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103 Cards in this Set
- Front
- Back
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Epistaxis Rx Anterior |
Most cases controlled by leaningforward with direct pinching of nostrils against nasal septumfor at least 10 min. Plug for return to play? |
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Epistaxis Rx Posterior |
examine posterior pharynx, requiresmedical management (e.g. epistaxis balloon). |
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Tooth Avulsion Rx |
retrieve tooth, handle by crown, ifdirty irrigate with sterile saline, milk, or sucked cleanunder tongue, re-implant and splint if athleteconscious and alert (within 15 min), bite on sterilegauze, transport.• If athlete is not fully alert, store tooth in sterile salineor skim milk, transport (re-implant within 2 hrs) |
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Luxation of tooth Rx |
reposition and splint, transport |
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Signs/Symptoms Grade 1 Muscle Strain |
tenderness and pain |
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Acute Dislocations Rx |
Glenohumeral• Patellofemoral• Fingers Rx: stabilize, monitorneurovascular status,transport Reduction byphysiotherapist? |
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Acute tendon injuries Rx Achille’s tendon (Thompson test, Matle’s test)• Biceps brachii• Other: pec maj, finger flexor tendons |
PRICE– Transport– Surgery / immobilize |
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Fractures Rx |
immobilize, monitor neurovascular status,transports (as a physio, if you think there may be a fracture, if they can't weight bear four steps, and there is tenderness in the area - send them to a doctor to get an xray for the diagnosis) |
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Wound (abrasion or laceration) Rx |
clean (soap & water, not alcohol), debride,dress with non-adherent bandage if abrasion |
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What is Exercise-Induced Bronchospasm and when does it occur |
Also known as exercise-induced asthma• Incidence increasing• Occurs during recovery from exercise (reducedflow rates and volumes) |
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Signs and symptoms of exercise-induced bronchospasm |
SOB, chest tightness, wheeze, drycough post-exercise, poor performance,fatigue. |
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Bronchospasm Rx |
bronchodilator, monitor athlete• Pulmonary embolism?? ( |
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Muscle Cramp Three theories |
Electrolyte Depletion Theory– Dehydration Theory– Fatigue Based Reflex Theory (Electrolyte Depletion and Dehydration theories not really supported by evidence |
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Muscle Cramp Fatigue Based Reflex Tehory |
↑ firing rate Type 1a afferents(muscle spindle)• ↓ firing rate Type 2b afferents(GTO)• 2 joint muscles vs. 1 jointmuscles• Racing vs. training? |
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Cramps Rx |
passive stretch/rest/recover |
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Sports Concussion Definition |
defined as a complexpathophysiological process affecting the brain, induced by traumaticbiomechanical forces. (Zurich, 2012 |
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A concussion must involve one (at least) of the following: |
Loss of consciousness (most concussions do not involve LOC)• Loss of memory of events immediately before or after the accident• Any alteration in mental state• Focal neurological deficit |
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Does a concussion only result from a blow to the head |
No, it's caused by a direct blow to head/face/neck or elsewhere on thebody (impulsive force transmitted to head). |
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Do concussions change the neurological structure of the brain? Why or why not? |
No, a concussion may result in neuropathological changes but the acute clinicalsymptoms largely reflect a functional disturbance rather than astructural injury. It is typically associated with grossly normal structural neuroimagingstudies. |
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Describe the pathophysiology of a concussion |
Biomechanical injury to the brain - metabolic ionic changes - acute energy crisis |
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How long to most concussions take to resolve |
Majority ofconcussions (80-90%) resolve without complication over 7-10days (may take longer in children & adolescents). |
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What is recommended for the treatment of concussions (or guidelines for return to play) |
Acute Injury: if any signs & symptoms of a concussion, the player:1. Is not allowed to return to play on day of injury.2. Should not be left alone, regular monitoring over initial fewhours.3. Should be medically evaluated.4. Return to Play must be medically supervised, stepwise process(“When in doubt, sit them out”). |
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what are some examples of a pre-participation testing that can help develop a baseline for concussion assessment |
Digit symbol substitution test (DSST): sensitive to ↓ speed ofinformation processing. Scores can ↑ with practice. If score is 4-5points below baseline suspect ongoing neuro deficits.• Balance Testing (e.g. Balance Error Scoring System). Balance deficitsmay last 72 hr following concussion. |
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What is the concussion return to play protocol? 6 steps |
Majority of concussions recover spontaneously over 7-10 days.Each step should take 24 hrs. 1. No activity, complete rest. Once asymptomatic, proceed to step 2. 2. Light aerobic exercise, (walk, swim, stationary bike) 3. Sport specific exercise (skating drills, running drills) 4. Non-contact training drills. May start resistance training. 5. Full contact training after medical clearance. 6. Return to play. If any post-concussion symptoms occur, drop back to previous level. |
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What are some reasons why a younger brain may be more vulnerable? |
• Immature CNS• Larger head-to-body ratio• Neck and shoulder muscles less developed• Thinner cranial bones |
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Concussion Gender Differences |
• Different symptoms in females?• Reported more drowsiness and sensitivity to noise• Greater cognitive impairment in females?• Increased reaction times• Greater mortality in females? |
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Name some of the cumulative effects of concussions |
Disorders: dementiapugilistica, traumatic boxer’s encephalopathy chronic traumaticencephalopathy - CTE Alzheimer’s, Parkinson’s Motor: ataxia, spasticity, impaired coordination, Parkinsonism• Cognitive: imparied attention, memory, and executive/frontal function• Behavioural: disinhibition, irritability, paranoia, violence, depression |
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Do helmets help prevent concussion? |
There is no clinical evidence thatcurrently availableprotective equipment willprevent concussion (mayprevent other forms of headinjury). |
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What is second impact syndrome? |
It's a rare, fatal, uncontrolled swelling of brain, minor second blow before initial symptoms have resolved |
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What are the stages of healing for soft tissues |
1. Inflammation: 48 to 72 hours 2. Repair/Regeneration: 72 hours to 6-8 weeks 3. Remodelling: a year to a year and a half |
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Reasons NOT to tape |
immediately following an acute injury (just to get back to play) sometimeswith acute swelling if further assessment is required if there is functional disability after cold application at night for certain sports (karate. judo) pre-puberty if you are unsure |
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Glasgow coma scale framework |
Grading best eye response, best verbal response and best motor response - adding up the points glasgow coma score less than 15 indication for emergency management |
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Maddocks score functionality and description |
For sideline diagnosis. Questions include general things about the environment: What venue are we at today, which half is it now? Who scored last in the match? Did your team win the last game? |
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Sideline assessment guidelines (indications for emergency management) (from Adult SCAT3) |
- Glasgow Coma score less than 15 - Deteriorating mental status - potential spinal injury - progressive, worsening symptoms or new neurologic signs |
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Signs to watch forProblems could arise over the first 24 – 48 hours. The athlete should not be left aloneand must go to a hospital at once if they: |
- Have a headache that gets worse- Are very drowsy or can’t be awakened- Can’t recognize people or places- Have repeated vomiting- Behave unusually or seem confused; are very irritable- Have seizures (arms and legs jerk uncontrollably)- Have weak or numb arms or legs- Are unsteady on their feet; have slurred speech |
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Recommendations for minor concussions (rest/cautions) |
Rest (physically and mentally), including training or playing sportsuntil symptoms resolve and you are medically cleared- No alcohol- No prescription or non-prescription drugs without medical supervision.Specifically:· No sleeping tablets· Do not use aspirin, anti-inflammatory medication or sedating pain killers- Do not drive until medically cleared- Do not train or play sport until medically cleared |
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Thompson Test |
The Thompson Test: When the tendon is intact, and the calf is squeezed, the ankle will plantar flex . |
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Components of the pocket-CRT |
The Pocket-CRT has 3 brief components; visual observations, symptoms and memory |
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Components of SCAT3 (Adult) |
SAC delayed recallCoordination examinationBalance examination (BESS or tandem gait)Neck examinationCognitive assessmentSymptom evaluationGlasgow coma scaleBackgroundMaddocks score (sideline assessment) |
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What is different about the Child SCAT3? |
For kids age 5-12 years• Child Maddock’s Score• Symptom evaluation: Child Report and Parent Report• Concentration: days in reverse order• Balance testing: no single leg test, there is a tandem gait test (3m, 38mm wide line)© Tyler Dumont. Not to be copied, used, or revised without explicit written permission from the copyright owner.Child-SCAT3• Return to School guidelines provided• Parent Advice: includes statement about computer, electronics, and gaming. Can’t return to school or sports until medically cleared. |
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Sideline assessment guidelines(indications for emergency management) (from Child SCAT3) |
if the concussed child displays any of the following, then do not proceedwith the ChildSCAt3; instead activate emergency procedures and urgent transportationto the nearest hospital: - Glasgow Coma score less than 15 - Deteriorating mental status - potential spinal injury - progressive, worsening symptoms or new neurologic signs - persistent vomiting - evidence of skull fracture - post traumatic seizures - Coagulopathy - History of neurosurgery (eg Shunt) - multiple injuriesChild-SCAT3™Sport Concussion Assessment Tool for children ages 5 to12 yearsFor use by medical professionals onlyglasgow coma scale (gCS) |
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What should an emergency action plan outline? |
Who will cover playing surface and attend to an injured athlete How to signal further assistance who will call/meet/direct the ambulance any other components specific to event (eg: crowd control |
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Acute muscle strain Rx |
RICE |
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Contusion Rx |
Control hemmorrhage, compress |
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What is a serious consequence of returning to play while still symptomatic |
second impact syndrome - uncontrolled swelling of your brain in 80% of cases can lead to death |
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how many signs or symptoms do you need to diagnose a concussion |
it could be just one |
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why do concussions get missed in younger athletes |
challenge in recognizing signs and symptoms, lack of reporting, lack of medical staff on hand |
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why can pediatric concussions be more serious |
laxity of membranes more vulnerable longer to recover persistent neurocognitive findings despite resolution of symptoms |
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gender differences in outcomes and incidences of concussion (debatable) |
more drowsiness and sensitivity to noise? cultural reporting issue makes this debatable hormonal influence on outdcomes could be a structural issue - reduced dynamic stabilization of head/neck |
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Physio Treatment options for concussion |
treating the neck - restoring mobility and stability (ROM), manual therapy vestibular rehab (treating the inner ear) balance, posture and proprioceptive training assist with baseline testing and return to play/ or learn protocol |
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Strategies for preventing concussions |
protective equipment technology education changing rules (less hits) rule of neck strengthening exercises |
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Physiologic Post Concussive Disorders |
headaches that increase with physical or mental activity dizziness, fatigue, slow speech, difficulty concentrating, light,sound sensitivity elevated or lowered resting heartrate (disturbance in autonomic nervous system |
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What do we do for patients with Physiologic Post Concussive Disorders |
Physical and cognitive test, school accomodation, sub symptom threshold aerobic exercise program |
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What are some vetibul-ocular post concussive disorders |
dizziness, vertigo, nausea, lightheadedness, gait, postural instability, blurred, dobule visual, difficulty tracking, motion sensitivity, headache |
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cervicogenic pcd - treatment |
manual therapy, balance and visual training, proprioceptive training, gate training, stabilizatin exercises, sub system threshold aerobic exercise program |
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cervicogenic pcd - |
.... |
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roles of protective equipment |
deflect, dissipate, or absorb |
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how do we treat vestibu-oular pcd? |
..... |
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Helmets and prevention |
deflect, dissipate, absorb - high velocity, low mass objects - hockey (protection from puck) -low velocity, high mass objects (football...a player lower velocity relative to a ball) - repeated impacts vs. single impact - (bike helmets are single impact |
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what are helmets good at preventing |
lacerations, skull fractions, major head trauma, but don't really prevent concussions |
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what kinds of helmets are targeting concussions |
BAuer Re-Akt helmet - has a liner that moves inside the helmet MIPs (multi directional impact protection system) - address rotational impact - make the helmets designed to absorb rotational impact as well |
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the effectiveness of mouthgards in protecting against concussion |
not effective, they do decrease dental and orofacial injury |
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what is the danger of going back to play to early? |
post concussion syndrome (second concussion that is more severe and potentially ongoing symptoms) or second impact syndrome |
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important concepts for concussion management |
baseline testing recognize signs and symptoms thorough assessment stewise return to play prevention is key |
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How do Tears Happen? |
high velocity, eccentric forces - transition from eccentric to concentric, multi joint, medial head of gastroc - stopping and starting. |
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Where do most tears happen? |
older athletes - usually tendon site younger - mid-belly tennis leg - right where gastroc mets achilles |
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1st degree tear |
no bruising , no obvious swelling, minimal loss of function, short duration of pain |
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2nd degree tear |
more tender, loss of movement, more pain, defect in the muscle possibly, detectable swelling |
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1st stage of healing |
Inflammatory (Acute) stage. Cascade of events with inflammatory mediators - starts right away lasts 48 - 72 hours Treatment principles: PRICE, POLICE (adding optimal loading) |
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2nd stage of healing |
repair or proliferation up to 6 weeks |
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3rd stage of healing |
remodelling - up to two years |
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Certificate Candidate |
graduate of accredited PT program, CPA & SPC member, Sports First Responder (Canadian Red Cross) |
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muscle cramping theories |
electrolytes - need increased firing of rate type 1a afferents, muscle spindle, then less firing rate of type 2b afferents, also using two joint muscles vs. 1 joint muscle, hence more fatigue |
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grades of ligament strain |
1 tweak, 2 structural damage, 3 complete tear |
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kinds of ligament strains |
knee, ankle, sholder, elbow, wrist, finger/thum |
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treatment of ligament sprain |
RICE, support |
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acute dislocations treatment |
stabilize, monitor, neurovascular status, stransport |
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types of acute dislocations |
usually go lateral glenohumeral, patellofemoral, fingers, xray, need to be evaluated |
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thompson test |
squeeze calf, should counterflex, if nothing happens the tendo is ruptures |
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matle's test |
.... |
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treatment for acute tendon injuries |
price, transport, surgery/immobilize (surgical repair not common) |
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Ottawa Ankle Rules |
clinical tool to decide when to get an x-ray 1) unable to weight bear for 4 steps 2) palpation hot spots (watch out for fractures)- lateral malleolus, base of the 5th metatarsal (serious, don't heal well), navicular (another nasty one), posterior edge of the medial malleolus 3) tuning forks - vibrating, if its over a stress facture it will really hurt |
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Treatment for Fractures |
PRICE, immobilize, monitor neurovascular status, transport and get imaging done as soon as possible |
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Rx for wound care |
clean with soap and water, don't use alcohol, debride, dress with non-adherent bandage if abrasion |
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taping precautions |
after cold application, pre-puberty, at night, allergies/skin sensitivity |
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Certificate |
practical experience (200 hrsmin, 75 hrsof contact sport: hockey, football, lacrosse, rugby, soccer), written assignment, written exam, practical exam. |
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Diploma |
practical experience (200 hrsmin, 2 teams for 2 full seasons, one team should be a contact sport –75 hrs), written assignment, written exam, practical exam. (WAWEPE) |
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Certificate Candidate Competency |
Basic emergency care |
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Certificate Competency |
emergency care, taping and strapping, protective equipment, functional sideline testing of the athlete, sports massage, and other basic needs of the athlete and the team. Eligible to apply to Developmental Games (e.g. Canada Winter Games, FISU Games). |
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Diploma Competency |
Competent in pre and post season screening, training and conditioning programs, exercise physiology, sports nutrition, psychology, pharmacology, and complete rehabilitation of the athlete back to competitive level. Eligible to apply to Developmental and Major Games (e.g. Commonwealth Games, Pan Am Games, Olympic Games). |
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How do you maintain SPC credentials? |
every 3 years •Current CPA and SPC member •Current Sports First Responder •60 hrs of post-graduate courses relevant to sport Physiotherapy •Minimum of 200 hrs of employment/volunteer work in sports Physiotherapy (minimum 75 hrs must be on-field) |
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What needs to be in an emergency action plan |
Who will cover the playing surface and attend to an injured athlete first (most often the PT or AT) How to signal/summon further assistance (e.g. physician, stretcher) Who will call the ambulance Who will meet the ambulance and direct them to the site Any other components for the specific event (e.g. crowd control, player control, designated team leader) |
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Grade 1 muscle strain |
mild tenderness and pain |
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Grade 2 muscle strain |
medium tenderness, pain and detectable swelling... mild loss of motion and palpable defect |
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Grade 3 muscle strain |
great tenderness, pain, detectable swelling and palpable defect...medium loss of motion |
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Grade 1 ligament sprain |
ligaments stretched or slightly torn |
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Grade 2 ligament sprain |
ligaments partially torn |
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Grade 3 ligament sprain |
Ligaments completely torn |
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What are some examples of acute dislocations? |
glenohumeral, patellofemoral, fingers |
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What do you do if there is an acute dislocation? |
basically you just protect it until someone else can fix it: stabilize, monitor neurovascular status, and transport |
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what are some examples of exercise induced bronchospasm? |
SOB, chest tightness, wheeze, dry cough post-exercise, poor performance, fatigue. |
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what is the treatment for exercise induced bronchospasm |
bronchodilator, monitor athlete...monitor for pulmanary embolism |
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matles test (for rupture of the achille's tendon) |
The patient lies in prone, active or passively flexing the knee to 90° with both feet and ankles in a neutral position according to the patient. When an absence of plantar flexion is observed, the test proves positive. The rupture will tend the foot more into dorsal flexion. |
