Prev & Care: AT 2356 Exam 2

If a uniform becomes saturated with blood, what is the proper action that should be taken for the athlete to continue participation?

The uniform should be changed immediately

Pain

"unpleasant sensory and emotional experience associated with actual or potential tissue damage" Function Warns of impending danger Alerts us that damage has occurred Activates protective reflexes Motivates behaviors to avoid further trauma

Lightning Safety

#2 cause of death by weather phenomena Emergency action plans must be set for this type of event Avoid large trees, flag/light poles, standing water, telephones, pools, showers, and metal objects (bleachers, equipment,umbrellas) If hair stands up on hand you are in imminent danger and should get down on the ground but not flat as that increases surface area Flash-to-bang methods estimates distance away for the storm From time lightening is sighted to the clap of thunder count, divide by 5 to calculate the number of mile away Count of 30 indicates inherent danger Count of 15 seconds everyone should leave the field Additional Guidelines Lightning is generally accompanied by thunder (except 20-40% of the time due to atmospheric disturbances)

Human Immunodeficiency Virus

**A retrovirus that combines with host cell Infects T4 blood cells, B cells and monocytes (macrophages) Estimated that 11 out of 1000 adults are infected with HIV 4.1 million new HIV infections occurred world-wide in 2005 Antibodies can be detected in blood tests within 1 year of exposure May go for 8-10 years before signs and symptoms develop

Hepatitis B

**Attacks liver, results in lifelong infection, cirrhosis, liver cancer, liver failure and death** Spread when blood from infected person enters the body of someone who is not infected Unprotected sex, sharing needles Individuals who have been vaccinated are at virtually no risk for infection **three dose vaccination over 6 months 350-400 million people are infected world-wide 8700 healthcare workers contract HBV each year, with 200 of these ending in death

Diagnostic Testing

**Blood Tests= Anemia Infection Glucometer= blood sugar Urinalysis= Diabetes Kidney problems Infection

Infectious Diseases, Bloodborne Pathogens, and Universal Precautions

**Bloodborne pathogens are transmitted through contact with blood or other bodily fluids Hepatitis, especially hepatitis B, human immunodeficiency virus are of serious concern Healthcare facility must be maintained as clean and sterile to prevent spread of disease and infection **Must take precautions to minimize risk

Clinical Evaluation & Diagnosis (off the field)

**Diagnosis Use of clinical or scientific methods to establish cause and nature of patient's illness or injury and subsequent functional impairment due to pathology Forms basis for patient care** Physicians make medical diagnosis Athletic trainers and other health care professionals use evaluation skills to make clinical diagnoses

Temperature

**Normal is 98.6o F -Measure with thermometer in mouth, under armpit, against tympanic membrane -Core temperature is best measured *rectally -Changes in temperature can be reflected in skin temperature

ROM

**Range of Motion Active Passive Goniometry

Emergency Splinting

**Splint where athlete lies and avoid moving them **Splint one joint above and one below fracture

Indirect transmission

**Travels via inanimate object- water, food, towels, clothing, utensils Via vectors- Insects, birds, animals Airborne transmission

Imaging Techniques

**Ultrasound= High frequency sound waves procude picture of internal structures Electrocardiography=Records electrical activity of the heart Electroencephalography= " " brain Electromyography=" "muscle

Opening the Airway

*Head-tilt, chin lift method* Push down on the forehead and lifting the jaw moves the tongue from the back of the throat

Imaging Techniques

*X-rays=Fx, Dislocations, bone abnorm *Arthrography=disruption of soft tissue *Athroscopy= used in surgery thru the jt space Myelograghy=dye to spinal canal to determine tumors, nerve root damage CT=view injure from many angles, Bone scan=stree Fx *MRI =soft tissue lesions

Dealing with Unconscious Athlete

-ALWAYS considered life-threatening condition -Note body position and level of consciousness -Check and establish airway, breathing, circulation (ABC) -*Assume neck and spine injury* -Remove helmet only after neck and spine injury is ruled out (facemask removal will be required in the event of CPR)

Types of Pain

-Acute Sudden onset Specific Physiological response -Chronic >6 months Diffuse/generalized Beyond healing time frame -Referred Visceral organs -Radiating Irritation of nerve roots -Phantom Pain from a body part that is no longer there Intermittent Sharp, throbbing, burning

Internal Hemorrhage

-Can occur beneath skin (bruise) or contusion, intramuscularly or in joint with little danger -Bleeding within body cavity could result in life and death situation

Primary survey

-Check Call Care -*Performed initially to establish presence of life-threatening condition* -Airway, breathing, circulation, shock and severe bleeding -Used to correct life-threatening conditions

On-field assessment

-Determine nature of injury -Provides information regarding direction of treatment -Divided into primary and secondary survey

Using an Automatic External Defibrillator (AED)

-Device that evaluates heart rhythms of victims experiencing cardiac arrest -Can deliver electrical charge to the heart *Fully automated - minimal training required* -Electrodes are placed at the left apex and right base of chest - when turned on, machine indicates if and when defibrillation necessary -Maintenance is minimal for unit

Pupils

-Extremely sensitive to situation impacting nervous system -Most individual's pupils are regularly shaped -Disparities must be known by the athletic trainer in the event that a condition arises -Failure to accommodate **may indicate brain injury, alcohol or drug poisoning**

Establish Unresponsiveness

-Gently shake and ask athlete "Are you okay?" -If no response, EMS should be activated and positioning of body should be noted and adjusted in the event CPR is necessary

HOPS

-History= Obtain subjective information relative to how injury occurred, extent of injury, MOI Inquire about previous injuries/illnesses that may be involved as well as past treatments Open ended questions -Observations= How does the athlete move? A limp or movement abnormal? What is the body position? Facial expression? Abnormal sounds? Asymmetries postural mal-alignments or deformities? Swelling, heat, redness, inflammation, swelling or discoloration? -Palpation= Bony and soft tissue palpation Perform systematically - begin away from the injured site Bony Compare bilaterally Look for abnormal gapping, swelling, abnormal protuberances -Special Tests= Used to detect specific pathologies ROM Compare inert and contractile tissues and their integrity Neurological assessment as well

Stages of Infection

-Incubation stage From time pathogen enters body to time signs and symptoms of disease appear -Prodromal stage Transfer to other hosts -Acute stage- reaches point of greatest development -Decline stage- 1st sign of recovery, could relapse -Recovery stage- overcoming invaded pathogen

Secondary survey

-Life-threatening condition ruled out -*Gather specific information about injury* -Assess vital signs and perform more detailed evaluation of conditions that do not pose life-threatening consequences

Obstructed Airway Management

-Mouth pieces, broken dental work, tongue, gum, blood clots from head and facial trauma, and vomit can obstruct the airway -*Stand behind patient with one fist against the body and other over top just below the xiphoid process* -*Provide forceful thrusts to abdomen (up and in) until obstruction is clear*

State of Consciousness

-Must always be assessed -Alertness and awareness of environment, as well as response relative to vocal stimulation -Head injury, heat stroke, diabetic coma can alter athlete's level of consciousness -Can be assessed using a variety of scales **AVPU scale assesses the following areas Alertness, verbal (responding to voice), pain (responds to painful stimulus), unresponsive (no response to pain) **ACDU scale = Alert Confused Drowsy Unresponsive

Musculoskeletal Assessment

-Must use logical process to adequately evaluate extent of trauma -Knowledge of mechanisms of injury and major signs and symptoms are critical -Once the mechanism has been determined, specific information can be gathered concerning the affected area

Bloodborne Pathogens

-Pathogenic organisms, present in human blood and other fluids (cerebrospinal fluid, semen, vaginal secretion and synovial fluid) that can potentially cause disease -Most significant pathogens are hepatitis B (HBV) , hepatitis C (HBC) and human immunodeficiency virus (HIV)

On-the-Field Acute Care and Emergency Procedures

-Primary concern is maintaining cardiovascular and CNS functioning -Mistakes in initial injury management can prolong the length of time required for rehabilitation or cause life-threatening situations to arise

Open fractures

1+ of fractured ends break through the skin - ends are not in close approximation

Universal Precautions in Athletic Environment

1991 OSHA (Occupational Safety and Health Administration) established standards for employer to follow that govern occupational exposure to blood-borne pathogens

Synovial Joints

2+ articulating bones with motion in 1+ places

If the flash to bang is 15 seconds, how far away is lightening occurring?

3 Miles

The HBV vaccine is given in:

3 doses over a 6-month period

If one thinks they have been infected by a bloodborne pathogen they should be tested at __weeks, __ months, and __ year(s).

6,3,1

Lifting

7+ people 1=head 2 shoulders 1-2 knees 1 spine board Lift and slide,strap into place, head person in charge

ABC's of CPR

A - airway opened B - breathing restored C - circulation restored Generally when A is restored B & C will follow

Which of the following substances is appropriate for cleaning tables in the athletic training room?

A 1:10 solution of bleach and water

Psychological Effects of Injury on the Athletic Trainer

AT may also be emotionally affected AT must make decisions regarding care and management of injury based on training Emotional attachment can not cloud judgment Must remain detached until a later time Outside counseling may be sought at a later time in order to assist in coping with the situation

Basic Knowledge Requirements

ATC must have general knowledge of anatomy and biomechanics as well as hazards associated with particular sport Anatomy Surface anatomy Topographical anatomy is essential Key surface landmarks provide examiner with indications of normal or injured structures **Body planes and anatomical directions Points of reference (midsagital, transverse, and frontal (coronal) planes)**

Tissue Property: Stiffness

Ability of a tissue to resist a load Greater stiffness = greater magnitude load can resist Stiffness of a rubber band changes with time. The older it gets the less stiff it is.

Control of Hemorrhage

Abnormal discharge of blood Arterial, venous, capillary, internal or external bleeding -*Venous - dark red with continuous flow -*Capillary - exudes from tissue and is reddish -*Arterial - flows in spurts and is bright red Universal precautions must be taken to reduce risk of bloodborne pathogens exposure

Contracture

Abnormal shortening of m. tissue Loss of resistance to passive stretch Developed scar tissue

Which of the following is the final Kubler-Ross stage?

Acceptance

A critical consideration in avoiding heat stress is to:

Acclimatize

Movement that is performed solely by the athlete is called:

Active

During stress the threat is immediate and the body's response is instantaneous

Acute

Two types of stress

Acute - threat is immediate and response instantaneous; response often entails release of epinephrine and norepinephrine Chronic - leads to an increase in blood corticoids from adrenal cortex When Patient/athlete is removed from sport because of injury or illness it can be devastating - impact on attaining goals Patient/athlete may fear experience of pain and disability Anxiety about disability, Injury is a stressor that results from external or internal sensory stimulus Coping depends on Patient/athlete's cognitive appraisal

Altitude Illnesses

Acute Mountain Sickness 1 out of 3 will experience when making the jump 7000-8000 feet. Experience headache, nausea, vomiting, sleep disturbance, and dyspnea Caused by brain disruption associated with sodium potassium imbalance resulting in fluid retention and cellular pressure changes Altitude Pulmonary Edema Occurs at 9000-10,000 feet. Lungs accumulate fluid in alveolar walls forming pulmonary edema Signs and symptoms: dyspnea, cough, headache, weakness and occasionally unconsciousness. Treat by moving athlete to lower altitude and providing oxygen High Altitude Cerebral Edema (HACE) Usually occurs in conjunction with other life threatening conditions that can lead to coma or death Occurs in ~1% of people adjusting to altitudes above 9,000 feet Result of increased cerebral edema due to increased cerebral blood flow, which is caused by increased permeability of cerebral endothelium when exposed to hypoxia The increased cerebral blood flow results in increased intracranial pressure Signs & symptoms Severe, persistent headache which may precede mental dysfunction, neurologic abnormalities Decent to lower altitudes may save those with HACE Sickle Cell Trait Reaction 8-10% of African Americans have sickle cell trait In most the trait is benign Abnormality in red blood cell hemoglobin structure When hemoglobin is deoxygenated, cells clump together causing blood cell to develop sickle shape making it easy to destroy Causes enlarged spleen and could rupture at high altitudes

Chronic Inflammation

Acute inflammatory process stalls or is incomplete Low levels of chemical mediators provides constant irritation Complications Degeneration to connective tissue Fibrosis Pain Infection Pitting edema- soft swelling, more fluid and is like memory foam > 1 month

Which of the following conditions is characterized by pain and discomfort during and immediately after exercise?

Acute onset muscle soreness

Which of the following nerve fibers transmit impulses from nocioceptors toward the brain?

Afferent fibers

Splints

Air splint Clear plastic splint inflated with air around affected part Can be used for splinting but requires practice Do not use if it will alter fracture deformity Provides moderate pressure and can be x-rayed through SAM splint Thin sheet of pliable aluminum covered with padding Half-ring splint Used for femoral fractures Requires extensive practice Open fractures must be dressed appropriately to avoid contamination -Rapid form immobilizer

Which type of assistance is given to an athlete that is able to walk after an injury a short distance?

Ambulatory Aid

HIV and Athletic Participation

American with Disabilities Act says athletes infected cannot be discriminated against and may only be excluded with medically sound basis

Traumatic vs. Overuse: Chronic

An acute injury that doesn't heal properly or an overuse injury

Tissue Property: Load

An external force acting on the body causing internal reactions within the tissues

Traumatic vs. Overuse: Acute

An injury with a specific MOI that initiates the healing process

Assisting with Healing

Anti-inflammatories NSAIDS: minimize pain and swelling Therapeutic Modalities Able to facilitate the healing process, or help provide a conducive environment to healing Exercise Rehabilitation Absolutely necessary to restore motion, strength, and function

Secondary Survey

Assessment of vital signs -Pulse - direct extension of heart function --Normal is *60-80 beats per minute (athlete's may be slightly lower) --Child's pulse is *generally 80-100 bpm -Respiration - *12 breaths per minute or 20-25 for children -Blood Pressure --*Measured w/ sphygmomanometer* indicating arterial pressure --Systolic blood pressure is pressure created by ventricle contraction (normal = 115-120 mm Hg) --Diastolic pressure is residual pressure present between beats (normal = 75-80 mm Hg)

Heat Syncope (heat collapse)

Associated with rapid fatigue and overexposure, standing in heat for long periods of time Caused by peripheral vasodilation, or pooling of blood in extremities resulting in dizziness and fainting Treat by placing athlete in cool environment, consuming fluids and laying down

Which of the following is NOT included in the history portion of an injury evaluation?

Athlete tries to assess the movement of the injured part

Identifying Susceptible Individuals

Athletes with large muscle mass Overweight athletes (due to increased metabolic rate) Death from heat stroke increase 4:1 as body weight increases Women are physiologically more efficient with regard body temp. regulation Others that are susceptible include, those with poor fitness, history of heat illness, or febrile condition, the young and the elderly

Post-exposure Procedures

Athletic trainer should have prompt medical evaluation that documents exposure route, identification of source/individual, blood test, counseling and evaluation of reported illness Laws that pertain to reporting and notification of results relative to confidentiality vary from state to state

Hyperthermia

Athletic trainers require knowledge and information concerning temperature, humidity and weather to adequately make decisions regarding environmental dangers Has caused a number of deaths over the years Must manage heat stress appropriately

If there is poor blood supply to a fractured area and a portion of the bone does not heal, this is called:

Avascular necrosis

Uniform Selection

Base on temperature and humidity Dress for the weather and temperature Avoid rubberized suits

Stress Fractures

Balance between osteoblast and osteoclast activity must be restores Untreated, may result in a complete fracture Treatment Decrease in activity Nutrition Training

Fibroblastic Repair Phase

Begins as the inflammation signs subside Blood flow increases to the area Strength of tissue increases Synthesis of weak scar tissue: type III collagen- weak patches up to hold things together Lasts ~6 weeks

Inflammatory Response

Begins immediately at time of injury Necessary for the healing process to begin Function Contains the injury Clears the area of debris

Synthetic Turf

Believed to be: durable, offer great consistency, usable with inclement weather, require less maintenance offer greater performance in areas of speed and resiliency Variety of surfaces have been created since 1960's Most recent is "resilient infill turf" Similar to grass, polyethylene and polypropylene yarn on a base of sand, rubber pellets or combination END OF CH.6

The application of mechanical forces, which may stem from within or outside of the body, to living organisms is called:

Biomechanics

Convective Heat Exchange

Body heat can be lost or gained depending on circulation of medium

Bone Functions

Body support Organ protection Movement (through joints and levers) Calcium storage Formation of blood cells (hematopoiesis)

Bone injuries Anatomical Considerations

Bone Growth Osteoblasts, osteoclasts, osteocytes Epiphyseal growth plate = location of growth Very susceptible to injury Periosteum = outter skin Cancellous/Spongy/Trabecular bone = more porous tissue Diaphysis = shaft Epiphysis = end

Subluxation

Bone comes partially out and spontaneously reduces Does it on it's own Shoulder, patella (females)

Hepatitis C

Both an acute and chronic form of liver disease caused by hepatitis C virus (HCV) **Most common chronic bloodborne infection in United States **Leading indication for liver transplant Signs & Symptoms: 80% of those infected have no S&S May be jaundice, have mild abdominal pain, loss of appetite, nausea, fatigue, muscle/joint pain, and/or dark urine

The pressure point most commonly used in the upper body to control external bleeding is the:

Brachial artery

Neurologic and circulation assessments

Brain Cerebral, cranial nerve function, cerebellar function Sensory & motor function **Dermatome Area of skin innervated by a single nerve **Myotome Muscle or group of muscles innervated by a specific motor nerve **Reflex testing Involuntary response to a stimulus Deep tendon - caused by stimulation of stretch reflex Superficial - stimulation of skin which causes reflexive muscle contraction Pathological - superficial reflex indicative of upper motor neuron lesion Babinski's sign, Chaddock's, Oppenheim's Gordon's Referred pain

Bursitis

Bursa are sacs (synovial membrane) filled w/ synovial fluid that develop in areas of friction Sudden irritation = acute bursitis Overuse & constant external compression = chronic bursitis Longer irritation = severity S/S = swelling, pain*, and some loss of function Repeated trauma = calcification & degeneration of internal bursa linings Subacromial, olecranon, and prepatellar bursa

Nerve

CNS: loses function when damaged PNS: may regenerate or compensation occurs 3-4 mm/day

Skin Color

Can be an indicator of health Red (hot), White (low blood, low blood flow, low blood pressure, anemic) , or Blue

Contusions

Can penetrate to skeletal structures causing a bone bruise Usually rated by the extent to which muscle is able to produce range of motion Blow can be so severe that fascia surrounding muscle ruptures allowing muscle to protrude Sudden body blow S/S: Impact causes pain and transitory paralysis, palpation reveals hardened area Ecchymosis = discoloration Calcium deposits = Myositis ossificans Prevention: padding, RICE Thigh, biceps Detectable by Xray Surgical removal ≥12mo post-injury

Muscle Soreness

Cause: New Physical Activity Acute-onset muscle soreness Fatigue Occurs immediately after exercise Delayed-onset muscle soreness (DOMS) Most intense 48hrs post, gradual recovery (3-4d) Causes: small m. tears (eccentric, isometric), disruption of CT holding it together Prevention = gradual build-up of intensity Care: Static or PNF stretching & ice application within 48-72 hrs

Inflammatory Response: Process

Cells are damaged Triggers chemical mediators Histamine: brings fluids, oxygen, and other nutrients to area Leukotrienes: triggers leukocytes (white blood cell- protects against infection) Cytokines: monitor and control response Immediate vasoconstriction: limits blood loss Followed by vasodilation Phagocytosis occurs to remove debris Platelets form a clot around the damaged area Should begin to resolve in ~48 hours

Preventing Heat Illness

Common sense and precaution Hydration Should begin activity well hydrated Involves hydrating during the 24 hours prior to activity Urine should be a light yellow in color Dark urine is an indication of dehydration Should consume fluid at regular intervals 17-20 fl oz of water or sports drink 2-3 hours prior to activity and an additional 7-10 fl oz 10-20 minutes before exercise

Bloodborne Pathogens in Athletics

Chance of transmitting HIV among athletes is low

Seasonal Affective Disorder

Characterized by mental depression during certain points of the year Occurs primarily in winter months due to decrease in sunlight Symptoms include fatigue, diminished concentration, daytime drowsiness Four times more common in women Treated with light therapy stress management, antidepressants and exercise

Frostbite

Chilblains result from prolonged exposure causing redness and swelling, tingling pain in toes and fingers Due to poor peripheral circulation _Superficial_ Frostbite involves only skin and subcutaneous tissue Appears pale, hard, cold and waxy When re-warming the area will feel numb, then sting and burn It may blister and be painful for several weeks _Deep_ Frostbite indicates frozen skin requiring hospitalization Rapid re-warming is necessary (100-110oF) Tissue will become blotchy red, swollen, painful and may become gangrenous

When an athletic trainer or other health care professional is denoting what disease, injury or syndrome a person has or is believed to have, he/she is making a(n)

Clinical Diagnosis

Reacting to Patient/Athletes with Injuries

Clinicians are not usually trained in areas of counseling and may require additional training Respond to individual not the injury During initial treatment stages, emotional first aid will be required Comfort, care and communication should be given freely Sports medicine team must be understanding and be prepared to answer Patient/athlete's questions

Capsulitis/Synovitis

Co-occur Cause Repeated jt sprains, or microtrauma Symptoms Edema = jt stiffness/fullness Degeneration Irregular thickening, fibrous tissue, exudation Reduced ROM Crepitus, grinding

Injury and or illness are stressors and the athlete's ability to cope with these stressors depends on the athlete's:

Cognitive appraisal

Hypothermia

Cold weather vs. nature of particular sport Most activity allows for adequate heat production (increased metabolism) and dissipation, allowing for sufficient functioning Impact on warm-up and "down time" Temperature in conjunction with _WIND_ chill and dampness or wetness can increase chances of hypothermia 65% of body heat is lost through radiation (head and neck 50%) 20% through evaporation 2/3 through skin and 1/3 through respiration Problems arise when heat lost exceeds heat production via metabolism Results in impairment of neuromuscular function Drop in core stimulates shivering but stops after temp. drops below 85-90oF Death is imminent when temp falls below 77-85oF.

Obsessive- Compulsive Disorder

Combination of emotional and behavioral symptoms Recurrent, inappropriate thoughts, feelings, impulses, or images arising from within Cannot be neutralized even though they are known to be wrong Engage in unreasonable repetitive acts which disrupts normal daily functioning Behavioral psychotherapy attempts to restructure environment to minimize tendencies to act compulsively Medication is also used

Radiant Heat Exchange

Comes from sunshine and will cause increase in temperature

Documenting Injury Evaluation Information

Complete and accurate documentation is critical Clear, concise, accurate records is necessary for third party billing While cumbersome and time consuming, athletic trainer must be proficient and be able to generate accurate records based on the evaluation performed

Dislocations

Complete articular separation Must be manually or surgically reduced Fingers, elbow and shoulder Gross deformity is typically apparent Stabilizing structures are disrupted (Avulsion) fx, fx growth plate??? Susceptible to subsequent dislocations X-ray is the only absolute diagnostic technique Dislocations (esp. 1st time) should always be considered and treated as a fracture until ruled out "Once a dislocation, always a dislocation"

A force that, with enough energy, crushes tissue is a force.

Compression

Advanced Postoperative or Rehabilitation Period

Conditioning should continue to train unaffected body parts Confidence must be built gradually and Patient/athlete must feel in control Positive reinforcement is critical and milestones must remain realistic Rehab must make transition to more sports specific

Disinfectant

Contaminated surfaces should be clean immediately with solution of 1:10 ratio approved disinfectant to water Wash in hot water (159.8 degrees F for 25 minutes) Laundry done outside institution should be OSHA certified

Musculotendinous Unit Injuries: Anatomical Characteristics of Muscles

Contractile cells 3 types: Smooth Cardiac Striated* Muscle Structure

Anxiety Disorders

Contributes to 20% of all medical conditions Anxiety can cause a variety of physiological responses Anxiety is abnormal when it begins to interfere with emotional well-being or normal daily functioning -Panic Attacks Unexpected and unprovoked emotionally intense experience of terror and fear Physiological responses similar to someone fearing for life Tend to occur at night and run in families Behavior modification and meds can be used to treat -Phobias Persistent and irrational fear of specific situation, activity, or object that creates desire to avoid feared stimulus May include fears of social situations, height, closed spaces, flying Symptoms include increased heart rate, difficulty breathing, sweating and dizziness Treatment includes behavior modification, anti-depressants and systematic desensitization

Heat is eliminated by the body in all of the following ways EXCEPT:

Conversion (is by conduction, evaporation, radiation)

Circadian Dysrhythmia (Jet Lag)

Desynchronization of biological and biophysical time clock Body maintains cyclical mechanisms over 24 hour periods (circadian rhythms) Body adapts over time to changes Immediately (protein metabolism) Over 8 days (body temperature) Three weeks (adrenal hormones)

Off-the-field Injury Evaluation

Detailed evaluation on sideline or in clinic setting May be the evaluation of an acute injury or one several days later following acute injury **Divided into 4 components (HOPS) History, Observation, Palpation and Special tests

When dealing with a possible unconscious athlete, the first action that must be taken is:

Determine the level of consciousness and unresponsiveness

Myofascial Trigger Points

Discrete, hypersensitive nodule w/in taut band of m. and/or fascia LATENT = Not painful at rest only touch, but restricts motion or causes weakness ACTIVE = Causes pain at rest (jump sign) Referred pain pattern* (spreading/radiating) Found usually in postural muscles Referred pain is a primary characteristic of MTPs

Cooperation between Emergency Care Providers

EAPS- "emergency action plan" and Parent notification Cooperation Professionalism EMT/Dr/ATC

Emergency Emotional Care

Emergency care relative to emotional reactions to trauma must also be provided Accept rights to personal feelings, show empathy, not pity Accept injured person's limitations as real Accept own limitations as provider of first aid Be empathetic and calm, being obvious that athlete's feelings are understood and accepted

Emotional Response

Emotional responses stem from thoughts Research has shown a fairly consistent response in injured athletes and it depends on severity Emotional response is mediated by personality and coping style Few athletes actually become clinically depressed

Environmental Conditions

Environmental stress can come in many shapes and forms and knowledge is key for prevention

Epidemiology

Epidemiology is a tool used to study infectious disease in a population Disease outbreaks -Sporadic (occasional, occurrence) -Endemic (regular cases often occurring in a region) -Epidemic (unusually high number of cases in a region) -Pandemic (global epidemic)

Soft Tissue

Epithelial: Skin, lining of organs and vessels Connective: Tendons, ligaments, cartilage, fat, blood Muscle: Skeletal, smooth, cardiac Nervous: Brain, spinal cord, nerves

Evaluation of Sports Injuries

Essential skill Four distinct evaluations Pre-participation (prior to start of season) 6wks On-the-field assessment Off-the-field evaluation (performed in the clinic/training room...etc) Progress evaluation

Descriptive Assessment Terms

Etiology - cause of injury or disease Pathology - structural and functional changes associated with injury process **Symptoms- perceptible changes in body or function that indicate injury or illness (subjective) **Sign - objective, definitive and obvious indicator for specific condition Degree- grading for injury/condition Diagnosis- denotes name of specific condition Prognosis- prediction of the course of the condition

Personality Disorders

Everyone has own differences in personality traits In the case of disorders, it is pathological disturbance in cognition, affect, interpersonal functioning or impulse control Generally long in duration and traceable to some event Treatment may involve psychotherapy and medications

A heat disorder caused by profuse sweating, diarrhea, persistent muscle cramps and dizziness with loss of coordination is:

Exertional heat exhaustion

Absence of sweating with hot, flushed skin, sudden collapse, altered consciousness and seizures is indicative of

Exertional heat stroke

Early Postoperative Period

Following surgery Patient/athlete becomes disabled individual and full explanations must be provided Patient/athlete must maintain aerobic conditioning

Factors that Impede Healing

Extent of damage Edema Hemorrhage Poor vascular supply Separation of tissue Muscle spasm Atrophy Corticosteroids Keloids Infection Humidity, climate Health, age, nutrition

Heat Stress

Extreme caution should be used when training in the heat OVEREXPOSURE could result heat stress It is PREVENTABLE Athletes that train under these extreme conditions are at risk Physiologically the body will continue to function if body temperature is maintained Body must dissipate heat to maintain homeostasis

Etiology refers to a perceptual change in an athlete's body that indicates injury or disease.

False

Testing Athletes for HIV is legal in regards to clearing them for play?

False

When an athlete is physically ready to return to play, the physical aspect is all the sports medicine team needs to be concerned with.

False

Exertional heat exhaustion is caused by the sudden onset of thermoregulatory failure, which can lead to death if untreated.

False, Exertional heat stroke would cause this

Return to Sport

Fear of re-injury Self Determination Theory Explains a patients motivation to return to sport Autonomy, competence, relatedness External versus internal motivation?

Athletes who sustain injuries that disable them from performing may experience:

Fear, Depression, Anger

Proper Fit and Use of Crutch or Cane

Fitting athlete Athlete should stand with good posture, in flat soled shoes Crutches should be placed 6" from outer margin of shoe and 2" in front Crutch base should fall 1" below anterior fold of axilla Hand brace should be positioned to place elbow at 30 degrees of flexion

Treatment

Fluid ingestion (intravenous replacement, ultimately) Place in cool environment Remove excess clothing Must continue to monitor vital signs Return to play - must be fully hydrated and be cleared by a physician If not appropriately treated it could progress to exertional heat stroke

Exertional Hyponatremia

Fluid/electrolyte disorder resulting in abnormally low concentration of sodium in blood Caused by ingesting too much fluid before, during and after exercise May be result of too little sodium in diet or to much ingested fluids over a period of prolonged exercise Athletes that ingest large quantities of water and sweat over several hours are at risk (marathon, triathlon) _Completely preventable_ - must maintain balance Signs and Symptoms Progressively worsening headache, nausea, vomiting Swelling of hands and feet, lethargy, apathy or agitation Low blood sodium Could compromise CNS and create a life-threatening situation If levels can not be determined on-site, measures to rehydrate should be delayed and the athlete should be transported to a medical facility Delivery of sodium, diuretics, or intravenous solutions may be necessary

3. Wiese-Bjornstal et al. (1998)

Focuses on personal and situational factors in cognitive appraisal Personal: Pessimistic explanatory style, dispositional optimism, hardiness, athletic identity, pain tolerance Situational: Sport, social, environmental

The Patient/Athlete and the Sociological Response to Injury

Following long term rehabilitation the Patient/athlete may feel alienated from the team Views of involvement and interaction with coaches and Patient/athletes may be disrupted Relationships may become strained Patient/athletes may pull away as injured Patient/athletes are a reminder of potential harm that can come to them Friendships based on athletic identification may be compromised Remaining a part of the team is critical - less isolation and guilt is felt

Tissue Loading: Shearing

Force that moves across the parallel organization of tissue

Tissue Loading: Tension

Force that pulls and stretches tissue

Tissue Loading: Compression

Force that results in tissue crush - two forces applied towards one another

Abdominopelvic Quadrants

Four corresponding regions of the abdomen Divided for evaluative and diagnostic purposes A second division system involves the abdomen being divided into 9 regions

Pain Control

Gate Control Theory Non-painful stimulus overrides a painful stimulus Descending Pain Control Previous experiences, emotional response affect perception of pain Beta Endorphin Release Endogenous opioids released in the brain All 3 systems work concurrently

Shock

Generally occurs with severe bleeding, fracture, or internal injuries

Muscle Strain

Grades I, II, III Causes: Overstretching of a muscle Contraction against too much force Result = tearing of muscle fibers Care: Healing time may be lengthy 6-8 weeks depending on severity Return to play too soon could result in re-injury

Gradual Acclimatization

Gradual Acclimatization Most effective method of avoiding heat stress Involves becoming accustomed to heat and exercising in heat Early pre-season training and graded intensity changes are recommended with progressive exposure over _7_-10 day period _80_% of acclimatization can be achieved during first 5-6 days with 2 hour morning and afternoon practice sessions Equipment restrictions may help athlete gradually acclimate

Types of fractures

Greenstick- peal off Comminuted- crushed, from jumping off roof Linear- length of bone Transverse- across bone, perpendicular Oblique- angled Spiral- plant and twist creating a spiral break Impacted- bones impacted out into the tissue Depressed- bone becomes depressed

Paranoia

Having unrealistic and unfounded suspicions about specific people or things Person is constantly on-guard and cannot be convinced that suspicions are incorrect Overtime resentment develops and ultimately requires the use of medical care

Heat Illnesses

Heat rash (prickly heat) Benign condition associated with red, raised rash, combined with prickling with sweat Result of continuously wet un-evaporated sweat Continually toweling the body will prevent Generally localized to areas covered with clothing

Monitoring Heat Index

Heat, sunshine and humidity must be monitored closely Wet bulb globe temperature index (WBGT) provides objective measure for determining precautions concerning participation in hot

Additional Hepatitis Viruses

Hepatitis A May show no outward signs or symptoms Adults may exhibit dark urine, light stools, fatigue, jaundice and fever Hepatitis D (HDV) causes inflammation of the liver Hepatitis E (HEV) Causes inflammation of the liver Rarely found in the United States

Which of the following chemical mediators is a powerful vasodilator found in mast cells?

Histamine

The type of shock that results from trauma in which there is blood loss is called:

Hypovolemic shock

Salter-Harris Fracture Classification

I = compete separation of physis from metaphysis II = separation of growth plate and part of metaphysis III = fx of physis, bown but no growth plate IV = fx of portion of physis and metaphysis but growth place still in place V is catastrophic for patients - no way to grow it back- growth plate shoved up

In which of the phases of rehabilitation does the patient feel fearful and may be in denial?

Immediate post-injury

Progressive Controlled Mobility

Immobilization is the biggest hurdle to healing Wolff's Law: Tissue needs to be exposed to increasing loads through rehabilitation Benefits Decreased scar tissue Decreased atrophy Improved motion Improved tensile strength Thin line between good activity and aggressive activity

Specific Fx Types

Impacted Fx Less common types of fractures Avulsion-Separation of bone fragment from cortex via pull of ligament or tendon Blowout fracture- when an object comes into contact with a persons orbit(eye) depressing the eye in or out, shattering the eye around Serrated fracture Depressed fracture Countercoup fracture

Adaptations to Altitude

Increased height = reduced barometric pressure resulting in decreased partial pressure of oxygen = less saturation of red blood cells Individual adaptations dependent on whether the person is a native, resident or visitor Native has larger chest capacity, more alveoli, capillaries and red blood cells Resident makes partial adaptations (increased mitochondria and hemoglobin, glycogen conservation) Visitor responds with increased breathing, heart action, hemoglobin, blood alkalinity, myoglobin and changes in blood flow and enzyme activity Other uncertainties with regards to training and competition Time to adjust (2-3 weeks vs. 3 days) Short adjustment allows acid-base balance to recover but does not allow significant changes in blood volume and maximum cardiac output

Movement

Indicate: CNS, brain trauma, stroke, and spine -Abnormal Nerve Response Numbness/tingle Local pain is an indicator that spinal injury is NOT present

Assessment

Individualized, subjective Visual analog scale Pain chart McGill pain questionnaire Numeric rating scale

Tissue Property: Strain

Internal change in tissue (i.e. length) resulting in deformation Strain is what happens when you apply a great enough load that you change the shape/length of an object/tissue. If only lightly pull on a rubber band the stiffness is able to produce enough stress to overcome the load = no defmormation. But if you putt on it hard enough, it stretches and becomes longer

Tissue Property: Stress

Internal resistance to a load Stress is related to stiffness - the greater the stiffness the more stress it can resist

Infectious Disease

Invasion of a host (animal or person) by a microorganism (pathogen- disease causing) Most common pathogens = bacteria, viruses, parasites or fungi An infectious disease = contagious if transmission occurs from one individual to another Direct vs. indirect transmission **3 Types of direct transmission -Contact of body surfaces (touching, sexual intercourse) -Droplet spread (inhalation or air droplets) -Fecal-oral spread (feces on hands contact with mouth

Muscle Guarding

Involuntary contraction (splinting) of muscles surrounding an injured area Triggered by pain NOT a spasm

Muscle Spasms

Involuntary contraction that negatively affects voluntary motion Sudden, painful onset w/o injury 2 Types: Clonic - on/off contractions Tonic - constant contractions May lead to a m. strain Spasticity = abnormal increase in muscle stiffness = inability to control m's Nerve injuries/diseases

Weight Records

Keep track of before and after measures for first two weeks If increase in temperature and humidity occurs during the season, weights should again be recorded A >_2_% loss of BW could be a health threat and should be removed from practice until normal weight is achieved(150 before and 145 after) NO (150 before 148 after)yes (3lbs bad)

Soft Tissue Healing: Cartilage

Limited capacity to heal Little to no blood supply ~ 2 month healing time

Torsion

Loads caused by twisting in opposite directions from opposite ends Shear stress encountered will be perpendicular and parallel to the loads

Common Cold Injuries

Localized cooling can result in tissue damage Formation of ice crystals between cells, destroys cells, disrupts blood flow, clotting may occur Frost _nip_ Involves, ears, nose, chin, fingers, and toes Occurs with high wind and/or severe cold Skin appears firm with cold painless areas that may peel and blister (_24-72 hours) Treat with firm pressure, blowing warm air or hands in armpits (if fingers involved)

Mental Training Techniques

Long been used to enhance sports performance and useful during rehabilitation Serious emotional disabilities should be referred to professionals A series of techniques are available to help cope

In giving emergency treatment for a heat stroke victim, the athletic trainer should direct efforts at:

Lower body temperature with a cool towels and transport to a hospital

Testing Athletes for HIV

Mandatory testing may not be allowed due to legal reasons (American with Disabilities Act and HIPAA) Testing should be secondary to education Athletes engaged in risky behavior should undergo voluntary anonymous testing for HIV Testing should occur at 6 weeks, 3 months, and 1 year

Lightning Detectors

Many kinds Not by cell phones Not under stadium lights Not by radios THORGUARD- BIG facilities $$$$ Best way Loud

When leukocytes line up along the wall of the blood vessel it is called

Margination

The Immune System

Mechanical defenses Skin, mucous membranes, nasal hairs, cilia lined airways Cellular System (Immune system) Eliminates microorganisms, foreign proteins and antigens

Body Mechanics and Injury Susceptibility

Mechanical reasons for injury: Hereditary Congenital Acquired defects may predispose athlete to injury Other potential predispositions = Body build, structural make-up, habitual incorrect application of skill Postural Deviations Often an underlying cause of injury Result of unilateral muscle, bony, or soft tissue asymmetries

Treating Pain

Medications Therapeutic Modalities Can be used to trigger pain control systems

Injuries to the musculotendinous unit commonly occur at all of the following sites except in the?

Mid-tendon area

Dehydration

Mild dehydration occurs when _2_% of body weight is lost in fluid Signs & symptoms Thirst, dizziness, dry mouth, irritability, excessive fatigue, and possible cramps Must move individual to cool environment and begin rehydration Return to normal weight and absence of symptoms 1-2% drop in body weight (due to dehydration) results in thirst If thirst is ignored, dehydration results in: _nausea_, vomiting, fainting and increased risk for heat illness

All of the following are functions of bone EXCEPT?

Mineral production not calcium (Hematopoiesis, Body support, Organ protection)

Altitude

Most events do not occur at extreme _elevation_ As height increases, maximum oxygen uptake decreases resulting in a decrease in performance Body compensates through tachycardia and hyperventilation Responses are a result of having fewer red blood cells than necessary to adequately capture available oxygen

Stress Fractures

Multiple possible MOIs Overload due to muscle contraction Altered stress distribution due to muscle fatigue Changes in surface Rhythmic repetitive stress vibrations Causes in Sports Overtraining Returning from injury/illness too fast Improper training for new event Too rapid ramp up for training Changing training habits/environment Additional Causes Pes planus, Mortons toe, hypermobile MT S/S: Focal tenderness, pain, swelling, night pain TX: X-rays (~4wks), CT, MRI, rest Tibia, Fibula, MT shaft (2nd and 3rd), calcaneus, femur, pars interarticularis (Lumbar), ribs, humerus

Tears generally occur

Muscle belly (least common) Musculotendinous junction (most common) Avulsion fx (age dependent)

Malignant hyperthermia

Muscle disorder causing hypersensitivity to anesthesia and heat Similar S&S to heatstroke - muscle biopsy is needed to detect Athlete will complain of muscle pain after exercise Temperature will remain elevated 10-15 minutes following exercise Athlete with condition should be disqualified from competition in hot, humid environments

Preventing Spread of Infectious Disease

Must be diligent in efforts to minimize transmission of disease **Most effective practice = washing hands Ensure that patient immunizations are up to date Be sure to educate patients on inability of antibodies to impact viruses, and need to taking antibiotics as directed **Encourage healthy lifestyle in patients

Moving and Transporting Injured Athletes

Must be executed with techniques that will not result in additional injury No excuse for poor handling Planning is necessary and practice is essential Additional equipment may be required

Sharps

Needles, razorblades, and scalpels Use extreme care in handling and disposing all sharps Do not recap, bend needles or remove from syringe Scissors and tweezers should be sterilized and disinfected regularly

Sharp or burning pain is characteristic of what type of injury?

Nerve injury

HIV and Athletic Participation

No definitive answer as to whether asymptomatic HIV carriers should participate in sport

Pain Transmission

Nociceptors: superficial pain receptors Something stimulates the nociceptors Turns that into an electrical impulse Travels on the afferent nerve pathway to the spinal cord Initiates reflexive response Continues up the spinal cord to the brain Interprets pain signal to determine severity, location, etc. Efferent response sent back to the extremity

Metabolic Heat Production

Normal metabolic function results in production of heat (will increase with intensity of exercise)

Staleness

Numerous reasons including, training to long and hard w/out rest Attributed to emotional problems stemming from daily worries and fears Anxiety (nondescript fear, sense of apprehension, and restlessness) Patient/athlete may feel inadequate but unable to say why May cause heart palpitations, shortness of breath, sweaty palms, constriction of throat, and headaches Minimal positive reinforcement may make Patient/athlete prone to staleness

Mental Disorders

Occasionally, athletic trainer must deal with Patient/athletes with mental illness Must be able to recognize when an Patient/athlete is having a problem and make referral Mental illness is any disorder that affects the mind or behavior Classified as neurosis or psychosis Neurosis: unpleasant mental symptom in individual with intact reality testing Symptoms include anxiousness, depression or obsession with solid base of reality Psychosis Disturbance in which there is disintegration in personality and loss of contact with reality Characterized by delusions and hallucinations

Bone Fractures

Serious condition if not managed properly Signs & symptoms Deformity, pain, point tenderness, swelling, pain on active and passive movements Possible crepitus X-ray for definitive (medical) diagnosis Mechanism of Injury- Fracture may be direct or indirect Sudden violent and forceful muscle contraction

Sprains

Only happens to ligaments, still Graded the same as Strains I,II, III

Which of the following is a common apophyseal injury?

Osgood Schlatter's Disease

The constant ongoing remodeling of bone is caused by the:

Osteoblasts and osteoclasts

Muscle Cramps

Painful involuntary contractions NOT associated with an injury Calf, Hamstring, Quads, Abdomen Causes: Fatigue??

Heat Cramps

Painful muscle spasms (calf, abdominal) due to excessive water loss and electrolyte imbalance Occurs in individual in good shape that overexert themselves

Factors that effect the response to injury for the Pt.

Past Hx Coping skills Social support Personal traits Family pressure No prev Hx on inj Situational factors

Which of these is not a symptom of shock?

Patient has a very slow pulse

Techniques for Coping with Pain

Patient/athlete can be taught simple techniques to inhibit pain Should never be completely inhibited as pain serves as a protective mechanism Three methods can be used to reduce pain Tension Reduction Attention Diversion Altering Pain Sensation

Return to Activity

Patient/athlete generally returns physically ready but not psychologically (level of anxiety remains) Tension can lead to disruption of coordination producing unfavorable conditions for potentially new or current injuries To help Patient/athlete regain confidence Progress in small increments Instruct Patient/athlete on systematic desensitization

Role in Providing Social Support

Patient/athlete should get the perception that the clinician cares May have a huge impact on success of rehab process Communication is critical Clinician should take an interest in the Patient/athletes and their well-being before injuries even occur The Clinician should do the following Be a good listener Be aware of body language Project a caring image Find the problem Explain the injury to the Patient/athlete Manage the stress of the injury Help the Patient/athlete return to competition

Patient/athletes Psychological Response to Injury

Patient/athletes deal with injury differently Viewed as disastrous, an opportunity to show courage, use as an excuse for poor performance, escape from losing team Severity of injury and length of rehab Short term (<4 weeks) Long term (>4 weeks) Chronic (recurring) Terminating (career ending) Response- No matter the length of time, three reactive phases occur Reaction to injury Reaction to rehabilitation Reaction to return to play or termination of career 1. Kübler-Ross's Model of _Reaction_ to Death & Dying Often linked to injury- 1.Denial 2.Anger 3.Bargaining 4.Depression 5.Acceptance Other matters that must be considered are past history, coping skills, social support and personal traits Injury may impact a number of factors socially and personally and emotions may be _scary_

The Catastrophic Injury

Permanent functional disability Intervention must be directed toward the psychological impact of the trauma and ability of the Patient/athlete to cope Will profoundly affect all aspects of the Patient/athlete's functioning Can also have major effects on teammates and must be cognizant of that fact

The process of ingesting microorganisms, other cells, or foreign particles commonly performed by monocytes is called:

Phagocytosis

Air Pollution

Photochemical haze: nitrogen dioxide and stagnant air acted on by sunlight to produce ozone Smog: combination of carbon monoxide, sulfur dioxide, and particulate matter _Ozone_: Formed by the action of sunlight on carbon based chemicals (hydrocarbons) in combination with nitrogen dioxides May experience shortness of breath, coughing, chest tightness, pain with deep breathing, nausea, eye irritation, fatigue, lung irritation, lowered resistance to lung infection Asthmatics are at greater risk Others: Sulfar dioxide, nitrogen dioxide, carbon monoxide, particulate Matter

Conductive Heat Exchange

Physical contact with objects resulting in heat loss or gain

Acquired Immunodeficiency Syndrome (AIDS)

Positive test for HIV cannot predict when the individual will show symptoms of AIDS 50% develop AIDS w/in 10 years of HIV infection After contracting AIDS, people generally die w/in 2 years of symptoms developing Prevention is key!!!! Management No vaccine for HIV, no cure even though drug therapy is available

Overexposure to Sun

Precautions must be taken to protect athletes, coaches, athletic trainers and support staff _Long_ Term Effects on Skin Premature aging and skin cancer due to ultraviolet exposure Premature aging is characterized by dryness, cracking and inelasticity of the skin Skin cancer is the most common malignant tumor found in humans Damage to DNA is suspected as the cause of cancer Major types include basal cell carcinoma, squamous cell carcinoma and malignant melanoma Rate of cure is 95% with early detection Fair skinned individuals are more susceptible to these maladies

Guidelines for Athletes Who Intentionally Lose Weight

Predispose themselves to heat related injuries and could create life-threatening situations Weight loss should not be accomplished through dehydration Gradual process over weeks and months and should be a result of body fat lost NCAA and high school federations have established guidelines for weight loss in wrestling

Prevention

Prevention Apparel geared for weather to provide semitropical microclimate for body and prevent chilling Waterproof and windproof fabrics that allow passage of heat and sweat and allow movement Layers and adjusting them are key to maintaining body temperature (during period of (in)activity) Inadequate clothing, improper warm-up and chill factor can lead to injury, frostbite, chilblains, and/or minor respiratory problems Be aware of hydration levels as well to enhance blood volume and heat maintenance

Immediate Treatment

Primary goal is to limit swelling and extent of hemorrhaging If controlled initially, rehabilitation time will be greatly reduced **Control via(P)- protection or stabilized RICE(S)= REST ICE COMPRESSION ELEVATION

Preparing the Athlete

Prior to participation, all open wounds and lesions should be covered with dressing that will not allow for transmission Sterile dressing lessens chance of cross-contamination When Bleeding Occurs Athletes with active bleeding must be removed from participation and returned when deemed safe Bloody uniform must be removed or cleaned to remove infectivity Personal Precautions Those in direct contact must use appropriate equipment including Latex gloves, gowns, aprons, masks and shields, eye protection, disposable mouthpieces for resuscitation Emergency kits should contain, gloves, resuscitation masks, and towelettes for cleaning skin surfaces Hand washing Latex Sensitivity and Nonlatex Gloves

Heat Prevention

Profuse sweating results in loss of water and electrolytes (sodium, potassium, magnesium, and calcium) Prevent by consuming extra fluids and maintaining electrolyte balance Treat with fluid ingestion, light stretching with ice massage Return to play unlikely due to continued cramping

Psychological Intervention for Sports Injuries and Illnesses

Psychological and sociological consequences of injury can be as debilitating as the physical aspects of an injury Must have an understanding of how psyche, emotions and feeling enter into the treatment process Athletic Trainers must be: Aware of the cultural factors of an injured patients that may factor into the rehab process Sensitive to these factors and concerns of the patient

Sixty-five percent of the heat produced by the body is lost in cold weather by:

Radiation

Mood Disorders

Range from happiness to sadness Pathological when it disrupts normal behavior, is prolonged and accompanied by physical symptoms (sleep and appetite disturbances) Depression is also common Unipolar - feeling move from "normal" to helplessness, loss of energy, excessive guilt, diminished ability to think, changes in eating and sleeping habits, and recurrent thoughts of death Bipolar (manic depression) - goes from exaggerated feelings of happiness and great energy to extreme states of depression Treatment is individualized and might include psychotherapy and antidepressant medication

Post-Traumatic Stress Disorder

Re-experiencing of psychologically traumatic events May experience numbing of general responsiveness, insomnia, and increased aggression. May persist for decades Group therapy is useful for treatment

Maturation Remodeling Phase

Realignment of collagen fibers Type III replaced by Type I- lined up with muscle structure and bone structure Increasing tensile strength of tissue Scar tissue is never as strong as original tissue May take up to two years to complete the process

SOAP Notes

Record keeping can be performed systematically which outlines subjective & objective findings as well as immediate and future plans SOAP notes allow for subjective & objective information, the assessment and a plan to be implemented -S(subjective) Statements made by athlete - primarily history information and athletes perceptions including severity, pain, MOI -O(Objective) Findings based on ATC's evaluation -A (Assessment) ATC's professional opinion regarding impression of injury May include suspected site of injury and structures involved along with rating of severity -P (Plan) Includes first aid treatment, referral information, goals (short and long term) and examiner's plan for treatment

5 Cardinal Signs of Inflammation

Redness Swelling Pain Increased temperature Loss of function

Pain that is felt at a place other than the origin of the pain is known as?

Referred pain

Muscle

Regeneration of tissue Strength regained through active contraction ~ 6-8 week healing time

The purpose of a sling psychrometer is to measure:

Relative humidity

Ligament

Replaced with scar tissue Stability must be compensated by structures around the joint ~ 2-8 week healing time

Tendon

Requires abundance of collagen to heal May result in fibrosis ~ 4-5 week healing time

Overtraining

Result of imbalances between physical load being placed on Patient/athlete and his/her coping capacity Physiological and psychological factors underlie overtraining Can lead to staleness and eventually burnout

Exertional Heat Exhaustion

Result of inadequate fluid replacement Unable to sustain adequate cardiac output Will exhibit signs of profuse sweating, pale skin, mildly elevated temperature, dizziness, nausea, vomiting or diarrhea, hyperventilation, persistent muscle cramps, and loss of coordination May develop heat cramps or become faint/dizzy Core/rectal temperature will be <_104 o Performance may decrease

Epiphyseal growth plate injuries have been classified into five types by

Salter-Harris

Which of the following mood disorders can be treated with light therapy?

Seasonal affective disorder

Conditions following and resulting from a disease or injury are referred to as:

Sequela

Exertional Heatstroke

Serious life-threatening condition, with unknown specific cause Characterized by sudden onset - sudden collapse, LOC, CNS dysfunction, flushed hot skin, minimal sweating, shallow breathing, strong rapid pulse, and core temperature of > 104o F Breakdown of thermoregulatory mechanism Drastic measures must be taken to cool athlete Strip clothing Sponge with cool water Use of ice packs Do not immerse in water - CAUTIOUS!! Transport to hospital immediately Cool first, transport second Athlete should avoid exercise for a minimum of one week and gradually return to full practice Must be asymptomatic and cleared by physician Death may result if not treated appropriately

PPE

Setting up Med Hx Exam Vitals, gen med, cardio, pulmonary, musculoskeletal, neuro, eye, dental, gastro, genitourinary

Ligaments

Sheets or bundles of collagen that form connection between two bones = jt stability Both intrinsic (inside the capsule) and extrinsic (outside the capsule) Strong in the middle, weak at the ends Avulsion injury- tendon ripped off the bone Viscoelastic(solid and a liquid, stretch a little bit, but can still maintain its shape) properties are primary factor in ligamentous injuries

Acute Fractures

Should have a good union in order to heal May require surgery Interference Poor blood supply Avascular necrosis- without blood Poor immobilization Infection Soft tissue interference

All of the following are qualities of a synovial joint EXCEPT?

Slightly movable (Lined with a synovial membrane, Has a joint space, Has a capsule or ligaments)

Predictors of Injury

Some psychological traits may predispose Patient/athlete to injury No one personality type Risk takers, reserved, detached or tender-minded players, apprehensive, over-protective or easily distracted Lack ability to cope with stress associated risks Other potential contributors include attempting to reduce anxiety by being more aggressive, continuing to be injured because of fear of failure, or guilt associated with unattainable goals

Acute Exertional Rhabdomyolysis

Sudden catabolic destruction and degeneration of skeletal muscle (myoglobin and enzyme leakage into vascular system) Occurs during intense exercise in heat and humidity resulting in: gradual muscle weakness, swelling, pain, dark urine, renal dysfunction severe case = sudden collapse, renal failure and death Associated with individuals that have sickle cell trait Should be referred to a physician immediately

Emotional Response to Stress

Sports serve as stressors Besides performance peripheral stressors can be imposed on Patient/athlete (expectations of other, concerns about school, work, family) Coach is often first to notice Patient/athlete that is emotionally stressed Changes in personality and performance may be indicator of need for change in training program Conference may reveal need for additional support staff to become involved

2. Cognitive Appraisal Model

Stage models ignore individual and contextual differences Cognitive appraisal models focus on personal and situational factors Cognitive interpretations and injury related sequela affect behavioral response to injury Not unidirectional but is reciprocal

External Bleeding

Stems from skin wounds, abrasions, incisions, lacerations, punctures or avulsions -Direct pressure= Firm pressure (hand and sterile gauze) placed directly over site of injury against the bone -Elevation= Reduces hydrostatic pressure and facilitates venous and lymphatic drainage - slows bleeding -Pressure Points= Eleven points on either side of body where direct pressure is applied to slow bleeding

Stress and the Risk of Injury

Stress = positive and negative forces that can disrupt the body's equilibrium Tells body how to react A number of studies have indicated negative impact of stress on injury particularly in high intensity sports Results in decreased attentional focus, create muscle tension (reduces flexibility, coordination, & movement efficiency) Eustress = positive stress (beneficial) Distress = negative stressors Slight differences between eustress and distress Living organisms have the ability to cope with stress - without stress there would be little constructive or positive activity Individual engages in countless stressful situations daily

Protecting the Athletic Trainer

Strict guidelines are designed to protect coaches, athletic trainers and other employees Provide necessary supplies and education

SO.A.P. stands for:

Subjective, objective, assessment, plan

Psychological Factors of Rehabilitation Process

Successful rehab plan takes Patient/athlete's psyche into consideration Plan involving exercise and modalities must also include rapport, cooperation and learning Rapport- is the existence of mutual trust and understanding (Patient/athlete must believe therapist has best interests in mind) Cooperation- Patient/athlete may begrudge every moment in rehab if process is moving slowly Blame may be placed on members of the staff To avoid problems, Patient/athlete must be taught that healing process is a cooperative undertaking Patient/athlete must feel free vent and ask questions, Patient/athlete must also take responsibility in process Patience and desire are critical in the rehab process To ensure maximal positive responses Patient/athlete must continually be educated on the process Provide information in layman's language and commensurate with Patient/athlete's background

Patient/athlete and Social Support

Support can be supplied by organization or others that have gone through similar rehab Need to prevent feeling of negative self-worth and loss of identity Stress the importance of remaining a teammate Patient/athlete/Athletic trainer relationship is key Must be developed, strengthened and maintained Sports specific drills must be incorporated in rehab (ideally during practice) Opportunity for reentry into the team, increases levels of effort, may allow Patient/athlete to gain appreciation of skills necessary to return to play

Ambulatory Aid

Support or assistance provided to injured individual to walk Prior to walking, serious injury should be ruled out along with further injury with walking Complete and even support should be provided on both sides by individuals of equal height when providing ambulatory aid Arms of athlete are draped over shoulders of assistants, with their arms encircling his/her back

Evaporative Heat Loss

Sweat glands allow water transported to surface Evaporation of water takes heat with it When radiant heat and environment temperature are higher than body temperature, loss of heat through evaporation is key Lose 1 quart of water per hour for up to 2 hours Air must be relative water free for evaporation to occur relative humidity of _65_% impairs evaporation relative humidity of _75_% stops evaporation

Burnout

Syndrome related to physical and emotional exhaustion leading to negative concept of self, job and sports attitudes, and loss of concern for feeling of others Burnout stems from overwork and can effect Patient/athlete and athletic trainer Can impact health Headaches, GI disturbances, sleeplessness, chronic fatigue Feel depersonalization, increased emotional exhaustion, reduced sense of accomplishment, cynicism and depressed mood

Synovial joint injuries Anatomical Characteristics

Synovial Joints Hyaline/articular cartilage Joint capsule, Synovial membrane & Synovial fluid (shock absorption, nutrition) Mechanoreceptors- help us determine pain Fibrocartilage = Menisci (congruency, shock absorbency) Ligaments- connect bone to bone

A condition that has a gradual onset with diffuse tenderness, inflammation and usually crepitus of a tendon is called

Tendinitis

Tendinopathy: Tenosynovitis

Tendon cannot slide properly through synovial sheath Long finger flexors, biceps S/S: Same as tendinitis Tx: Same of tendinitis, NSAIDs( non steroidal anti- inflammatory drugs) for chronic cases

Behavioral Response

The last step in the psychosocial response to injury; typically refers to adherence behavior Coping behaviors vary so it is important to provide a variety of skills and resources

In an effort to accurately assess the extent of a musculoskeletal injury, it is vitally important to know:

The mechanism of the injury

When an athlete is being placed on a spine board, which of the following personnel is in control?

The person stabilizing the victim's head

Systolic blood pressure indicates:

The pressure on the blood vessel walls when the left ventricle contracts

Nerve Trauma Anatomical Characteristics

Three Types of Neurons

Epiphyseal Conditions

Three types can be sustained by adolescents (injury to growth plate, articular epiphysis, and apophyseal injuries) Occur most often in children ages 10-16 years old Growth plate Classified by Salter-Harris into five types

Pathogen entry into body

Through skin, respiratory system, digestive or reproductive system Ability to generate infection dependent on: Acquired immunity Overall health Health-related behavior

Mechanical Injury

Trauma = physical injury or wound sustained in sport, produced by internal or external force Force or mechanical energy that changes state of rest or uniform motion of matter mechanical injury Injury in sports can result from external forces or can occur within the body internally

Bone Healing

Trauma occurs Hematoma forms Fibroblasts lay down collagen, resulting in callus Ossification: Osteoblasts replace callus with permanent bone Osteoclasts resorb old fragments and debris Remodeling: Continuous process of building up and breaking down of bone Healing: ~3 weeks, small bones ~6-8 weeks, large bones

Nerve Injuries

Trauma or overuse Hypoesthesia = decrease feeling Hyperesthesia = increase feelings (pain, touch) Paresthesia = numbness, prickling, tingling Most frequent = neuropraxia (direct trauma) Transient loss of fxn (hitting funny bone) Lacerations / compression of nerves (fractures and dislocations) can impact nerve function

An evaluation commonly used by athletic trainers is HOPS; History, Observation, Palpation, and Special Tests.

True

Death is imminent if the core body temperature rises above 104 F for an extended period of time or drops between 77º F and 85º F.

True

Injury may affect an athlete as much psychologically as it does physiologically

True

The period of scar formation is known as fibroplasia.

True

Bending

Two force pairs act at opposite ends of a structure (4 points) Three forces cause bending (3 points) Already bowed structures encounter axial loading

Nerve Injuries and trauma

Two main MOI = compression and tension Acute or chronic Long term problems (neuritis) can go from minor nerve problems to paralysis Cell body injury = cell death Axon injury = slow regeneration (~3-4mm/day) CNS injury = poor healing Pain can be referred

In transporting an athlete with a suspected spinal or pelvic injury: third supporting the trunk as you support the head and neck

Use a spine board and move under medical direction

After a virus enters and attacks a host cell it:

Uses the cell to replicate, Directs the cell to make a protein shell, Emerges after destroying the cell to infect other tissues, Destroys the cell (all of the above)

During the inflammatory response phase there is a period of followed by .

Vasoconstriction, vasodilation

Atrophy

Wasting away of muscle Main cause = Immobilization

Tendon Injuries

Wavy parallel collagenous fibers organized in bundles - upon loading Collagen straightens during loading (creep) but will return to shape after loading (elasticity) Breaking point occurs at 6-8% of increased length (mechanical failure) Repeated microtraumas can lead to chronic m. strains

Lightning Protocol

Weather Channel www.weather.com National Weather Service www.nws.noaa.gov/ CNN Weather www.cnn.com/WEATHER/ WHEN IN DOUBT GET INSIDE!

All of the following are signs and symptoms of HBV except: C Headache

Weight loss (Jaundice and abdominal pain are)

Progress Evaluations

When rehab is occurring, follow-up evaluations must be performed to monitor progress Seeing the athlete daily allows for daily modification Progress evaluations should be based on healing process at any given time - providing a framework for the rehabilitation and sometime constraints on progress Progress evaluations are generally more limited in scope - focus on specific injury and progress relative to previous day Should still follow similar outline to evaluation

Healing Process

Why should AT's know about healing? Allow them to create an environment conducive to healing Allow them to devise safe and effective rehabilitations for injuries Healing occurs along a continuum Inflammatory- response phase Fibroblastic- repair phase Maturation remodeling phase

Psychological Approaches During Various Phases of Rehab

With changes in modalities and exercises, psychological issues must be addressed Immediate Post Injury Anger and denial reign Patient/athlete may be experiencing pain and disability Emotional first aid must be administered Complete diagnosis and explanation must be provided Patient/athlete must know and understand process and outcome

Apophyseal Injuries

Young physically immature athletes are susceptible Traction injuries Injury sites serve as sites of origin and insertion for muscles Common avulsion conditions include Sever's disease and Osgood-Schlatter's disease (Ch 20)

The step of infection, which stage is when the person feels bad and can not get out of bed?

acute stage

HBV can live outside the body for __

at least 1 week

Osteoarthritis

bone break- down Wearing away of hyaline cartilage as a result of normal use Changes in joint mechanics from direct blow or repeated trauma = joint degeneration Mostly WB joints (knees, hips, lumbar spine), shoulders & cervical spine Sx: pain*, stiffness, prominent morning pain, localized tenderness, crepitus Generalized or localized joint pain

Closed fractures

bone is w/in skin - end may be closer together

Hyaline/articular cartilage

cartilage covering end of bones

During the inflammatory response phase of healing vasoconstriction causes swelling and redness.

false

It is always advisable to remove an athlete's helmet in case an airway problem develops.

false

What is the job of the T cells?

fight

Acute response to negative stress cause adrenal secretions causing the _____ response to stress.

fight and flight

Long bones

humerus, ulna, tibia, radius, fibula, femur most commonly injured

Tendinopathy: Tendinitis

inflam of tendon S/S: pain w/ movement, swelling, heat, crepitus Tx(how to treat): Rest, not irritable activity

Injury prevention

is psychological and physiological Clinicians must be aware of counseling role they play

Modified technique

modified jaw thrust maneuver

NATA and National Weather Service

recommend returning to the field 30 minutes following the last clap of thunder or lightning strike Major misconception is that lightning that is seen striking is coming down In actuality it is the return stroke of the lightning going back up after it has already hit the ground

Diastasis

separation of bony articulating surfaces

Flat bones

skull, ribs, scapulae

Tendinopathy: Tendinosis

tendinous microtears/degeneration w/o inflammation (chronic tendinitis) Most common chronic tendon dx S/S(signs&symptoms): pain w/ movement and touch, swelling, stiffness, dec. ROM, tender lump, crepitus More common in middle to old age & repetitive athletes

A sign is a an objective measure. It is definitive.

true

As a result of staleness, athletes will exhibit higher blood pressure or an increased pulse rate, both at rest and during activity.

true

Tenosynovitis is an inflammation of the sheath covering the tendon.

true

Irregular bones

vertebrae and skull

Short bones

wrist and ankle