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