EMR for the Sports Physical Therapist

Ureter - body area of referred pain

Costovertebral angle, radiating to the lower abdomen, testicles (males), and inner thigh

Guidelines for Water Rescue

Requirements: - Good swimmer - specially trained in water rescue - wearing of a personal flotation device - accompanied by other qualified responders Use "reach, throw, row then go" technique "Go" is only for those trained in deep-water rescue

Diaphragm - body area of referred pain

anterior shoulders

Managing a Seizure

Prevent injury Protect the patient's airway Ensure the airway is open after the seizure has ended

Secondary Assessment for an Unresponsive Patient

Pt is breathing normally, has a pulse, but is unresponsive: 1. Consider need to advance life support & transport 2. Provide updates to responding units dispatch 3. Perform rapid patient assessment (Head to toe) 4. Obtain baseline vitals (RR, HR, BP) 5. Position pt in side-lying recovery position and ensure protection of airway

Partial Thickness Burns (2nd degree)

Red & wet (blisters) Swelling in the burn area Heal in 3 - 4 weeks possibly with a scar

Direct Contact

direct contact transmission occurs when infected blood or OPIM from one person enters another person's body at a correct entry site

Body temperature = or > air temperature

sweating occurs and excess heat is lost through evaporation the most effective method of cooling

Adaptive Immunity

the ability to recognize and remember specific antigens and mount an attack on them

Thermoregulation

the body's attempt to maintain a core temp of 98.6 Fahrenheit controlled by the hypothalamus

Cauliflower Ear (Ear Injury)

A relatively minor injury caused by repeated blunt trauma or friction to the external ear; seen most frequently in boxing or wrestling Trauma tears overlying tissue away from cartilage, resulting in bleeding and fluid accumulation; hematoma may form if fluid allowed to solidify Drawing fluid may be necessary if swelling is still present after ice and compression

Throat Injuries

Contusions/Fractures - occur to the trachea, larynx, and hyoid bone during hyperextension of the neck combined with an anterior blow - bc the trachea and superficial carotid arteries course through the neck, severe blows can disrupt the function of one or both of these structures, which can become life threatening

Superficial Burns (1st degree)

Red, dry, painful Warm to touch Often cause swelling in the burn area Heal in a few days without scarring

Signs and Symptoms of Significant MSK Injury

"DOTS" - Deformity, Open Injury, Tenderness, Swelling - Discoloration of the skin - Exposed bone ends/visible bone fragments (don't "push" it back in, rather leave it where it is, pad/stabilize) - Joint locked into position - Inability to use/move affected body part

Syncope

"Passing out", loss of consciousness or fainting - When the brain is suddenly deprived of its normal BF & momentarily shuts down - Often resolves itself when the person lies down - Indicates need for more advanced medical care and activation of EMS system

Lift (6-8 person lift)

- 3 people on each side - 1 person stabilize cervical spine - arms crossed over chest as if going down waterslide - supporting personnel at sides may place their head on opposite person's shoulder for leverage when performing lift - lift athlete up simultaneously - slide spine board underneath athlete

Treatment of Lightning Injuries

- CPR - most effective means of survival - all 911 - AED - Cervical Spinal Immobilization - First Aid for Burn care - Don't forget internal injuries

General Care for Significant MSK Injury

- Control major bleeding/manage life threatening injuries - Call EMS if (severe bleeding; impaired breathing; shock, etc.) - Any involvement of the head, neck, and/or back - RICE - Immobilize as indicated

Physiological Adaptations to hot, humid enviornment

- Dec HR for same intensity - Dec RR for same intensity - Dec skin BF (dry heat) - Inc blood volume - Inc rate of sweating - rapid response - More evaporative loss of heat - efficiency - Less concentration of sodium in sweat

Purpose of Immbolization

- Decrease pain (i.e. fracture, with bone separation there can be muscle spasms that shut bone fragments together causing pain so immobilization hopes to relax muscle) - Prevent further damage to soft tissues - Reduce risk of serious bleeding - Reduce the possibility of loss circulation to the injured part - Prevent closed injuries from becoming open injuries

Mechanism of injuries

- Direct Force - Indirect Force - Twisting/Torsional Force - Shearing Force

Hypothermia - Cold Injury

- Generalized cooling of the body - Decrease in heat production - Increase in heat loss - Classified as mild, moderate, and severe - Thermal control is lost when core temp drop below 95 F

Causes of altered mental status

- Head injury - Fever - Infection - Poisoning or overdose - Substance abuse or misuse - Blood sugar and endocrine emergencies - Inadequate oxygenation or ventilation - Dec BF or oxygen to the brain - Cardiac emergencies - Diabetic emergencies - Shock - Stroke - Seizures

Exertional Hyponatremia Symptoms

- Headache - Nausea - Vomiting - Swollen extremities - Irregular diet inadequate sodium intake - Copious urine w/ low specific gravity - Lethargy/apathy or agitation - Body temp < 104 F

Heat Exhaustion Symptoms

- Headache - Nausea and vomiting - Profound sweating - Decreased appetite - Thirst, fatigue - Normal core temperature - Weak, rapid pulse - Cool, clammy, inelastic skin - Cramps, muscle spasms - Loss of balance, alteration of gait

C-Collar

- Help person at the head stabilize the neck - May have to adjust hands when placing C-Collar

Types of Tissue Damage (BONE)

- Instantaneous Injury - Closed (simple) - Open (compound) - Comminuted - Avulsion - Growth plate-physeal - Stress Fracture - Osteochondritis

Abdominal Injuries (Intra-abdominal)

- Kidney Contusions - Bladder Contusions - Liver Contusions - Appendicitis - Splenic Ruptures

Types of Tissue Damage (SKIN)

- Laceration - Abrasion - Hematoma - Puncture Wounds - Crush and Laceration - Burns - Blisters - Callous Formation

Stroke - Signs & Symptoms

- Looking/feeling ill (common) - Weakness or numbness face, arm, or leg - Facial drooping or drooling - Speech difficulties - Visual disturbances or loss - Dizziness, confusion, agitation or loss of consciousness

Facial Fractures Common in Sports

- Mandibular - Zygomatic - Maxillary - Nasal - Orbital "Blow-Out"

Log Roll Technique (Supine)

- Min of 4 people - pt. legs together & arms crossed - person stabilizing cervical spine is in control of the situation/process - 1 person stabilizes the head; others kneeled onto one side of athlete to perform roll (supine --> side-lying --> slide spine board underneath --> supine --> readjust/center pt)

Heat Cramps

- Muscle cramps - Hot, moist skin - Normal core temp - Normal BP - Inc HR - Exhaustion, extreme fatigue - Normal mentation (mental activity)

Log Roll (Prone)

- Person stabilizing cervical spine must keep hands in the same position during the roll w/o readjusting (hands crossed at first) - athletes arms at side for more comfortable roll - lay spine board on supporting personnel's thighs once athlete is rolled onto their side - Pull athlete towards you not away when doing a log roll

Heat Stroke - Return to Play Criteria

- Physician clearance is necessary - Careful return to play under supervision - Severity of incident determines length of recovery time - Realize that the athlete's heat tolerance may be temporarily or permanently compromised

Exertional Hyponatremia - Return to Play Criteria

- Physician clearance strongly recommended - Mild cases - activity can resume in a few days - Education for specific hydration and nutrition protocol - Monitor fluid intake before, during, and at athletic event/practice

Effective pre-hospital care for athletes

- Rapid response - Accurate primary screening & appropriate injury management - Effective pt stabilization for transport to a medical facility for advanced care

Heat Stroke - Emergency Care

- Recognize sings and symptoms early - Remove from heat source - Remove all clothing - Cool the body as quickly as possible - Remember ABC's - Load and go - Ice packs to neck, axillas, elbows, wrists, groin, knees, ankles - Wet sheet or ice towels - Treat for shock

Hypothermia - Emergency Care

- Remove wet clothing - Keep victim dry - Warm the victim - Breath warm moist oxygen if available - Monitor vital signs - Handle gently to avoid soft tissue damage - No hot liquids, massage, or exercise - "No one is dead until they are warm and dead"

Cardiothoracic Injuries

- Rib Contusions - Rib Fractures - Costochondral Separation/Dislocation - Sternum Fracture - Muscle Injuries - Lung Injuries - Heart Contusions - Sudden Death Syndrome

General Principles of Care for Substance Abuse and Misuse

- Size up the scene - Perform a primary assessment - Summon more advanced medical personnel - Perform a physical exam - Take a SAMPLE history to try to find out what substance was taken, how much was taken and when it was taken - Calm and reassure the pt - Keep the pt from getting chilled or overheated - Keep the pt airway clear - If the pt has difficulty breathing, administer supplemental oxygen, based on local protocols

Immobilizing Significant MSK Injuries

- Support the injured part - Cover any open wounds with dressing and bandage - Check for circulation & sensation distal to injury before and after immobilizing (mark w/ pen) - Check that rigid splint has padding - Elevate the splinted part if possible - Check ABCs and for signs of shock

Return to Play Criteria

- Symptom free and fully hydrated - Physician clearance - R/O underlying condition - Avoid intense practice in heat as necessary - Correct underlying cause if related to acclimatization and/or fitness level

Types of Tissue Damage (JOINT)

- Traumatic Synovitis - Loose Bodies - Osteochondromatosis - Ectopic Calcification - Ligament Injury - Subluxation - Dislocation

Strapping

- Use "head blocks" to secure heads - Straps placed over forehead and chin - Body straps (shoulder, hips, thighs, & lower legs)

Asthma - Emergency Treatment

- Usual medications first - Oxygen to alleviate hypoxia (not asthma) - Remove from triggers - Loosen tight clothing - Slow breathing, emphasis on exhalation w/ medication (inhaler) - Other bronchial dilators (in hospital)

Prevention of EIA

- exercising in a warm, moist environment - shorter workouts followed by adequate rest - gradual build-up of exercise tolerance - athletes w/ EIA may also use a bronchodilator prior to exercise

Heat Exhaustion - Emergency Care

- recognize symptoms early - remove from heat source - remove of loosen clothing - cool the body with air or water - give water if conscious - load and go if core temperature is greater than 101 F vomiting or diarrhea

Emergency Management (Hot Environment)

- remove from heat source - give water if conscious - remove tight or restrictive clothing - cool the body - gentle massage and stretch

Re-acclimatization Following Heat Stroke

1) Begin w/ easy to moderate exercise in climate controlled increase intensity gradually 2) Easy to moderate exercise in heat for several days, gradually inc intensity 3) Easy to mod exercise in heat with equipment, gradually increasing intensity - Monitor weight loss, fluid intake, performance - Satisfactory, asymptomatic performance at one level indicates progression to the next level

Exposure Incidents - what to do if you're exposed:

1) Clean the contaminated area with soap and water 2) Wash needlestick injuries, cuts and exposed skins with soap and water 3) Flush with water any blood and OPIM that splashes on the mouth or nose 4) If the eyes are involved, irrigate with clean water, saline or sterile irrigate for 20 min 5) Seek immediate follow-up care 6) Report and document incidents

Care for Altered Mental Status

1) Conduct primary & secondary assessments and SAMPLE history 2) Perform ongoing assessments 3) Ensure an open airway 4) Place an unresponsive patient in a recovery position if there is no suspected head, neck, spinal, hip, or pelvic injury 5) Do not give the pt anything to eat or drink

Stages of Frostbite

1) Initial - blanching of the skin, painless 2) Superficial - skin is blanched or white and has a firm, waxy feel; tissue underneath is soft, painful 3) Deep - tissue feels solid, skin is mottled white to gray - tissue eventually turns black where tissue death occurs

5 General Stages of Hypothermia

1) Shivering 2) Apathy 3) Decreased consciousness 4) Decreased vital signs 5) DEATH

Conditions Necessary for Spreading Disease

1) pathogen must be present 2) sufficient quantity of the pathogen - a reservoir or source that allows the pathogen to survive and multiply (i.e. blood) 3) mode of transmission from source to host 4) susceptible person 5) pathogen passing through entrance through which the pathogen may enter the host

Care for Major Open Wounds

1. Don't waste time washing the wound 2. Apply clean dressing with gloved hand 3. Control bleeding with direct pressure and elevation 4. Apply bandage over the dressing 5. Summon advanced medical personnel 6. Wash hands after giving care

Spine Board General Protocol

1. Maintain cervical spine stabilization 2. Wait for EMS to show up 3. Spine board per EMS protocol (varies on location)

Significant MSK injury has occurred (i.e. fracture), what to do

1. Make sure distal PMS (pulse, movement, sensation) is intact 2. 60 - 90min to restore if PMS is not present

Shoulder Dislocation (Athlete Relocating Procedure)

1. Run hand up shirt/jersey 2. Starting at SC joint palpate along the clavicle 3. If there is a deformity in the clavicle, DO NOT perform "shoulder dislocation reduction" 4. Position pt sitting 5. Affected arm wrapped around knee 6. Place hand behind their back 7. Have pt. lean back while affected arm wrapped around knee - long axis traction will help reduce shoulder dislocation

Principles of Splinting

1. Splint only if you can do it w/o causing more pain and discomfort to the victim 2. Splint an injury in the position you find it 3. Splint the injured area and the joints/bones above & below the injury site (joint - splint bone above & below | bone - splint joint above & below) 4. Check for proper circulation and sensation BEFORE & AFTER splinting (mark if possible)

Care for Minor Open Wounds

1. Wash with water or saline 2. Place sterile dressing over wound 3. Apply direct pressure to control bleeding 4. Secure in place with bandage tape

Burns Classification

1st degree - Superficial 2nd degree - Partial Thickness 3rd degree - Full Thickness

What are the body's natural defenses?

3 Different types of immunity: - Innate - Adaptive - Passive

Abdominal Screening

4 Quadrants Light palpation - abdominal rigidity Deep palpation - rebound tenderness may indicate complication in abdominal cavity

Substance Abuse and Misuse

Abuse - the deliberate, persistent and excessive use of a substance w/o regard to health concerns or accepted medical practices Misuse - the use of a substance for unintended purposes or for appropriate purposes but in improper amounts or doses

Prevention of Heat Cramps

Acclimatization Dietary changes Increased flexibility

How long is the waiting period before resuming competition

According to NCAA and NATA Guideline - 30 minute waiting period

Asthma Signs & Symptoms

Acute exacerbation - "asthma attack" - shortness of breath and wheezing - rapid breathing - prolonged expiration - rapid HR - Ronchous lung sounds - Over inflation of the chest

Acclimatization

Adjusting to a new range of environmental temperatures. Should occur over 5-10 days of exposure to hot, humid environment

Advanced Directives

An advanced directive is a set of written instructions that describes a person's wishes about medical care Do Not Resuscitate (DNR) Physician Orders for Life-Sustaining Treatment (POLST) - document types of treatments a pt wants/doesnt not want in case of a medical emergency Living Wills - outline a patient's wishes about certain kinds of medical treatments and procedures that prolong life in the event pt cannot communicate healthcare decisions

Legal Issues (Assault, Battery, Abandonment, Negligence)

Assault - is a threat or an attempt to inflict harm on someone; can be physical ,sexual, or both Battery - describe the unlawful touching of a person without that person's consent Abandonment - once you have started emergency care, you are legally obligated to continue that care until a person with equal or high training relieves you, you are physically unable to continue or the pt refuses care Negligence - refers to a failure to follow a reasonable standard of care, thereby causing or contributing to injury or damage to another

Exercise Induced Asthma (EIA)

Asthma symptoms in conjunction w/ exercise Athlete w/ EIA often has airway narrowing caused by bronchial wall thickening and excess production of mucous - causes difficulty with inhalation and exhalation

Exertional Hyponatremia

Athlete consumes more fluid than necessary before, during, and after exercise Sodium is lost in sweating resulting in decrease sodium in the blood; severity inc as sodium levels dec May result in CNS dysfunction, respiratory changes resulting from pulmonary edema and/or cerebral edema - Risk is decreased w/ proper fluid and sodium intake

Intestines - body area of referred pain

Back (backache or sharp pain in the back), umbilicus

Heart - body area of referred pain

Base of neck, left jaw, and left shoulder and arm

Body temperature < air temperature

Blood is shunted to the vital organs it increase core temperature

How are bloodborne pathogens spread?

Bodily fluids - cerebrospinal fluid (brain) - synovial fluid (joints) - pleural fluid (lungs) - amniotic fluid (uterus) - pericardial fluid (heart) - peritoneal fluid (abdomen) - semen / vaginal secretions - blood Contaminated sharp object cut/punctures the skin or touches inflamed skin, acne, or skin abrasion

Maintain Equilibrium (Sweating)

Body can withstand losing 1 liter of water per hour for a max of 2-4 hrs 85% of heat loss occurs through the skin Sweating is compromised and can no longer evaporate when the relative humidity is in excess of 75%

Congenital Coronary Artery Anomalies

Born with, coronary arteries are relatively small Abnormal artery is compressed as the ascending aorta dilates with exercise BF from the heart is limited --> hypoperfusion of the myocardium occurs and is the primary cause of death Early symptoms include fatigue, exercise-induced syncope, chest pain

Secondary Assessment

Brief head to toe assessment to see if there are any other major medical problems you need to check for before going into Tertiary assessment

Full Thickness Burns (3rd degree)

Brown or charred with white tissues underneath Extremely painful or painless Prolonged period of healing often with skin grafting and permanent scarring

Types of Splints

Can get creative with use of items as splints: Soft - rolled towel, pillow, blanket Rigid - Board splint, SAM splint, vacuum splint Anatomic - Other limb or body area Traction - Hare splint; used for femur fractures

Stroke

Cerebrovascular accident Causes: - blood clots - rupture and bleeding of arteries in the brain Transient ischemic attack (TIA) referred to "mini-stroke"

Diabetic Emergency - Signs & Symptoms

Changes in level of consciousness, dizziness, drowsiness or confusion Irregular breathing Abnormal pulse (rapid or weak) Feeling and looking ill Abnormal skin characteristics

Stroke Assessment

Cincinnati Prehospital Stroke Scale - FAST: - Face, Arm, Speech, Time

Hip Pointer

Closed wound contusion to the iliac crest (below) pain, muscle spasm, limited trunk and LE mobility relative rest 2-3 days (PRICE) then return to activity with area padded

Closed Wounds

Damage to tissues below the surface of the skin causing internal bleeding Blood and other fluids seep into the surrounded tissues causing discoloration and swelling Most do not require immediate special medical care - PRICE (P-protect, R-est, I-ce, C-ompression, E-levation)

Substance Abuse Terms

Dependency Addiction Withdrawal Tolerance Overdose

How does disease spread?

Direct Indirect Respiratory Droplet Vector-Borne Transmission

Pancreas - body area of referred pain

Directly behind the pancreas, lower left quadrant of abdomen, umbilicus

Inhalants

Effects on the body: - altered mood - partial or complete loss of feeling (effects similar to drunkenness) - damage to the heart, lungs, brain and liver Signs and Symptoms: - drunken or disoriented appearance (similar to hallucinogen abuse) Examples: - Medical anesthetics, fuel

Hallucinogens

Effects on the body: - changes in mood, sensation, thought, emotion, and self-awareness - altered depression, tension and anxiety - visual, auditory and tactile hallucinations Signs and Symptoms: - sudden mood changes - claims of seeing or hearing something not present - anxiety and fear

Depressants

Effects on the body: - decreased PA and mental activity - altered level of consciousness (LOC) - depressed respirations - impaired coordination and judgment Signs and Symptoms: - drowsiness, confusion - slurred speech - slow HR and RR Examples: - alcohol

Cannabis Products

Effects on the body: - feelings of elation, great happiness and exhilaration - distorted perceptions of time and space - impaired motor coordination and judgment - inc HR Signs and Symptoms: - red, bloodshot eyes Examples: - mariijuana

Stimulants

Effects on the body: - increased PA and mental activity - temporary feelings of alterness - appetite suppression - energy bursts Signs and Symptoms: - Rapid pulse, breathing - high BP - excitability, restlessness, talkativeness or irritability Examples: - cocaine and crack cocaine

Opoid Narcotics

Effects on the body: - pain relief - stupor or euphoria (high addictive) - coma or death Examples: - morphine, heroin, opium

Care for Stroke (Unconscious Patient)

Ensure an open airway Care for any life-threatening conditions Position the patient in the side-lying recovery position to allow any fluids to drain out of their mouth

Return to Play Guidelines

For MSK Injuries (UE & LE) will depend on: - Structures involved - Extent of injury - Surgical intervention - Prior conditioning levels - Previous injuries - Physical clearance "If you can run, jump, cut without a limp or discomfort we will allow you to go back and play"

Epidemiology of Athletic Injury

For both practices & games, player contact accounted for majority of injuries (Football w/ highest injury rate & baseball/softball w/ lowest injury rates) < 50% of reported injuries were to LE (knee & ankle)

Types of Seizures

Generalized tonic-clonic (grand mal) Partial: - Simple - Complex Absence (petit mal) Febrile

HIV

HIV is the virus that causes AIDS HIV attacks WBC and destroys the body's ability to fight infection - weakens the body's immune system Blood test can detect HIV antibody

Kidneys - body area of referred pain

High in the posterior costovertebral angle and radiating forward around the flank

Heat Stroke symptoms

Hot, red, usually dry skin (may not be seen in athletes) Initial pulse of 160+ but will diminish with brain damage Pupils are constricted initially, but later dilate Confusion, anxiety, irritable behavior and may become hysterical or psychotic Initially deep respirations, will regress to shallow as condition deteriorates Severe headache, extremely dry mouth, thirsty Shortness of breath, difficulty with respirations Nausea, vomiting, diarrhea, dizziness, weakness Decreased urinary output\ Collapse, coma, DEATH

Innate Immunity

Immunity that is present before exposure and effective from birth. Responds to a broad range of pathogens. Natural barriers (skin, mucus membrane, lining inside our nose, gastrointestinal tract, etc.)

Indirect Contact

Indirect contact transmission can occur when a person touches an object that contains the blood or OPIM of an infected person, and that infected blood or OPIM enters the body through a correct entry site

Patient Consent & Refusal of Care

Individuals have a basic right to decide what can and cannot be done to their bodies; they have the legal right to accept or refuse care First obtain patient consent before providing care to an injured or ill person

Myocarditis

Inflammatory process of the myocardium Caused by certain viruses Suffer from: - dyspnea, orthopnea - exercise intolerance - tachycardia - diarrhea, malaise, myalgia - persistent and productive cough* Treatment: - rest, steroids, or non-steroidal anti-inflammatories

How does poison enter the body?

Ingestion Inhalation Absorption Injection

Open Wounds

Injuries that break the skin: 1. Abrasions - rubbing/scrapping; bleeding easily controlled 2. Lacerations - sharp edged object or direct blow; bleed freely/profusely 3. Avulsions - portion of skin or tissue partially/completely torn away 4. Punctures - severe internal bleeding a concern; risk of infection 5. Amputations - complete avulsion of a limb; severe bleeding; save amputated part

What stops the spread of bloodborne pathogens?

Intact skin - 1st defense against disease Bloodborne pathogens cannot "soak" through normal intact skin

Generalized Seizure - Signs & Symptoms

Irregular breathing Drool Eyes rolled upward Body becomes rigid Loss of bowel and bladder control Convulsions

Implied Consent

Law assumes that the patient would give consent for care if they were able to do so (i.e. unconscious, altered level of consciousness) Implied consent & minors: Need consent from parent/guardian, if one is not present and the condition is life threatening then consent is implied

Spleen - body area of referred pain

Left shoulder & upper 1/3 of arm

Hepatitis A, B, C, D, and E

Liver disease Hepatitis C caused by hepatitis C virus (HCV) is the most common chronic bloodborne infection in the US

Bladder - body area of referred pain

Lower abdomen & upper thighs

Primary Assessment

Making someone is alive; check vital signs

Hernia (Abdomen Injury)

Mechanism of Injury: - A natural weakness of the muscles is aggravated by a strain or direct blow Signs and Symptoms: - Pain or prolonged discomfort from a previous blow or strain to the groin - Superficial protrusion that in increased by coughing or reported feeling of weakness and pulling sensation in the groin Management: - Surgical management

Solar Plexus Contusion aka "Wind Knocked Out" (Abdomen Injury)

Mechanism of Injury: - Blow to the sympathetic celiac plexus (solar plexus) produces a transitory paralysis of the diaphragm ("wind knocked out") Signs and Symptoms: - Paralysis of the diaphragm stops respiration and leads to anoxia (usually unable to inhale) Management: - Have the athlete bend their knees - Take short inspirations and long expirations

Costochondral Separation/Dislocation

Mechanism of Injury: - Direct blow to anterolateral thorax - Sudden twist or a fall (compression of the rib cage) Signs and Symptoms: - Pain localized in the junction or cartilage and rib - Sharp pain w/ quick sudden trunk movements - Difficulty breathing - Rib deformity with crepitus Management: - X-ray - RICE - Immobilization

Muscle Injuries (Cardiothoracic Injuries)

Mechanism of Injury: - Direct blows or sudden torsions Signs and Symptoms: - Pain with active motion - Pain with inspiration/expiration, laughing, coughing, or sneezing Management: - Application of cold for 1 hour - Immobilization

Rib Fractures

Mechanism of Injury: - Direct trauma: kick or well-placed block - Indirect trauma: general compression of rib cage Signs and Symptoms: - Sharp pain during inspiration - Severe, sharp pain (possibly crepitus) with palpation Management: - X-ray - RICE - Rib brace

Heart Contusion

Mechanism of Injury: - Heart is compressed b/w sternum and spine by a strong outside force Signs and Symptoms: - Severe shock and chest pain - Arrhythmias that cause a decease in CO Management: - Transported to the hospital immediately - Be prepared to administer CPR

Sternum Fracture

Mechanism of Injury: - High impact blow to the chest Signs and Symptoms: - Point tenderness over the sternum at the site of the fracture - Exacerbated by deep inspiration and forceful expiration Management: - X-ray - Monitor closely for signs of trauma to the heart

Stitch in the Side (Abdomen Injury)

Mechanism of Injury: - Idiopathic Signs and Symptoms: - Cramp-like pain on either R/L costal angle during PA (especially ruunning) Management: - Relaxation of the spasm: 1) stretch the arm on the affected side as high as possible or 2) flexing trunk forward on the thighs

Mandibular Fractures (Facial Injury)

Mechanism of Injury: - Occur often in collision sports and second in incidence of all sport-related facial fractures Signs and Symptoms: - facial deformity - malocclusion of the teeth - pain when biting down - bleeding around the teeth - lower lip anesthesia Management: - Cold packs to the side of the face - Immobilization w/ an elastic or 4-tailed bandage - Displaced fractures may require jaw wiring or surgical fixation w/ plates and screws - Return to play in 6-8 weeks

Abdominal Muscle Strains (Abdominal Injury)

Mechanism of Injury: - Sudden twisting of the trunk or reaching overhead Signs and Symptoms: - Severe pain - Hematoma formation Management: - Ice and elastic compression - Exercise within pain-free limits

Periorbital Ecchymosis (Eye Injury)

Mechanism of Injury: - Usually the result of a direct blow to the eye, injuring the surrounding tissue and producing capillary bleeding into the tissue spaces Signs & Symptoms: - "Black Eye" Management: - cold application to the eye - caution athlete not to blow their nose following an acute eye injury as this may increase hemorrhaging

Rib Contusions ("bruised rib")

Mechanism of Injury: - blow to the rib cage Signs and Symptoms: - Sharp pain during breathing - Point tenderness - Pain elicited when rib age compressed (exhale) Managament: - X-ray - RICE

Jaw Dislocation (Facial Injuries)

Mechanism of Injury: - jaw is prone to dislocation due to excess movement and construction of the TMJ - side blow to the open mouth, dislocating TMJ Signs and Symptoms: - locked-open position of jaw - overriding malocclusion of the teeth Management: - ice pack to relieve pain and swelling - may apply ACE bandage for stabilization - do not open mouth wide for first 6 weeks

Nasal Fracture (Facial Injury)

Mechanism of Injury: - most common fracture in athletics - usually caused from a direct blow to the nose from the front or side Signs and Symptoms: - deformity (lateral force tends to cause greater deformity & lateral displacement) - profuse hemorrhage due to laceration of the nasal mucosa Management: - ice application - fractures with septal deviation often require special treatment to prevent later problems with nasal breathing

Maxillary Fracture (Facial Injuries)

Mechanism of Injury: - usually caused by a severe blow to the upper jaw by an object such as a hockey puck or stick Signs and Symptoms: - pain while chewing - appearance of a "longer" face - Nosebleed, diplopia, numbness in lip/cheek area Management: - bleeding is usually profuse, airway management is essential - apply ice to the area - usually requires surgical fixation

Orbital "Blowout" Fracture (Facial Injury)

Mechanism of Injury: - usually caused from a blow to the face from an object that is larger than the eye socket; strikes the eye and the orbital ridge Signs and Symptoms: - diplopia - athlete unable to actively move eye due to inferior rectus muscle becoming stuck in inferior orbital floor - numbness below the eye - hemorrhage around the inferior margins of the eye (later stages) Management: - may need surgery to repair the defect in the orbital floor - return to play in 4-8 weeks

Corneal Abrasion (Eye Injury)

Mechanism of Injury: - usually caused when a foreign object gets into the eye and scratches the cornea Signs and Symptoms: - Sudden onset of pain; aggravated by blinking - excessive tearing Management: - treated with a topical antibiotic

Zygomatic Fracture (Facial Injury)

Mechanism of Injury: - usually the result of low-medium velocity injury to the cheekbone from a direct blow Signs and Symptoms: - Deformity in the cheek region - usually accompanied by a nosebleed - double vision (diplopia) - swelling around eye and/or appear "sunken in" on fractured side Management: - apply ice to control pain & swelling - surgical repair should be performed 7-10 days to prevent early fracture consolidation

Meningitis

Meningitis is a contagious meningococcal infection that attacks the meninges, the protective coverings that surround the brain and spinal cord Bacteria & virus can cause meningitis

Care for Stroke (Conscious Patient)

Monitor pt condition Check for non-life threatening conditions Offer comfort and reassurance Do not give the pt anything by mouth

Hypertrophic Cardiomyopathy

Most common cause of Sudden Cardiac Death (SCD) - up to 50% of sudden death in young athletes Difficult to diagnose May not manifest until late adolescence or young adult hood Exercise induced syncope (loss of consciousness)

Types of Tissue Damage (MUSCLE)

Muscle Injury - Partial Rupture - Complete Rupture - Myositis Ossificans Tendon Injury - Tendonitis - Tenovaginitis - Partial Tear - Complete Tear

Football Equipment Removal

NATA recommendation is football equipment (helmet & shoulder pads) is removed at the field and stabilized on the spine board without equipment on During removal of the helmet, person stabilizing head would need to relinquish control of head over to another person who is holding onto the face to prevent neck extension

Dental Injuries

Nearly all oral and dental injuries are preventable through regular use of mouth guards in sports When teeth are injured by facial trauma, associated maxillary or mandibular fractures must also be suspected

Thermal Injury

Occurs when the body cannot produce enough heat loss to maintain a constant core temperature of 98.6 F Normal body temp in athletes involved in strenuous activities can reach up to 101 F When the body cannot control core temp; thermoregulation is lost and the end result can be death

Asthma

One of the most common respiratory diseases; may be chronic and intermittent and is usually triggered by a number of stressors: - respiratory tract infection - inhalation of a noxious odor - exposure to a specific allergen - changes in barometric pressure or temperature - emotional upset or anxiety

Respiratory Droplet

Pathogens (i.e. flu virus) can enter the body through droplet transmission - occurs when a person inhales droplets propelled from an infected person's cough or sneeze from within a few feet - person can also become infected by touch contaminated surface by infected droplets then touching eyes, mouth, nose

Visceral Anatomical Review

Right Upper Quadrant: - Liver - Kidney - Pancreas (midline) Left Upper Quadrant: - Spleen - Stomach (midline) - Aorta Right Lower Quadrant: - Cecum - Umbilicus (midline) Left Lower Quadrant: - Sigmond Colon - Bladder (midline)

Appendix - body area of referred pain

Right lower quadrant of abdomen, umbilicus

Liver - body area of referred pain

Right shoulder

Winslow Equation

SH = MH +/- R +/- Cd +/- Cv - E Stored heat equals metabolic heat plus or minus Radiation plus or minus conduction - Radiation: Mechanism for the body to give off heat - Evaporation: Changing liquid into a gas - Convection: Exchange of heat by movement of particles - Conduction: Giving off heat through direct contact of the object to surrounding object

Anaphylaxis

Severe allergic reaction to poisons and a form of shock Signs & Symptoms: - trouble breathing - swelling of the face, neck, tongue or lips - feeling of tightness in chest or throat - skin reactions - signs and symptoms of shock

Ear Injuries

Sport injuries to the ear most often occur to the external portion; a blow to the ear, pressure changes, and infection can injure the internal structures of the ear

Spine Board Hand Position

Stabilizes the head and neck Two Methods: 1. Use hand to grasp the upper traps & forearm to squeeze the head to keep it from moving laterally/rotating 2. Use hand to keep head in neutral w/ thumbs towards the nose (best for rolling in supine)

Categories of Abused Substances

Stimulants Hallucinogens Depressants Opioid narcotics Inhalants Cannabis products

Coronary Artery Disease

Sudden Cardiac Death (SCD) in Mature Athletes - accounts for 75% of all cardiac deaths Factors: - smoking, high cholesterol, inactivity, obesity, hypertension, diabetes - correctable factors ^^^

Tuberculosis (TB)

TB is an infection caused by a bacterium called Mycobacterium tuberculosis bacteria usually attacks the lungs Symptoms: - bad cough lasting 3 weeks or longer - pain in the chest - coughing up blood or bloody sputum (phlegm from inside the lungs) - weakness and/or fatigue

Facial Injuries

The most prevalent cause of facial injury is a direct blow that injures both soft & bony tissue You must also suspect a possible head or neck injury

Diabetes

Type 1 Type 2

Injuries to the Lungs (Cardiothoracic Injuries)

Types: - Pneumothorax: pleural cavity filled with air through an opening in the chest; lung collapses - Tension Pneumothorax: pleural sac on one side fills with area displacing heart & lung towards the opposite side; compression and collapse of opposite lung - Hemothorax: blood within pleural cavity; lung hemorrhage - Traumatic Asphyxia: violent blow to or a compression of the rib cage that causes cessation of breathing Management: Each is a medical emergency that requires immediate medical attention. The athlete should be transported to a hospital ER ASAP

Tertiary Assessment

When you perform an evaluation

Duty to Act

While on duty, an EMR has an obligation to respond to an emergency and provide care at the scene

Soft Tissue Injuries

Wounds (Closed or Open) & Burns

Refusal of Care

You should honor their refusal of care even though a pt may be seriously injured or ill

Surrogate Decision Making

a 3rd party who has been given the legal right to make decisions regarding medical and health issues on another person's behalf through a durable power of attorney for healthcare

Seizures

a disorder in the brain's electrical activity, sometimes marked by loss of consciousness and often by uncontrollable muscle movement; also called a convulsion

Esophagus - body area of referred pain

along sternum, left upper thorax

Poison

any substance that causes injury, illness or death if it enters the body is a poison toxins are poisonous substances produced by microorganisms that can cause certain diseases but are also capable of stimulating neutralizing antibodies or antitoxins

Body Substance Isolation (BSI) Precautions

are a group of measures to prevent exposure to pathogens - Personal protective equipment (PPE) - Proper hand hygiene - Engineering controls (are objects used in the workplace to help reduce the risk of an exposure incident) - Work practice controls - Proper equipment cleaning - Spill cleanup procedures

Bloodborne Pathogens

are microorganisms, such as bacteria and viruses that are present in blood and other potentially infectious materials (OPIM) and cause disease when certain conditions are present

AIDS

caused by HIV virus pt. may be diagnosed as having AIDS when an infected person has a significant drop in a certain WBC or shows signs of having certain infections or cancers

Critical Burns

causes breathing difficulties covers more than 1 body part partial or full thickness burns

What core temperature indicates heat stroke?

core temp exceeds 103 F

Hyperglycemia

glucose too high; insulin too low

Hypoglycemia

glucose too low; insulin too high < 70 mg/dL provide 15-20g of glucose

Opportunistic Infection

infections that strike people with weakened immune systems

Emergency Medical Responder (EMR) scope of practice

is defined as the range of duties and skills an EMR is allowed and expected to perform as appropriate

Vector-Borne Transmission

occurs when an infectious source (i.e. animal or insect) bite or sting penetrating the body's skin malaria, rabies, West Nile virus

Good Samaritan Law

protect people against claims of negligence when they provide emergency care in good faith without accepting anything in return EMR are not usually considered "Good Samaritans" when working, though many states have other laws that protect EMRs from negligence claims arising out of job activities in some situations

Expressed Consent

pt can give expressed consent verbally or through a gesture If pt is a minor, law requires that an EMR obtain consent from a parent or guardian if available pt can withdrawal consent for care at any time

Quadricep Contusion

severe impact to below the anterior thigh Pain, temporary loss of function (limited knee flex), immediate swelling

Body temp >> air temperature

shunting of blood to the periphery - loss of heat through convection and radiation

Standard of Care

the public expects a certain standard of care from personnel summoned to provide emergency care. The standard of care is the criteria established for the extent and quality of EMR care

Passive Immunity

the short-term immunity that results from the introduction of antibodies from another person or animal. Immunity gained from external sources (i.e. mothers milk)