chapter 5-6 KNES Quiz 2
proliferative phase
other charactersitics of the __________________ include an increased number of blood vessels, increased water content in the injury zone, and re-epitheliazation at the surface caused by epithelial cells migrating form the periphery toward the center of the wound 69
inflammatory phase movement
the advantages of movement during the _______________ include: encouraging venous return encouraging fluid resorption encouraging phagocytosis preventing contracture and loss of range of motion 85
emergency plan rehearsed
developing an ________________ is one part of planning for the management of injuries; in order to ensure the plan is efficient and effective, it must be ___________; the emergency response team should practice the emergency plan through regular educational workshops and training exercises; the use of interactive or simulation practice exercises can better prepare individuals to assume their roles in rendering emergency care 79
bony tissue healing phases
*Acute inflammatory phase* -Formation of hematoma -Inflammatory response *Proliferative phase* -Osteoclasts—resorb damaged tissue; osteoblasts—deposit new bone -Callus formation *maturation phase* -Continued activity of osteoclasts and osteoblasts -Remodeling of bone slide 14
tendons, ligaments, and muscles maturation phase
-Muscle fibers form adhesions -Tendons and ligaments slower to heal -Potential for atrophy to muscle, tendon, and ligament with immobilization e.g. cast; more severe with weight bearing limb -Loss of strength and decreased rates of healing are directly related to length of immobilization. -Begin strengthening as soon as it's safe after injury to ensure hypertrophy of healing tissues and decreased reoccurrence of injury slide 11
bony tissue healing timeframes
1. IMMEDIATE effects of injury; periosteum, medulla, cortex, damage to surrounding tissue with bleeding, dead tissue 2. AFTER 4-5 DAYS, inflammatory reaction, new blood vessels, fibrocartilage forming, dead tissue removed by phagocytes and macrophages 3. AFTER FIRST WEEK, early bone regeneration and periosteal growth 4. AFTER THREE WEEKS well formed callus, deposition of minerals in callus, increased osteoblast and osteoclast activity 5. WEEKS TO MONTHS after injury, remodeling of callus 6. MONTHS after injury well healed with fracture site invisible
legal duty
The team physician, athletic trainer, and coach have a ____________ to develop and implement an emergency plan to provide health care for participants; slide 3 NOT IN BOOK
zone of secondary injury
_____________ *includes all of the tissue affected by inflammation, edema, and hypoxia*
universal precautions
_____________ include: if possible, wash hands before treatment if possible, cover any existing personal wounds apply gloves (e.g. latex) before initiating treatment; in some instances, it may be appropriate to give the patient a sterile gauze pad to apply to the wound while the gloves are being applied if splattering or splashing of blood is anticipated, wear additional personal protective equipment (e.g. goggles; masks; gowns) if it becomes necessary to treat another individual, apply a new pair of gloves immediately following treatment, thoroughly wash hands and other skin surfaces with soap and warm water; in the absence of soap and water, disposable towel wipes or sanitizing lotions should be used dispose of all contaminated materials (E.g. gloves, gown, gauze pads) in an appropriate container marked for biohazardous waste 80
local factors influencing healing
_____________ occur at the site of the wound; _______________________ that delay healing include: extent or size of the injury extent (amount) of hemorrhage and edema muscle spasm inflammation infection poor blood supply prolonged immobilization; excessive motion or repeated adverse stress 72 slide 20
medical emergency fracture
_____________ while waiting for medical assistance to arrive, the following actions should be considered in managing the condition: control any bleeding (application of gentle pressure) immobilizing the injured area in the position it was found applying cold to the area if shock is suspected, then providing treatment for shock 86
emergency action plan
______________ requirements: •Serves as a blue print on how to respond to emergencies •Plan should identify -Personnel and qualifications -Equipment -Mechanism of communication -Facilities -Documentation verifying the implementation and evaluation of EAP- emergency action plan -Documentation of annual review and rehearsal slide 2; starts talking about on pg 76
universal precautions
______________ should always be practice in treating any open wound; best practice is to treat the blood of any individual as if it is infected with a bloodborne pathogen 80
mast cells
_______________ are connective cells that carry heparin, which prolongs clotting; histamine, which promotes further vasodilation; and bradykinin, which promotes vasodilation, increases blood vessel wall permeability, and stimulates nerve endings to cause pain 68 ________________ release •Heparin: thins the blood and prolongs clotting •Histamine: promotes further vasodilation •Bradykinin: opens the blood vessel walls; causes pain slide 3
systemic conditions influencing healing
_______________ can affect multiple organs, systems, or the entire body; _______________________ that can impede wound healing include: poor nutrition- a diet deficient in proteins, vitamins, and minerals is problematic vascular insufficiencies- these conditions can result in poor circulation and absence of sufficent blood supply to an area age- elderly individuals are more susceptible to difficulties infection- a systemic infection or local infection will delay healing metabolic disorders- individuals with diabetes mellitus are affected by the regulation of their serum glucose levels 72 slide 21
closed wound care
_______________ focuses on immediately reducing inflammation, pain, and secondary hypoxia; the process for providing immediate management for an acute closed soft tissue injury includes several components, commonly referred to as the PRICE principle (i.e. protected rest, ice, compression, and elevation 82 •PRICE -Protected Rest -Ice -Elevation -Compression
local and systemic factors
a variety of ________________ can delay the healing process; some of these factors can respond to treatment, while others are difficult to control 72
inflammatory phase (0-6 days)
_______________ involves: vasoconstriction- initial attempt of body to stop blood loss; beginning of coagulation; initaites clotting vasodilation- increased blood flow; swelling; increased capillary permeability release of chemicals- promotes vasodilation edema- large amounts of fluid (plasma and water) and exudate (fluid with cellular debris and high protein content) in the involved area clot formation- fibrin deposits an irregular meshwork of short fibers in the region to contain the area phagocytosis- leukocytes (neutrophils and macrophages) ingest the cellular debris; in doing so, prepares the area for repair 69
stress fractures
________________ continue to worsen as long as the site is overloaded, it is important to recognize these injuries as early as possible; elimination or reduction of the repetitive mechanical stress causing the fracture is the primary factor necessary for healing; this allows a gradual restoration of the proper balance of osteoblast and osteoclast activity present in the bone 70
stages of cold sensation
________________ include: initial cold sensation (0-3 minutes) burning and aching sensation 2-7 minutes numbing sensation (anesthesia) 5 to 12 minutes 83
maturation and remodeling of bone tissues
________________ involve osteoblast activity on the concave side of the fracture, which is loaded in compression, and osteoclast activity on the conex side of the fracture, which is loaded in tension; the process continues until normal shape is restored and bone strength is commensurate with the loads to which the bone is routinely subjected •___________________ -Continued activity of osteoclasts and osteoblasts -Remodeling of bone slide 14
maturation (up to 1+ years)
________________ involves: development of scar tissue- initially fibrous, inelastic, nonvascular scar tissue is formed that is approximately 50% less in strength than its preinjury strength; scar formation continues modification based of the realignment of collagen fibers, based on the lines of habitual stress; potential for increased strength of scar tissue; scar tissue formation results in decreased size and flexibility of the involved tissues return to normal histochecmical activity- allows reduced vascularity and water content 69
cold packs
________________ should be applied to the injured area as soon as possible following the injury; the length of application time can range from 15 to 30 minutes; the time for a larger muscle mass, such as the quadriceps, would be 30 minutes and for a smaller site, such as a finger, 15 minutes should be sufficient; cold applications should be repeated every 1 to 2 hours while the patient is awake and continue for at least 72 hours post injury; during the application, the patient can expect to experience progressive sensations, namely cold, burning, aching, and analgesia (numbing) 83
during the event, responsibilities
________________ that should be defined could include: assessment of a condition (e.g. specific protocol for a potential head, neck or internal injury) on site treatment of a condition (e.g. application of ice and compression for a soft tissue injury; conditions, whereby protective equipment should not be removed: conditions, whereby an injured participant should not be moved; identification of conditions which warrant activation of the local EMS implementation of the emergency plan (E.g. if the injury requires contacting the parents, who will make the phone call; if the condition requires obtaining the services of local EMS who will make the call) proper disposal of items and equipment exposed to blood or body fluids documentation of actions taken in response of an injury condition 77
maturation phase or remodeling phase
________________: remodeling continues for a year or more as collagen fibers become oriented to the tissue's normal mechanical stress; the tensile strength of scar tissue may continue to increase for as long as 2 years post-injury 69
indications for applying cold
_________________ include: acute or chronic pain acute or chronic muscle spasm/ guarding acute inflammation or injury postsurgical pain and edema neuralgia- nerve pain, normally the face or head superficial first-degree burns used with exercises to: facilitate mobilization relieve pain decrease muscle spasticity 83
open wound conditions warranting referal
_________________ include: life-threatening wounds (EMS should be activated) uncontrolled bleeding inability to cleanse all the debris from a wound a wound that potentially requires stitches a penetrating wound (a tetanus shot may be necessary to avoid serious infection) 82 Identify conditions that warrant immediate referral: -Life-threatening wounds -Uncontrolled bleeding -Inability to cleanse all the debris from the wound -A wound that needs stitches -A penetrating wound slide 8
three phases of soft tissue healing
_________________ include: inflammation, proliferation, and maturation; although it is useful to discuss the healing phenomeon in terms these different stages, it should be recognized that there is usually overlap of these processes, both spatially and temporally, within injured tissues 67
proliferation (3-21 days)
_________________ involves: angiogenesis- development of new blood vessels to promote healing fibrous tissue formation- fibroblasts produce a supportive network of collagen fiber; stabilizes the wound site, but the area is significantly weaker than the normal healthy tissue surrounding the damaged area 69
documentation
_________________ is essential to verify the implementation of the emergency plan in response to any injury or condition; the actions taken by the coach in assessing and managing the injury should be documented using appropriate forms; these forms should be completed as soon as possible following the incident; any unnecessary delay in completing the forms could result in failure to accurately recall all the actions that took place 79
bloodborne pathogens
_________________, such as Heptitis B virus, Hepatitis C virus, and Human Immunodeficiency Virus are microorganisms present in blood and other body fluids (e.g. semen; vaginal secretions) of infected individuals; the microorganisms can be transmitted when contaminated blood or bodily fluids enter the body of another person 80 •Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and Human Immunodeficiency Virus (HIV) are microorganisms that are present in blood and other bodily fluid slide 6
fracture red flags to alert EMS
_________________- include: an open or compound fracture suspected multiple fractures suspected fracture of the femur, hip, pelvis, vertebra (E.g. cervical; lumbar), or skull a limb or joint presents with significant deformation the toes or fingers of the involved extremity are pale, blue, cold, or numb (suggesting circulatory compromise) signs and symptoms of shock 86 -Open or compound fracture -Suspected multiple fractures -Suspected fracture of the femur, hip, pelvis, vertebrae, or skull -A limb or joint presents with significant deformation -Distal extremities (toes/fingers) are pale, blue, cold, or numb -Signs and symptoms of shock slide 10
closed wound care
_________________: -Goal: reduce inflammation, pain, and secondary hypoxia -Treatment: PRICE- protected rest, ice, compression, and elevation slide 12, NOT IN BOOK
open wound care
_________________: Any open wound Step number one: Control bleeding, evaluate wound, determine if EMS is needed -Follow universal precautions and infection control standards to prevent spread of bloodborne pathogens -General •Apply pressure •Cleanse the wound •Dress and bandage the wound •Use of creams or ointments Re-dress and inspect slide 12 NOT IN BOOK
elevation of injured body part
__________________ at least 6-10 inches above the heart can reduce bleeding in the area, encourage venous return, and prevent pooling of blood in the extremities; __________________ should be performed as often as possible during the 72 hours postinjury; if the injury is to the lower extremity, in preparation for sleeping, raising the end of mattress (using a hard object, e.g. a suitcase) will permit elevation throughout the night; while the use of several pillows under the lower extremity is a viable option, there could be a tendency for the pillows to move and compromise the elevation 84
contraindications for applying cold
__________________ include: decreased cold sensitivity and/or hypersensitivity cold allergy/ cold-induced ultricaria circulatory or sensory impairment rayund's phenomenon advanced diabetes hypertension uncovered open wounds cardiac/respiratory disorders nerve palsy- paralysis arthritis 93
implementing emergency plan
__________________ include: rehearsing and practice review by administrator or someone not in the plan
communication
__________________ involves attention to other areas including: determining when and who will call 911 (i.e. summon EMS) determining when and who will call the parents of a minor to advise them of an injury sustained by the child the timing of the phone call to the parents should also be determined in advance determining when and who will call or inform personnel affiliated with an institution/ facility (E.g. athletic director; school principle; fitness facility director) of an incident 79
soft tissue injuries
__________________ may involve open wounds (e.g. abrasions; blisters; lacerations; puncture wounds) or closed wounds (e.g. contusions; sprains; strains) 79
bone tissue maturation
__________________- involves osteoblast activity on the concave side of the fracture, which is loaded in compression, and osteoclast activity on the convex side of the fracture, which is loaded in tension 72
muscle fibers
___________________ are permanent cells that do not reproduce or proliferate in response to either injury or training; however, reserve cells in the basement membrane of each muscle fiber are able to regenerate muscle fiber following injury; severe muscle injury can result in scarring or the formation of adhesions within the muscle, which inhibit the potenital for fiber regeneration from the reserve cells; consequently, following severe injury, muscle may regain only about 50% of its pre-injury strength -Muscle fibers form adhesions slide 11
following the event
___________________-, the emergency plan should identify the personnel responsible for follow up communication and documentation, as necessary with, the injured participant or their parents and other personnel within the institution/ organization; it is also essential that the plan have specific guidelines for documenting the actions taken by personnel in the implementation of the emergency plan; written documentation should be required for ANY incident that requires a response by facility personnel, not just for those incidents deemed a true emergency; if a coach assesses an injury, determines it to be minor, applies ice and compression, and provides instructions for return to play, the coach should be required to document the event 77
determining when and who will call 911
_____________________ (i.e. summon EMS); again, it becomes important to anticipate potential issues; for example, a school system may already have a plan in place that requires certain personnel be informed before 911 can be called; if so, that policy should be part of the emergency plan; if the decision to call 911 is at the discretion of the coach, there are still items that must be addressed; if the coach is the only adult on-site and is tending to the injured individual, it may become necessary for one of the students on the team to place the call; the role of a student as a member of the emergency response team should be included in the emergency plan 78
notifying institution or facility management
______________________ (e.g. athletic director, school principal, fitness facility director) of an incident; an option for ensuring that necessary personnel have been informed is to create a chain of command; this option should allow for an efficient and effective means for disseminating information as necessary 79
emergency conditions warranting written protocols
______________________ include: on-site management of an unconscious individual head and neck injuries acute cardiac conditions (e.g. cardaic arrest; commotion cordis) acute respiratory distress (e.g. asthma, exercise induced bronchospasm, exposure to allergen) life or limb threatening orthopedic injuries (e.g. femoral fracture, hip dislocation, posterior sternoclavicular dislocation) general medical conditions (e.g. diabetes, sickle cell anemia) environmental conditions (e.g. heat illness)
managing acute injuries or conditions
______________________- is a major responsibility for individuals involved in the instruction, supervision, or administration of programs involving physical activity; in performing this responsibility, the *COACH must be concerned with providing the appropriate medical care for the participant and it must be within the standards of care of a COACH* 75
determining when and who will call parents of a minor
__________________________ to advise them of an injury sustained by their child; again, if the coach is not available to make the call, it may become necessary for a student to make the call; the plan should not only ensure that a student member of the emergency response team is prepared to make such a phone call, it should also ensure that parents are advised in advance that in some scenarios, a student will be part of the emergency response team 79
fracture
a ____________- can range in severity from a minor injury to a life-threatening emergency; as such, the immediate management of a _____________ must take into consideration the nature and severity of the _____________; IN ALL INSTANCES, MEDICAL ATTENTION IS REQUIRED 85
chronic inflammatory response
a ____________________ is prolonged and is characterzied by nongranular leukocytes and the production of scar tissues 67
factors that delay healing
a variety of ____________________ of a wound; in general, these factors can be characterized as systemic or local; the ability to manage or influence these factors varies; the coach will likely have minimal influence in controlling or managing most of the factors; however, the coach is positioned to have an impact on some local factors subsequent to their involvement in the immediate management of an acute injury 71
coach
accidents and injuries are to be expected; participants in sport and physical activity need to understand that certain inherent risks are involved with their participation; the _______________ needs to have that same understanding and, as such, be prepared to provide immediate management for potenital injuries/conditions; _____________ as the first responder when an injury is sustained, the coach is expected to *evaluate the situation, assess the severity of injury, recognize life-threatening conditions, provide immediate care, and initiate procedures, as necessary, to ensure proper referral for ongoing management* 75
vasodilation
after vasoconstriction, _________________, or an increase in blood flow, occurs; one process activated during this phase is the attraction of NEUTROPHILS and MACROPHAGES to rid the injury site of debris and infectious agents through PHAGOCYTOSIS; as blood flow to the injured area slows, these cells are redistributed to the periphery, where they begin to adhere to the endothelial lining; MAST CELLS are connective cells that carry HEPARIN, which prolongs clotting; HISTAMINE, which promotes further vasodilation; and BRADYKININ, which promotes vasodilation, increases blood vessel wall permeability, and stimulates nerve endings to cause pain 68 -_______________brings neutrophils (make up 60-75% of white blood cells) and macrophages to clean the area via phagocytosis. -Mast cells release •Heparin: thins the blood and prolongs clotting •Histamine: promotes further vasodilation •Bradykinin: opens the blood vessel walls; causes pain slide 3
scar tissue
although the epithelium has typically completely regenerated by 3-4 weeks post-injury, the tensile strength of the wound at this time is only approximately 25% of normal; after several more months, strength may still be as much as 30% below preinjury strength; this is partly caused by the orientation of the collagen fibers, which tends to be more vertical during this time than in normal tissue; the collagen turnover rate in a newly healed scar is also high; therefore failure to provide appropriate support for the wound site can result in a larger scar 69 -Scar tissue is fibrous, inelastic, and nonvascular •Less functional and flexible than original tissues •Tensile strength §3 to 4 weeks: 25% of normal §4 to 5 months: 30% below preinjury strength that means that it is 70% of what it was before injury slide 10
acute inflammatory response
an _________________ is relatively brief and involves the creation of EXUDATE, a plasma like fluid that exudes out of tissues or its capillaries and is composed of protein and granular leukocytes (aka white blood cells) 67 ________________ occurs when edema forms when histochemical agents open the pores in the vascular walls, allowing plasma to migrate into the interstitial space 68 the tissue EXUDATE provides a critically important part of the body's defense, both by diluting toxins present in the wound and by enabling delivery of the cells that remove damaged tissue and enable reconstruction 68
emergency plan
an _________________ should be developed for the purpose of providing direction to the coach and other individuals who will have responsibilities in managing an injury/condition; the plan should not be limited to emergency conditions, but rather it should include injuries of varying severity (e.g. mild, moderate, severe, life-threatening) 86
emergency action plan
an _____________________ is a well-developed written process that defines the policies and procedures to be used in the management of an acute injury to a participant; the plan should provide direction to those individuals who will have responsibilities in managing the condition; the plan should not be limited to emergency conditions, but rather it should include injuries of varying severity (E.g. mild, moderate, severe, life-threatening); the ______________________ should be a written document that is comprehensive, yet flexible enough to adapt to any emergency situation at any activity venue; while some items should automatically be included in an _______________, no single ______________ can satisfy the needs of every institution, organization, or facility; as such, every program should design a plan specific to their facility, population served, personnel, and any other factors that could influence injury management 75
transmission of bloodborne pathogens
as part of the treatment of an open wound, attention must also be given to managing the TREATMENT SETTING; in the absence of appropriate housekeeping or environmental control procedures, the risk of infection could still be present; procedures to prevent _____________ include: cleaning work surfaces immediately following treatment; an approved biohazard product or bleach and water solution (ratio of 1:10) should be available cleaning floor spills in accordnace with infection control standards; it is important to designate the staff responsible for cleaning various types of SPILLS; for example, if a physical education student sustains an injury that results in blood spots on the gymnasium floor, *the physical education teacher should know in advance, if it is their responsibility to clean the floor* or if it is their responsibility to inform another staff member (E.g. maintenance personnel) of the spill making biohazard waste bags and containers available for dispensing of contaminated disposable materials as well as handling of nondisposable contaminated materials (E.g. clothing; towels) establishing protocols for collection of biohazard materials by an appropriate agency 80
zone of secondary injury
as the body continues to react to the inflammatory process, reparative cells in the exudate arrive at the injury site; platelets and basophil leukocytes release enzymes that interact with other chemicals in the cell membranes to produce chemical mediators; these *mediators include prostaglandins and leukotrines, which attract leukocytes to the damaged area*; this chain of chemical activity *produces the _____________, which includes all of the tissue affected by inflammation, edema, and hypoxia*; after the debris and waste products from the damaged tissues are ingested through phagocytosis, the leukocytes re-enter the blood stream and the acute inflammatory reaction subsides 68 -____________________ •Interstitial tissues affected by inflammation, edema, and hypoxia •Prostaglandins promote further healing and clearing of debris ____________ is general term applied to biological tissues that can lead to dysfunction and death Indirect, can occurs hours to days after initial trauma slide 5
tendons and ligaments
because ___________________ have few reparative cells, healing of these structures is a slow process that can take more than a year; regeneration is enhanced by proximity to other soft tissue that can assist with supply of the chemical mediators and building blocks required; for this reason, isolated ligaments, such as the anterior cruciate, have poor chances for healing; if the ______________________ undergo abnormally high tensile stress before scar formation is complete, the *newly forming tissues can be elongated; if this occurs in ligaments, joint instability may result* 70 -Tendons and ligaments slower to heal slide 11
tendons, ligaments, and muscles
because ____________________ hypertrophy and atrophy in response to levels of mechanical stress, complete immobilization of the injury leads to atrophy, loss of strength, and decreased rate of healing in these tissues; the amount of atrophy is generally proportional to the time of immobilization; *although immobilization may be necessary to protect the injured tissues during the early stages of recovery, strengthening exercises should be implemented as soon as appropriate during rehabilitation of the injury; * increased risk for re-injury exists as long as the affected tissues are below pre-injury strength 70 -Potential for atrophy to muscle, tendon, and ligament with immobilization e.g. cast; *more severe with weight bearing limb* -Loss of strength and decreased rates of healing are directly related to length of immobilization. -*Begin strengthening as soon as it's safe after injury to ensure hypertrophy of healing tissues and decreased reoccurrence of injury* slide 11
bloodborne pathogens
because the potential does exist for exposure to _____________ in blood or other infectious fluids among coaches and participants, guidelines must be in place to ensure compliance with the OSHA universal precautions and infection control standards to minimize health risks, including transmission of HBV and HIV 86
responding to blood or other body fluids exposure
because the potential exists for accidental ____________, A PLAN MUST BE IN PLACE for responding to any such scenario; areas to be addressed include: establishing a protocol for obtaining appropriate medical testing and treatment for the individual exposed to the pathogen developing a reporting system for results of any examinations, medical testing, and follow-up procedures defining procedures for documentation of the incident (e.g. date of incident, nature of the exposure, amount of blood involved in the exposure, follow-up recommendations) identifying personnel who should be informed about the incident establishing procedural steps for ensuring confidentiality of the parties involved 81
zone of primary injury
blood from the broken vessels and damaged tissues form a hematoma that, combined with necrotic tissue, forms the __________________
splints
consideration should be given to purchasing commercial-type _____________ as part of an institution's first aid supplies; it is important that the _________________ purchased are suited for use by the coach as compared to those ____________- (e.g. air splints) that should only be used by trained medical personnel (e.g. EMTs; athletic trainers); in the absence of commercial ____________, __________ can be made from materials that will provide rigidity, such as magazines, strips of wood, and cardboard; in a similar manner to the treatment of closed wound injuries, cold packs can be applied to reduce swelling, and the area elevated, as the physiological effects of both will minimize the secondary injury zone and optimize the healing process 85
proliferative phase bone
during repair and regeneration for bone tissue healing, OSTEOCLASTS resorb damaged bone tissues, whereas OSTEOBLASTS build new bone; between the fractured bone ends, a fibrous, vascularized tissue known as a *CALLUS* is formed; the callus contains weak, immature bone tissues that strengthen with time through bone remodeling; the process of callus formation is known as ENCHONDRAL BONE HEALING; an alternative process, known as DIRECT BONE HEALING, can occur when the fractured bone ends are immobilized in direct contact with one another; this enables new, interwoven bone tissues to be deposited without the formation of a callus; unless a fracture is fixed by metal plates, screens, or rods, healing normally takes place through the ENCHONDRAL BONE HEALING process; because noninvasive treatment is generally preferred, a FIXATION DEVICE is only implanted when it appears unlikely that the fracture will heal acceptably without one 70 •Proliferative phase -Osteoclasts—resorb damaged tissue; osteoblasts—deposit new bone -Callus formation slide 14
inflammatory phase movement
during the ________________ can be initiated when bleeding has stopped; bleeding can persist for up to 36 hours; the type of movement should be gentle and controlled motions that progress to routine activities of daily living; for example, if the injury is an ankle sprain, the movements could include wiggling the toes, performing plantar flexion and dorsiflexion within pain-free limits, and using the foot and ankle to make the letters of the alphabet; the next step in the progression would be to initiate walking within the parameters of being pain-free and maintaining a normal gait (i.e. without a limp) 85
acute inflammatory response
during the ___________________blood loss is curtailed, clotting takes place, and histochemical reactions promote coagulation, vasodilation, and attraction of specialized cells to rid the wound site of foreign or infectious agents 72
emergency response team
every facility or institution should have an ___________________; the _________________ should practice the emergency plan through regular educational workshops and training exercises 86
emergency response team
every institution/organization should have an _______________; the responsibilities of team members should be clearly defined; in doing so, it is important to recognize that in any given situation, the members of the emergency response team can vary; for example, in a school setting, a nurse may be available during the school day, but not available for after-school activities; in a fitness facility, additional healthcare practitioners (e.g. physician, nurse practitioner) may be available during hours of operation that a cardiac rehabilitation program is conducted rather than the entire time that a facility is open for business 77
protected rest
following an injury, the area should be _______________ to avoid further damage to the involved tissues; if continued unrestricted activity is permitted, it could result in increased bleeding, increased pain, and delayed healing; if the injury is to a lower extremity and the individual is unable to walk pain-free without a limp, the individual should be placed on crutches and an appropriate protective device applied to limit unnecessary movement of the injured joint; if the injury is to an upper extremity and the individual is unable to move the limb without pain, then the individual should be fitted with an appropriate splint or brace 84
independent administrator review
following any implementation of the emergency plan, personnel other than just those individuals involved in implementing the plan (e.g. administrators) should evaluate the process for the purposes of identifying any areas, which require attention; in particular, any obstacles (e.g. breakdown in communication; unforeseen circumstances) that delayed the process should be identified and the appropriate steps taken to rectify the situation in the future implementation of the plan 79
coach
following completion of an on-site assessment, the ______________ must analyze the information obtained and make decisions on the best way to manage the situation; it is especially important to determine whether hte situation can be handled on site or if referral to a physician is warranted 75
bone fractures
healing of acute _______________ is a three-phase process that includes the ACUTE INFLAMMATORY PHASE, PROLIFERATIVE PHASE, and MATURATION PHASE, just like soft tissue healing has three phases; 70
potential injuries/ conditions
identifying every ______________ that could be sustained by a participant in sport or physical activity and including it in an emergency plan *is not a reasonable expectation*; however, it is reasonable to anticipate and identify potential emergency conditions that could be associated with some situations; for example, head and neck injuries are more likely to occur in football than tennis; an elderly population is more vulnerable to a cardiac episode than students in an elementary school; an individual with diabetes must be concerned with maintaining appropriate blood glucose levels during participation in physical activity; as such, establishing written protocols for some injuries and conditions can potentially reduce confusion through advanced planning and, in doing so, increase the potential for ensuring appropriate management; written protocols for specific injuries/conditions should be considered for inclusion in the emergency plan 76
external support personnel
if ________________ (e.g. emergency medical technicians (EMT); athletic trainers; parents) are used in the implementation of the emergency plan, their roles, responsibilities, and protocols should also be defined; for example, if an athletic trainer is hired to provide medical coverage for an event, then there must be a clear delineation of the responsibilities regarding services to be provided by that individual; it should not be assumed that the athletic trainer will provide specific services; rather, the services to be provided must be determined in advance; in a school or recreational setting, parents can be a valuable resource; for example, if a school knows that the coach is responsible for providing medical care for participants during away contests, recruiting parents to serve as members of the emergency medical team during away contests could be extremely beneficial; however, in order to avoid confusion and ensure appropriate implementation of the emergency plan, the decision to use parents should be determined in advance, so they can be informed of their roles and responsibilities 78 •Preseason preparation -Meet with representatives from local EMS agencies to discuss, develop, and evaluate plan -WRITTEN PLAN FOR EACH ACTIVITY SITE -Practice the emergency plan •Responsibilities of medical personnel -Team physician •Prior to season, delineate responsibilities of all personnel •On the field -Athletic trainer •Event setup •Home versus away Presence or absence of physician slide 4
fracture
if a ___________________ is suspected, there should be no attempt to realign the bones or move the injured individual, until the site is stabilized 86
fracture
if a suspected _______________ to an extremity is associated with minor trauma, the initial focus of the immediate management should include splinting the extremity in the position in which it is found and immobilizing the joint above and below the fracture site; there should be no attempt to realign the bone or move the individual until the suspected fracture is stable; immobilization is necessary to prevent any further damage to the bone and surrounding tissues (e.g. blood vessels; nerves; muscle) and it should aid in reducing pain 85
fracture
if a suspected ________________ is associated with a major trauma or injury, it should be treated as a medical emergency; such a condition warrants activation of the emergency medical plan, including summoning of 911 85
tendons and ligaments
if the ______________________ undergo abnormally high tensile stress before scar formation is complete, the *newly forming tissues can be elongated; if this occurs in ligaments, joint instability may result* 70
stitches
if the coach suspects that a wound requires _______________, arrangements should be made to have the individual seek medical attention at an emergency room or urgent care center; if necessary, __________ should be applied within 6 hours to avoid contamination of the wound; if a physician's evaluation suggests contamination, a wound cannot be ____________, as doing so would compromise the healing process 82
return to activity
if the evaluation suggests that the wound does not require immediate medical attention, the individual may be permitted to _________________ after the wound has been dressed and bandaged securely; if the wound resulted in blood on the individual's clothing, the clothing should be changed prior to be changed prior to return to activity if it appears wet or has soaked through the fabric; if the blood presents as small droplets of dried blood, it is not necessary to change the clothing 82
OSHA standards hepatitis B
if the nature of a job puts an employee at a reasonable risk of coming into contact with blood or other bodily fluids, employers are required by the ___________________ to offer Hepatitis B vaccinations to their employees; the Hepatitis B vaccination prophylaxis is considered the best defense against contraction of HBV; the vaccination involves a series of three shots over a 6 month period; the CDC reports very small risk of serious side-effects with the vaccination; the most common side-effect is soreness at the injection site; it is believed that the potential risks associated with HBV are far greater than any risk associated with the vaccine; if an employee should decline the vaccination, the decision to decline should be appropriately documented 81
establishing specific responsibilities prior to program
in _____________ of personnel, IT IS NECESSARY TO ADDRESS DUTIES PRIOR TO THE BEGINNING OF A PROGRAM OR EVENT, DURING THE ACTIVITY, and AFTER THE ACTIVITY; areas of importance prior to the initiation of a program or event could include: identifying the personnel responsible for ensuring that first aid kits are appropriately stocked and restocked after use identifying the personnel responsible for ensuring that emergency equipment are available and optional 77
open wound management
in individual should be instructed to change the dressing daily; as part of that process, potential signs of infection should be assessed, including localized heat, swelling, redness, pus, and pain; body temperature should also be taken as an elevated temperature could be indicative of infection; if signs of infection are present, the individual should seek medical attention 82
medical emergency fracture
in a situation considered a __________________, IT IS BEST TO AVOID MOVING OR TRANSPORTING THE INDIVIDUAL; *because movement could aggravate the condition, the individual should remain in the position found and paramedics should handle transport* 86
documentation
in addition to _________________ of a specific incident, other information pertaining to the plan should be documented; a procedure should be in place for the verification and _____________ of: must document an ANNUAL REVIEW and REHEARSAL OF THE EMERGENCY PLAN, including notations indicating whether the emergency plan was MODIFIED and, if so, the changes made personnel training and current certification e.g. CPR, BLS, AED, etc. equipment maintenance and replacement as necessary, e.g. AED 79
injury management
in addressing ______________, two broad areas should be considered; one area is the use of an emergency/ action plan to provide direction for the coach in managing a condition; the second area is the on-site treatment appropriate for acute musculoskeletal injuries 75
emergency plan
in developing the ____________________, the institution/facility should design a plan specific to their facility, population served, personnel, and any other factors (e.g. availability of medical/first aid equipment; communication; facility access; documentation) that could influence injury management 86
equipment and supplies
in developing the emergency plan, decisions must be made with regard to the specific equipment and supplies that must e available to implement the plan; in making such decisions, it is essential to ensure that the materials are appropriate to the level of expertise or qualifications of the personnel implementing the plan; for example, it may not be appropriate to have an AED available for use in the absence of personnel trained to use the equipment; the same applies to less-sophisticated equipment, such as crutches; if crutches are to be made available for use by an injured participant, the coach must be familiar with the guidelines for the proper fitting of crutches and instructions on the use of crutches; even the items selected for first aid kits should be predetermined and not left to the discretion of individual personnel; in all instances, personnel should be familiar with the first aid and medical supplies available for their use in advance of making use of them 78
open wounds
in general management of __________________ involves controlling bleeding, evaluating the wound to determine whether emergency treatment is necessary, cleansing the wound, and dressing the wound; in addition, care of open wounds includes following universal precautions to reduce the risk of transmission of bloodborne pathogens 79 •Open Wound Injury Care -KEY: control bleeding and evaluate the wound to determine if emergency treatment is necessary -Cleans and dress the wound -Make sure universal precautions are followed to reduce risk of bloodborne pathogens slide 5
immobilization and remobilization
in general, soft tissues respond to the physical demands placed on them, causing the formation of collagen to remodel or realign along the lines of stress, thus promoting healthy joint biomecahnics (Wolff's law); continuous passive motion can prevent joint adhesions and stiffness, and decrease joint hemiarthrosis (blood in the joint) and pain; early motion, and loading and unloading of joints, through partial weight-bearing exercises maintain joint lubrication to nourish articular cartilage, menisci, and ligaments; this leads to an optimal environment for proper collagen fibril formation 85
acute injury management
in general, the options available to the coach in _______________ would include: standard acute care (i.e. cold, compression, elevation, protected rest, as appropriate) with no physician referral, but providing the individual with a written instruction sheet identifying signs and symptoms that would necessitate immediate care by a physician standard acute care with physician referral prior to return to activity standard acute care with immediate physician referral (i.e. emergency care facility) summon emergency medical services (EMS) 75
facility access
in some environments, ________________ may not be a concern; however in other settings it should not be overlooked; for example, if an injury occurs during a physical education class being held outdoors, the emergency plan may stipulate that the teacher uses a cell phone to call school personnel for necessary assistance; if the cell phone is not available, it may become necessary to send a student to the school building to obtain help; in many schools, the outside doors are locked during the school day; if the door closest to the outdoor teaching area is not a door that can be readily accessed, the potential time delay to locate an unlocked door could have serious consequences for the injured individual; again, the emergency plan is intended to anticipate any potential problems/issues in advance, so access to the facility should be addressed in developing the plan 78
proliferative phase
in the ________________, healing through scar formation begins with the accumulation of EXUDED FLUID (EXUDATE), which contains a large concentration of protein and damaged cellular tissues; this accumulation forms the foundation for a highly vasculairzed mass of immature connective tissues that include fibroblasts, which are cells capable of generating collagen; the new connective tissue matrix is fueled by nutreints from the new blood supply and the newly forming blood vessels, which depend on the mechanical support and protection from the matrix; the matrix rapidly forms cross-links that contribute to stabilization of the wound site; the fibroblasts that have been checmically drawn to the hypoxic sites within the wound region secrete the collagen and promote ANGIOGENESIS by helping growing blood vessels attach to the basement membrane collagen; these cells then fuse and form new vessels other charactersitics of the __________________ include an increased number of blood vessels, increased water content in the injury zone, and re-epitheliazation at the surface caused by epithelial cells migrating form the periphery toward the center of the wound 69 -Hematoma reduces in size for new healing to take place -Scar formation with soft tissue -Accumulated exudate contains fibroblasts that generate new collagen that makes up the matrix for scar tissue formation -Newly formed blood supply and support of matrix will determine overall healing of new tissue slide 8
cold, wet compression
in the immediate management of injury, the use of a ___________________ is advantageous; using an elastic wrap to secure the cold agent to the body part produces a significant reduction in subcutaneous tissue temperatures as compared with simply placing the cold agent on the skin; one layer of the wrap should be applied to the injured site prior to placing an ice bag over the area; the remainder of the wrap should be used to secure the ice bag in place; when the treatment time for the cold back is complete, a dry compression wrap should be applied; the compression wrap should be worn throughout the day and night 84
open wound management
in the process of cleaning the wound, the coach must evaluate the wound to determine whether immediate or emergency care is required when the wound is clean and the bleeding has stopped, the next step is to dress the wound with a sterile bandage; the bandage could be a simple gauze pad or an occlusive type pad; in addition, an antiseptic ointment can be used to reduce bacterial growth; if the wound is a laceration, incision, or avulsion, butterfly strips can be used to join the edges of the wound; if the wound is deep enough that subcutaneous fat is visible or wide enough that it cannot be easily closed, it may require stitches; in addition, location of the wound can be a factor in determining the need for stitches; specifically, if the wound site is an area that readily stretches or moves, a medical professional should evaluate the condition 82
fracture
individuals with a suspected _______________ should be advised to seek treatment at an urgent care center or emergency room; _______________, even those minor in nature, should be treated as soon as possible to avoid complications and optimize the conditions for proper healing 85
cold packs
instant (checmical) ______________- are convenient to carry in a first aid kit, disposable after a single use, and can conform to a body part; each bag contains two chemicals separated by a plastic barrier; when the barrier is ruptured, the chemicals mix, producing cold; disadvantages of this type of application are the short duration of the cold application, the expense in using the pack only once, and the potential for the pack tearing or leaking; the chemical substance that produces the cold has an alkaline pH, which can cause burns, if the liquid substance comes in contact with the skin; as such, the PACKS SHOULD NEVER BE SQUEEZED OR USED ABOUT THE FACE, and if possible, should be placed inside another plastic bag 83
coach
it is not within the standards of care of a ______________ to prescribe therapeutic exercises; however, a general understanding of the role of movement in the healing of soft tissue injury enables the _______________ to educate and advocate for injured individuals; in particular, it would be advantageous for the coach to understand the importance of movement during the inflammatory phase of healing 85
ice
plastic bags filled with crushed __________ or small cubes can be safely applied to the skin without danger of frostbite; __________ bags can be molded to the body's contours, held in place by a cold compression wrap, and elevated above the heart to minimize swelling and pooling of fluids in the interstitial tissue spaces 83
written plan
regardless of the severity of injury, a _______________ should be in place to direct the coach through the implementation of each option 75
transmission of bloodborne pathogens
research suggests that the risk of ______________ in an athletic or physical activity setting is RELATIVELY LOW; regardless such guidelines are necessary to minimize health risks and to protect both the coach and participant; in developing the guidelines, *several areas should be addressed, including universal precautions, housekeeping, and biohazard waste disposal, accidental exposure, pre-exposure prophylaxis with Hepatitis B vaccine, documentation, and wound management* 80
acute inflammatory phase bone
the *_______________* lasts approximately 4 days; the formation of a hematoma in the medullary canal and surrounding tissues causes damage to the periosteum and surrounding soft tissues; the ensuing inflammatory response involves vasodilation, edema formation, and the histochemical changes associated with soft tissue inflammation •Acute inflammatory phase -Formation of hematoma -Inflammatory response slide 14
maturation phase or remodeling phase
the ______________ involves remodeling of the newly formed tissues 72
healing process
the ________________ takes place in a regular and predictable fashion that includes three phases, namely the inflammatory phase, the proliferative phase, and the maturation phase; an understanding of each phase is essential to determining the appropriate management of an injury and monitor the healing progress 72
proliferative phase
the __________________ includes angiogenesis, fibroplasia, re-epitheliaziation, and wound contraction 72
proliferative phase
the __________________ involves repair and regeneration of the injured tissue; this phase takes place form aproximately 3 days after injury through the next 3-6 weeks, overlapping the later part of the inflammatory phase; the proliferative processes include the development of new blood vessels ANGIOGENESIS, FIBROPLASIA- the process of fibrous tissue formation, REEPITHELIALIZATION- the generation of new epithelial tissue, and wound contraction; _____________ stage begins when the size of the hematoma is sufficently reduced to allow room for new tissue growth; although skin and bone can regenerate themselves, other soft tissues replace damaged cells with scar tissues 68 •____________ (3 to 42 days) -Repair and regeneration of tissue -Processes •Angiogenesis- development of new blood vessels •Fibroplasia- development of new fiberous tissue formation •Reepithelialization- generation of new epithelial tissue •Wound contraction slide 7
application of a compression
the ___________________ following an acute injury can aid in reduction of swelling to the injured site; _________________ decreases hemorrhage, reduces the space available for the seepage, and encourages fluid absorption; in doing so it promotes rather than delays healing; an exception for the use of ______________ in managing soft tissue injury is *any injury in which the additional compression would compound the trauma;* for example, the addition of a _______________to an acute compartment syndrome in the lower leg is contraindicated 84
reparative process
the ______________________ for injured tissues involves a complex series of interrelated phyiscal and chemical activities; because the normal healing process takes place in a regular and predictable fashion, knowledge of the various signs and symptoms exhibited at the injury site is essential to determining management and treatment options and monitor healing progress; ultimately, this information is critical to decisions regarding immediate management, rehabilitation, and return to participation following injury 67
open wound management
the _______________________ includes application of pressure to control bleeding, cleansing the wound, evaluating the wound to determine if referral is necessary, and dressing the wound 86
timing of phone call to parents
the ________________________ should also be determined in advance; for example, if it becomes necessary to activate EMS, it would seem that the parents should be called immediately after the call to 911; an argument could be made that it is not necessary to call the parents until the EMS unit arrives and determines their response; regardless of the decision, the appropriate timing of a phone call to the parents should be determined in advance and included in the emergency plan 79
communication
the availability of a phone is a critical component in the development of an emergency plan; the coach must have access to a working telephone at all times; while the availability of cell phones would seem to negate the importance of this component, it should not be overlooked; a plan must be in place for addressing potential problems with the availability of a cell phone (e.g. the phone loses its charge unexpectedly; phone service is not available in a particular areas) 78
acute inflammatory response
the beginning of the _______________ involves the activation of three mechanisms (VASOCONSTRICTION, PLATELET REACTION, and COAGULATION CASCADE) that act to stop blood loss from the wound; first blood flow is reduced through local VASOCONSTRICTION, lasting from a few seconds to as long as 10 minutes; the resulting reduction in blood flow volume in the region promotes increased blood viscosity or resistance to the flow, which further reduces blood loss at the injury site a second response to the loss of blood is the PLATELET REACTION; the platelet reaction causes clotting as individual cells irreversibly combine with each other and with fibrin produced by the COAGULATION CASCADE, which is the result of the third response to trauma; when combined, a mechanical plug is formed that occludes the end of a ruptured blood vessel; the platelets also produce an array of chemical mediators that play significant roles in the inflammatory and proliferation phases of healing 67 •______________ (0 to 6 or 7 days) -Acute or chronic inflammation possible -Exudate forms -Mechanisms for stopping blood flow •Local vasoconstriction •Platelet reaction •Coagulation cascade slide 2
emergency action plan
the development of an __________________ should be recognized as a significant endeavor that requires input from several sources; ____________ should be developed with input form the personnel at the facility, higher authorities to which the institution reports (e.g. individual school as part of a school system; a fitness facility as a company-owned entity), medical personnel (e.g. physicians; representatives from local EMS agencies; athletic trainers), and legal personnel (e.g. school lawyer; company lawyer); in developing the ________________, several areas must be addressed, including the *population being served, potential injuries/conditions, personnel, availability of medical/first aid equipment, facility access, communication, and documentation* 76
facility access
the emergency plan should also identify the process for ensuring that emergency vehicles (e.g. EMS, have easy access to the facility and any outdoor venues; in some settings, the exact location of an outdoor venue may not be readily apparent to a responding EMS unit; if the emergency plan has identified a member(s) of the emergency response team to meet the EMS unit at the main entrance and direct them to the appropriate area, it could reduce an otherwise unforeseen delay in reaching the injured participant 78
qualifications
the emergency plan should be developed with an understanding of the ______________ of personnel that will be part of the emergency plan; the institution/organization would be well advised to require involved personnel to maintain certification in first aid, CPR, AED training; institutions should also consider requiring personnel to be trained in the handling of bloodborne pathogens; an emergency plan for an institution that does not require first aid, CPR, and AED training for their staff would necessitate a very different plan form that of an constitutions requiring such certifications; every institution/organization should have an emergency response team; 77 see below
cold
the extent of a soft tissue injury can be significantly affected by altering the temperature of the injured tissues; within minutes of an injury, the application of ______________ can lead to vasoconstriction at the cellular level and decreased tissue metabolism (i.e., decreases the need for oxygen), which reduces secondary hypoxia; capillary permeability and pain are decreased, and the release of inflammatory mediators and prostaglandin synthesis are inhibited; as temperature of peripheral nerves decreases, a corresponding decrease in seen in pain perception; because nerve impulses are inhibited and muscle spindle activity is decreased, muscles in spasm are relaxed, breaking the pain-spasm cycle and leading to an analgesic, or pain-free effect; as such, *cold is the modality of choice during the acute phase of injury* 83
inflammation
the familiar symptoms of _______________ have long been recognized as rubror (redness), calor (local heat), tumor (Swelling), dolor (pain), and in severe cases, loss of function; inflammatory phase lasts from 0-6 days; although ______________ can be produced by adverse response to chemical, thermal, and infectious agents, the focus of this explanation is on the characteristic course of the _________________ response following injury 67
maturation phase or remodeling phase
the final phase of the soft tissue wound repair is the _________________ or remodeling phase, and can last up to *one plus years*; this phase involves the maturation of the newly formed tissue into a scar tissue; the associated characteristics include decreased fibroblast activity, increased organization of the extracellular matrix, decreased tissue water content, reduced vascularity, and a return to normal histocehmical activity; in soft tissues, these processes begin about 3 weeks post-injury, overlapping the proliferative phase; because scar tissue is fibrous, inelastic, and nonvascular, it is less strong and less functional than the original tissues; the development of the scar also typically causes the wound to shrink, resulting in decreased flexibility of the affected tissues; this explains why a person with paraplegia, who has a healed pressure sore from a wheelchair seat in poor condition, can easily redevelop breakdown in the same area, if the pressure stresses reoccur in the same area 69 -Associated processes -Remodeling of fibrous matrix to form mature scar tissue •Decreased fibroblastic activity •Increased organization of new tissue •Decreased water content •Decreased blood flow •Resumption of normal cell activity in the area slide 9
open wound management control of bleeding
the first step in _________________ is to control the bleeding; in order to initiate the healing process, the blood must clot; clotting will not take place when blood is flowing; the best method for controlling bleeding is the application of direct pressure; using gauze pads to apply the pressure to the would will promote the clotting process; while applying direct pressure, elevating the wound to a position above the heart will slow the flow of blood and make it easier to control the bleeding; if bleeding cannot be controlled using direct pressure and elevation, indirect pressure should be applied; specifically, pressure should be applied to sites where the blood vessel is relatively superficial and at a spot between the wound and the heart; sites for indirect pressure to stop blood flow include __________________: the upper arm for the brachial artery the groin region for the femoral artery the posterior knee for the popliteal artery 81 •Control the Bleeding (1st step) -Use gauze pads to apply pressure to the wound to promote the clotting process -Elevate the wound while direct pressure is maintained -If direct pressure does not control the bleeding, indirect pressure can be applied •Brachial artery (upper arm) •Groin region (femoral artery) •Posterior knee (popliteal artery) slide 7
bloodborne pathogen documentation
the importance of ____________ cannot be overlooked in efforts to prevent the transmission of bloodborne pathogens; the type of records that should be maintained can vary relative to the work setting and practices; in general, records should include: verification of completion of OSHA training HBV vaccinations or declining of the vaccination Medical records for individuals exposed to blood or other body fluids; information required as part of a medical report (e.g. exam results; medical testing) policies and procedures for ensuring the ________________ and maintenance of appropriate information must be regulated; in particular, a process must exist for maintaining confidentiality of medical reports 81
zone of primary injury
the increased blood flow to the region causes swelling or edema; blood from the broken vessels and damaged tissues form a hematoma that, combined with necrotic tissue, forms the __________________; approximately 1 hour post-injury, as the vascular walls become more permeable and increased pressure within the vessels forces a plasma exudate out into the interstitial tissues (between the cells), swelling increases; this increased permeability of the blood vessel walls exists for only a few minutes in the case of mild trauma; normal permeability usually returns in 20-30 minutes; more severe trauma can result in a prolonged state of increased permeability and sometimes result in delayed onset of increased permeability; swelling is not apparent until sometime has elapsed since the original injury; the tissue EXUDATE provides a critically important part of the body's defense, both by diluting toxins present in the wound and by enabling delivery of the cells that remove damaged tissue and enable reconstruction 68 •Inflammatory phase (cont.) -______________ •Hematoma forms -Edema occurs •Increased permeability and pressure within the vessels forces a plasma exudate into the interstitial tissue slide 4
protected rest
the length of time for _______________ will vary relative to the severity of the injury; mild injuries may only require 24 hour rest, while a major injury could require at least 72 hours of rest; ________________ does not imply cessation of activity, but simply means relative rest, decreasing activity to a level below that required in participation in sport or physical activity, but tolerated by the recently injured tissue or joint 84
application of a compression
the most common __________________ requires an elastic wrap or bandage; the wrap should be applied in a DISTAL TO PROXIMAL direction to avoid forcing extracellular fluid into the distal aspect of an extremity; the wrap should be applied with sufficient tension to ensure compression without impairing blood supply; as a general rule, the patient should feel the firmness of the wrap, but should not experience a throbbing sensation; another way to ensure that a wrap is not overly tight is to assess the distal pulse of the involved limb; if a wrap is too tight, it should be removed and re-applied, not simply removed 84
open wound management
the next step in ___________________ is to clean the wound; mild soap and water should be used ot clean the wound and the area around it (i.e. at least twice the size of the wound; the area should be cleaned and rinsed thoroughly, ensuring removal of any debris or soap; saline water can also be used to cleanse the wound; in fact, saline is often preferred over water as it is less irritating than water 81 •Clean the Wound -Mild soap and water -Remove all debris Identify conditions that warrant immediate referral: -Life-threatening wounds -Uncontrolled bleeding -Inability to cleanse all the debris from the wound -A wound that needs stitches -A penetrating wound slide 8
transmission of bloodborne pathogens
the risk for exposure to __________________ can vary relative to the workplace setting; for example, opportunities for exposure are greater for a registered nurse in an emergency room than an athletic trainer in a high school setting; in an athletic or physical activity setting, _______________ could potentially occur through open wounds subsequent to contact between the damaged skin and infected body fluids, and *when contaminated fluids come into contact with the mucous membranes of the eyes, mouth, and nose* 80
closed tissue injury
the standard acute care for the management of a __________________ includes the application of ice, compression, elevation, and protected rest; in addition, for some injuries, the performance of gentle and controlled motions during the inflammatory phase of healing can optimize healing conditions 86
necrosis
trauma or physical damage results in the destruction of tissues; _______________ is the death of living cells; it is due to the disruption of the oxygen supply (hypoxia) to the involved area; the extent or amounts of necrosis depend on the cause of trauma and the contributing factors 67
nerve tissue healing
when a nerve is completely severed, healing does not occur and loss of function is typically permanent; unless such injuries are surgically repaired, random regrowth of the nerve occurs resulting in the formation of a neuroma or nerve tumor when nerve fibers are ruptured in a tensile injury, but the surrounding myelin sheath remains intact, it is sometimes possible for a nerve to regenerate along the pathway provided by the sheath; however, such regeneration is relatively slow proceeding at a rate of less than 1 mm per day or about 2.5 cm per month 71 •Severed nerve- can be catastrophic - healing does not occur; loss of function is permanent •Tensile injury where surrounding myelin sheath is intact -May be possible for nerve to regenerate -Slow process •Rate of less than 1 mm per day (2.5 cm per month) slide 19
fracture
while any suspected _______________ requires medical attention, a suspected ______________ associated with a major trauma or injury should be treated as a medical emergency 86
population served
while the immediate on-site treatment for any given musculoskeletal injury may be the same, regardless of the age or gender of the person, the _________________ must be considered in developing an emergency plan; by recognizing that a population may have a higher susceptibility to a specific condition, consideration for the potential consequences associated with that condition can be addressed in advance; for example, elderly participants in an exercise program would be at greater risk for cardiac-related conditions than third-grade students in a physical education class; in a similar manner, a 12-year-old recreational soccer player presents with a predisposition to musculoskeletal injuries different from those of a 30 year old recreational soccer player; it is also important to acknowledge the general cognitive awareness of the population being served; for example, the reaction of a third-grade student having sustained an open fracture of the forearm during an activity in a physical education class is likely to be very different if the same injury were sustained by a tenth-grade student or a 40 year old; in a similar manner, the physical education teacher will have the additional responsibility of supervising and controlling the rest of the third-grade students in the class and, typically, without the initial assistance of another adult 76
immobilization and remobilization
while the protected rest is an important component of injury management, it is equally as important to appreciate the effects of both _______________ on injured tissues; in certain instances, immobilization can prolong the repair and regeneration of damaged tissues, while early controlled mobilization can optimize the healing process; for example, immobilization can lead to a loss of muscle strength within 24 hours; this is manifested with decreases in the muscle fiber size, total muscle weight, mitochondria (energy source of the cell) size and number, muscle tension produced, and resting levels of glycogen and adenosine triphosphate, which reduces muscle endurance; in comparison, muscle regeneration begins within 3-5 days after mobilization; in a similar manner, ligaments adapt to normal stress by remodeling in response to the mechanical demands placed on them; stress leads to a stiffer, stronger ligament, whereas immobilization leads to a weaker, more compliant structure; this causes a decrease in the tensile strength, thus reducing the ability of ligaments to provide joint stability 84
cold
while there are a variety of options for applying __________ (e.g. ____________ packs, ice massage, cold whirlpool, vapocoolant sprats), coaches should consider using an ice bag (e.g. crushed or cubed) or an instant cold pack; for practical reasons, these methods are relatively convenient options; from a physiological perspective, it is not appropriate to use ice massage or whirlpool in the immediate management of an injury; the massaging effect produced by these techniques is not a desirable effect, until bleeding has subsided 83
Emergency Medical Services System
•Preseason preparation -Meet with representatives from local EMS agencies to discuss, develop, and evaluate plan -Written plan for each activity site -Practice the emergency plan •Responsibilities of medical personnel -Team physician •Prior to season, delineate responsibilities of all personnel •On the field -Athletic trainer •Event setup •Home versus away •Presence or absence of physician SLIDE 4; ALSO SEE RESPONSIBILITIES ABOVE
Emergency Medical Services System
•Process that activates the emergency health care services of the athletic training facility and community to provide immediate health care to an injured individual slide 3 NOT IN BOOK
Nerve tissue
•Spinal nerve -Roots •Posterior: afferent •Anterior: efferent -Heavily vascularized Myelin sheath slide 18 NOT IN BOOK