Emergencies In Sports Medicine

Front 1

Explain the pathophysiology of a concussion.

Back 1

- Complex pathophysiological process affecting the brain induced by traumatic biochemical forces.
- Caused by an impulsive force transmitted to the head.
- Results in rapid onset of short-lived impairment of neurological function that resolves spontaenously.
- Graded sets of clinical syndromes.

Front 2

Does the acute clinical symptoms of a concussion reflect a functional disturbance or structural injury.

Back 2

Functional disturbance.

Front 3

What are the complications of a concussion?

Back 3

- Impaired reaction time.
- Delayed information processing.
- Second impact syndrome.
- Post-concussive syndrome.

Front 4

What is the treatment for a concussion?

Back 4

- Exclude serious injury.
- Admit to hospital if:
a) Focal neurological signs.
b) Cerebral irritation > 1 hour.
c) Deteriorating mental state.

Relative indications:
d) Loss of consciousness greater than 5 minutes.
e) Convulsion.
f) > 1 episode of moderate to severe concussion in season.

Front 5

What are the cognitive features of a concussion?

Back 5

- Unaware of the score, period of a game, etc.
- Confusion.
- Amnesia.
- Loss of consciousness.
- Unaware of time, date, place, etc.

Front 6

What are the signs and symptoms of a concussion?

Back 6

- Headache.
- Dizziness.
- Nausea.
- Unsteadiness and poor coordination.
- Poor concentration.
- Unusual emotions and personality changes.
- Reduced playing ability.
- Visual disturbance.

Front 7

Return to activity protocol for a possible concussion.

Back 7

- 6 step return-to-play protocol.
- Full STM & information processing.
- Neuropsychological testing - DSST.

Front 8

What are the indications for ordering a CT or MRI in a concussion?

Back 8

- Prolonged disturbance of conscious state.
- Focal neurological deficit.
- Seizure activity.
- Persistent clinical symptoms.

Front 9

Preventative measures against concussion.

Back 9

- Mouth guards.
- Conditioning neck muscles.
- ?Headgear.
- Rule changes.

Front 10

What percentage of spinal injuries is caused by an motor vehicle accident?

Back 10

50%.

Front 11

What percentage of spinal injuries in caused by sport?

Back 11

12%.

Front 12

What are the typical causes of spinal injury?

Back 12

- Forced flexion.
- Axial compression.
- Hyperextension.
- Flexion/rotation.

Front 13

When do you start suspecting a spinal injury?

Back 13

- Nature of injury e.g. direct blow or severe deceleration.
- Pain & tenderness.
- Neurological symptoms - even if transient.
- Comatose or stuporose.
- Associated injuries:
Facial e.g. nose or jaw fracture.
Head injury especially if LOC.

Front 14

Assessment of possible spinal injury include:

Back 14

- ABC.
Initial assessment
- LOC.
- Motor loss.
- Sensory loss.
- Spinal palpation.

More detailed assessment:
- ABC.
- BP.
- Full neuro assessment, including:
= Document highest normal motor level and specific movements.
= Document sensory level - light touch and pinprick.
= Sacral sparing - lesion incomplete.

Front 15

When transferred to hospital, spinal injuries should have what in the way immediate management?

Back 15

- Nasogastric tube if significant defect.
- IV -- Nil by mouth. Beware of neurogenic shock. Don't overload. 80mms systolic is satisfactory.
- IDC.
- Oxygen.
- Analgesia.
- Antiemetics.
- Imaging.

Front 16

What imaging investigations should be ordered for a spinal injury?

Back 16

- Xray in collar - lateral initially including C7.
- If normal, AP & oblique.
- CT scan if any evidence of fracture.

Front 17

Extensive subconjuctival haemorrhage may indicate what?

Back 17

Retrobulbar haemorrhage and/or basal fracture.

Front 18

What possible eye injuries may involve the cornea?

Back 18

- Abrasion or erosion.
- Foreign body.

Front 19

What possible eye injury may involve the iris?

Back 19

Hyphema.

Front 20

What possible eye injuries may involve the lens?

Back 20

- Trauma.
- Subluxation risk in Marfan's syndrome.

Front 21

What possible vitreous injury of the eye may occur?

Back 21

- Haemorrhage.

Front 22

What kind of retinal injuries may occur?

Back 22

- Haemorrhage.
- Tears.
- Detachment.

Front 23

To avoid penetrating eye injuries, do the following:

Back 23

- Never force open lids.
- Never use local anesthetic to decrease pain.
- Never instill ointments.
- Never double-fold pad.
- Urgent referral.

Front 24

What kind of retinal injuries may occur?

Back 24

- Haemorrhage.
- Tears.
- Detachment.

Front 25

To avoid penetrating eye injuries, do the following:

Back 25

- Never force open lids.
- Never use local anesthetic to decrease pain.
- Never instill ointments.
- Never double-fold pad.
- Urgent referral.

Front 26

Direct impact to the eye can result in fracture of...

Back 26

the bony orbit.

Front 27

Fracture of the bony orbit results in double vision upon upward gaze. This is due to...

Back 27

entrapment of the inferior rectus muscle.

Front 28

With a fracture of the bony orbit, you should avoid blowing your nose. Otherwise...

Back 28

it may allow contents of the maxillary sinus to track into orbit.

Front 29

If you suspect eye injury, you need to examine the following:

Back 29

- Visual acuity.
- Visual fields.
- Pupil and iris.
- Evert lids.
- Ocular movements.

Front 30

Equipment used in treatment of eye injuries.

Back 30

- V.A. card.
- Penlight.
- Flurosceine strips.
- Eye pads.
- Cottonbuds.
- Irrigating solutions.

Front 31

If a chipped or avulsed tooth cannot be found after a tooth injury, what may need to be ordered?

Back 31

Chest & abdominal x-ray.

Front 32

What happens if you get a crown fracture that exposes the dentine?

Back 32

It becomes painful and requires urgent dental referral.

Front 33

Before you refer to a dentist, what needs to be done for a tooth subluxation injury?

Back 33

Repositioning and splint.

Front 34

How do you treat a tooth avulsion?

Back 34

- Irrigate the retrieved tooth with sterile saline solution or milk.
- Reimplantation and splint if patient is conscious.

Front 35

Clinical features of a zygoma fracture:

Back 35

- Bruising eyelid.
- Asymmetry.
- Paraesthesia or numbness of the cheek.
- ? teeth feel normal.

Front 36

Clinical features of a zygoma fracture:

Back 36

- Bruising eyelid.
- Asymmetry.
- Paraesthesia or numbness of the cheek.
- ? teeth feel normal.

Front 37

Orbital floor fractures can result in sensory loss to the face due to...

Back 37

infra-orbital nerve damage.

Front 38

For a possible mandibular fracture, what things do you need to examine for?

Back 38

- Check teeth for blood or displacement.
- Examine for sensory loss to lip, chin & lower teeth.
- Check dental occlusion.
- Feel for fracture.

Front 39

Sensory loss to lip, chin and lower teeth from a mandibular fracture is due to...

Back 39

inferior alveolar nerve damage.

Front 40

Ear injuries
How is a haematoma of the ear treated?

Back 40

Usually requires drainage and packing for 2 weeks to prevent cauliflower ear.

Front 41

Laceration of the ear...
1. Frequently involves what type of tissue?
2. Requires what for treatment?

Back 41

1. Cartilage.
2. Oral antibiotics.

Front 42

Ear injuries
Avulsion requires what treatment?

Back 42

- A lot will survive on the small pedicle.
- Evert edges, drain haematoma, pack & pad for 2 weeks.

Front 43

Common nose injuries in sport.

Back 43

- Epistaxis.
- Nasal fractures.
- Septal haematoma.

Front 44

Nose injuries

What are the clinical features of a septal haematoma?

Back 44

- Increasing pain with possible fever.
- Cherry like structure occluding nasal passage.

Front 45

Nose injuries

How do you treat a septal haematoma?

Back 45

- Evacuation of the clot with a wide bore needle or small incision followed by packing.
- Antibiotic prophylaxis to prevent septal abscess & subsequent cartilage necrosis.

Front 46

Main causes of chest injuries in sports

Back 46

- Acceleration/deceleration.
- Compression.
- High speed impact.

Front 47

Multiple rib fractures, especially in the elderly or those with chronic lung disease, can cause serious...

Back 47

Difficulties in ventilation.

Front 48

Fracture of the first rib may be associated with...

Back 48

Aortic rupture.

Front 49

Fractures of the lower ribs may be associated with...

Back 49

Rupture of the spleen or liver.

Front 50

What is a flail chest?

Back 50

Isolated segment of ribs displaced outwardly during expiration.

Front 51

What is the treatment for flail chest?

Back 51

- Selective endotracheal intubation in patients exhibiting significant difficulties in oxygenation.
- Use of epidural narcotics or local anaesthetics is the best form of analgesia.

Front 52

Scapular fractures are significantly associated with what complications?

Back 52

Pulmonary contusion, brachial plexus injury and arterial injury. This is why hospital admission is advisable.

Front 53

Why do most sternal fractures require no therapy?

Back 53

Because most sternal fractures are non-displaced.

Front 54

What do sternal fractures increase the incidence of?

Back 54

It slightly increases the incidence of myocardial contusion and aortic rupture.

Front 55

Costochondral injuries can cause very severe pain. What management steps are involved in treating a costochondral injury?

Back 55

Initial management is conservative with rest & local heat application.
If pain persists, local anaesthetic injections or intercostal nerve block can be used.

Front 56

Whereabout's on the clavicle do 80% of clavicular injuries occur?

Back 56

Middle third of the clavicle. Most clavicular injuries heal without difficulty.

Front 57

Anterior & posterior sterno-clavicular dislocations can usually be reduced with...

Back 57

Closed technique and local anaesthesia.

Front 58

Tension pneumothorax is potentially fatal. How is it diagnosed?

Back 58

Recognised by diminished breath sounds with possible shift of the trachea to the contralateral side.

Front 59

Tension pneumothorax is potentially fata. How is it treated initially?

Back 59

Insertion of a 14-gauge catheter into the 2nd intercostal space in the mid-clavicular line is usually adequate initial treatment.

Front 60

How should an open pneumothorax be handled?

Back 60

It should be covered and secured on 3 sides.

Front 61

What structures are usually injured to cause a haemothorax?

Back 61

Great vessels, bronchial circulation, lung parenchyma, or intercostal vessels.

Front 62

How should fluid collections from a haemothorax be drained?

Back 62

With a large bore chest tube in the 5th intercostal space.

Front 63

An urgent thoracotomy is usually necessary for a haemothorax if...

Back 63

Initial drainage > 1500ml or continues at a rate of > 300ml/hr for 3 consecutive hours.

Front 64

Which organ is most vulnerable to abdominal injuries in football?

Back 64

Spleen.

Front 65

Which organ is most frequently damaged in boxers?

Back 65

Kidneys.

Front 66

Abdominal injuries to the pancreas are _____ but have a _____ mortality.

Back 66

Abdominal injuries to the pancreas are rare but have a high mortality.

Front 67

Hollow viscera injuries are uncommon abdominal injuries. However, fixed areas such as _____, ______, and _____ are most vulnerable.

Back 67

Hollow viscera injuries are uncommon abdominal injuries. However, fixed areas such as duodenum, 1st part of the jejunum and caecum are most vulnerable.

Front 68

In what situation is the spleen particularly vulnerable to abdominal injury?

Back 68

When enlarged, such as in lymphoma or infectious mononucleosis. Contact sports are contraindicated for 6 months after all symptoms have disappeared.

Front 69

Rupture of the spleen may be delayed and can be fatal if missed. What do you need to do if there is any suspicion of splenic injury?

Back 69

Order a CT scan.

Front 70

What management is useful for kidney damage from abdominal injuries?

Back 70

Most cases can be managed by conservative treatment including bed rest, IV fluids, antibiotics and careful observation.

Front 71

If kidney damage results in frank swelling, evidence of hypotension and increasing pain, what should be done?

Back 71

Laparotomy.

Front 72

About 50% of liver injuries are simply...
Bleeding is usually minimal and self-limiting in these causes.

Back 72

Capsular tears or superficial parenchymal lacerations.

Front 73

CT scan of the liver in sports injuries might...

Back 73

Determine the extent of the liver injury. This is often important to do as severe injury with massive bleeding requires immediate surgery.

Front 74

What should you be suspicious of with liver injuries?

Back 74

Bowel peritonitis.

Front 75

2nd and 3rd parts of the duodenum are vulnerable to contusions caused by...

Back 75

Impaction against the vertebral column. A resulting haematoma may go unrecognised until vomiting appears.

Front 76

What is required if there is suspicion of duodenal, pancreas or colon injury?

Back 76

CT scan.

Front 77

Injury to colon in blunt force trauma may go unrecognised until what complication?

Back 77

Peritonitis (so CT scan to be safe!).

Front 78

Pelvic fractures usually occur in what type of sport?

Back 78

High speed sports

Front 79

If the pelvic ring has been destroyed in a pelvic fracture, what complications may occur?

Back 79

- Ruptured bladder.
- Ruptured urethra.
- Rectal injury.
- Internal haemorrhage.

Front 80

List the possible causes of acute knee pain. Include a list of NOT TO BE MISSED causes.

Back 80

- Medial meniscus tear.
- MCL sprain.
- ACL rupture.
- Lateral meniscus tear.
- Articular cartilage injury.
- PCL sprain.
- Patellar dislocation.

NOT TO BE MISSED:
- Fractured tibial plateau.
- Avulsion fracture.
- Osteochondritis dissecans.
- Reflex sympathetic dystrophy.

Front 81

Steps in the examination of the knee.

Back 81

1. Observation.
- Standing, walking and supine.
- Look for swelling, deformity and bruising.
2. Active movements.
3. Passive movements.
4. Palpation.
5. Special tests
- Presence of effusion.
- Stability tests: MCL, LCL, ACL (Lachman's, Anterior Draw, Pivot Shift), PCL.
- Stability tests (McMurray's, Patellar Apprehension Test).

Front 82

Possible investigations for knee injuries.

Back 82

- Xray.
- MRI.
- Ultrasound.
- Arthroscopy.
- CT scan.

Front 83

List the possible causes of shoulder pain (including a NOT TO BE MISSED list!)

Back 83

- Rotator cuff strain & tendinopathy.
- Glenohumeral dislocation.
- Glenohumeral instability.
- Referred pain.
- Fractures.
- Muscle tears.
- Brachial plexus injuries.
- Adhesive capsulitis.
- Nerve entrapments.

NOT TO BE MISSED!
- Tumours.
- Referred pain from diaphragm, gallbladder, perforated duodenal ulcer, cardiac & spleen.
- Thoracic outlet syndrome.
- Axillary vein thrombosis.

Front 84

What structures do you need to examine for in a pelvis and groin injury?

Back 84

Bone:
- Osteitis pubis.
- Stress fracture pelvis.
- Stress fracture femur.

Joints
- Hip.
- Sacroiliac joint.
- Lumbar facet.

Muscles:
- Adductors.
- Hip flexors.
- "Hernia"

Front 85

Active Movements needed to be assessed with a pelvic/groin injury.

Back 85

- Hip flexion/extension.
- Hip abduction/adduction.
- Hip internal/external rotation.
- Squeeze test.
- Lumbar spine movements.
- Abdominal flexion.
- Iliopsoas flexion.

Front 86

Passive Movements needed to be assessed with a pelvic/groin injury.

Back 86

- Hip quadrant.
- Adductor muscle stretch.
- Quadriceps muscle stretch.
- Psoas muscle stretch.

Front 87

Resisted Movements needed to be assessed with a pelvic/groin injury.

Back 87

- Hip flexion.
- Hip adduction.
- Abdominal flexion.
- Iliopsoas flexion with adduction.

Front 88

Structures needed to be palpated with a pelvic/groin injury.

Back 88

- Adductor muscles/tendon.
- Pubis symphysis/ramus.
- Rectus abdominis.
- Iliopsoas.

Front 89

Functional movements needed to be assessed with a pelvic/groin injury.

Back 89

- Hopping.
- Sit-up.
- Lunge.
- Zig-zag.

Front 90

Special tests in the examination of pelvic/groin injuries.

Back 90

- Lumbar spine.
- Sacroiliac joint.
- Patrick's (FABER) test.
- Thomas test.
- Trendelenburg test.
- Cough impulse.
- Ober's test.