How to assess an athletic injury.

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These are important proficiencies that everyone on the athletic heath care team must possess
The knowledge and expertise of the certified athletic trainer, which are applied to evaluate injuries immediately after they occur, helps in getting the proper aid to the athlete as quickly as possible

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Certified athletic trainers can assess and evaluate, but cannot diagnose
Diagnosis is the domain of the licensed health care provider, typically a physician, although sometimes limited by his or her specialty
The physician uses all the information obtained in the evaluation to arrive at a diagnosis of the injury
The certified athletic trainer uses information from the physician to set short-term and long-term goals for recovery

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Many factors influence the type and severity of athletic injuries
 Some but not all can be controlled by the athlete
Anthropomorphic data
 includes the size, weight, structure, gender, strength, and maturity level of the athletes involved
 compare high school and college athletes
○ JV athletes are much smaller than Varsity athletes
○ college athletes are stronger, faster, and have mature body structure

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Mechanism of force
 comprises all forces involved at the time of an impact, including:
○ the direction of the force
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○ its intensity and duration the activity being undertaken
○ the position of the body part at the time of injury

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Speed
 influences the type and severity of athletic injuries because a greater speed of collision causes a greater chance of injury
 If athletes of greatly differing skill levels practice together, the lesser skilled athlete typically has the greater chance of being injured
Protective equipment
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Greatly reduce the risk of injury by absorbing and distributing force that would be otherwise absorbed by the body
New materials and better equipment design have helped to reduce injuries even though athletes are getting bigger, faster, and stronger

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The skill level of the athlete
 influences the rate and severity of athletic injuries because the more skilled athlete has a greater knowledge of what to do to minimize risk of injury
 Playing within one’s ability, and being in control, is an important factor in minimizing the risk of injury

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Certified Athletic Trainers are trained to:
 Recognize when an injury has occurred
 Determine its severity
 Apply proper evaluation procedures and treatment protocols
Recognition of injuries is the process in which the certified athletic trainer determines the probable cause and mechanism of injury, based on direct observation or second hand accounts

 Involves controlling life-threatening conditions first and activating the emergency medical services
(EMS) when needed.
 Evaluators look for the basic ABCs

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Airway
 Open the victim’s airway by tilting the head back and lifting the chin, unless spinal injury is suspected, the jaw-thrust technique is safer
Breathing
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Listen, look, feel for breathing
If victim is not breathing, give two breaths and check for circulation
Circulation
 Check for signs of circulation such as breathing, coughing, or movement in response to the breaths. If there are no signs, start chest compressions

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Only individuals properly trained and certified in CPR should practice this application
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The Good Samaritan law protects most helpers from legal actions brought against them, but not if the helper performs procedures for which he or she is not properly trained

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For those trained in CPR, the American
Heart Associate provides guidelines, recommending that rescuers phone 9-1-1 for unresponsive adults before giving CPR
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 provide one minute of CPR for infants and children to the age of eight before calling 9-1-1
Begin chest compressions in the absence of circulation signs, giving about 100 compressions per minute for a person over 8 years old, at a ratio of 30 compressions to 2 breaths.
Chest-compression-only CPR is recommended only when the rescuer is unwilling or unable to perform mouth-to-mouth rescue breathing

 The Secondary Survey involves the management of nonlife-threatening injuries, entailing a thorough, methodical evaluation of an athlete’s overall health. The H.O.P.S (history, observation, palpation, special tests) evaluation if often used
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Take their time and be thorough, ruling out the most serious injuries first
Athletic Trainers run the risk of overlooking additional injuries if they are pressed to return an athlete to competition
The well-being of the athlete always comes first

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Gather history before touching the athlete. Question others who witnessed the incident
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What happened? Body part injured; description of injury.
When did the injury occur?
What factors influenced the injury? Some factors include position of the body and injured area; activity (collision or contact); speed; direction of force; the force’s intensity, duration, and results (twisting, hyperextension, hyperflexion).
Was a sound heart? Was it a pop, snap, rip?

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Where is the pain located now? Where was the pain at the time of injury?
Describe the pain: sharp or dull/achy, stabbing, throbbing, constant, cramping, and intermittent. Is the pain present at rest or with use of the injured body part? What is its intensity (rate on a scale of 1-10)?
Are neurological functions intact? Is there numbness, pins-and-needles prickling, muscle weakness, paralysis, burning sensation?
Is there instability? A sense that something not working right (do not have the person actually use the part in question)
Is there a prior history associated with the injured body part?

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Expose the injury to observe the extent of damage.
 It is important to recognize the privacy of the athlete, exposing the injury in a locker room or private area if at all possible
 It is good practice to have a member of the training staff who is the same sex as the inured athlete in attendance for all examinations

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Observation
 Compare the injured side to the uninjured side
 Always look above and below injury site
 look especially for deformity, swelling, bleeding, and skin color changes

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Palpation is the touching of the injured athlete
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 should be firm enough to cause pain palpating too lightly may result in missing a significant injury observe facial expressions 
Active motion is movement done by the athlete, asking him or her to move the injured body part through its full range of motion
Passive motion is movement done by the examiner, with the athlete relaxing all muscles
Resistive motions is when a force is applied to the athlete’s movement

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Test for strength
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Ask athlete to contract muscles around the injury without moving bones (isometric contraction)
Note any visible defects and palpate for knots or lumps in the injured muscle
Stability tests investigate ligamentous laxity, a stress test for ligaments. A sprain can then be graded 1, 2, 3
 A grade 3 sprain or complete tear will require prompt referral to an orthopedic surgeon for repair
Special tests and examinations may be necessary to establish the degree of injury

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Functional activity tests determine the level of activity the athlete may resume.
Allow the injured athlete to stand, walk, hop, jog, sprint, cut, and twist.
Test the uninjured side first for comparison purposes.
Sports-specific activity tests determine if the athlete can safely resume the activities of a particular sport.
Injured athletes are asked to demonstrate specific maneuvers and actions of their sports, with appropriate supporting devices such as taping.

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Full strength refers to muscles, ligaments, and tendons being at 100% of pre-injury strength
An athlete must be free from pain during return-to-play performance tests.
Skills required for the sports are tested, starting at a low level of intensity and gradually increasing until the athlete is performing at game speed. If at any time the athlete is not able to perform one of the tests, the athlete is not ready to return to the sport

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Emotional recovery is just as important as physical recovery/ counseling by the certified athletic trainer or sports psychologist helps the athlete work through any hesitation of returning to play

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Advantages of complete documentation
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One of the biggest reasons for complete documentation is for the follow-up care
Athletes are more likely to get the treatment they need with proper documentation
A profile of injuries in a sport can allow the program director to recognize trends, which can be shared with coaches who can then develop strengthening and stretching programs that may lower injury rates
If a lawsuit is filed for negligence or malpractice, good recordkeeping will help keep the facts straight

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SOAP notes refer to a particular format of recording information regarding treatment procedures (subjective, objective, assessment, plan)
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Subjective
○ The component that incorporates subjective statements made by the injured athlete, often obtained through history taking
Objective Finding
○ include the certified athletic trainers’ visual inspection, palpation, and assessment

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Assessment of the injury
 certified athletic trainer’s professional judgment and impression as to the nature and extent of the injury
Plan
 First aid treatment rendered to the athlete and the sports therapist’s intentions as to disposition, which could include referral for more definitive evaluation or simply application of a splint, wrap, or crutches and a request for reevaluation the next day

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The daily sideline injury report is a way to track every athlete who participates in a sport.
 Data can later be analyzed by computer to reveal injury patterns
The training room treatment log is filled out by certified athletic trainers as they treat athletes
 Everyone taped, wrapped, iced, and so on should be documented

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Daily red cross list
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Used to inform coaches of the status of their athletes from one practice to another
After athlete returns to full practice and competition, his or her name is removed from the list
An athlete medical referral form
 From the certified athletic trainer taken to the doctor allows accurate communication between the training staff and the physician’s office