Injury Care & Prevention Exam #2

Front 1

The Emergency Action Plan (EAP) should include:

Back 1

-separate plan for each venue.
-determine who will be on the field during practices and games. Each person should understand their role & responsibility.
-determine which emergency equipment should be present for each sport for practices and games. The needs will be different for each sport.
-determine the location of emergency equipment.
-establish specific procedures re: removal of protective equipment, especially helmet and shoulder pads.
-phone, gate, key. cell or digital phones are recommended.
-Know where the local 911 calls are directed. Is 911 accessed by a cell phone or land line?
-

Front 2

Emergency Situation Procedures:

Back 2

Quick evaluation includes:
-# of injuries/people present to help
-ABCs: airway, breathing circulation. also check for shock or profuse bleeding.
-condition of each injury
-necessary treatment/order: 3 Cs = check, call, care.
-Quickly determine what the necessary course of action will be.
-Complete detailed documentation of the incident, injury/ies, who was present, course of action, transportation etc.
-Follow-up: follow-up with the athlete to determine outcome and rehabilitation if necessary.

Front 3

Course of Action:

Back 3

-Consent to treat and/or transport from a parent for minors.
-Contact emergency contact to inform of the injury and location of treatment.
-Self/parent transport
-EMS
-Cooperation is crucial:
- backboarding
-equipment removal
-allergies/medication

Front 4

Evaluation or Life Threatening Injury Assessment:

Back 4

-Injury
-ABCs
-Primary Survey
-Level of Consciousness

Front 5

Unconscious Athlete: 3 Cs = check, call, care.

Back 5

-stabilize cervical spine (always assume head and neck injury has occurred).
-responsiveness, ABCs, shock, bleeding.
-911
-Care

Front 6

Conscious Athlete:

Back 6

-secondary survey
-vital signs, Hx, MS Eval
-treatment
-transportation

Front 7

Primary Survey:

Back 7

-Equipment considerations
-LOC (level of consciousness)
-Opening Airway
-open/gain access by placing hand on forehead and tilting the chin down.
-if airway is obstructed, remove item.
-Establish breathing & circulation by: rescue breathing, CPR, AED

Front 8

Primary Survey & Controlling Bleeding:

Back 8

-External Bleeding:
-apply direct pressure.
-elevation above the heart
-use pressure points to stop bleeding if direct pressure is not working.
Internal Bleeding:
-Invisible
-skull, thorax, abdomen will get hard if there is bleeding.
-determinable by X-ray or MRI

Front 9

Primary Survey & Shock:

Back 9

Signs & Symptoms:
-pale, cool & clammy skin.
-irritable, restless, excitement, disinterested.
-weak & rapid pulse.
-increased & shallow breathing.
-decreased BP.
-urinary & feces retention incontinence.
Management:
-911
-core temp. maintained at close to normal.
-elevate legs 8-12" to keep blood flow to the core.

Front 10

Injury Assessment
-Vital Signs:

Back 10

-Heart Rate (HR)
- Location: 1st choice = radial pulse located @ wrist.
2nd choice = carotid pulse located @ neck.
- Normal pulse = adults 60-80, kids 80-100.
-Abnormal pulse = tachycardia (rapid), arythmea (irregular), bradycardia (slow)

Front 11

Injury Assessment
-Vital Signs:

Back 11

Temperature:
- locations: rectum, tympanic membrane (ear)
- normal = 98.6 F
- abnormal is lower or higher than 98.6F
Skin color:
-Pale = circulation, shock, hemorrhage, heat exhaustion, insulin shock, fright.
-Red = heatstroke, high BP, high temp.
-Blue (cyanotic) = located on lips and finger nails. Means airway obstruction or respiratory insufficiency.

Front 12

Injury Assessment
-Vital Signs:

Back 12

Pupils:
-Should be equal size.
-If pupils are unequal then it could be a stroke, head injury or drugs.
-Should respond to light by either dilating or constricting.
Level of Consciousness:
-Normal = alert, aware of environment, responsive.
-Not normal = weakness on one side of the body, numbing, tingling, loss of sensation.

Front 13

Neurological Changes:

Back 13

Dermatomes = sensory levels (locations)
Myotomes = motor levels (locations)

Front 14

On-Field Evaluation:

Back 14

Primary survey = injury seriousness, first-aid, immobilization, necessary transportation, physician treatment.

Front 15

On-Field Evaluation:

Back 15

Secondary survey =
-Questions like did they hear any sounds when injury occurred, how did it happen.
-Observations, ex. injury site.
-Palpations (feeling) pin point location of pain = fracture.
Special tests (off field)
-Transportation needs.
-Documentation

Front 16

Off-Field Evaluation:

Back 16

-More thorough evaluation.
-To be completed by: Dr. PA, ATC, PT
-SOAP/HOPS/HIPS Notes: Need to know:
-Documentation
- Format
- Law

Front 17

SOAP Notes:

Back 17

- S = subjective. pain scale, their perceptions of how they feel, their experience of the injury.
- O = objective. what you see, feel and do to the athlete. ex. swelling (adema), bruising (ecomosis), redness (erythema)
- A = Assessment, diagnosis.
- P = Plan

Front 18

Immediate Treatment:

Back 18

PRICE:
P=protection, R=rest, I=Ice, C=compression, E=elevation.
Emergency Splinting for a fracture = commercial emergency splint, 1 joint above fracture & 1 joint below fracture.
-NSAIDs = non steroidal anti-inflammatory drugs. non prescription dose given is 400 mg.

Front 19

Splinting:

Back 19

Lower extremity=
-Injury to the foot/ankle: splint up to the knee.
-Injury to the knee: splint up to the hip.
Upper extremity=
-Injury to the finger: splint the finger.
-Injury to the hand/wrist: splint up to the elbow.
-Injury to the elbow: splint up to the shoulder.
-Injury to the shoulder: sling and strap to the body.
-Cervical Spine: collar.

Front 20

Transportation Methods:

Back 20

- #1 goal is to CAUSE NO FURTHER HARM.
-Spine boarding
-know the correct method
-all personnel spine boarding should cooperate.
-2 person carry/manual

Front 21

Crutches:

Back 21

Fit:
-1" from pad & armpit.
-Walking DON'T Swing
-Partial weight bearing
-Stairs- up with the good leg first, down with the bad leg first

Front 22

Mechanical Injury:

Back 22

-Trauma is a physical injury or wound sustained in a sport and produced by internal or external force.
-Injury in sports can be the result of external forces directed on the body or can occur within the body internally.
Sprain = ligaments
Strain = muscle and tendons.

Front 23

Tissue Stresses:

Back 23

-Results from a break in the skin as a result of trauma.
-Anatomical Considerations:
-Skin (external covering on the body): largest organ of the body & consists of 2 layers:
-epidermis - dead cells, top surface of skin, will bleed.
-dermis (corium) - more painful, below the epidermis level.

Front 24

Tissue Stresses:

Back 24

-Injurious mechanical forces: include friction, scraping, compression, tearing, cutting and penetrating.
-Wound classification:
-Friction blister: due to poor fitting shoes, weight lifting, crutches.
-Abrasion: scraping injuries. exposes blood capillaries leads to increase of skin infection so injury has to be cleaned very good.
-Skin bruise (contusion): treat with ice, NSAID, pad the injury.

Front 25

Tissue Stresses:

Back 25

-Wound classification cont'd:
-Laceration: jagged-edge irregular cut. High risk of infection, needs to be cleaned.
-Skin avulsion: skin is torn from the body and associated with major bleeding. tissue preserved on saline solution moist gauze and placed in a plastic bag, immersed in cold water & accompanies athlete to hospital.
-Incision: smooth edged clean cut.

Front 26

Skeletal Muscle Injuries:

Back 26

-High incidence occurrence in athletics.
-Anatomical characteristics:
-composed of contractile cells that produce movement.
-Possess following characteristics: contractility & elasticity.

Front 27

Three Types of Muscle:

Back 27

-Cardiac
-Smooth
-Striated (skeletal)

Front 28

Acute Muscle Injuries:

Back 28

-Contusions:
-Result of mechanism of injury.
-Can be both deep and superficial and an MRI is required to determine.
-Can penetrate to the bone.
-Usually rated by the extent to which muscle is able to produce range of motion.
-Blow can be so sever that fascia surrounding muscle ruptures allowing muscle to protrude.
-Hematoma results and the bruising determines the grade of an injury. Speed of healing dependent on the extent of damage.

Front 29

Acute Trauma:

Back 29

Signs & Symptoms of Severe Contusions:
-Athlete reports being struck by hard object.
-Impact causes: rapid swelling, hard to the touch, bruising around swelling.
-Palpation reveals hardened area.
-Possible ecchymosis.
*Apply ICE!

Front 30

Muscle Strain:

Back 30

Strains:
-Stretch, tear or rip the muscle.
-Cause is often obscure, muscle tightness.
-Abnormal muscle contraction can be the result of strength imbalance and explosive movements. Women have weaker hamstrings.
-May range from a small separation of connective tissue to complete muscle rupture.

Front 31

Muscle Strain Grades:

Back 31

-Grade 1: some fibers have been stretched or actually torn resulting in tenderness & pain on active ROM, movement painful but full ROM present.
-Grade 2: number of fibers have been torn & active contraction is painful, usually a depression or divot is palpable, some swelling & discoloration is present.
-Grade 3: complete rupture of muscle or musculotendinous junction, significant impairment, initially a large amount of pain that diminishes due to nerve damage.

Front 32

Muscle Spasms:

Back 32

-A reflex reaction caused by trauma.
-Two types:
-clonic - alternating involuntary muscular contractions & relaxations in quick succession.
-tonic - rigid contraction that lasts a period of time, muscle cramp.
-May lead to muscle or tendon injuries if you use the muscle during spasms.
-Treatment: stretch, massage, ice.
-Prevention: sodium, potassium, fluid & magnesium.

Front 33

Overexertional Muscle Problems:

Back 33

-Reflective in muscle soreness, decreased joint flexibility, general fatigue (24 hours post activity).
-4 indicators of possible overexertion:
1) Muscle soreness:
- Due to overexertion in strenuous exercise.
- Generally occurs following participation in activity that individual is unaccustomed.
2) Muscle stiffness:
- Does not produce pain
- Result of extended period of work.
- Fluid accumulation in muscles, with slow reabsorpbion back into bloodstream, resulting in swollen, shorter, thicker muscles which become resistant to stretching.
- Light activity, motion, massage & passive mobilization assist in reducing stiffness.

Front 34

Overexertion:

Back 34

-4 indicators of possible overexertion cont'd:
3) Muscle cramps:
- Extremely painful involuntary skeletal muscle contraction.
- Occurs in well-developed individuals when muscles is in shortened position.
- Experienced at night or at rest
-Often occurs in the calf, abdomen or hamstring.
-Can be prevented with adequate replacement of electrolytes that are lost during exertion through sweat: sodium, chloride, potassium, magnesium, calcium, fluid.
-Can be treated with ice, stretch & massage.

Front 35

Overexertion:

Back 35

4) Muscle guarding:
-Following injury, muscles within an effected area contract to splint the area in an effort to minimize pain through limitation or motion.
- Involuntary muscle contraction in response to pain following an injury.

Front 36

Chronic Musculoskeletal Injuries:

Back 36

-Progress slowly
-Due to repetitive motions.
-Due to not removing the source of the swelling and pain.
-Constant use of the muscle or tendon will result in constant pain.
-Chronic muscle injuries are due to acute injuries being improperly managed.

Front 37

Chronic Musculoskeletal Injuries:

Back 37

-Tendonitis:
- Is an example of a chronic injury.
- Occurs due to swelling or inflammation of a tendon.
-Tenosynovitis:
- Results in swelling & fluid around tendon in the sheath.

Front 38

Tendon Healing:

Back 38

-Tendons connect muscle to bone.
-Tendons complicate healing.
-Requires a strong union, but also flexibility.
-Needs a lot of collagen to be strong enough.
-Too much collagen & it will not be flexible.
-Achieve appropriate tensile strength at approx. 5 weeks, which means working on flexibility can begin AFTER 5 weeks.

Front 39

Nerve Healing:

Back 39

-Can NOT generate if the nerve cell is dead.
-If the nerve cell body is not injured, it can regenerate.
-Regeneration in nerve cells is a very slow process.
-CNS regenerates very slowly compared to peripheral nerves. ex. the spine heals much slower than the nerves in arms & legs.

Front 40

Bone Healing:

Back 40

-Similar to soft tissue: includes all phases.
-Bone regeneration is limited.
-Osteoblasts: cells that produce bone
- creates a callus
- size of callus depends on fx (function).
- Osteoclasts: cells that reabsorb bone & clean up debris.
- It takes approx 6-8 weeks for bone to heal.
- Plates & screws actually speeds up healing of fractured bones.

Front 41

Acute FX Management:

Back 41

- Bone will die if there is a poor blood supply.
- Poor immobilization occurs if movement is allowed between the separated bone ends.
-As the muscle around the broken bone atrophies the cast should be taken off & bone recast 3-4 weeks after initial cast.
- Infection:
- Staph infection is an easily spread & rampant infection.
- Will interfere with union of bones.

Front 42

Stress Fracture:

Back 42

- Compression or tension of the muscle pulling on the bone.
- Causes an increase in bone re-absorption.
- Can lead to a complete fracture if not treated correctly.
- Treatment:
- Rest
- Non weight bearing exercising.

Front 43

Soft Tissue Healing:

Back 43

- Management:
- manage pain & inflamation
- PRICE, prevention, rest, ice, compression, elevation.
- NSAIDs:
- Decrease pain, decrease inflammation
- muscles slow down healing process.
- Modalities:
- Stim = electrical stimulation.
- US = Ultra-sound.
- Ice for 72 hours.
- Heat
- Exercise:
- Regain strength and ROM, promote healing.
- Proprioception = balance w/o seeing

Front 44

Pain:

Back 44

- Subjective: what the athlete feels & will be different for everyone.
- Cutaneous:
- Sharp, bright, burning
- Muscle, tendon, bone, ligament
- Visceral (damage to internal organ)
- Diffuse, later becomes localized.
- Internal organs, ex. appendicitis.
- Psychogenic:
- Feels pain, but is an emotional reaction rather than physical. Could be a result from emotional stress.

Front 45

Referred Pain:

Back 45

- Pain that occurs away from the site of irritation. ex. internal organs.
- Depends on nerve fibers.
- Trigger points is a point that is palpated but the pain is felt elsewhere.
- Heart attack is felt in the left arm, left shoulder.
- Appendix is felt @ Burney's point.
- Spleen is felt in the left arm, left shoulder (Care signs)

Front 46

Pain Assessment:

Back 46

- Visual scale: smiley faces to sad faces.
- Pain chart
- Numeric scale

Front 47

Inflammatory Process

Healing Process:

Back 47

- The healing process is the same with all injuries.
- There are 3 different phases:
- Inflammatory response
- Fibroblastic repair
- Maturation-Remodel: Scar
- There is no definitive beginning or ending.
- The phases overlap each other.

Front 48

Inflammatory Response:

Back 48

- 5 Signs:
- Symptoms: swelling (adema), pain, heat (hyperthermia), loss of function, redness (erythema).
- Necessary for healing to occur.
- White blood cells & phagocytic cells are delivered to injured tissue.
- They set the stage for repair.

Front 49

Inflammatory Response:

Back 49

- Vascular Reaction:
- blood vessels will vasodialate (increase in size)
- increased vascular permeability.
- increased blood viscocity (blood flows slower).
- decreases lymphatic dreainage. Localized.

Front 50

Inflammatory Process:

Back 50

- Chemical Mediators:
- Limit amount of swelling:
- Histamine: causes vasodialation (open up)
- Leukotaxin: causes increase in vascular permeability.
- Necrosin: aid in blood coagulation to form a blood clot.

Front 51

Inflammatory Process:

Back 51

- Clot Formation:
- Platelets stick to collagen fibers to create a sticky mess.
- Other platelets & WBC stick to this & create a plug or a clot.
- This plug does not allow for blood & fluid to pass through.
- Begins approx a few seconds & developed in a few minutes after injury.

Front 52

Inflammatory Process:

Back 52

- Chronic Inflammation:
- Occurs when rehab is completed too quickly.
- The injuring agent is not eliminated.
- Tissue is not restored.
- WBC leukocytes are replaced with: macrophages, lymphocytes (attack specific antingens), plasma cells.
- Causes:
- Overuse
- Continuous micro-trauma.

Front 53

Fibroblasic Repair:

Back 53

- Scar Formation:
- Fibroplasia, or fibrogenesis = creation. Genesis = creation of.
- Begins w/in a few hours of injury.
- Collagen fibers are laid down in random order.

Front 54

Fibroblasic Repair:

Back 54

Tissue Repair:
-Endothelial capillaries allow for oxygen to get to tissue to increase blood flow.
-Granulation tissue forms and it is delicate, breaks down the clot & fills in the gaps.

Front 55

Maturation Remodel:

Back 55

-Long term, it can take weeks, months or years.
-Re-align collagen fibers in the scar tissue.
-Re-align according to the stresses placed upon it: Wolff's Law. ex. knee extension.
-May take several years for completion.

Front 56

Controlled Mobility:

Back 56

-Gradually increase loads placed in injured body part, so that the tissues may adapt & remodel themselves = controlled mobility.
-Immobilization:
- Good during the inflammatory process to control the swelling.
- Bad during the later phases: permanent scar tissue can lead to a decrease in ROM & strength.

Front 57

Interferes With Healing:

Back 57

-Extent of Injury: macro v.s. micro.
-Edema: swelling, increase pain, decreases strength & ROM.
-Hemorrhage: swelling, increase pain, decreases strength & ROM.
-Poor vascular supply: ex. Achilles tendon.

Front 58

Definitions:

Back 58

-Hx: history
-Contusion: bruise
-Edema: swelling
-LOC: level of consciousness
-Dermatomes: sensory levels
-Myotomes: motor levels.
-Pin point pain: fracture
-SOAP: subjective, objective, assessment, plan
-PRICE: prevention, rest, ice, compression, elevation
-NSAIDs: non-steroidal anti-inflammatory drug
-Non-contractile tissue: skin, ligaments, tendons.
-Contractile tissue: muscle.

Front 59

Definitions:

Back 59

-Abrasion: scraping injuries.
-Laceration: jagged edge irregular cut.
-Avulsion: skin coming off of the body.
-Incision: smooth edge cut.
-Puncture: penetrating cut.
Striated muscle: skeletal

Front 60

Definitions:

Back 60

-Sprain: ligament.
-Strain: muscle, tendon.
-Hematoma: collection of blood, clot, caused by the break in the wall of a blood vessel.
-Fx: fracture.
-Cutaneous: muscle, tendon, bone, ligament
-Visceral: internal organs.
Proprioception: balance w/o seeing.

Front 61

Definitions:

Back 61

-Hyperthermia: heat
-Erythema: redness
-Vasodialate: increase in size.
-Fibroplasia or Fibrogenesis: creation of.
-WBC: white blood cells.
-Wolff's Law: re-align tissue according to stress placed on it.
-Keloids: too much scar tissue formatoin.
-Atrophy: wasting away of muscle.
Contracture: abnormal shortening of the muscle tissue.

Front 62

Definitions:

Back 62

-Sublaxation: partial dislocation of two bones.
-HBV: hepatitis B
-HBC: hepatitis C
-Sx: sypmtoms
-Asymptomatic: no symptoms
-PPE: personal protective equipment.