen? Where does it hurt? What did you hear? Previous injury? Observation: Look for bleeding, swelling, discoloration, deformity and compare anatomical structures Palpation (to touch): Palpate anatomical structures above and below injured site (start away - work toward); Palpate affected area//Bones, Ligaments, & Muscles Special Tests: Joint stability; Muscle/tendon//Range of Motion, Strength SOAP Subjective Findings: Ask detailed questions like when conducting an injury history Objective Exam Examination and Findings: Measureable visual, physical, and functional findings Assessment: Review the probable cause and mechanism of injury based on subjective a objective finding Plan: Outline appropriate action plan for care & rehab. Example-History A female high school long jumper sustains an ankle injury during practice and immediately reports to the athletic training room. What questions should be asked to identify the cause and extent of this injury? In attempting to determine the cause and extent of injury, the female long jumper should be asked questions pertaining to the following: primary complaint (i.e., what, when, and how questions), mechanism of injury (i.e., position of the ankle at the time of injury and the direction of force), characteristics of symptoms (i.e., nature, location, severity, and disability), unusual sensation (i.e., sounds and feelings), related medical history, and past injuries/treatment. Example-Observation A detailed history of the injury has been gathered from the long jumper. The information suggests a sprain of her right ankle. In the continued assessment of this individual, observation and inspection should be performed. What observable factors might indicate the seriousness of injury? Observable factors relative to the injured sight that might indicate the seriousness of the injury sustained by the female long jumper include deformity, swelling, discoloration, and signs of previous injury. It is important to perform a bilateral inspection of the injury site as well as of the surrounding area. In addition, observation of general presentation, including the presence of guarding or antalgic gait, will provide important information concerning the nature of the injury Basic Treatment Protocols After the eval, often the treatment is going to be similar and may or may not include physician referral. PRICES Protection – protect injury from further damage Rest – length depends on the injury Ice – 15 to 20 minutes Compression – elastic wrap to control swelling Elevation – higher than the heart if possible Support – splint, crutches, or sling First Aid Equipment Fixation Splint – Most common – board, SAM, pillow, etc. Vacuum Splints – conform to the injury Air Splints – No longer used often Traction splints – Long bone fractures, used by EMS 10 Key Points for Splinting Inspect for open wounds or deformity 2. Check pulse, motor, and sensation 3. Cover wounds 4. Do NOT move the athlete 5. Select proper splint 6. Place splint beside the injured extremity 7. Apply the splint with minimal movement 8. Secure the splint with straps 9. Check pulse, motor, and sensation again 10. Apply cold and document the time. 1.