Domain 3

Discuss the treatment for spinal cord injuries . ( Part I )

( Part I ) Spinal cord injuries may result from blunt trauma , falls from a height , various types of sports injuries ( especially contact sports , gymnastic , diving ) , or penetrating trauma . Damage results from mechanical injury and secondary responses resulting from hemorrhage , edema , and ischemia . The type of symptoms relate to the area and degree of injury . Anterior cord : The posterior column functions remain , so there is sensation of touch , vibration , and position remaining below injury , but with complete paralysis and a loss of sensation of pain and temperature . Prognosis is poor . ● Brown - Séquard : The cord is hemisected , resulting in spastic paresis , loss of sense of position and vibration on the injured side , and loss of pain and temperature on the other side . Prognosis is good .

Discuss how to recognize and treat a patient suffering from a diabetic coma and insulin shock .

A diabetic coma is a life - threatening condition that may develop when a patient's diabetes is not properly managed . Prevention of a diabetic coma is the best course of action . This can be achieved through monitoring blood glucose levels , ensuring a proper diet , and urine dipstick testing . Signs and symptoms of a diabetic coma include difficulty breathing , extreme thirst , a fruit - smell to the breath , flushed skin , mental confusion , and nausea . Emergency medical care is required and an insulin injection may be advisable . Insulin shock occurs when the diabetic patient has too much insulin and suffers low blood sugar . Signs and symptoms of insulin shock include a tingling sensation , weakness , headache , irritability , shallow breathing , and a rapid heartbeat . If the hypoglycemia is mild , the patient may respond well to glucose tablets , orange juice , or candy . However , if the reaction is severe , or the patient has a loss of consciousness , emergency medical care is required .

Describe mechanisms of injury for zygomatic complex fractures , signs , symptoms , and proper management .

A fracture to the zygomatic complex ( cheekbone ) usually occurs from a forceful blow to the area . There are three different attachment sites for the zygoma to the surrounding facial bones . The zygoma attaches to the frontal bone , the maxilla , and the temporal bone . Since the zygoma is such a thick bone , fractures usually occur along the suture lines where it attaches to the surrounding bones . Signs and symptoms of a fracture to the zygomatic complex include pain , swelling , possible trismus ( reduced opening of the jaw ) , and possible numbness . There will not be an obvious deformity unless all three of the attachments to the facial bones are fractured . In that case , the zygoma usually rotates downward causing in a decreased prominence of the cheekbone when compared bilaterally . Proper management depends on the severity of the fracture . If an obvious deformity is present , an immediate referral for advanced medical care is warranted . If the fracture is not displaced , ice , ibuprofen , and a referral to a physician within 24 hours is sufficient .

Discuss hernia .

A hernia occurs when the abdominal wall separates , allowing the protrusion of abdominal tissue . The most common hernia for males is the inguinal hernia , and for females , the femoral hernia . Hernias may be caused by inherent weakness in the muscles , straining ( as for heaving , lifting , or bowel movements ) , or stress on the muscles from obesity . Hernias are often not associated with pain but present as a soft bulge in the abdomen , groin , or scrotal area . The bulge enlarges on standing and often reduces when lying flat . There may be sharp or dull aching pain associated with the hernia , usually increasing with straining . Hernias are only medical emergencies if they become incarcerated ( a loop of bowel protrudes and twists , cutting off circulation ) . With incarceration , there is acute severe pain , sometimes with nausea and vomiting . Hernias must be examined by a physician , and the athlete should be restricted from activities until cleared by the physician . Surgical repair is usually performed .

Discuss sprains and contusions of the knee .

A sprained knee is a common sports injury . Usually the athlete will complain of acute pain at the time of injury and may feel the knee snap . Palpation may elicit pain or complaints of numbness . On a physical exam , the athlete may stand unevenly or walk with a limp . Normal range of motion may be impaired such that the knee cannot be straightened . Edema and ecchymosis may develop . The athlete should not bear weight on the knee , although splinting is not necessary . RICE therapy may be used initially to reduce pain and swelling , and the athlete should be referred to medical care . A contusion of the knee is a less serious injury that may include pain and tenderness on palpation , edema , and ecchymosis . Range of motion and ability to walk are not impaired . RICE therapy is usually sufficient treatment .

Describe mechanisms of injury for a subdural hematoma , signs , symptoms , and proper management .

A subdural hematoma is a life - threatening medical condition resulting from acceleration and deceleration forces that cause injury to the brain . These forces result in torn vessels between the dura mater and the brain causing bleeding and increased intracranial pressure . Acute subdural hematomas are the most common cause of death for athletes . These acceleration and deceleration forces can be produced by a blow to the head , such as a player being hit in the head by another player , an object , or hitting their head on the ground . Signs and symptoms of a subdural hematoma vary but can include a headache that gets worse , one pupil dilated , nausea , dizziness , lethargy , and unconsciousness . Patients suffering from an acute subdural hematoma need immediate advanced medical care for best possible results .

Discuss fracture of the wrist .

A wrist fracture can occur in the distal radius ( thumb side ) , ulna , or the wrist joint . The radius is the most commonly fractured , but both the radius and ulna may be fractured . Fracture usually occurs when a weight falling on an outstretched hand , resulting in hyperextension , or during direct blunt trauma . It is most common in sports like football , soccer , hockey , skiing , and ice - skating . Pain is usually severe , and deformity may be obvious . Mobility is often markedly decreased , and the athlete has an inability to bear any weight on his wrist . Edema often begins immediately , and there may be tingling or numbness as nerves are compressed . Any bleeding should be controlled with compression ; dressings applied to open wounds ; splinting of the wrist ; and the athlete transported to an ED for treatment and casting . If both bones are broken , internal fixation may be required .

Discuss acute appendicitis .

Abdominal pain is not uncommon in athletes . Exercise - related transient abdominal pain ( ETAP ) , a pain in the side , occurs while running in those not properly conditioned . In addition , muscles may be strained or injured by blunt trauma , so the pain associated with appendicitis may be overlooked . Appendicitis usually develops over 4 to 48 hours , with some combination of abdominal pain , lack of appetite , nausea , and fever . Pain often begins at the umbilical area and moves to the right lower quadrant , although some people have generalized abdominal pain . Palpation may show point tenderness in the RLQ , especially at McBurney's point ( 2/3 of the way from the umbilicus to the anterior superior iliac spine ) , which is the base of the appendix , with rebound tenderness at the point if it is compressed and suddenly released . Athletes with signs of possible appendicitis should be immediately referred to the ED , because an inflamed appendix can burst and cause peritonitis .

Discuss the treatment of snake bites ( coral snakes ) .

About 45,000 snakebites occur in the United States each year , with about 8000 poisonous . In the United States , an estimated 25 species of snakes are venomous . There are two types of snakes that can cause serious injury , classified according to the type of fangs and venom . Coral snakes have short fixed permanent fangs in their upper jaw and venom that is primarily neurotoxic , but may also have hemotoxic and cardiotoxic properties : Wounds show no fang marks , but there may be scratches or semi - circular markings from teeth . ● There may be little local reaction , but neurological symptoms range from mild to acute respiratory and cardiovascular failure . Treatment includes : Cleansing wound thoroughly of dirt and debris and either leaving it open or covering it with a dry dressing . ● Transporting immediately to ED for administration of antivenin even without symptoms , which may be delayed , and tetanus toxoid or immune globulin .

Discuss fracture of the femur .

Although femur fractures are not common in sports , they can occur , especially in sports such as skiing where the athlete falls with force . Stress fractures may occur as well . The athlete will have acute pain and often reports hearing or feeling the bone snap . There may be considerable blood loss and edema at the site of injury , depending upon the amount of displacement of the bone . Immediate treatment includes treating the person for shock as indicated by symptoms . The person should be flat with the uninjured leg raised above the level of the heart . Any hemorrhage of an open wound should be controlled by compression . An open wound should be covered with a dressing , and the injured leg should be splinted to prevent movement . The posterior tibial / dorsal pedal pulse should be monitored to ensure that circulation is not impaired . The athlete should be transferred to the ED immediately for further treatment .

Discuss cardiac arrest and CPR . ( Part I )

Any person who loses consciousness should immediately be assessed for cardiac arrest by observing the chest for respirations and palpating the carotid artery ( between the larynx and sternocleidomastoid muscles ) for pulse . If there are no pulse or respirations , the trainer should tell someone to call 9-1-1 and begin cardiopulmonary massage immediately , noting the time . If no one else is available to call 9-1-1 , the trainer should do that before beginning CPR , unless the victim is a child . In that case , CPR should be done for one minute before stopping to call 9-1-1 . The person in cardiac arrest should be placed in supine position on the floor or ground . Compressions are performed on the lower third of the sternum , above the sternal notch , using care to avoid the xiphoid process . Compressions are made with the palm of the hand ( fingers raised ) . The non - dominant hand is placed on the sternum , arms crossed , and the top hand placed on top of the bottom hand . ( Continued )

Discuss barotraumas , including treatment .

Barotrauma ( barotitis media ) caused by increased pressure in the air ( as for instance when descending in an airplane or diving underwater ) is damage to the middle ear . Barotrauma may also occur at high altitudes . Individuals with upper respiratory infections are at greatest risk , so athletes should not attempt to dive with a URI . With barotrauma , the tympanic membrane of the ear is pulled inward , because the middle ear pressure is less than the external pressure . Pain will usually be acute in the affected ear and may be accompanied by tinnitus , decreased hearing , and dizziness . The Valsalva maneuver may reduce pressure : taking a breath , holding the nose , closing the mouth and breathing out while trying to force air into the ears . If symptoms worsen or do not subside , the athlete should be seen by a physician for emergency treatment , as the tympanic membrane may rupture .

Discuss blisters , including treatment .

Blisters occur when friction causes fluid to collect in the outer layer of the dermis , especially during hot humid weather . Blisters are common on hands and fingers ( gymnasts , pitchers ) , feet ( runners , dancers ) , and buttocks ( bicycle / horse riders ) . Preventive methods include avoiding socks or wearing light cotton socks ; taping vulnerable areas ; applying 10 % tannic acid to skin 1-2 times daily for 2-3 weeks ; and wearing properly - fitted gloves and shoes . Immediate treatment includes : Cleaning and leaving small blisters ( < 1 inch ) intact with no other treatment . ● Applying an ice pack for 5 minutes to painful blisters or blisters > 1 inch . ● Blisters > 1 inch may be washed thoroughly with soap and water and punctured at several points with a sterile needle , while pressure applied to drain blister . Then , a compression dressing should be applied . ● Non - prescription topical antibiotics , such as Neosporin® , may be applied to prevent infection . Protective dressings , including foam or moleskin with holes cut above the blister , should be applied over compression dressings for weight - bearing areas , such as the foot .

Discuss chemical eye burns .

Chemical eye burns are caused by the splashing of chemicals ( solid , liquid , or fumes ) into any part of the eye , often related to facial burns . Chemical burns may damage the cornea and conjunctiva , although other layers of the eye may also be damaged , depending upon the chemical and degree of saturation . Many injuries are work - related and involve alkali ( > 7 pH ) , acid ( < 7 pH ) ( muriatic acid or sulfuric acid ) , or other irritants ( neutral pH ) such as pepper spray . Alkali chemicals ( such as ammonia , lime , and lye ) usually cause the most serious injuries . Symptoms include : ● Pain . ● Blurring of vision . ● Tearing . Edema of eyelids . Immediate treatment includes irrigating the eye and other contacted areas with copious amounts of water or normal saline . A history should be obtained to determine the cause of the injury , and the person immediately should be referred for further emergency care and eye exam .

Discuss compartment syndrome .

Compartment syndrome occurs when muscle perfusion is inadequate because of constriction caused by a cast or tight dressing , or because of an increase in the contents of a muscle compartment because of edema or hemorrhage ( often related to fractures or blunt trauma , especially to the anterolateral leg ) . The result is an increase in soft tissue pressure . It most often affects the forearm and leg muscles . Symptoms include : Severe throbbing pain unrelieved by opiates . Numbness and tingling as the pressure on nerves increases . ● Cyanosis and decreased or lacking pulse . ● Edema . ● Treatment must be initiated immediately to prevent neurovascular damage and necrosis : ● Elevation of affected limb above the heart . ● Release of constricting cast or dressings . ● Immediate transfer to ED for Doppler ultrasonograph to verify pulses and tissue fasciotomy to relieve constriction if the condition is advanced or does not respond to medical treatment . The wound is left open , allowing the muscle tissue to expand , and covered with moist sterile NS dressing while the limb is elevated .

Discuss conjunctivitis , including treatment .

Conjunctivitis is an inflammation of the conjunctiva , the membrane that lines the eyelid and eye , usually caused by bacteria , virus , or allergen . The inflammation causes small capillaries to rupture , resulting in the " pink eye " appearance . The inflammation is usually accompanied by itching and discomfort in the affected eye . If caused by bacteria or virus , conjunctivitis is contagious while symptomatic , and may be spread by contaminated fingers , towels or washcloths . If inflammation worsens or doesn't begin to clear in 48 hours , the athlete should be referred to a physician . Bacterial conjunctivitis is treated with topical antibiotics , and allergic conjunctivitis with antihistamine eye drops , but there is no effective treatment for viral conjunctivitis . The athlete should be advised to wash his hands often , avoid touching his eye or sharing towels , and avoiding eye makeup . Cool or warm moist compresses to the eye for 10 15 minutes 3-4 times daily may relieve symptoms . The infection usually clears in 1-2 weeks or 1-2 days after antibiotic treatment if bacterial .

Discuss constipation and fecal impaction .

Constipation is a condition in which bowel movements are less frequent than normal for a person , or hard , small stool is evacuated less than 3 times weekly . Constipation results from the colon , where fluid is absorbed . If too much fluid is absorbed , the stool can become too dry . The person may have abdominal distention and cramps and need to strain for defecation . Fecal impaction occurs when the hard stool moves into the rectum and becomes a large , dense , immovable mass that cannot be evacuated even with straining , usually as a result of chronic constipation . In addition to abdominal cramps and distention , the person may feel intense rectal pressure and pain accompanied by a sense of urgency to defecate . Occasional use of non - prescription laxatives , stool softeners and even enemas ( in the case of impaction ) can resolve acute constipation , but chronic use only worsens the problem . The athlete should be instructed in dietary modifications ( increased fluids and fiber ) and referred to a physician if the problem is chronic .

Discuss cardiac arrest and CPR . ( Part II )

Continuation of cardiac arrest and CPR ( Part II ) : The top hand does the compression , pushing the bottom hand with the elbow locked and at a 90 ° angle to the ground . Compressions should depress the chest 1 inch for an infant or young child , and 1.5-2 inches for others . Previous guidelines recommended 15 compressions followed by 2 respirations ( for 2 - person ) and 30 to 2 for one - person , but current guidelines for CPR advise cardiac massage only at the rate of about 100 compressions per minute . Exceptions are children ( more likely to suffer respiratory problems ) and adults with oxygen deprivation ( near drowning ) . The compressions should continue without stopping until help arrives or until the person begins breathing and develops a pulse spontaneously . If an automatic defibrillator ( AED ) is available , this should be used as soon as possible , as brain death begins to occur in 4-6 minutes .

Discuss the treatment for heat exhaustion and exertion heat stroke . ( Part II )

Continuation of heat - related illness ; Immediate treatment for heat exhaustion includes : Cooling with evaporative techniques ( spraying with cool water , fanning ) and cold packs to neck , groin , and axillae . ● Monitoring temperature ( usually < 105 ° F and may be normal ) and vital signs . ● Slow rehydration with sports drink ( 0.1 % isotonic NaCl ) , about ½ glass every 15-20 minutes . ● Rest for 2-3 hours . If symptoms worsen or do not subside within 2-3 hours , the athlete should be monitored for 24 hours and , in severe cases , transferred to ED for evaluation and intravenous fluids . Exertion heat stroke ( EHS ) is the most common type of heat stroke in athletes . Heat builds up in the body faster than it can be dissipated . Typical symptoms include temperature variations , diaphoresis , dizziness , loss of consciousness , and alterations in consciousness , beginning with irritability and progressing to seizure and coma . Heat stroke is life threatening , and the athlete must be transferred immediately to an ED for treatment . Evaporative cooling techniques should be instituted while awaiting transfer .

Discuss the treatment for pneumothorax . ( Part II )

Continuation of pneumothorax : Symptoms of pneumothorax vary widely depending on the cause and degree of the pneumothorax , but include : Acute sudden pleuritic pain ( 95 % ) , usually on the affected side . ● Decreased breathing sounds on the affected side , associated with dyspnea and increasing cyanosis . ● Tension pneumothorax : tracheal deviation , distended neck veins , decreased breath sounds , and hemodynamic compromise . Treatment includes : Call for emergency transfer to ED immediately . ● Check airway , breathing , and circulation . ● Administer oxygen if available . ● Bandage all wounds of the neck or chest at once , and cover sucking chest wounds with airtight material , such as plastic wrap or gauze pads coated with petroleum jelly ( except for one corner of the gauze , to allow air to escape but not enter ) .

Discuss corneal ulcerations .

Corneal ulceration is an open lesion on the cornea of the eye . It often occurs during sports played in windy conditions , in which sand or gravel is in the air . It can also be caused small particles becoming embedded in the eye , by irritation from contact lenses , or by infection . Typically , symptoms include tearing , eye pain , photophobia , spasms of the eyelid , blurring of vision , and redness of the eye . Treatment includes the immediate removal of any contact lens , if possible . Because ulceration leaves the eye vulnerable to infection , the athlete should be referred to an ophthalmologist for treatment . The trainer should avoid touching or rubbing the eye , as this may cause further damage . A clean cool moist compress may be placed over the eye for comfort during transit to a physician . Non - prescription drugs , such as NSAIDs , may relieve discomfort .

Discuss costochondritis ( Tietze's syndrome ) , including treatment .

Costochondritis , inflammation of the cartilage that attaches the ribs ( usually the 2nd and 3rd ) to the sternum , can cause sharp pain in the chest wall , sometimes radiating to the arm and accompanied by tightness in the chest . There is usually point tenderness in the affected area . Costochondritis may result from blunt trauma or repetitive trauma from physical activity that causes strain and is of short duration . The athlete should be advised to stop activity and rest . Heating pad or ice may be applied , depending on which provides the most comfort . Non - prescription NSAIDs may relieve discomfort . The person should avoid movements that aggravate the pain , although easy stretching of the chest muscles 4-5 times a day may be useful . Activity should not resume until symptoms subside as they may recur or become chronic .

Explain how creating an emergency action plan and keeping it up - to - date benefits the athletic trainer .

Creating an emergency action plan and keeping it up - to - date benefits the athletic trainer by ensuring proper preparation for any emergency situations that may arise . There are many factors that must be considered to properly respond to emergency situations such as the inclusion of multiple personnel and specialty equipment . During emergencies , time is of the essence , so a well - developed and practiced emergency action plan will help to reduce stress , increase timeliness , and ensure all involved parties know their role in the event of an emergency . A swift and appropriate response could quite possibly be the difference in life or death for the patient . The emergency action plan should account for the proper management of multiple types of emergencies as well as dictate the directions emergency personnel will need to access all venues in which the athletic trainer provides coverage such as the bleachers of a football field or an indoor swimming pool .

Discuss the proper use of crutches .

Crutches should be properly fitted before the athlete attempts ambulation . Correct height is one hand - width below axillae . The handgrips should be adjusted so that the athlete can support his body weight comfortably with his elbows slightly flexed rather than locked in place . The athlete should be cautioned not to bear weight under the axillae , as this can cause nerve damage , but to hold the crutches tightly against the side of the chest wall . The type of gait that the athlete uses depends on the type of injury . Typical gaits include : Two - point , in which both crutches are placed forward and the healthy leg advances first to the crutches . Three - point , in which the injured extremity and both crutches are advanced together , at which point the healthy leg advances to the crutches . The athlete should be advised whether there is partial or no weight bearing , and demonstration should be provided . Stair climbing should be practiced : ● Ascending : Healthy foot goes first , followed by crutches and injured extremity . ● Descending : Crutches go first , followed by the healthy foot .

Discuss knee or patellar dislocation .

Dislocation of the knee or patella can occur as the result of a sharp blow to the knee joint . Symptoms include immediate acute severe pain and obvious deformity of the joint . The posterior tibial / dorsal pedal pulse is often absent , so immediate medical care is critical . The knee should be splinted in the present position during transfer to an ED . Patellar dislocations are a less severe injury than knee dislocation , and may result from twisting injuries or blunt trauma . There is less pronounced deformity than with a knee dislocation , although patellar dislocation may be obvious on comparison with the other knee . Edema and pain may be present . Immediate treatment includes RICE therapy and splinting the knee in the position found without attempting to realign the kneecap . The athlete should be referred for medical treatment .

Discuss elbow dislocation / fracture .

Dislocation or fracture of an elbow may present with similar symptoms and radiograph may be needed for diagnosis . The injury usually results from a fall or blunt trauma to the elbow . The athlete complains of severe pain , and muscle spasms may occur . Mobility is limited and there may be obvious deformity . Usually edema begins immediately after injury . There may be pallor and coolness of the arm and hand distal to the injury . The person may exhibit signs of shock . Immediate care includes treating for shock , monitoring pulses , and splinting the elbow . No attempt should be made to change the position of the elbow , as it may increase damage to nerves and vessels . It should be splinted as found and ice should be applied while in transit to the ED for further medical treatment .

Discuss ethanol overdose .

Ethanol overdose affects the central nervous system , as well as other organs in the body . Typical symptoms of ethanol overdose include : ● Altered mental status with slurred speech and stupor . Nausea and vomiting . ● Hypotension . ● Bradycardia with arrhythmias . Respiratory depression and hypoxia . ● Cold and clammy skin or flushed skin ( from vasodilation ) . ● Acute pancreatitis with abdominal pain . Loss of consciousness . Circulatory collapse leading to death . If people are easily aroused , they can usually safely sleep off the effects of ingesting too much alcohol , but if the person is semi - conscious or unconscious , emergency medical treatment should be initiated . One should not give the person coffee to " awaken " them or encourage them to " walk off " the overdose but should , instead , transfer the person to a physician for care . A warming blanket may be applied to maintain body temperature .

Discuss exercise - associated leg cramps , including treatment .

Exercise - associated leg cramps are painful involuntary muscle contractions , usually in the calf of the leg , occurring during endurance sports , most commonly swimming or running . The cause is not clear . Some theorize it's related to dehydration , changes in electrolyte levels , or abnormal activity of motor neurons . Individuals with diabetes are often subject to cramps . Other risks include old age , family history , increase in BMI , irregular or short stretching exercises , and intensity of training . Immediate treatment includes passively stretching the affected muscle and kneading the cramped area by squeezing and releasing . The athlete can be advised to flex her foot and point her toes upward , and to hold that position until the cramp eases . This is particularly useful for swimming cramps . Ice applied to the area may relieve pain . The athlete should be kept cool and given sports drinks as she rests the limb until cramping eases . If there are multiple or persistent unrelieved cramps , the athlete should be taken to the ED , as muscles may be injured by severe cramping .

Discuss exercise - induced asthma , including treatment .

Exercise - induced asthma ( bronchospasm ) is a particular risk for those with pre - existing asthma or allergies , especially with high pollen counts , high levels of smog , and cold dry weather . Athletes usually begin to cough , wheeze , and complain of shortness of breath and chest tightness after about 5 minutes of exercise . The symptoms may increase 5-10 minutes after exercise ceases , but symptoms usually recede by 30 minutes . Athletes should be cautioned to regularly take all prescribed preventive medications and warm up for 5-10 minutes before performing strenuous exercise . Additionally , they should breathe through their noses to warm the air and learn to monitor their own breathing . Immediate care includes stopping activity , positioning the person in an upright position , and having the athlete use his or her inhaled bronchodilator . If the symptoms are severe and do not begin to subside after ceasing activity and using the bronchodilator , the athlete should be transferred to an ED for further treatment .

Discuss finger dislocation and sprain of the finger .

Finger dislocation is a common sports injury . The athlete complains of immediate acute pain on injury and examination shows an obvious deformity with edema . The injured finger appears shortened , and mobility is markedly impaired . Treatment is similar to that of a fracture . The trainer should make no attempt at realigning the finger . The finger may be splinted as for fracture and an ice pack applied during transfer for medical care . Sprain of a finger may result from compression , twisting , or being stepped on . The pain is less severe than with a dislocation and there is no deformity , but pain and edema may occur over the joint and palpation elicits tenderness on both lateral aspects of the joint . The athlete usually has limited mobility , cannot make a fist , and exhibits weak grip with pain . Buddy taping ( or figure 8 for thumb ) and ice ( for twenty minutes ) can be applied . If symptoms have not subsided , then further medical care should be sought .

Discuss foot and ankle injuries .

Foot and ankle injuries are very common in athletes . Sprains and fractures may be differentiated by palpation : Pain over the back edge of the malleolus , the fifth metatarsal or the navicular bone may indicate fracture . Usually , the athlete will be able to take at least 4 steps on a sprained ankle but will be unable to walk if there is a fracture . While some advocate leaving the shoe in place to provide compression , this is not a safe practice , as the foot should be examined for circulatory impairment . If there is NO apparent fracture , immediate treatment includes : RICE therapy to decrease edema for 24-48 hours . ● If edema persists for three to seven days , contrast baths of cold water ( 45-60 ° F for 1 minute ) and warm water ( 100-105 ° F ) for 4 minutes twice daily for 1-2 weeks . The baths should be followed by passive flexion and extension of the foot . ● Weight bearing should wait until swelling and pain subsides .

Discuss fracture of the finger .

Fracture of a finger may occur as the result of fall or other blunt trauma during sports activity . The athlete may still be able to move the injured finger , but will complain of acute pain . There may be deformity ( if the bone is misplaced ) and edema at the site of injury . On palpation , the athlete may complain of point tenderness or some lack of sensation . Testing includes placing the hand flat on a hard surface with the injured finger straight , if possible . Then , the trainer gently taps the end of the injured finger in the direction of the wrist . Fracture elicits pain in the finger , sometimes radiating into the hand . The fracture should not be aligned but splinted by buddy - taping the finger to an adjoining finger or cupping the fingers about padding held in the palm of the hand and securing the arm and hand to a rigid splint . A thumb may be splinted with figure 8 taping about the thumb . Ice may be applied during transfer for medical care .

Discuss fracture of tibia / fibula .

Fracture of the tibia or fibula , or both bones , may occur as a result of a twisting injury at any point from the proximal to the distal ends . The fibula is more protected by tissue , and fracture of this bone alone may be more difficult to detect , as the tibia provides a natural splint . There may be little obvious deformity , and the person may be able to walk . Tibia fractures are more likely to result in an open fracture because of proximity to the skin surface . If both bones are fractured , there is usually pronounced deformity and edema at the site of the fractures , with severe pain and marked tenderness on palpation . Immediate treatment includes stopping blood flow with compression , monitoring pulses , applying dressing to an open wound , and splinting the leg with rigid splints on each side of the leg to prevent the legs from rotating . ( The legs can be tied together if splints are unavailable . ) Ice should be applied and the athlete should be transferred to an ED .

Explain how having established referral strategies increases the timeliness of care .

Having established referral strategies increases the timeliness of care because it simplifies the referral process and ensures that appropriate healthcare professionals are readily available to provide specialized care as needed . There are a multitude of injuries and illnesses the physically active population experiences and many times the athletic trainer will be the first member of the healthcare team to see these patients . It is important for the athletic trainer to recognize those injuries and illnesses that require referral and have a specialist in that field of healthcare available for referral . For example , athletic trainers may see patients who suffer from injuries and illnesses that require referral to a dentist , a podiatrist , an orthopedic surgeon , a psychiatrist , a neurologist , and a cardiologist , just to name a few . Having healthcare professionals in these fields available to evaluate and treat these patients will ease the stress and uncertainty patients and their families may experience and can make setting up appointments more efficient .

Discuss heart attack .

Heart attack should be suspected in those with chest pain that lasts more than 10 minutes or who exhibit typical symptoms of heart attack , such as sudden severe chest pain accompanied by nausea , signs of shock , pain radiating to neck and arms ( especially left ) , pallor , and diaphoresis . Females may have less specific symptoms , such as neck pain , epigastric pain , or " severe indigestion . " Immediate treatment includes calling 9-1 1 for emergency transfer to ED ; giving the person an aspirin if one is available and the person is not allergic ; monitoring vital signs ; and positioning person in comfortable position ( often with head elevated ) . If the person has nitroglycerine , this should be administered as well . If oxygen is available , that should be administered while awaiting transfer . If the person goes into cardiac arrest , cardiopulmonary resuscitation should be started immediately and should continue until help arrives or the pulse and respirations begin spontaneously .

Discuss the treatment for heat stress and heat exhaustion . ( Part I )

Heat - related illnesses include heat stress , heat exhaustion , and heat stroke . Each of these conditions requires different treatment ; however , treatment for all types of heat - related illness should begin with immediately removal from the hot environment . Heat stress may include sunburn , edema , heat syncope , and heat cramps . Immediate treatment includes rehydrating , treating symptomatically , and observing for signs that may indicate impending heat exhaustion or heat stroke . Heat exhaustion may be related to water depletion if the person is not adequately hydrated , resulting in dry mouth , increased thirst and decreased urinary output . Heat exhaustion may also be related to sodium depletion , even with adequate hydration , if the person is not acclimated to heat , resulting in weakness and headache . With both types of heat exhaustion , flu - like symptoms and pulse and BP changes may occur . ( Continued )

Discuss human / animal bites , including treatment .

Human " bites " occur when the teeth of one person injure another , not necessarily through intentional biting . This is not uncommon in contact sports . Human bites may also be the result of altercations , and are referred to as " fist - bites . " There are three common types : Closed fist bite , resulting in a small wound on the metacarpophalangeal joint of the middle finger . Bacteria enter the wound when the person extends the fingers , carrying bacteria to the extensor tendons , which can result in infection . ● Finger bite , in which a finger may be partially or completely severed . ● Puncture bite , usually on the face , from contact with another person's tooth . Immediate treatment includes applying pressure to stop bleeding , and then thoroughly flushing the wound with dilute Betadine , dilute peroxide , or normal saline solution . Protective dressings should be applied . Large wounds or those with skin flaps or signs of more serious tissue injury should be referred to a physician .

Discuss hyperventilation .

Hyperventilation can occur in response to emotional stress , diabetic ketoacidosis , shock , and high - altitude sickness . Symptoms include feelings of lightheadedness , dizziness , anxiety , and agitation . If prolonged , calcium levels may drop and paresthesia with numbness and tingling or muscle twitching may occur . Dyspnea is > 40 / min . If related to altitude sickness , the person should not climb further but , once stabilized , should descend until dyspnea subsides . Contrary to common practice , the person hyperventilating should not be asked to rebreathe using a paper bag , as this does little to alter blood gas and can stress the cardiopulmonary system . Instead , the trainer should provide reassurance and calmly coach the person to breathe more slowly , inhale through the nose , hold the breath for a short period , and then exhale slowly until breathing slows .

Discuss hyphema .

Hyphema is bleeding in the fluid - filled anterior chamber lying between the cornea and the iris . This injury occurs from direct impact of the eye , as by a hand or ball . Initially , the blood in the chamber impairs vision , and the athlete may report dramatic vision loss . If there is a large amount of bleeding , the entire eye may appear red , but smaller bleeds may not be evident . As the blood settles , vision begins to clear . Often , this problem resolves and the blood is reabsorbed , but a hyphema is a medical emergency requiring referral to an ophthalmologist or ED so that the extent of injury can be assessed . The eye should be left uncovered . Initial treatment includes bed rest for 48-72 hours to reduce stress on the eye and prevent further bleeding , as sometimes an initial small bleed is followed by more severe bleeding in 3 to 5 days . The athlete must not return to sports activities until participation is cleared by an ophthalmologist .

Discuss the different types of shock : Hypovolemic ● Respiratory Neurogenic ● Psychogenic Cardiogenic ● Septic Anaphylactic ● Metabolic

Hypovolemic shock occurs from trauma that results in a large amount of blood loss . The lowered blood volume makes the body incapable of effectively transporting oxygen to the body organs . ● Respiratory shock occurs when the body cannot deliver enough oxygen throughout the body due to an injury to the lungs or the breathing control center . ● Neurogenic shock occurs as a result of general dilation of the blood vessels , which results in inadequate oxygen delivery throughout the body . ● Psychogenic shock is caused by a temporary dilation of the blood vessels , resulting in a lowered amount of blood flow to the brain . Fainting is the common term for psychogenic shock . ● Cardiogenic shock occurs when the heart is unable to pump blood throughout the body . ● Septic shock occurs as a result of a severe infection , usually bacterial in nature . Anaphylactic shock occurs as a result of a patient being exposed to something they are extremely allergic to such as a food or insect stings . ● Metabolic shock occurs when a severe medical condition goes untreated over time .

Discuss the treatment for mononucleosis .

Infectious mononucleosis ( caused by the Epstein - Barr virus ) is very common among young people and can be caused by exchange of saliva , as from kissing or sharing water bottles . Clothing may also become contaminated , so jerseys and other clothing should not be shared . Incubation periods range from 2-6 weeks and active infection from 3-15 days . Athletes with signs of infection ( usually upper respiratory symptoms with enlarged lymph nodes and marked fatigue ) should be restricted from play . Of more concern is the fact that the liver and spleen may be affected . The spleen often enlarges , putting the athlete in danger of splenic rupture from blunt trauma . The most dangerous period for rupture is between the 4th and 21st day after the onset of symptoms , so the athlete should be barred from play during this time . After 3 weeks , the athlete may resume light activity if there are no symptoms of liver or spleen disorder and no fever .

Discuss contusions of the quadriceps muscle ( thigh ) .

Injuries to the quadriceps muscle in the thigh are common in athletes as the result of direct blunt trauma to the anterior thigh , for instance contact with a helmet in football . Contusions are characterized by edema , pain with tenderness in the anterior thigh , and tautness of the muscle on palpation . Ecchymosis begins within hours of injury . Knee flexion may be limited , and the athlete walks with an obvious limp . Immediate treatment includes keeping the knee immobilized in a supported , flexed position ( 120 ° ) for the first 24 hours , with ice applied for 20 minutes initially and then every 2-3 hours . The limb must be observed carefully , as a severe impact that causes swelling may result in compartment syndrome , which is a medical emergency . Passive stretching or electrical stimulation of the muscle may begin after 24 hours , with icing of the muscle following the stretching / stimulation . Weight bearing should resume gradually as symptoms recede .

Discuss the treatment of debris ( sand , dirt ) in the eye .

It is not uncommon for athletes to get small debris in their eyes . The immediate symptom is photophobia , tearing , and discomfort . The person may feel something gritty within the eye . Debris in the eye can cause corneal abrasion , so protective eyewear should be worn when possible . The athletic trainer should wash his or her hands before examining the eye under a good light . The lower lid is pulled downward while the athlete looks up , and then the upper lid is pulled upward while the athlete looks down . If debris is imbedded or there is obvious corneal irritation , the eye should be covered with a clean pad and the athlete should be transferred for treatment immediately . If a small speck of debris is noted in the sclera ( white part of eye ) , it may be removed gently with a cotton swab . If no debris is seen or it cannot be easily removed , the eye should be flushed with clean water ; if symptoms persist , the person must be seen by an ophthalmologist .

Discuss mandibular fractures .

Mandibular fractures usually result from blunt trauma during contact sports . Initial symptoms include pain ; edema and distortion of the jaw ; and , on exam , difficulty speaking , swallowing , or opening the mouth . There may be lacerations of the mouth , or loose or knocked out teeth . ABCs should be assessed with attention to airway , and cuts or bleeding lacerations should be treated with pressure to control bleeding . Neurological status should be evaluated . If there is bleeding and no apparent skull or brain injury , the person should be seated upright and leaning forward so that blood doesn't run down the throat . Any dislodged teeth still in the mouth should be removed to prevent aspiration , and the jaw should be immobilized with a wrap around the jaw and top of the head , secured above one ear . Any dislodged teeth should be wrapped as is in moist gauze and transported to the ED with the athlete . When cleared to return to play , the athlete should wear a mouthguard to prevent reinjury .

Describe mechanisms of injury for maxillary fractures , signs , symptoms , and proper management .

Maxillary fractures typically occur from a powerful blow to the upper jaw such as being hit by a hockey puck or ball traveling at a high speed . The front of the maxilla is thin and , therefore , is usually where fractures occur . However , a severe fracture of the maxilla , called a Le Fort fracture , occurs when the maxilla becomes detached from the skull . This is uncommon in sports and is more likely to occur in a motor vehicle accident . Fractures of the maxilla are the fourth most common fractures to the face . Signs and symptoms of a maxillary fracture include swelling over and around the maxilla and possible numbness in the area if there is involvement of the infraorbital foramen and nerve . Occasionally , there is associated bleeding of the nose ( epistaxis ) . With a Le Fort fracture , there will be significant malocclusion of the teeth and epistaxis . Proper care depends on the severity of the fracture . A Le Fort fracture must be referred immediately for advanced medical care . For a less severe fracture that does not contain malocclusion or excessive epistaxis , ice , ibuprofen , and a referral to a physician within 24 hours is appropriate . If numbness is present , the patient should be referred for a CT scan right away to determine proper care .

Discuss suspected fracture of the knee joint .

Memo A fracture of the knee joint can occur as the result of blunt trauma or a fall . Fractures can occur in the distal femur , proximal fibula , or patella , and they may be difficult to diagnose . Typical symptoms include edema , deformity of the joint , and pain or tenderness to palpation . If the knee straightens easily , there is no obvious deformity , and a posterior tibial pulse is present , the knee should be splinted above and below the injury , with all joints splinted as well as the associated side of the trunk . If there is considerable deformity but a posterior tibial pulse / dorsal pedal is still evident , then no attempt should be made to straighten the leg , but it should be splinted in the position in which it is found to prevent further injury . If the posterior tibial pulse is absent and the area below the injury is pale or frankly cyanotic , this is a medical emergency requiring immediate transfer . In all cases , the person should be transferred to an ED for treatment .

Discuss the treatment for missile / impalement .

Missile / Impalement injuries include arrow , gunshot , paint gun , nail gun , and shrapnel wounds . These injuries are usually circular , oval , or triangular , and may have both an entry ( with abrasion at periphery ) and exit site . Other residue , such as gunpowder , may be evident at the entry . Puncture wounds are difficult to properly clean and become infected easily , even with treatment , so the athletic trainer should apply compression dressing only to puncture wounds and should not attempt to remove any impaled object . A bulky supportive dressing should be placed about the object to provide compression , decrease bleeding , capture drainage , and prevent the object from becoming dislodged . The person should be transferred to an ED immediately and positioned such that there is no pressure against an impaled object . Treatment varies according to the site , type , and degree of injury , and may include tetanus prophylaxis , wound irrigation , removal of any foreign body , and antibiotics as indicated .

Discuss treatment for traumatic injury with bleeding / hemorrhage .

Most sports - related traumatic injuries with bleeding are not a life threatening hemorrhage , although some areas , such as the face , may appear to bleed heavily . The injured person should always be evaluated quickly for signs of shock . ● For minor cuts and lacerations , the immediate care is to apply direct pressure ( as with gauze pads ) to the bleeding lesion , elevating the area of injury above the level of the heart if possible . Bleeding usually slows almost immediately and stops within minutes , after which a compression dressing can be applied . ● Severe hemorrhage is a medical emergency that requires a 9 1-1 call and immediate transfer to an ED . A tourniquet should not be used , as this may cause more damage , but pressure should be maintained over the wound and the wound should be elevated . The artery feeding the area ( such as the femoral artery for the leg and brachial artery for the arms ) should be compressed . If signs of shock manifest , the person should be in a supine position with feet elevated while awaiting transfer .

Discuss nail evulsion of the hand or foot .

Nail avulsion occurs when injury partially or completely tears a nail away from the nail bed . The athlete complains of acute pain , and the nail bed may bleed . Immediate care includes flushing the area with soap and water if dirty , gently applying pressure to control the bleeding , and applying antibiotic ointment ( such as Neosporin® ) to the nail bed . If the nail remains partially adhered , it should be secured intact ( not trimmed ) over the nail bed with adhesive bandaging . If the nail has been completely torn away , a dressing should be applied over the nail bed to protect it from further injury . The athlete should be referred to a physician for further treatment as necessary . The nail bed must be protected while the nail grows back , so protective bandaging or cushioning may be necessary during sports activities .

Discuss nasal fractures .

Nasal fractures are most common in contact sports , such as football , and usually result from direct blunt trauma to the face . Immediate symptoms include intense pain , tenderness and mobility of the bridge of the nose on palpation , and bleeding from the nostrils . Usually deformity is evident . The athlete should be positioned sitting and leaning forward , so that blood doesn't run down the throat . The nostrils should be compressed to control bleeding . If there is clear fluid draining from the nostrils ( cerebrospinal fluid ) , one should not apply pressure . An ice pack may be placed over the injured area to reduce swelling and decrease bleeding . The athlete must be transferred to an ED for further treatment , and should be restricted from sports for about 6 weeks . Upon return , the athlete should wear a protective face guard if engaging in contact sports .

Explain steps that should be taken to obtain consent to treat for a minor .

Obtaining consent to treat for minors should be achieved prior to the start of the athletic season . To do this , parents or guardians should be asked to sign a consent form allowing medical treatment to be given to their child if necessary . In the event of an emergency , if possible , the parents should be informed of the emergency , what treatment the athletic trainer intends to provide , and should be asked for consent to treat for that specific incident . If the parent cannot be reached , the consent - to - treat form signed at the beginning of the season can be sufficient . If there is no consent form , the patient's implied consent to save their life can be enacted upon . When traveling , the athletic trainer should bring consent - to - treat forms as well as contact information for parents and guardians .

Discuss orbital blowout fracture .

Orbital blowout fracture damages the bones that comprise the eye socket , most often those of the orbital floor . In sports , it is most often caused by severe blunt trauma , as from a baseball bat or elbow , directly to the eye socket . Symptoms include severe pain about the eye and socket ; edema ; bruising about the eye ; diplopia ; and , in some cases , proptosis ( protrusion of the damaged eye from the socket ) . On palpation , crepitus from air in the subcutaneous tissue may be noted , and the person may complain of numbness in the cheek on the affected side , caused by pressure on the infraorbital nerve . Sometimes nosebleeds occur as well , and pain in the eye may increase with nose blowing . There may be reduced eye movement and pain on eye movement , especially vertical . Immediate treatment includes applying soft dressing to cover the eye and ice pack ( 15-20 minutes ) to reduce swelling . This is a medical emergency and the athlete should be transferred immediately to an ED for evaluation by ophthalmologist .

Discuss otitis externa ( swimmer's ear ) .

Otitis externa ( swimmer's ear ) , inflammation of the external ear canal , is popularly thought to afflict only athletes in water sports , though it can also afflict other athletes , such as runners , when perspiration runs into the ear and keeps it moist . This warm moist atmosphere leads to the development of bacterial or fungal infections that cause pain , itching , discharge , and sometimes hearing deficit in the affected ear . Upon examination of the ear , discharge or odor may be noted , and pulling on the earlobe usually elicits an increase in pain . The athlete should be referred to a physician for appropriate antibacterial or antifungal medications . The athlete should avoid getting water in the ear for 3 weeks after treatment , and should protect the ear during showering and hair washing . The athlete should be advised to avoid cleaning the ear with objects ( such a cotton swabs ) or chemical washes . Once treated , the athlete may need to use eardrops recurrently to control flare - ups . Swimmers may need to wear earplugs to protect the ear from chlorine .

Discuss the evaluation of pain .

Pain is subjective and may be influenced by the individual's pain threshold ( the smallest stimulus that produces the sensation of pain ) and pain tolerance ( the maximum degree of pain that a person can tolerate ) . The most common current pain assessment tool is the 1-10 scale : 0 no pain 1-2 mild pain 3-5 moderate pain 6-7 severe pain 8-9 very severe pain 10 excruciating pain However , there is more to pain assessment than a number on a scale . Assessment also includes information about onset , duration , and intensity . Identifying what triggers pain and what relieves it can be very useful when developing a plan for pain management . Patients may show very different behavior when they are in pain : some may be fearful of disability , some may cry and moan with minor pain , and others may exhibit little difference in behavior when truly suffering ; thus , judging pain by behavior can lead to the wrong conclusions .

Discuss patellofemoral pain syndrome , including treatment .

Patellofemoral pain syndrome ( runner's knee ) occurs more commonly in females and males , usually between 12 and 36 years old , and among those who are physically healthy . The disorder often relates to overstressing the knee while playing sports that require running , such as sprinting , soccer , and basketball . This is a progressive disorder , with pain increasing over time . Usually pain is about and beneath the patella , especially at the inner aspect , and is aggravated by walking or running on a grade , flexing the knee as in squatting , or taking off in running . The knee may have a clicking sound and may feel unstable . Risk factors include flat feet or abnormalities in the femur , such as shortening or turning inward . Immediate treatment includes ice packs for 20 minutes 2 to 4 times daily for 2 to 4 days , followed by applications of heat . NSAIDs may be used for pain . Quadriceps exercises should begin when pain subsides . Assessment should identify the cause , as orthotics or modifications in activities may be needed .

Discuss plantar warts , including treatment .

Plantar warts are caused by infection with human papillomavirus ( HPV ) , usually on the plantar surface of the feet . They begin as pin - sized lesions , often with dark spots at the center , but a number of them can grow together and cause large lesions called " mosaic warts . " Lesions grow as the virus enters cells and causes them to reproduce more quickly . The lesions become increasingly painful as they grow and compress underlying tissue . Plantar warts shed a virus that is contagious to others , so going barefoot in showers or sharing shoes can spread the infection . Cushioning in shoes may be needed for comfort . Medicated pads are available ; these can be applied after soaking the foot in soapy water . The pad is left in place for 2 days , and then the white tissue is scraped off and the area is exposed to air for two days . This treatment is repeated for two weeks . Physician referral should be made , as home treatment is time consuming and not always successful .

Discuss the treatment for pneumothorax . ( Part I )

Pneumothorax is a leak between the lung tissue and the chest wall such that extraneous air is in the pleural space , causing a partial or complete collapse of a lung . Types include : Spontaneous / Simple pneumothorax is a breach of the parietal or visceral pleura , such as when an air - filled bleb on the lung surface ruptures . Traumatic pneumothorax is a lacerating wound of the chest wall , such as a gunshot or knife wound . Open pneumothorax occurs when air passes in and out , causing the lung to collapse ; it is indicated by a sucking sound and a paradoxical movement of the chest wall during respiration . Tension pneumothorax is similar to traumatic open pneumothorax ; however , the air can enter the pleural sac but can't be expelled , causing a pronounced mediastinal shift to the unaffected side with severe compromise of cardiac and respiratory function .

Describe mechanisms of injury for cervical fractures , signs , symptoms , and proper management .

Possible mechanisms of injury for cervical fractures include an axial load to the top of the head combined with neck flexion and forceful hyperextension of the head . Signs and symptoms of a possible cervical fracture include pain in the cervical region of the neck , pain in the chest , point tenderness on the neck , restricted movement , spasm in the cervical musculature , loss of sensation in the limbs or trunk , loss of strength in the limbs or trunk , inability to move the limbs or trunk , and loss of control over the bowels and / or bladder . Proper management includes immediate immobilization of the cervical spine , activation of advanced emergency medical services , and spine boarding by emergency medical personnel prior to transportation for advanced medical care .

Discuss preventing exacerbation of non - life threatening conditions through standard procedures : RICER therapy .

RICE ( sometimes extended to RICER ) therapy is a frequent emergency treatment after sports injuries , especially for contusions , strains , and sprains . This therapy reduces swelling and discomfort and promotes increased circulation and healing : Rest : The athlete should immediately cease the activity that caused the problem in order to avoid further damage . Ice : Ice or cold compresses should be applied for 15-20 minutes for the first 24-48 hours , to reduce swelling . Compression : An Ace bandage or similar dressing should be used to apply gentle pressure and prevent and / or reduce swelling . Elevation : The injured area should be elevated above the level of the heart , often by using pillows to elevate the body part . ( Referral ) : Referral should be made to an appropriate physician for care as needed .

Describe mechanisms of injury for second - impact syndrome , signs , symptoms , and proper management .

Second - impact syndrome occurs when a patient suffers from a second injury to the head before they have fully recovered from their first head injury . The second injury to the head results in quick swelling and herniation of the brain creating a life - threatening emergency condition . The second impact does not even have to be severe or a blow to the head to result in second impact syndrome . For example , if a patient is hit in the chest , causing the head to move around quickly , this can create enough force to cause a second injury to the already damaged tissue in the brain . Initially , a patient suffering from second - impact syndrome may seem normal but within a few seconds to several minutes their condition rapidly deteriorates . They may display dilated pupils , lose the ability to move their eyes properly , and collapse . Patients suffering from second - impact syndrome need immediate advanced medical care . This is a life - threatening condition , and about half of patients who suffer from second - impact syndrome die from it . Preventing second - impact syndrome from occurring is the athletic trainer's primary defense . Making wise , cautious decisions about return - to play following a head injury , and following nationally accepted practices for head injury management is key to preventing this life - threatening condition from occurring .

Discuss seizures .

Seizures are sudden involuntary abnormal electrical disturbances in the brain that can manifest as alterations of consciousness , spastic tonic and clonic movements , convulsions , and loss of consciousness . Tonic - clonic ( Grand Mal ) : Occurs without warning . a . Tonic period ( 10-30 seconds ) : Eyes roll upward with loss of consciousness , arms flex , and body stiffens in symmetric contractions with cyanosis and salivating . b . Clonic period ( usually 30 seconds or longer ) : Violent rhythmic jerking with contraction , relaxation , and sometimes incontinence of urine and feces . Following seizures , there may be confusion ; disorientation ; impairment of motor activity , speech and vision for several hours ; and headache , nausea , and vomiting . During the seizure , the athlete's head and body should be protected from injury , but no attempt should be made to restrain the athlete or insert anything into his mouth . The athlete should be screened from spectators if possible , and turned onto his side if vomiting to prevent aspiration . The athlete should be referred for medical care with prolonged seizures ( > 5 minutes ) or seizures without prior history of epilepsy .

Discuss shin splints .

Shin splints most often result from repetitive stress and inadequate warm - up exercises . This injury is common among runners . Symptoms include aching pain in the shin area that recedes after stopping activity . Treatment includes both preventive measures before activity and treatment after activity , as well as modifying activities to prevent further injury . ● Pre - exercise interventions include applying ice pack for 15-20 minutes before beginning exercise and applying compression dressing with 3 - inch elastic stretch bandage in a spiral wrap from distal to proximal end of the shin . ● Post - exercise intervention includes RICE therapy . NSAIDs ( such as aspirin and ibuprofen ) may relieve discomfort for adults . The athlete should be advised regarding restriction of activity until he or she is pain - free and has made modifications in training to prevent recurrence .

Explain why shock occurs , how to prevent , and proper care .

Shock can occur during all types of injuries but is more likely to develop when serious injuries are present such as with fractures , internal injuries , and severe bleeding . Shock occurs due to a dilation of blood vessels that allows the liquid portion of the blood to leave the blood vessels and enter tissue spaces of the body . This leaves the blood cells in the vessels with limited plasma , resulting in lowered blood flow and not enough oxygen being transported throughout the body , especially the nervous system . This causes tissue death and will lead to death of the patient unless advanced medical care is given . There are steps the athletic trainer should take to prevent a patient from suffering from shock . The athletic trainer should remain calm , reassure the patient , keep bystanders away , and not let the patient look at their injury if it is serious . Clothing should be loosened , the patient's body temperature should be maintained , and elevation that is appropriate to the injury should be provided .

Discuss shoulder dislocation .

Shoulder dislocations are common injuries resulting from blunt trauma or hyperextension . Usual symptoms include the injured athlete holding the arm away from his body ( fractured humerus usually causes the person to hold his arm against his body with his arm across his chest . There is usually acute severe pain in the shoulder , obvious squaring deformity , and functional loss . There may be numbness or partial paralysis of the arm from compression on nerves or blood vessels . The trainer should not attempt to reduce the dislocation , as this could cause further damage . The arm should be supported by placing a pillow or other roll ( such as a blanket ) between the chest wall and the arm . Then , an arm sling with swathing may be applied to prevent pressure on the joint . Pulses and circulation must be monitored . The person should be transferred for medical care .

Discuss skull fracture .

Skull fractures are most common in contact sports , such as football , but may also result from severe blunt trauma , as for instance being hit with a baseball bat . Symptoms will relate to the location and extent of the fracture , but typically include : ● Bruise , swelling , deformity , or laceration at the point of injury . ● Bleeding from nose or ears . ● Clear fluid draining from eyes or ears ( cerebrospinal fluid ) . ● Pain and tenderness at injury site , and more generalized headache . ● Battle's sign - bruising behind the ear - indicates a posterior basilar fracture ( delayed sign ) . Raccoon eyes - bruising and discoloration about the eyes - is a sign of a frontal basilar fracture ( delayed sign ) . ● Alterations in consciousness or lack of consciousness . Unequal pupils . Assessment for ABCs should be done first , followed by neurological assessment . The person should be immobilized while awaiting emergency transfer , as skull fractures may be associated with spinal cord injury .

Discuss the treatment for spinal cord injuries . ( Part II )

Spinal cord injuries ( Part II ) : ● Cauda equina : Damage is below L - 1 with variable loss of motor ability and sensation , and bowel and bladder dysfunction . Injury is to peripheral nerves , which can regenerate , so prognosis is better than for other lesions of the spinal cord . Central cord : Results from hyperextension and ischemia or stenosis of the cervical spine , causing quadriparesis ( more severe in upper extremities ) with some loss of sensation of pain and temperature ) . Prognosis is good , but fine motor skills are often impaired in upper extremities . ● Conus medullaris : Injury to lower spine ( lower lumbar and sacral nerves ) . ● Posterior cord : Motor function is preserved but without sensation . ● Spinal shock : Injury at T6 or above , results in flaccid paralysis below lesion , with loss of sensation , loss of rectal tone , bradycardia , and hypotension .

Discuss the treatment for spinal cord injuries ( Part III ) .

Spinal cord injuries ( Part III ) : Patients with spinal cord injuries should immediately be evaluated for airway control , and their spine kept immobilized . Emergency services must be called to transport the person to an ED . Spinal injury can occur at any point in the spine , with symptoms dependent upon the point of injury . Initial symptoms may be inability or reluctance to move . In severe injuries , there may be decorticate or decerebrate postures . Range of motion and sensory testing can help to determine if there is injury , but these should not be performed if cervical spine injury is suspected . In this case , the head should be immobilized and the helmet left in place unless it interferes with ventilation or fails to hold the head secure . If necessary , the helmet and shoulder pads should be removed simultaneously , so that the cervical area is not hyperextended . One should not attempt to move or roll a person with suspected spinal cord injury unless emergency services are not available .

Discuss the treatment for ruptured spleen .

Splenic rupture , a concern after mononucleosis , can also occur as a result of blunt trauma to the abdominal area , as from sports where falls or sharp contact are common , such as football , hockey , soccer , snowboarding , mountain biking , and body boarding . Splenic rupture is characterized by initially sharp pain in the left upper quadrant , followed by dull flank pain . If the spleen is leaking more slowly , the person may not exhibit symptoms at first , but then will complain of left shoulder pain ( Kehr's sign ) . In some cases , rupture may occur a month after an injury . Rupture should be suspected in any person who sustains an abdominal injury and has difficulty arising or reports abdominal pain or dyspnea . If the spleen has completely ruptured , the athlete will have signs of shock . This is a medical emergency : 9-1-1 should be called and the athlete transferred to an ED . Any athlete suspected of splenic injury should be removed from play , referred for medical attention , and then barred from play until the spleen has healed .

Discuss the application of splints .

Splinting is used in the case of suspected or obvious dislocations and fractures before the person is moved to prevent further injury . Before applying a splint : Control bleeding through compression , and apply dressing to cover open wounds . Monitor circulation , sensation , and mobility ( CSM ) . If circulation is impaired and pulse is absent , gently partially realign the limb while assessing circulation until pulse is felt or cyanosis subsides . ● Rule of thirds : For injury to the proximal third of a bone , splint both below the injury and the joint above the injury . For injury to the middle third , splint joints above and below the injury . For injury to distal third , splint above the injury and the joint below the injury . If possible , one person should stabilize the limb while splinting is done . ● Provide splints on both sides of the injury to prevent rotation .

Discuss syncope ( fainting ) , including treatment .

Syncope , fainting , occurs when the blood pressure drops suddenly , and can result from prolonged exertion ( especially in hot weather ) , prolonged straining ( as when lifting weights ) , prolonged squatting followed by standing during which the legs are rapidly perfused ( orthostatic ) , and from holding the breath while weightlifting ( " weightlifter's blackout " ) . It may also result from low blood sugar or use of alcohol or drugs . When an athlete faints , the trainer should immediately check for respiration and check the carotid pulse to make sure that the person has not suffered a cardiac arrest . If there are respirations and a pulse , the athlete should be placed in the supine position with his feet elevated above the level of his heart . This should raise the blood pressure and the person should regain consciousness , but he should remain in this position for 10-15 minutes . Assessment should be made to determine the cause of fainting and further treatment , such as glucose , may be given as indicated . Preventive measures should be taken , such as monitoring the athlete's techniques .

Discuss the implementation of emergency action plans for sports - related activities .

The Certified Athletic Trainer and others in a sports program should establish emergency action plans that include the following : Map of facility with specific designations for first - aid equipment and plans for entry and exit routes for EMS personnel , as well as the location of any necessary keys . ● Immediate telephone access ( usually cell phone ) . Fully - stocked first - aid kits , fire extinguishers , and flashlights with easy access . ● Medical release , physical examination , incident , and transfer forms . ● CPR and other first - aid training for support staff . ● Identification of all support staff on site and external support ( EMS , fire department , etc. ) . ● Posting of telephone numbers for EMS , physicians , medical facilities , Hazmat team , etc. ● Chain of command for managing emergencies , calling 9-1-1 , contacting family / guardians , and reporting to media . ● Medical supervision . ● Medical supplies : splints , dressings , tape , etc. Budget .

Discuss referrals for psychological problems .

The Certified Athletic Trainer is in a unique position to observe athletes for psychological problems . If the trainer and the athlete have a relationship of mutual trust and respect , the trainer should be able to discuss concerns about the athlete's psychological status . It is important , however , that the trainer remain supportive but refrain from trying to provide psychological counseling unless qualified to do so . In some cases , conflicts may arise among team members or between the trainer and an athlete , and these problems should be dealt with directly rather than avoided , as avoidance will only worsen the problem . It is normal that athletes express anxiety and fears , especially after an injury or loss : psychological problems are those that are chronic and impair functioning . Athletes with psychological problems should be referred to mental health practitioners .

Discuss the other members of the health care team with whom the Certified Athletic Trainer may cooperate .

The Certified Athletic Trainer is just one of a group of healthcare providers working together to reduce morbidity in athletes . Other members of the healthcare team may include : Physician : The team physician or family physicians provide medical support and assessment , evaluating the criteria for safe participation and return to play . Physician's assistant ( PA ) : The PA assists with diagnosis and treatment . Physical therapist ( PT ) : The PT devises and supervises exercises and activities for strengthening and recovery . Chiropractor : Treatments may reduce pain , especially related to pulled muscles or nerve compression . Acupuncturist : Similar to chiropractor . Massage therapist : Treatment increases circulation , stimulates muscles , and reduces pain . Personal trainer : This person helps the athlete to devise a personal plan for strengthening or exercise , and assists in the implementation of the plan . Sports nutritionist : The nutritionist helps the athlete maintain an adequate intake of nutrition and fluids , appropriate to the sport . Psychologist : Mental health care helps the athlete deal with stress .

Describe what personal protective equipment and supplies are needed so that universal precautions can be taken when exposed to blood or bodily fluids .

The Occupational Safety and Health Administration ( OSHA ) has established regulations employers must adhere to in order to protect employees and patients from exposure to bloodborne pathogens at the workplace . In the field of athletic training , the employing institution must provide the supplies athletic trainers need to properly follow universal precautions . Athletic trainers must ensure these precautions are followed in the athletic training clinic . Personal protective equipment needed includes disposable non - latex gloves , disposable mouthpieces for resuscitation devices , eye protection , masks , and shields . Also , a container for disposal of biohazardous materials and a container for sharps disposal is needed . For proper cleanliness of the athletic training clinic , disinfectants approved by the Environmental Protection Agency , chlorine bleach , and antiseptics are essential . Finally , any contaminated laundry should be separated from other laundry in biohazard bags and washed separately in hot water with a detergent capable of deactivating bloodborne viruses .

Explain the acronym POLICE in reference to immediate treatment of musculoskeletal injuries .

The acronym POLICE stands for protection , optimal loading , ice , compression , and elevation which are appropriate treatments following common acute musculoskeletal injuries . Protection is implemented to keep the damaged tissue from suffering from additional damage and bleeding . Depending on the injury , this may require the use of crutches , braces , or slings . Optimal loading is achieved by introducing appropriate mechanical loading to the tissue after a brief period of protection . This will optimize healing by improving the physical qualities of collagen . Ice application serves many functions . It works as an analgesic , which can reduce muscle guarding secondary to pain . It promotes vasoconstriction , which limits excessive edema and decreases intravascular pressure . It also lowers the tissue's metabolism and its need for oxygen , which reduces cell death due to hypoxia ( lack of oxygen . ) Compression decreases bleeding and swelling by placing pressure on the injured area and increases lymphatic drainage . Elevation assists in preventing excessive edema accumulation by allowing gravity to aid in lymphatic drainage . The higher the elevation of the involved area , the more effective it is . Both compression and elevation should be performed as often as possible for 72 hours following the injury .

Describe the role and scope of the athletic trainer , emergency medical technician , and team physician when making patient - care decisions during an emergency situation .

The athletic trainer , emergency medical technicians , and team physician should all work collaboratively to ensure the proper management of emergency situations that may arise . Prior to an emergency situation , all involved parties should discuss their roles in patient care so any emergencies can be handled efficiently to provide best patient care . Generally , the athletic trainer has more emergency management training than the team physician so the athletic trainer should be able to determine appropriate management for emergency situations . If it is determined that emergency medical services will be needed , they will be called to the site of the emergency . Once on scene , the emergency medical technicians will determine proper management of the injury as they have the most training in emergency management . Throughout the emergency situation the athletic trainer should remain readily available to assist the emergency medical personnel , pass on pertinent information , and assist with athletic equipment such as football facemask removal .

Describe mechanisms of injury for mandibular fractures , signs , symptoms , and proper management .

The mechanism of injury for a mandibular fracture is direct blow to the lower jaw . In the athletic environment , this injury usually occurs in contact sports . Mandibular fractures are the second most common facial fracture , second to nasal fractures . As with all injuries to the face , the athletic trainer should also suspect and evaluate the patient for a possible head injury as well . Signs and symptoms of a mandibular fracture include a mandible deformity , malocclusion of teeth with possible bleeding , numbness in the lower lip , pain with biting , and trismus , which is a reduced ability to open the jaw . Proper management requires immediate immobilization with an elastic wrap and referral for advanced medical care . A physician must reduce and fixate the patient's mandible . Full return - to - play following this injury typically takes two to three months .

Describe mechanisms of injury for skull fractures , signs , symptoms , and proper management .

The mechanism of injury for a skull fracture is usually a forceful blow such as a baseball or a shot put hitting the head . Signs and symptoms of a skull fracture include unconsciousness or severe headache and nausea . Blood may be observed in the middle ear , the ear canal , and the nose . Ecchymosis behind the ear ( Battle's sign ) and around the eyes ( raccoon eyes ) may develop . Cerebral spinal fluid , which is straw - colored , may appear in the ear and nose . A skull fracture is a medical emergency and the patient must be immediately referred for advanced medical and be seen by a neurosurgeon . With a skull fracture it is not the actual fracture itself that makes the injury such an emergency , it is the complications from intracranial bleeding , bone fragments on the brain , and possible infection .

Describe mechanisms of injury for orbital fractures , signs , symptoms , and proper management .

The mechanism of injury for an orbital fracture is a blow to the eye in which the eye is pushed backwards into the socket . This creates compressive forces that can result in a fracture to the bony structure surrounding the eye . Signs and symptoms of an orbital fracture include limited eye mobility , double vision , edema , the affected eye may appear downwardly displaced , and the patient may experience pain or numbness to the area . The athletic trainer should immediately refer a patient suffering from a potential orbital fracture for immediate advanced medical care . Most orbital fractures require surgical repair along with antibiotics .

List mechanisms of injury for tooth subluxation , luxation , and avulsion . Describe the signs , symptoms , and proper management for each .

The mechanism of injury for tooth subluxation , luxation , and avulsion is a blow to the mouth . Signs and symptoms for a tooth subluxation is slight looseness of the affected tooth without any misalignment . The patient may report that the tooth does not feel right and may be sensitive to touch and biting . With a tooth luxation , the affected tooth is very loose and out of place , either shifted forwards or backwards . An avulsed tooth is completely knocked out . Proper management differs on the extent of the tooth injury . For subluxation , the patient should be referred for a dental examination within 48 hours of the injury . With luxation , the athletic trainer should attempt to realign the affected tooth if it moves easily and the patient should be referred for immediate dental care . With a tooth avulsion , the tooth should be rinsed clean but not scrubbed or scraped . The athletic trainer should then try to reimplant the tooth as the sooner the tooth is reimplanted , the better the outcome . If the tooth cannot be reimplanted , the tooth should be stored in a tooth - saving kit , in the patient's saliva in a plastic bag , milk , saline , or inside the patient's mouth between their cheek and gum . Regardless of if the tooth can be successfully reimplanted or not , the patient should be referred for immediate dental care .

Differentiate between the primary injury survey and the secondary survey .

The primary and secondary surveys are both parts of the on - the - field injury assessment . During the primary survey , the athletic trainer assesses the patient for life - threatening conditions such as unconsciousness , lack of respiration , no circulation , severe bleeding , and shock . The primary survey is performed first and if any threat - to - life is determined , the athletic trainer must call for advanced medical care and provide appropriate immediate care . If the patient is conscious and stable , a primary survey is not needed and the athletic trainer can proceed directly to the secondary survey . During the secondary survey the athletic trainer determines specifics about the injury . Pertinent information about the injury from the patient is gathered , vital signs are observed , and the athletic trainer determines the appropriate steps to be taken to properly care for the patient's injury .

Discuss the treatment of snake bites ( pit vipers ) .

The second type of snake that can cause serious injury are the pit vipers . Rattlesnakes , copperheads , and cottonmouths have erectile fangs that fold until they are aroused ; their venom is primarily hemotoxic and cytotoxic , but may have neurotoxic properties . O Wounds usually show 1 or 2 fang marks . O Edema may begin immediately or may be delayed up to 6 hours . O Pain may be severe . O There may be a wide range of symptoms , including hypotension and impairment of blood coagulation that can lead to excessive blood loss , depending upon the type and amount of venom . O There may be local infection and necrosis . Treatment includes : Cleansing the wound thoroughly and dressing as indicated . ● Circling edema with a permanent marker and recircling every 15 minutes . ● Transporting immediately to an ED for tetanus and antivenin as indicated . ● NSAIDs and aspirin should NOT be given for pain .

Discuss Injury to the testes .

The testes are vulnerable to injury from blunt trauma in a variety of contact sports . The immediate response is severe pain , which may be accompanied by light - headedness , bradycardia , and nausea . The pain may extend from the testicular region to the mid - abdomen . Initial treatment includes : Having the athlete lie in the supine position with his knees flexed to the chest until pain subsides . Applying ice or cold compress : Ice may increase pain , so the ice pack should not be placed in direct contact with the genitalia . Cold compresses alone often suffice . Because testes are soft tissue , there may be increasing swelling that can cause compression of testicular tissue . For this reason , the athlete should be monitored for the next hour or more , and if there is increased pain or if pain fails to subside , the athlete should be referred for emergency evaluation , because a surgical operation to decrease pressure must be done within 4 hours of injury .

Discuss splinting related to specific injuries .

The type of splinting required depends upon the site of injury : Shoulder : The arm should be placed in a sling , with the wrist / hand above the level of the elbow . Humerus : A rigid splint should be applied on the lateral humerus , and the arm secured in a sling across the chest with a swath binder . Elbow : Splint in position found . If straight , splint from axilla to wrist along medial aspect with splint tied in place If bent , place rigid splints from upper arm to wrist and support in sling . Forearm : Place rigid splint , or SAM splint , on both sides of arm with thumb upward from palm and extending past elbow . Then , support in sling with swath binder about body . Pelvis and hip : Provide firm backboard and avoid lifting legs . Femur : Rigid splints on both sides of leg can be used , or buddy splinting can be used if necessary . Traction splints are preferred , but usually only available with EMS .

Discuss the phases of wound healing after a soft tissue injury .

There are 4 primary phases to wound healing : Hemostasis takes place within the first few minutes after injury and bleeding , when the platelets begin to seal off the vessels and secrete substances that cause vasoconstriction . Thrombin is produced to stimulate the clotting mechanism , forming a fibrin mesh . Inflammation ( lag or exudative ) phase occurs over the first four days after the injury . During this phase , there is erythema and edema along with pain , as the blood vessels release plasma and neutrophils or polymorphonucleocytes to begin phagocytosis , which removes debris and prevents infection . Proliferative / granulation ( fibroblastic ) phase occurs over days 5 to 20 after injury . During this phase , fibroblasts produce collagen to provide support and granulation tissue starts to form . Epithelization and contracture of the wound occur . Maturation ( differentiation , remodeling or plateau ) phase occurs after day 21 , and lasts for an indeterminate duration . The fibroblasts leave the wound and the collagen tightens to reduce scarring . The tissue gains tensile strength . This stage can last up to 2 years , and the wound can break down easily again during this phase .

Discuss the treatment for shock .

There are a number of different types of shock . Hypovolemic shock results from loss of body fluids as with severe diarrhea ; cardiogenic shock from heart disorder ; hemorrhagic shock from blood loss ; neuropathic shock from neurological injury ; hypoglycemic shock from hyperinsulinism ; and septic shock from infection . Interference with the lungs ' ability to receive oxygen or the heart's ability to circulate blood can result in shock . During shock , the cells don't receive enough oxygen to metabolize glucose and , as the cells compensate , lactic acid forms , changing the acid - base balance . This prompts the cells to leak toxins into the blood , at which point cells begin to die . Symptoms include diminished blood pressure , tachycardia dyspnea , pallor , confusion , cool clammy skin , and loss of consciousness . Emergency treatment includes : ● Calling 9-1-1 for emergency transfer to ED . ● Placing the person flat and elevating his or her feet above the level of his or her heart . ● Controlling hemorrhage by compression . ● Administering oxygen if available .

Discuss the different types of splints that may be used for immobilization .

There are a number of different types of splints that may be used for immobilization . There are many commercial splints available , but in an emergency , rolled - up newspapers or other material may be used : ● Anatomic or " buddy " splints involve using adjacent body parts to provide immobilization , such as taping fingers together , tying legs together , or securing an arm across the chest . ● Rigid splints are not flexible and may be plastic boards or wooden boards , padded or unpadded , or heavy cardboard . Molded SMA splints fit around the limb . Rigid splints must be of sufficient length to extend well above and below the point of injury . Soft splints , such as pillows , may be used if no other splints are available for support of fractures of the lower arm or leg . Inflatable splints are also available and can provide very good immobilization .

Discuss the procedures and purposes of taping and bandaging .

There are a number of different types of tape used for taping and bandaging : ● Zinc oxide tape is non - elastic and is used to strap joints or prevent blisters , but it shouldn't be used to enclose muscles or areas that may swell with exercise , as it may interfere with circulation . ● Self - adhering tape sticks to itself but not to the skin , and is elastic . It can be used to strap joints , provide compression , and finish ( top layer ) bandaging . ● Elastic adhesive bandages are elastic with zinc oxide and are used around muscles that may expand during exercise . Foam tape may be used to provide a cushion beneath other types of tape . There are a number of purposes for taping and bandaging : ● Provide support for muscles and joints and protect unstable joints . ● Limit mobility of injured joints or prevent abnormal movement . ● Protect skin from infection and blistering . ● Secure protective equipment . ● Provide compression to control hemorrhage .

Discuss steps an athletic trainer can take to control bleeding .

There are actions athletic trainer can take to control external bleeding and with all these actions , universal precautions must be used . Direct pressure can be applied by pressing a sterile gauze pad onto the injured tissue firmly . Elevation of the injured body part should also be performed if necessary . If direct pressure and elevation do not control bleeding , applying pressure to the appropriate pressure point should be employed . There are 11 pressure points on each side of the body . The two most common pressure points used to control hemorrhaging are the brachial and femoral arteries . Internal hemorrhaging can be a life - threatening condition . If a patient is suspected to have internal hemorrhaging within the abdomen , thorax , or skull they should not be moved and the athletic trainer must call for immediate advanced medical care . To prevent shock , the patient should be kept calm and their body temperature should be sustained .

Discuss signs the unconscious patient may exhibit when suffering from the following medical conditions : Heat syncope ● Concussion Grand mal epilepsy

There are many potential conditions that may cause a patient to lose consciousness . The physical signs of the patient may help the athletic trainer to determine the cause of unconsciousness . When a patient suffers heat syncope , signs they may display include a pulse that is fast and weak , breathing that is shallow and fast , dilated pupils , and their skin may be cold and clammy . When a patient suffers a concussion that causes unconsciousness , signs they may display include a pulse that is irregular and weak , shallow and irregular breathing , and their skin may appear pale and feel cool to the touch . A patient suffering from Grand Mal Epilepsy may display a fast pulse , noisy breathing that turns deep and slow as time progresses , and dilated pupils .

Describe the necessary components of an emergency action plan .

There are several components an emergency action plan ( EAP ) must include and an EAP must be developed for every venue in which athletic trainers provides coverage . EAPs must specify emergency personnel , equipment , and phone lines available . EAPs should establish protocols for the removal of sports equipment such as helmets and shoulder pads . EAPS must plan for easy access to emergencies by establishing which gates , doors , and padlocks must be opened to allow emergency medical personnel access to the site of the emergency . EAPs assign roles staff members must perform during an emergency . For example , a designated person should call 911 and be ready to communicate all essential information . A person should be designated to meet the emergency medical personnel and direct them to the emergency , another to keep spectators away , and a person should go with the patient to the hospital . All staff should know their role in an emergency . EAPs should not only plan for potential injuries and illnesses to athletes , but also other emergencies that may arise at venues such as a spectator suffering a heart attack . The EAP should be reviewed , updated , practiced , and documented annually .

Describe how to properly remove the facemasks of football helmets .

There are several tools used to remove the facemasks of football helmets . These tools cut , unscrew , or release the fasteners that attach the facemask to the helmet . Athletic trainers must be familiar with the fasteners used on the helmets their athletes wear and have the needed tools to remove those fasteners , detaching the facemask within 30 seconds . Before removing a facemask , a trained rescuer should immobilize the patient's head to limit any movement . There are usually four fasteners that attach the facemask to the helmet . The two side fasteners should be removed first and then the two fasteners on the top should be removed . The tools used should be equipment - specific , based on the type of fasteners used on the helmets . For quick - release fasteners , a quick release tool is required . The use of an electric screwdriver can be faster and produces less movement than cutting tools such as the FM Extractor and Anvil Pruner . However , these cutting tools must always be available in case a screw fails and cannot be removed with a screwdriver .

List various causes of seizure disorders , appropriate activity restrictions , and explain proper care for patients who suffer from seizures .

There are various causes for seizure disorders . For example , some patients suffer from seizure disorders as a result of genetic predisposition , others from alterations in brain metabolism , and others suffer seizure disorders as a result of previous injuries . When determining activity restrictions for patients who suffer from seizure disorders , the needs of the individual must be considered . If a patient's seizures are properly controlled , then limited or no activity limitations are needed . However , patients with seizure disorders should not swim by themselves , scuba dive , or participate in activities at high heights . If a patient's seizures disorders are not properly controlled and they experience severe daily or weekly seizures , the patient should not participate in collision sports . To care for a patient suffering from a seizure , the athletic trainer should not restrain the patient , assist them to the ground if possible , keep them away from anything that may cause them injury during the seizure , loosen any tight clothing , and remain calm .

List emergency medical equipment that is required to properly manage emergency situations that may arise .

There is a variety of emergency medical equipment that needs to be readily available for athletic trainers to properly manage emergency situations that may arise . For example , athletic trainers need a variety of splints for possible fractures , crutches , slings , wound care supplies , and emergency cutting tools for football helmet facemask removal . Additionally , athletic trainers need face shields for CPR , and AEDs readily available at all sites in which athletic training services are provided . Access to cold - water immersion must be available when high heat and humidity makes heat stroke a threat for athletes . When caring for athletes with specific medical conditions , athletic trainers should have access to the patients ' emergency medical devices such as EpiPens , insulin injections , and inhalers for asthma . Communication devices must be readily available at all locations to activate emergency medical services as needed .

Discuss the removal of ticks .

Ticks can spread a number of different diseases , including Babesiosis , ehrlichiosis , Lyme disease , and Rocky Mountain spotted fever . Those in tick - infested areas should be cautioned to avoid tall grass and shrubby areas , use repellants ( DEET ) , and wear light - colored clothing with their arms and legs covered and their pants tucked into their socks . Athletes should shower and examine their skin immediately after returning indoors , as ticks often wander about the body for 30 minutes before biting and feed 12-24 hours before spreading infection . The groin , axillae , and neck are common sites for ticks . The CDC recommends removing ticks with tweezers , and NOT using petroleum jelly , nail polish , alcohol or other methods , as these may cause the tick to regurgitate and spread infection . The tick should be grasped near the skin and pulled upward without twisting . Then , the skin should be washed with soap and water . The tick should be saved in a plastic bag in case testing is needed . Burrowed ticks must be removed by a physician .

Explain proper procedures for wound cleansing , debridement , and dressing .

To properly cleanse an open wound , the athletic trainer should irrigate the wound with a nontoxic solution such as simple saline or tap water as soon as possible to remove any debris , exudate , and bacteria from the wound . However , if bone or tendon is visible , tap water should not be used . Antiseptics such as iodine and hydrogen peroxide may harm patients ' tissues causing a delay the healing process and therefore should be used with caution . If needed , debridement should be performed to remove any necrotic tissue and foreign bodies from the wound to promote healing . Wounds should be covered with a proper dressing that is selected based on the type of wound and the needs of the patient . Occlusive dressings have been shown to increase healing and decrease the risk of infection . The athletic trainer should inspect the wound daily and check for possible signs of infection . If signs of infection are present , the athletic trainer should refer the patient to a physician .

Explain how using appropriate emergency care procedures can reduce the risk of morbidity and mortality .

Using appropriate emergency care procedures can reduce the risk of morbidity and mortality because when patients are given the advanced medical care they need in a timely fashion they have better outcomes . Planning for various emergency situations that may arise in the multiple venues in which an athletic trainer provides coverage increases the timeliness and effectiveness of care during emergency situations . For example , having an AED readily available will increase the likelihood of a patient surviving a sudden cardiac arrest with ventricular fibrillation . Having appropriate splints readily available and properly splinting a fractured bone before moving a patient limits secondary damage to the surrounding tissues , prevents the fracture from being further displaced , and lessens the extent of the injury and recovery time . There are many other emergency scenarios , that when given appropriate emergency care , decrease patients ' risks of morbidity and mortality .

Explain how to properly splint a fracture and discuss common splints used by athletic trainers .

When a fracture is suspected , the injured patient should not be moved until the fracture is immobilized . The fracture must be splinted in the position it is found . Do not attempt to realign displaced bones . In the event of an open fracture , the wound must be dressed to prevent infection and blood loss . A splint must be selected that can immobilize the joint above and the joint below the fracture . If there is a suspected lower - leg fracture , both the knee and foot must be immobilized . A rapid form vacuum immobilizer is commonly used for this type of injury . Possible wrist fractures require the fingers and elbow to be immobilized which can be accomplished with a SAM splint . The injured arm should also be placed in a sling . For suspected fractures around the shoulder a sling is applied and the injured arm is secured to the upper body . For possible femur fractures a special splint is made that properly immobilizes this injury , the half - ring splint . Once the appropriate splint is applied , the distal pulse and the color of the patient's fingers or toes should be monitored to insure proper circulation . The patient must be referred to receive immediate medical care .

Describe the proper procedure for removing a patient with a suspected cervical spine fracture from a pool .

When a patient in a swimming pool has a suspected cervical fracture , the proper procedure for removing the patient from the pool must be followed for best patient outcomes . The athletic trainer must call for emergency services , get into the water with the patient , and immobilize the patient's head and neck while waiting for additional help to arrive . The patient's neck can be effectively immobilized by positioning the patient face up in the water , extending the patient's arms overhead , extending their elbows , and squeezing their arms together against their head , stabilizing the cervical spine . Once a spine board and a second rescuer are available , extraction from the pool can be performed . The primary rescuer continues to immobilize the head and neck while the second rescuer places the spine board under the patient . The second rescuer then stabilizes the patient's head and neck while the primary rescuer securely straps the patient to the spine board at the levels of the head , chest , hips , and thighs . Once the patient is secured to the spine board , one rescuer will get out of the pool while the other stays in and both rescuers work together to slide the patient out of the pool while keeping them securely fastened to the spine board . Finally , the patient can be transported to an emergency medical treatment facility .

Discuss signs the unconscious patient may exhibit when suffering from the following medical conditions : Brain compression and injury ● Heatstroke ● Diabetic coma ● Shock

When a patient suffers from a brain compression and injury their decent to unconsciousness is usually gradual . Their pulse will gradually get slower , breathing may be noisy and slow , skin hot to the touch and flushed , and pupils may be unequal . When a patient suffers a heatstroke , they may have difficulty breathing , have a fast pulse , and their skin may be hot to the touch . When a patient becomes unconscious from a diabetic coma , signs they may display include a weak but fast pulse , deep breathing with sighing , and an acetone smell to their breath . An unconscious patient suffering from shock may display a weak but fast pulse , breathing that is rapid and shallow , clammy skin that is cold to the touch , and dilated pupils .

What actions should be taken when a patient has a suspected drug overdose ?

When a patient suffers from a suspected drug overdose the athletic trainer should immediately activate emergency medical services and contact their local poison control center . While waiting on emergency services to arrive , the poison control center can give directions on how to immediately care for the patient . The poison control center will need specific information to provide the best care . They will need to know the name and age of the patient , the name of the drug that was taken along with the amount taken and the time it was taken if known , signs and symptoms the patient displays , vital signs , and the name and location of the person calling .

Discuss small cuts and lacerations .

When an athlete gets a cut or laceration from blunt or sharp trauma , he or she may react to the trauma by becoming faint ; additionally , if there is excessive blood loss the person may develop shock as the blood pressure falls , so the overall condition and amount of blood loss should be assessed . ( Hemorrhage requires immediate emergency transfer to an ED ) . Pressure should be applied to a bleeding lesion to stop bleeding , at which point the area should be thoroughly flushed with soap and water or saline , especially if the wound is contaminated . For small cuts , skin edges should be aligned , Steri - strips® placed over the wound , and a protective dressing should be placed over the cut / laceration . Antibiotic ointment , such as Neosporin® , may be applied to reduce the chance of infection . The person should be referred to a physician for suturing and a tetanus injection as indicated .

Explain the importance of triage when managing multiple patients suffering from various injuries .

When managing multiple patients suffering from varying injuries and illnesses , triage is important to determine who needs to receive medical care first . If immediate care is provided to patients suffering from only minor injuries , while other patients with life - threatening conditions do not receive immediate care , their outcome may be detrimental . For example , if two football players hit helmet - to - helmet and both players are injured , the athletic trainer should quickly assess both patients to determine who needs the most immediate care . If one patient reports symptoms consistent with a concussion while the other patient reports symptoms consistent with a spinal injury , the patient with the possible spinal injury should receive immediate care . A responsible adult must monitor the patient with the possible concussion until the patient with the possible spinal injury is transported to an advanced medical care facility . Once this is completed , the athletic trainer can then evaluate and care for the player with the possible concussion .