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62 Cards in this Set
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The Emergency Action Plan (EAP) should include:
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-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? - |
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Emergency Situation Procedures:
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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. |
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Course of Action:
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-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 |
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Evaluation or Life Threatening Injury Assessment:
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-Injury
-ABCs -Primary Survey -Level of Consciousness |
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Unconscious Athlete: 3 Cs = check, call, care.
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-stabilize cervical spine (always assume head and neck injury has occurred).
-responsiveness, ABCs, shock, bleeding. -911 -Care |
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Conscious Athlete:
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-secondary survey
-vital signs, Hx, MS Eval -treatment -transportation |
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Primary Survey:
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-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 |
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Primary Survey & Controlling Bleeding:
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-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 |
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Primary Survey & Shock:
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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. |
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Injury Assessment
-Vital Signs: |
-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) |
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Injury Assessment
-Vital Signs: |
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. |
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Injury Assessment
-Vital Signs: |
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. |
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Neurological Changes:
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Dermatomes = sensory levels (locations)
Myotomes = motor levels (locations) |
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On-Field Evaluation:
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Primary survey = injury seriousness, first-aid, immobilization, necessary transportation, physician treatment.
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On-Field Evaluation:
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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 |
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Off-Field Evaluation:
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-More thorough evaluation.
-To be completed by: Dr. PA, ATC, PT -SOAP/HOPS/HIPS Notes: Need to know: -Documentation - Format - Law |
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SOAP Notes:
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- 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 |
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Immediate Treatment:
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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. |
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Splinting:
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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. |
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Transportation Methods:
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- #1 goal is to CAUSE NO FURTHER HARM.
-Spine boarding -know the correct method -all personnel spine boarding should cooperate. -2 person carry/manual |
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Crutches:
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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 |
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Mechanical Injury:
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-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. |
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Tissue Stresses:
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-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. |
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Tissue Stresses:
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-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. |
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Tissue Stresses:
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-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. |
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Skeletal Muscle Injuries:
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-High incidence occurrence in athletics.
-Anatomical characteristics: -composed of contractile cells that produce movement. -Possess following characteristics: contractility & elasticity. |
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Three Types of Muscle:
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-Cardiac
-Smooth -Striated (skeletal) |
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Acute Muscle Injuries:
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-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. |
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Acute Trauma:
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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! |
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Muscle Strain:
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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. |
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Muscle Strain Grades:
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-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. |
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Muscle Spasms:
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-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. |
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Overexertional Muscle Problems:
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-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. |
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Overexertion:
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-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. |
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Overexertion:
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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. |
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Chronic Musculoskeletal Injuries:
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-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. |
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Chronic Musculoskeletal Injuries:
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-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. |
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Tendon Healing:
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-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. |
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Nerve Healing:
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-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. |
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Bone Healing:
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-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. |
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Acute FX Management:
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- 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. |
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Stress Fracture:
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- 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. |
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Soft Tissue Healing:
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- 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 |
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Pain:
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- 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. |
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Referred Pain:
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- 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) |
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Pain Assessment:
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- Visual scale: smiley faces to sad faces.
- Pain chart - Numeric scale |
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Inflammatory Process
Healing Process: |
- 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. |
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Inflammatory Response:
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- 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. |
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Inflammatory Response:
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- Vascular Reaction:
- blood vessels will vasodialate (increase in size) - increased vascular permeability. - increased blood viscocity (blood flows slower). - decreases lymphatic dreainage. Localized. |
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Inflammatory Process:
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- 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. |
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Inflammatory Process:
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- 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. |
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Inflammatory Process:
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- 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. |
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Fibroblasic Repair:
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- 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. |
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Fibroblasic Repair:
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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. |
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Maturation Remodel:
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-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. |
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Controlled Mobility:
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-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. |
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Interferes With Healing:
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-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. |
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Definitions:
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-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. |
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Definitions:
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-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 |
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Definitions:
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-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. |
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Definitions:
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-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. |
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Definitions:
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-Sublaxation: partial dislocation of two bones.
-HBV: hepatitis B -HBC: hepatitis C -Sx: sypmtoms -Asymptomatic: no symptoms -PPE: personal protective equipment. |