Intro to Emergency Care

mental status assessment

*Alert *Awake (eyes open); *Responds sensibly to questions (aware of surroundings and conditions) *Questions about Time, place, person and event *A/O x 4 (alert and orientated times 4) *Verbal response *Responds only when prompted - loud voice, etc *Painful response *Responds only to painful stimuli *Unresponsive *Does not respond to verbal or painful stimuli

decerebrate posturing

*Arms are extended by the sides *Head is arched back *Legs are extended *Indicates brain stem damage

decorticate posture

*Arms flexed (curled) *Hands are clenched into fists *Legs extended *Indicates damage to the cerebrum, thalamus or midbrain *Not as serious as decerebrate posturing

BSI precautions

*Body Substance Isolation *Gloves *Mask *Major bleeding *Advanced Airway Procedures *Gown *Major bleeding *Eye Protection *Major Bleeding *Advanced Airway procedures

deaths

08-11 there was 210+ deaths sport related 11K spinal cord injuries

athletic trainers

. Experts in prevention, diagnosis, treatment, and recognition of injuries and emergencies . Serves as the "captain" of the team Must possess State and National Credentials . In NC, we work directly under the supervision of a PHYSICIAN. ◦Protocol

AEMT

. Formerly known as EMT-I . Requires 300 - 400 hours of training . Focus: Provide basic and limited advanced emergency medical care and transportation for critical and emergent patients . Airways, suctioning, vitals, lung sounds, glucometry, IV's, IO's, non-medicated IV fluids, nitroglycerine, IM epinephrine, Oral glucose, IV dextrose to a hypoglycemic patient, administers MDI's, administers narcotic antagonists, administered nitrous oxide for pain relief

prep. for an emergency

. Make sure to have well developed, rehearsed, Emergency Action Plans . Meet your local EMS and hospital staff . Have in-service meetings with EMS . Provide EMS maps and directions to faciliites . Greet EMS when they arrive at the site

EMT

. Must possess a HS diploma or GED, or pass a basic reading comprehension examination at the minimum of a tenth-grade level. . Requires 120 + hours of training . Must complete EMT course ◦Basic & Intermediate ? . Provides basic emergency medical care and transportation for critical and emergent patients who access the emergency medical system . Will have the final say in how a patient will be transported . Basic knowledge and skills to provide patient care and transport

Paramedics

. Requires college level A & P . Program is Certificate or Associates Degree level . Recommended 500 clinical hours in clinical and Field work . Allied health professional whose primary focus is to provide advanced emergency medical care for critical and emergent patients

stress

. State of physical arousal that helps one respond to threatening or demanding situations, either actual or perceived. . Good Stress & Bad Stress . "Stress is in the eye of the beholder"

prehypertension

120-139/ 80-89

Sum of Paramedic

Possesses complex knowledge and skills necessary to provide patient care and transportation using basic and advanced equipment for the critical patient who accesses the EMS system

EPI

7. Psychological first aid 8. Facilitating access to appropriate levels of care when needed 9. Assisting special and diverse populations 10. Spiritual assessment and care 11. Self care and family care 12. Post incident evaluation and training

developing an EAP

Base actions on sport-specific venues -Why venue specific? -Can be duplicated for multiple locations, but each venue should have its specific EAP •Should be reviewed by legal counsel

secondary survey

Behavior / attitude Swelling Deformity Bleeding Discoloration -Battles Sign ; Raccoon eyes Cerebrospinal Fluid Pupils -PEARRLA (round reactive to light, equal) -Nystagmus (abnormal eye movement) Characteristics of respirations Skin coloring / ecchymosis Posturing Body Position Protective Equipment -Helmet -Shoulder Pads -Mouthpiece

slow and strong

-stroke -skull fracture -brain trauma

scope of practice for AT's

. Establish and execute the EAP . Triage injuries and illnesses . Implement appropriate emergency and immediate care procedures . Implement referral strategies for timely transfer of care

airway, breathing, circulation

*Open the Airway *Head Tilt / Chin Lift or Jaw thrust- difference is when you suspect a C' spine injury. don't do chin lift *Airway adjuncts- ex. OPA, NPA, King LT, bag mouth mask, Oxygen *Check for Breathing *Look, listen and feel (10secs) *Rate, quality, and effort *Check for Circulation *Check carotid artery for pulse *Rate, quality *Check for severe bleeding *Check for Shock- also check pupils, skin color/temp.

secondary assessment for trauma

*Rapid Trauma Assessment *Head to toe Examination to evaluate for any injuries *Typically in a situation of potential multiple traumas *Observation/ Palpation / Evaluation *DCAP-BTLS *Deformity, contusion, abrasion, puncture-burn, tenderness, laceration, swelling *Head *Eyes *Nose *Mouth *Neck *Chest *Abdomen *Pelvis *Extremities

sample history

*SAMPLE History *Not typically what AT's will typically follow, but.... *Information needed for EMS professionals.... *If injury/illness is obvious.... *Signs/symptoms *Allergies *Medications *Past medical history *Last oral intake *Events leading to injury/illness

approach/ manage the scene

*Survey the scene *Identify potential hazards *See the "Big Picture!" *Visiting team locations! *Manage the scene *Protect yourself and those bystanders *Determine the nature / cause of the condition or illness *Determine if additional medical professionals around to provide assistance *Determine supplies available and necessary

general guidelines for secondary assessment

*Trauma Assessment vs. Emergency Medical Assessment *Uncovers problems that do not pose an immediate threat to life....however, may do so later if uncorrected. *Typically the on-field examination of an AT

initial assessment

*Utilized to assess life or limb threatening injuries *Mental Status Assessment *ABCDE *Airway, breathing, Circulation, Disability/Defibrillation, Exposure CPR is CAB

palpation/ eval

*Vital Signs *Assess pain and point tenderness *Fracture? *Severe injury? *Cranial nerves *Breath sounds *Neurological *Sensation *Motor function

history on field

*What is wrong? *Where is your pain? *How did it happen? *Previous Injury? *LOC? *Previous LOC? *Any Neck Pain? *Type of Pain? *Unusual Sensations -tinnitus, nausea, etc *Medications?

can change with

-Age -Fitness level -Level of anxiety -Medical condition

life threatening conditions

-Cardiopulmonary emergency* -Loss of consciousness (head injury/concussion)* -Environmental stress (heat stroke, hyponatremia -Exertional sickling -Anaphylaxis -Obstructed airway -C-spine injury -Direct trauma -Hemorrhage (internal injury) -Shock (Numerous causes) -*Leading causes of death

rapid and strong

-Early stages ofshock -Overexertion -Fright -Anxiety -Heat illness -Hyperglycemia -Fever

communication

-Identification, nature of emergency (type, number, etc), condition of patient, first aid administered, directions, other information as requested

rapid and weak

-Internal bleeding -Later stages of shock -Heat illness -Hypoglycemia -Failing circulatory system

quantitative

-Objective measurements -Rate of breaths/heart beats

vital signs

-Pulse and respiration rate -Blood pressure -Skin temperature, condition, and color -Capillary refill -Pupils

early psychological intervention

1. Pre-incident training 2. Incident assessment and strategic planning 3. Risk crisis communication 4. Acute psychological assessment 5. Crisis intervention with large groups / small groups / individuals 6. Planning and intervention with communities / organizations

KSI recs

1.Every school or organization that sponsors athletics should develop an EAP for managing serious and/or potentially life-threatening injuries. 2.The EAP should be developed and coordinated with local EMS, school public safety officials, on site medical personnel or school medical staff, and school administrators. 3.Every school should have a written EAP document distributed to all staff members. 4.The EAP should be specific to each venue and include maps and/or specific directions to that venue

pulse assessment

136 BPM, irregular rhythm and poor strength (thready pulse), suggests shock

hypertension stage 1

140-159/ 90-99

KSI

5.On-site emergency equipment that may be needed in an emergency situation should be listed. 6.The EAP should identify personnel and their responsibilities to carry out the plan of action with a designated chain of command. 7.Appropriate contact information for EMS. 8.Facility address, location, contact information etc. should be identified in the EAP. 9. Plan should specify documentation actions that need to be taken post emergency. 10. EAP should be reviewed and rehearsed annually by all parties involved. 11. Healthcare professionals who will provide medical coverage during games, practices, or other events should be included.

hypertension stage 2

>160/ >100

advanced out of hospital care

Goal: Assess patient and begin maintain appropriate care until he or she can be packaged and transported to the hospital

psychological trauma

A type of damage to the psyche that occurs as a result of traumatic event. When that trauma leads to post-traumatic stress disorder, damage may involve physical changes inside the brain and to brain chemistry, which changes the person's response to future stress.

skin

Assesses: -Color -Temperature -Cool (Shock, mild hypothermia, or poor circulation) -Cold (Cold exposure, hypothermia/frostbite, profound shock) -Hot (Fever, heat exposure, and sunburn) -Condition •Normal -Dry •Abnormal -Clammy (Moist, cool, and pale): Shock, heat exhaustion, cardiac distress, pain, and anxiety -Moist/wet (diaphoretic): Strenuous exercise, heat exposure, fever

emergency med team

Athletic Trainers Sideline Physician Emergency Medical Services Personnel ◦Emergency Medical Responder (EMR's; first responders) ◦Emergency Medical Technicians (EMT) ◦Advanced Emergency Medical Technicians (AEMT) ◦Paramedic Emergency Room Physician Hospital Staff Coaches? Athletic Staff? Administration? Law Enforcement?

pulse rate

BPM . also assess rhythm and strength (bounding, weak/ thready, absent)

Call EMS

Call 911 Be prepared to answer: ◦Specific Location ◦Phone number you are calling from ◦Nature of the emergency ◦Care being given Do NOT hang up until you are told to do so! EMS will send appropriate responders to you.

post emergency

Document what happened -File any necessary paperwork -Who provided care, roles, responsibilities -Time of injury, EMS call, arrival, treatment provided, and departure -Outcomes? -What went well? What didn't go well? Complications of implementation? -Debriefing -Psychological counseling as needed

equipment

Emergency equipment should be: -At the site and quickly accessible -In good operating condition -Checked on a regular basis -Appropriate for the level of training of the emergency medical providers •Emergency personnel should: -Be familiar with the function and operation of each type of emergency equipment. -Rehearse the use of the emergency equipment. •Create an equipment inspection log book.

stressor

Event placed on individual that brings about the stress response

Glasgow Coma Scale

I. Motor Response 6 - Obeys commands fully 5 - Localizes to noxious stimuli 4 - Withdraws from noxious stimuli 3 - Abnormal flexion, i.e. decorticate posturing 2 - Extensor response, i.e. decerebrate posturing 1 - No response II. Verbal Response 5 - Alert and Oriented 4 - Confused, yet coherent, speech 3 - Inappropriate words, and jarbled phrases consisting of words 2 - Incomprehensible sounds 1 - No sounds III. Eye Opening 4 - Spontaneous eye opening 3 - Eyes open to speech 2 - Eyes open to pain 1 - No eye opening Glascow Coma Scale = I + II + III. A lower score indicates a deeper coma and a poorer prognosis.

hospital trauma level system

Identification of the ability of a hospital to respond to a trauma ◦Designation Process -Adult or pediatric ◦Verification Process -Evaluation process performed by the American College of Surgeons to evaluate and improve trauma care -Verifies presence of resources . Categorized by legislative or state regulatory authority Level I - V Trauma Centers ◦ Mission is Level 2

emergency medical responders

In NC.... . Must possess a HS diploma or GED, or pass a basic reading comprehension examination at the minimum of a tenth-grade level. . 50 - 60 hours of training . Initiates immediate lifesaving care to critically injured patients ◦Possess basic knowledge and skills necessary to provide lifesaving interventions ◦Airway and breathing emergencies (OPA, NPA, BVM, supplemental oxygen) ◦Autoinjectors for MEDS, MDI's, oral glucose ◦AED's ◦Stabilization extremities and CS; bleeding control, emergency moves

critical incident stress management

Integrated multicomponent comprehensive system of care for those in crisis •Referral Process for advanced psychological consultation or care •Used when there is an emergency situation to assist all parties involved •Implements early psychological Intervention

sideline physicians

Not always available! Must have an official role ◦EAP role Has ultimate say in the care of the patient

PTSD

Occurs after extremely difficult event ▫Affects social or occupational lives for more than one month after event occurs •S & S ▫Nightmares and "flashbacks" ▫Concentration problems, extreme irritability, emotional fluctuations, insomnia, attempts to avoid reminders of the event •Problem? ▫May last several years

legal liability

Professional Behaviors Good Samaritan Law Legal Duty to Act Abandonment Consent Patient Confidentiality

Sum of AEMT

Provides basic and limited advanced emergency medical care and transportation for the critical and emergent patient who accesses the EMS system

Summary of EMT

Provides basic emergency medical care and transportation for critical and emergent patients who access the EMS system

equipment

Spineboards •AEDs •Splints •Epi-pens •Oxygen •Suction

good/ bad stress

Stress causes into fight-or-flight reaction ▫Increase in strength, endurance and sensory perception ▫Initiates sympathetic and parasympathetic nervous system •Good Stress (Eustress) ▫Help us to improve and achieve higher performance •Bad Stress (Distress) ▫Negative effects of stress outweigh the benefits

ASD (acute stress disorder)

Used to describe the extreme stress reactions that occur within the first month following a traumatic experience •Emphasis is on dissociation •S & S similar...plus, on-going emotional numbness or detachment and/or unexplained memory loss for the events of the trauma

what is an emergency

an unforseen combination of circumstances and the resulting state that calls for immediate action

no pulse

cardiac arrest

skin cold and dry

cold exposure or diabetic emergency

skin hot and moist

heat exposure, fever, diabetic emergency

skin hot and dry

heat exposure, fever, spinal injury

sluggish

increased intracranial pressure

Summary of EMR

initiates immediate lifesaving care with minimal equipment to critical patients who access the EMS system

bilaterally fixed, dilated, nonreactive

massive intracranial swelling and bleeding, profound hypoxia, or brain death

bilateral, midsized, midposition, and nonreactive

midbrain trauma

hospital staff

nurses social worker physician radiology

fixed and dilated

oculomotor nerve trauma

chart

ppt

equality and reactivity chart

ppt

pulse chart

ppt

resp. chart

ppt

rhythm chart

ppt

skin chart

ppt

chain of survival

recognize and activate EMS, EMR, Advanced out of hospital care, Hospital care, Rehab

qualitative

rhythm and strength

skin cool and moist

shock, heart attack, anxiety

Transportation

•Activation of EMS? •Protocols on how an athlete is to be transported from each venue should be established •Any emergency situations with impairment in level of consciousness, airway, breathing, circulation, neurovascular function should be considered as "load and go" situations.

skin turgor

•Assesses degree of fluid loss/dehydration by determining elasticity of skin -Pinch and lift skin of forehand, sternum, dorsal surface of hand, or abdomen for several seconds •Normal turgor -Skin immediately snaps back to normal. •Decreased turgor -Skin remales elevated for several seconds -Excessive vomiting, diarrhea, increased urination, malnutrition, or corticosteroid reaction

Kleinknecht vs Gettysburg College

•Background -Drew Kleinknecht died of fatal arrhythmia -Cleared to play during PPE -Lacrosse practice with no AT -Coaches not certified in CPR •Argument -Parents claim Gettysburg College had a duty to protect Drew -Gettysburg College claimed the event was not "reasonable foreseeable" and therefore had no duty •Outcome -In favor of defendant, Gettysburg College; however, upon appeals the decision was reversed because they determined Gettysburg College had a duty to provide care factors. PPE, EAP, duty, foreseeability

results of K vs C

•Became a driving force toward the establishment of emergency action plans by all NCAA institutions •Position statements were developed by NCAA and NATA for emergency care and planning for atheltics

cap refill

•Capillary refill time (CRT) -Measures circulation and tissue perfusion •Assessment -Apply pressure to athlete's nail bed until it becomes blanched -Immediately release pressure -Record amount of time for nail bed to return to normal pink color •Normal -Less than 2 seconds •Abnormal -Delay of longer than 2 seconds -Dehydration and shock

EAP components

•Emergency personnel •Emergency communication •Emergency equipment •Medical emergency transportation •Venue directions with a map •Roles of first responders •EAP for non-medical emergencies

respirations

•Evaluation of respiration rate and quality of breaths •Observation to determine: -Does the chest rise and fall evenly or unevenly? -Do you feel or hear an exchange of air through nose and mouth, noting any obstructions? -Do you hear breath sounds with auscultation? •Frequency of a person breaths in 1 minute -One cycle of inspiration and expiration -Count number of breaths for 30 seconds and multiply by 2

personnel

•Personnel: who is involved? What is everyone's role? •Basic functions of the emergency team -Establish safety of the scene and provide immediate care -Activate emergency medical services (EMS) -Retrieve equipment -Direct EMS personnel to the scene

symptoms of stress

•Physical •Emotional •Behavioral •Cognitive •Relational •Spiritual

EAP practice and education

•Practice to determine feasibility •Revise as necessary •Practice annually at a minimum •Document rehearsal and personnel training •Education: -Distribute EAP to all stakeholders -Read and understand EAP -Review individual roles

pupils

•Pupil -Spherical black center of the eye -Changes size dependent upon light •Pupil constriction -Bright light -Minimizes damage to eye structures •Pupil dilation -Dim environment •Assesses function of brainstem

EAP benefits

•Risk Management •Preparation •Appropriate care •Decreases legal liability •Protects AT

types of EAPs

•Standard injury protocol -Overall general action plan to address injuries/illnesses that require further attention. •Weather-related emergency -Policies for suspending and resuming activity, individuals in charge of assessing conditions and making notifications. •Trauma/medical emergency -Most specific protocols to be followed for all events and venues home and away

summary

•Survival may hinge on how well trained and prepared athletic health care providers are for athletic emergencies. •Organizations sponsoring athletic activities invest "ownership" in an EAP by involving athletic administration personnel, sport coaches, and sports medicine personnel. •It is important to review the EAP yearly with all athletic personnel, including CPR and first aid refresher training.

wrap up

•Vital signs assessed during secondary and ongoing assessments. •Pulse, respiration, skin, pupillary response, and blood pressure comprise vital signs. •Vital signs help determine efficacy of treatment. •Periodic practice of skills should be maintained for clinical competence.