ESSS209
Acromion driven away from clavicle
AC joint sprain
Hypothermia
Activate EMS Carefully move to warm shelter Rewarm by putting in sleeping bag or using external warming devices such as hot water bottles or heating pads Use hot tubs if available Let individual consume hot drinks rewarmed enough to swallow Continue to warm to nearest medical facility
Cervical Fractures and Dislocations
Activate EMS Do not move individual Stabilize head and neck without moving individual Asses ABC's Manage any life-threatening situations RTP- Medical clearance, no pain, full ROM, normal strength and function
Exertional Heat Stroke
Activate EMS Move individual to cool place Remove all unnecessary equipment and clothing Rapidly cool body
Focal Cerebral Injuries
Activate EMS, Check ABC's perform rescue breathing if necessary, monitor individual but do not administer medications RTP • No pain, normal function • Medical clearance with physician
Shock
Activate EMS, monitor ABC's, perform rescue breathing or CPR as necessary, control any bleeding, maintain normal body temperature, if no head/neck injury suspected, elevate legs and feet 8-12 in, if individual has breathing difficulties sit up in semi-reclined position, if head injury suspect elevate head, if neck injury suspected- do not move, if vomiting or unconscious roll on side if possible, keep individual quiet or calm. RTP after medical clearance
History of trauma, excessive exercise, vascular injury or prolonged, externally applied pressure Increasing severe pain and swelling appear to be out of proportion to clinical situation Firm mass in area Tight skin Loss of sensation dorsal to injury Diminished pulse dorsal to injury May have functional abnormalities within 30 minutes of onset hemorrhage
Acute Compartment Syndrome
Rapid increase in tissue pressure with non-yielding anatomical space that leads to increased local venous pressure and obstructs neurovascular network
Acute Compartment Syndrome
Lumbar Strain
Acute protocol Passive stretching of low back Refer to physician in moderate to severe conditions
Feeling of warmth with intense itching, especially on soles of feet and palms. Choking, wheezing, shortness of breath, rapid weak pulse, tightness and swelling in throat and chest, swelling of mucous membranes (tongue, mouth, nose) which may lead to respiratory distress or unconsciousness
Anaphylaxis
Severe allergic reaction that affects the entire body.
Anaphylaxis
Intense pain in shoulder Tingling and numbness extends down arm into hand Usually held at slight abduction and external rotation and stabilized against body by opposite hand sharp contour on affected shoulder with prominent acromion process can bee seen when compared to unaffected shoulder
Anterior acute dislocation of glenohumeral joint
Gastrocnemius Contusion
Apply ice Keep muscle stretched while icing If condition does not improve in 2-3 days, refer to physician
Orbital Blowout Fracture-
Apply ice to limit swelling, but DO NOT apply pressure, immediate referral to physician or emergency medical facility
Epistaxes
Apply mild pressure at nasal bone Ice may be applied to stop more persistent bleeding Tilt head slightly forward Avoid blowing nose following nosebleed If nosebleed lasts longer than 10 minutes, refer to physician
Kidney Contusion
Ask about history of injury Activate EMS if symptoms indicate serious condition If individual's condition deteriorates, activate EMS Monitor ABC's If history involves trauma involving for, inspect area for deformity, swelling, or discoloration If neck injury is expected, do not move individual RTP- no pain, full ROM, normal strength, normal funciton If seen by physician, medical clearance required
Liver Contusion/Rupture
Ask about history of injury Activate EMS if symptoms indicate serious condition If individual's condition deteriorates, activate EMS Monitor ABC's If history involves trauma involving for, inspect area for deformity, swelling, or discoloration If neck injury is expected, do not move individual RTP- no pain, full ROM, normal strength, normal funciton If seen by physician, medical clearance required
Throat Contusion/Fracture
Ask about history of injury Activate EMS if symptoms indicate serious condition If individual's condition deteriorates, activate EMS Monitor ABC's If history involves trauma involving for, inspect area for deformity, swelling, or discoloration If neck injury is expected, do not move individual RTP- no pain, full ROM, normal strength, normal funciton If seen by physician, medical clearance required
Deep
Away from body surface
Lateral
Away from midline of the body
Bilateral
Both sides of outer body
Painful palpation over spinous process Muscle spasms Palpable defect Muscular weakness in extremities Abnormal sensations in head, neck, trunk, or extremities Loss of coordinated movement Paralysis or inability to move a body part Absent or weak reflexes Loss of bladder or bowel control If dislocation, noticeable neck tilt to dislocated side
Cervical Fractures and Dislocations
Resulting from axial loading and violent neck flexion Common MOI: diving into shallow water, spearing in football May require immobilization in cervical collar or Halo vest
Cervical Fractures and Dislocations
Periorbital Ecchymosis (black eye)
Control hemorrhage and swelling with ice Check for concussion and orbital blowout fracture Refer to opthalmologist for further examination
Bending
Convex side sustains tension, concave side sustains compression (fracture)
Trauma to widespread areas of brain
Diffuse Cerebral Conditions
• Vacant stare • Visual problems • Headache, persistent headaches, migraines, or pressure in head • Delayed verbal and motor responses • Confusion and inability to focus attention • Disorientation • Slurred or incoherent speech • Gross observable incoordination with balance of dizziness • Emotions out of proportion to circumstances or irritability • Memory deficits or loss • Loss of consciousness • Blurred vision or localized area of blindness • Vertigo • May appear to be stunned, but continues action • Increase in ICP
Difuse Cerebral Conditions
Lateral Epicondylitis
Discontinue activity that could exacerbate condition Refer to physician Ice
Medial epicondylitis "Little League Elbow"
Discontinue activity that may exacerbate condition Refer to physician Ice area
Transverse plane
Divides body at waist, separates legs and upper body
Frontal Plane
Divides body in face-half and butt-half
Bleeding from nose
Epistaxes
Superficial blood vessels on anterior septum are lacerated
Epistaxes
Shear
Equal, but not directly opposite forces are applied forcing surfaces to move in parallel directions
Thirst Headache Dizziness Light-headedness Mild anxiety Fatigue Profuse sweating Weak and rapid pulse Low blood pressure in upright position Ashen and gray appearance Cool, clammy skin Uncoordinated gait Body temperature not exceeding 103 degrees
Exercise Heat Exhaustion
Unacclimatized individuals during first few intense exercise sessions on hot day Wearing protective equipment increases risk Ineffective circulatory adjustments compounded by depletion of extracellular fluids
Exercise Heat Exhaustion
Inadequate airflow during respiration due to constriction of bronchial smooth muscle, increased bronchial secretion, and mucosal swelling from exercise May be worsened depending on season, exposure to allergens, ambient air conditions, poor physical condition, respiratory infections
Exercise Induced Bronchospasm
• Phase 1- peak 5-10 minutes after exercise begins, lasts 30-60 min o Chest pain or tightness o Burning sensation o Wheezing o Regular dry cough o Shortness of breath shortly after or during exercise o Stomach cramps after exercise • Phase 2- 30 min-4 hours after exercise beings o Limited to no bronchospasm o May be possible to exercise longer and more strenuously without difficulty • Phase 3- recur 12-16 hours after exercise is completed, may remit within 24 hours o Similar to phase 1 symptoms, just less severe
Exercise Induced Bronchospasm
Typically in well-conditioned athletes <40 History of exercise-induced pain that is often described as tight, cramp-like, or squeezing ache and sense of fullness, over involved compartment Condition often affects both legs Symptoms usually relieve with rest, often within 20 minutes of exercise, only to recur if exercise is resumed Activity-related pain begins at predictable time after starting exercise or after reaching certain level of intensity and increases if training persists Mild foot drop or paresthesia on dorsum of foot and demonstrate facial defects or hernias, usually in distal third of leg over intramusuclar septum
Exertional Compartment Syndrome
Feeling of burning up Confusion Disorientation Irrational behavior Agitation Profuse Sweating Unsteady gait Sweating ceases as condition deteriorates Hot, dry skin that is reddened or flushed Hyperventilation or deep breathes Rapid, strong pulse (up to 150-170 BPM) May become hysterical or delirious Vasomotor collapse, shallow breathing, decreased blood pressure, rapid and weak pulse may be indication of tissue damage Muscle twitching, vomiting, or seizures may occur before individual lapses into coma
Exertional Heat Stroke
Thermoregulatory system is overloaded Body's cooling mechanisms fail to dissipate rising core temperature Hypothalamus shuts down all heat-control mechanisms Core temperature can rise to 105 degrees May cause death May cause tissue damage May lead to coma
Exertional Heat Stroke
Exercise-induced pain and swelling that is relieved by rest
Exertional compartment syndrome
Compression
External loads applied towards one another (bruise)
Stages of Icing
Feels cold (0-3 minutes) Burning and aching (2-7 minutes) Numbing sensation (5-12 minutes)
Localized collection of blood (hematoma) Additional fluid puts pressure on brain
Focal Cerebral Conditions
• Pupillary dilation and retinal changes on affected side • Irregular eye tracking or movement • Severe headache • Nausea and/or vomiting • Confusion and/or drastic changes in emotional control • Progressive or sudden impairment of consciousness • Rising blood pressure • Falling pulse rate • Irregular respirations • Increased body temperature
Focal Cerebral Conditions
Angiogenesis
Formation of new blood capillaries
Hypolycemia
Give simple sugars If individual is diabetic, administer insulin with sugars Monitor ABC's, perform basic life support if necessary Activate EMS if necessary RTP- if blood glucose levels return to normal by next day, may return to practice
Tightness in anterior thigh but normal gait (no limp) Passive knee flexion beyond 90 degrees may be painful
Grade I Quadriceps Strain
Point tenderness and mild pain over SC No visible deformity
Grade I SC joint sprain- anterior displacement
Tightness and tension in hamstring Passive stretching may be painful
Grade I hamstring strain
Joint leading to bruising, swelling and pain Inability to horizontally adduct the arm without considerable pain Holding arm forward and close to body, support it across chest Pain with scapular protraction and retraction can reproduce pain
Grade II SC joint sprain- anterior displacement
Tearing sensation or feeling "pop" leading to immediate weakness in knee flexion Sharp pain may be present in posterior thigh may occur during midstride Limping Unable to do heel-strike or fully extend knee Pain and muscle weakness elicited during active knee flexion
Grade II or Grade III hamstring strain
Individual reports snapping or tearing sensation during explosive motion Knee may be held in extension as means for protecting injured area Passive knee flexion is painful Pain and weakness in knee extension
Grade II quadriceps strain
Extremely painful Ambulation not possible (cannot walk) Obvious defect in muscle may be visible Resisted knee extension not possible ROM severely limited
Grade III Quadriceps Strain
Prominent displacement of sternal end of clavicle and may involve fracture Complete rupture of SC and costoclavicular ligaments Movement limitations present in 2nd degree sprain are greater and produce more pain Pain is severe when shoulders are brought together by lateral force
Grade III SC joint sprain- anterior displacement
Low glucose levels below 70 mg/dL History of skipped meals or intense exercise Pale skin Unexplained feeling of fatigue Increased heart rate Sudden nervousness or mood change Hunger Headache
Hypoglycemia
Low levels of glucose stretching below 60-70 mg/dL Especially dangerous in individuals with Type 1 Diabetes
Hypoglycemia
Exposure to cold for long periods of time Common MOI- in race and slowing down late in race due to fatigue
Hypothermia
Shivering Individual may appear clumsy, apathetic, confused Slurred speech Stumbling Shivering may stop Unable to feel sensation or pain Movements become jerky Unaware of surroundings
Hypothermia
Pain is present of lateral aspect of knee after running certain mileage, typically late in run, but does not restrict distance or speed As condition progresses, pain begins to occur earlier and earlier, and restricts distance or speed Pain may occur while running uphill and downhill and while climbing stairs Particularly intense on weight bearing from foot strike through midstrance Pain worsen with continued activity Flexion and extension of knee may produce creaking sound Eventually pain restricts all running and becomes continuous during activities of daily living
IT Band Friction Syndrome
IT band drops posteriorly behind lateral femoral epicondyle during extension
IT band Friction Syndrome
Acute Compartment Syndrome
Ice and total rest Do not compress or elevate Activate EMS or immediate referral to emergency medical facility
Proximal
Joint nearest injury moving towards body (shoulder is proximal to elbow)
Distal
Joint nearest to injury moving away from body (wrist is distal to elbow)
Common MOI: direct blow or contrecoup injury from high-speed collision Degree of renal injury depends on extent of distention and angle and magnitude of blow Hypovolemic shock make result from extensive bleeding
Kidney Contusion
Pain or tenderness Hermaturia Pain referred posteriorly to low back region, sides of buttocks, and anteriorly to lower abdomen
Kidney Contusion
Eccentric loading of extensor muscle during deceleration phase of throwing motion or tennis stroke
Lateral epicondylitis
History of gripping racquet too tight, improper grip size, excessive string tension, excessive racquet string tension, etc. Pain anterior or just distal to lateral epicondyle and may radiate into forearm extensors during and after activity Pain increases with resisted wrist extension or in an action similar to picking up full cup of coffee
Lateral epicondylitis
Special Test of Concussion
Level of orientation Person Place Time Situation Memory: Retrograde- events immediately preceding injury Anterograde- events following injury Concentration: Recall 3,4, and 5 digit sequences List months backwards Cranial nerves Pupil function Strength Balance and coordination: Finger to nose test Heel-to-toe walking Rhomberg test Provocative Tests- 40 yd sprint, five jumping jacks, 5 sit-ups, 5 push-ups, 5 knee bends
Common MOI: direct blow to upper right abdominal quadrant Systemic diseases may enlarge liver to be more susceptible to injury
Liver Contusion/Rupture
Significant palpable pain Point tenderness Hypotension Shock Referred pain in right scapula/shoulder
Liver contusion/rupture
Solar Plexus Contusion
Loosen restrictive equipment around abdomen Instruct individual to flex knees toward chest Instruct individual to take deep breath and hold it, repeat until breathing restored Instruct individual to whistle to restore normal breathing After breathing returns, intra-abdominal assessment should be performed
Pain and discomfort can range from diffuse to localized in low back Pain does NOT radiate into buttocks or posterior thigh No signs of neural involvement such as muscle weakness, sensory changes, reflex inhibition
Lumbar Strain
Result from sudden extension action with trunk rotation on an overtaxed, unprepared, or underdeveloped spine
Lumbar Strain
Characteristic mallet deformity Unable to fully extend DIP joint with forearm prontated
Mallet Finger
Forceful flexion of distal phalanx avulses lateral bands of extensor mechanism from its distal attachment
Mallet Finger
Repeated valgus forces on arm produce combined flexor muscle strain, ulnar collateral ligament sprain and ulnar neuritis
Medial Epicondylitis (little league elbow)
Shin Splints
Medial Tibial Stress Syndrome
Swelling of elbow Ecchymosis of elbow Point tenderness over humeroulnar joint or on medial epicondyle Pain usually severe and aggravated by resisted wrist flexion and pronation and by valgus stress If ulnar nerve involved, tingling and numbness may radiate into forearm and hand, particularly in fourth and fifth fingers History of throwing, tennis, golfing over use, improper technique, and fatigue Called little league elbow if medial humeral growth plate is affected
Medial epicondylitis (little league elbow)
Exercise Induced Bronchospasm
Medications such as inhaler If not prescribed medications, recommend seeing physician Good warm-up and cool-down If after medication signs and symptoms completely resolve, athlete may return to play Monitor condition, if necessary perform CPR, if lips, fingernails, or skin become blue, activate EMS If athlete does not improve within 15-20 min, activate EMS If medication not available, activate EMS, sit up in semi-reclined position, and monitor condition
Exercise Heat Exhaustion
Move to cool, shaded area Remove any unnecessary equipment Rapid cooling of body Elevate legs Cool body Replace fluids If recovery is not rapid or eventful, transport to nearest medical facility
Abduction
Movement along frontal plane where limb moves away from midline of body (raising of arm)
Adduction
Movement along frontal plane where limb moves toward midline of body (lowering raised arm
Flexion
Movement along sagittal plane that decreases angle of joint (bending of knee)
Extension
Movement along sagittal plane that increases angle of joint (straightening of knee)
Immediate tenderness, swelling, redness posterior to elbow Relatively painless If bursa ruptures, discrete, sharply demarcated goose egg is visible directly over olecranon process Limited motion at extreme of flexion as tension increases over bursa
Olecranon Bursitis
Direct macrotrauma or cumulative microtrauma by repetitive elbow flexion and extension causing inflammation
Olecranon Burstitis
• Mild swelling and ecchymosis • Double vision • Absent eye movement • Numbness of cheek and gum of involved side • Recessed, downward displaced globe
Orbital Blowout Fracture
Direct trauma to eye, forces drive orbital contents posteriorly against orbital walls Increase in intraorbital pressure may become great enough to produce fracture
Orbital blowout fracture
History of being a young athlete at age of growth spurt (female 8-13, male 10-15) Points to tibial tubercle as source of pain and tubercle appears enlarged and prominent Pain generally occurs during activity and is relieved with rest ROM usually intact Pain present at extremes of knee extension and forced flexion Pain may resolve after 24 hours after activity, pain may be during and after activity that does not hinder performance and resolves within 24 hours, or may be continuous pain that limits sport performance and daily activities
Osgood Schlatter's Disease
Traction-type injury to tibial apophysis where patellar tendon attaches to tibial tubercle
Osgood Schlatter's Disease
Olecranon Bursitis
PRICE for first 24 hours If significant distention, refer to physician
Chronic anterior knee pain of insidious onset, might be described as sharp or aching pain Initially pain after activity is concentrated on inferior pole of patella or distal attachment of patellar tendon on tibial tubercle As condition progresses, pain is present at beginning of activity, subsides during warm-up, then reappears after activity Increased pain often reported while ascending and descending stairs or after prolonged sitting Eventually pain is present both during and after activity and can become too severe for individual to participate
Patellar Tendinitis
Patellar tendon becomes inflamed and tender from repetitive or eccentric knee extension activities
Patellar tendonitis
Accumulation of blood and other fluids in interstitial spaces around eye that produce characteristic discoloration
Periorbital Ecchymosis (black eye)
Hemorrhage Swelling Pain May report blurred vision (all pertaining to eye)
Periorbital Ecchymosis (black eye)
pain on plantar, medial heel that is relieved with activity but recurs after rest Pain increases with weight bearing Particularly severe with first few steps in morning, particularly in proximal, plantar, medial heel, but diminishes within 5 to 10 minutes Normal muscle length not easily attained and leads to additional pain and irritation Point tenderness elicited over or just distal to medial tubercle of calcaneous and increases with passive toe extension Passive extension of great toe and dorsiflexion of ankle will increase pain and discomfort
Plantar Fascitis
Arm carried tightly across chest and across front of trunk in rigid adduction and internal rotation Anterior shoulder appears flat, caracoid process is prominent, and corresponding bulge may be seen posteriorly, if not masked by heavy deltoid musculature Attempt to move arm into external rotation and abduction produces severe pain Unable to supinate forearm with shoulder flexed
Posteriorly displaced Glenohumeral Joint Dislocation
Tension
Pulls Tissue apart (strain)
Seizures/Epilepsy
Remove or pad nearby objects Do not restrain individual, but protect head Remove bystanders from visual area Document time of seizure and time individual sleeps If seizure lasts longer than 5 minutes, activate EMS If second seizure sets in rapidly, activate EMS RTP- If first time, medical clearance required. Sit out remainder of day.
Osgood Schlatter's Disease
Rest and Ice Do not allow to continue activity Refer to physician
Over-use Injury Management/RTP
Rest and Ice Refer to physician Do not let them do activity that might exacerbate condition No pain, full ROM, normal strength, normal function Medical clearance required
Palpable depression between sternal end of clavicle and manubrium Unable to perform shoulder protraction May have difficulty swallowing or breathing May complain of numbness and weakness of upper extremity secondary to compression of structures in thoracic inlet If venous vascular vessels are impinged, patient may have venous congestion or engorgement in ipsilateral arm and diminished radial pusle
SC joint sprain- anterior displacement
Abnormal electrical discharge in brain
Seizures/Epilepsy
Tingling Numbness Loss of feeling Involuntary movement of face, limbs, or head Inability to speak Person may experience visual, olfactory, and auditory hallucinations May impair consciousness If involved in activity, one's movements are usually disorganized, confused, and unfocused Unresponsive to verbal stimuli
Seizures/Epilepsy
Heart is unable to exert adequate pressure to circulate enough oxygenated blood to vital organs.
Shock
Restlessness, anxiety, fear, or disorientation, cold clammy moist skin, profuse sweating, extreme thirst, eyes are dull sunken and pupils dilated, skin that is chalk-like and may alter appear cyanotic, nausea/ vomiting, shallow irregular breathing, breathing may also be labored rapid or gasping
Shock
Inability to catch one's breath Fear and anxiety may complicate issue History of blow to abdominal area
Solar Plexus Contusion
Difficulty breathing after blow to abdomen with abdominal muscles relaxed
Solar Plexus Contusion "wind knocked out"
Saggital
Splits body in left and right sides
Ligament pull
Sprain
Grade I Quadriceps Strain
Standard acute care with cold and compression Symptoms do not resolve within 2-3 days, coach should require approval by healthcare professional to return to play
Grade I hamstring strain
Standard acute care with cold and compression Symptoms do not resolve within 2-3 days, refer to healthcare professional to return to play
Mallet Finger
Standard acute care with cold, compression, and elevation Immediate referral to physician
Grade II and Grade III hamstring strain
Standard acute care, including use of crutches Refer to qualified healthcare practitioner for definitive diagnosis and ongoing treatment
Grade II and Grade III quadriceps strain
Standard acute care, including use of crutches Refer to qualified practitioner for definitive diagnosis and ongoing treatment options
Force drive proximal clavicle superior, medial, and anterior, disrupting costoclavicular and sternoclavicular ligaments leading to anterior displacement
Sternoclavicular Joint Sprain- anterior displacement
Muscle pull
Strain
Contusion/Fracture of trachea, larynx, and hyoid bone Common MOI: neck hyperextension
Throat Contusion/Fracture
Hoarseness Dyspnea Coughing Difficulty Swallowing Laryngeal tenderness Inability to make high-pitched "e" sounds Pain Laryngospasm Acute respiratory distress Deviated trachea or trachea that moves during breathing Anxiety, fear, confusion, or restlessness Distended neck veins Bulging or bloodshot eyes Suspected rib or sternal fracture Severe chest pain aggravated by deep inspiration Abnormal chest movement on affected side Coughing up bright red or frothy blood Abnormal or absent breath sounds Rapid, weak pulse Low blood pressure Cyanosis
Throat Contusion/Fracture
Posterior
Toward back of body
Anterior
Toward front of body
Superficial
Toward or at body surface
Superior
Towards head
Inferior
Towards lower part of body
Medial
Towards midline of the body
Torsion
Twisting in opposite directions causing shear force
AC joint Sprain S/O & treatment
Type I: No disruption of AC or coracoclavicular ligaments Minimal swelling and pain present over joint line and increase with abduction past 90o Inherently stable and pain is self-limiting Type II: Result form more severe blow to shoulder AC ligaments torn, but coracoclavicular ligament, only minimally sprained, is intact Vertically stable, but sagittal plane stability is compromised Clavicle rides above level of acromion and minor step or gap present at joint line Pain increases when distal clavicle is depressed or moved in an anterior-posterior direction, and during passive horizontal adduction Type III: Complete disruption of AC and coracoclavicular ligaments, resulting in visible prominence of distal clavicle Obvious swelling and bruising and, more significantly, depression or drooping of shoulder girdle Type IV-VI: Caused by more violent forces Extensive mobility and pain in area may signify tearing of deltoid and trapezius muscle attachments at distal clavicle Rare injuries must be carefully evaluated for associated neurologic injuries If higher than Type II, immediate referral to emergency medical facility Immediate application of cold to area Place in sling Refer to physician
Anaphylaxis
administer epinephrine, activate EMS, monitor ABC's, perform rescue breathing or CPR as necessary. RTP after medical clearance granted and facility cleared of allergen
Bruising of gastrocnemius
gastrocnemius contusion
Immediate pain and weakness Partial loss of motion Hemorrhage and muscle spasm lead to tender, firm mass that is easily palpable
gastrocnemius contusion
Diffuse Cerebral Injuries
• Mild/Grade I concussion, monitor condition, sit out game/practice, referral to physician • Moderate/Grade II concussion, immediate referral to physician • Severe/Grade III concussion, activate EMS, monitor ABC's, preform rescue breathing if necessary • Posttraumatic headaches, immediate referral to physician • Postconcussion syndrome, monitor condition • Second impact syndrome, activate EMS, monitor ABC's, perform basic life support RTP • No pain, normal function • Medical clearance with physician