Emergency Care

Describe the considerations that need to be taken for emergency equipment in order to properly prepare for any emergency

- on-site and quickly accessible - personnel should be familiar with and trained in the operation of equipment - equipment in good condition/checked annually - rehearsals - stored in clean and controlled area

Identify and briefly explain three of the main physiological factors affecting heat stress response (or those factors affecting an athlete's ability to cope with heat during exercise)

1. "critical core temperatures" that define our limits of when to stop exercising, but this can be overrided. 2. combo of cardiovascular strain resulting from high skin blood flow -> decrease in central blood volume causing greater cardiovascular strain 3. environmental conditions, head accplimatization status, hydration status, amount of type of equipment worn, intensity of exercise in relation to fitness level of athlete

List 10 emergency equipment items that should be included in an EAP

1. AED 2. Airway management supplies 3. Oxygen delivery system and pulse oximeter 4. Suction device 5. Body substance isolation equipment 6. Wound care supplies 7. Vital signs assessment: BP cuff, stethoscope, penlight, rectal thermometer 8. CPR pocket mask 9. Rigid cervical collar 10. Emergency shears

List at least five alternative etiologies of non-traumatic exercise-related syncope that should be considered after ruling-out sudden cardiac arrest

1. EHS 2. Hyponatremia 3. Hypoglycemia 4. Exercise-associated collapse 5. Pulmonary embolus 6. Neurocardiogenic syncope 7. Ion channel disorders 8. Coronary artery disease 9. Seizures 10. Cardiac arrythmias

List the 5 main components of an EAP

1. Emergency personnel 2. Emergency communication 3. Emergency equipment 4. Medical emergency transportation 5. Venue directions with map

List the questions you would include in a pre-participation exam to look for risk factors associated with exertional heat stroke, why you would include these questions, and what a response would indicate

1. Have you ever had heat illness and if so when? What was final diagnosis? 2. Do you find it hard to exercise in heat/ever have trouble doing so? 3. How much sleep do you get per night on average? 4. Do you sleep in an air-conditioned room? 5. Have you exercised in heat within the past 2 weeks/aerobic conditioning? 6. How many days per week did you perform a workout within last 3 months? 7. How many years been participating in sports? year-round?

List four other conditions that should be included in the differential diagnosis for exertional heat stroke

1. Heat exhaustion 2. Exertional hyponatremia 3. Exertional sickling 4. Diabetic emergency 5. Concussion 6. Heat syncope

Please list the top 10 causes of sudden in sport. Please aim to get as close to the correct order/ranking as possible

1. Sudden cardiac arrest 2. Heat stroke 3. Exertional sickling 4. Head injuries 5. Hyponatremia 6. Diabetes 7. Anaphylaxis 8. C-spine injuries 9. Lightening 10. Shock

Explain what steps you would take as the head athletic trainer for a high school football team to help reduce the risk of exertional heat stroke during preseason practices and explain why you would make these changes (why it is protecting the athletes)

1. always medical professional available 2. policy for practicing/competing in certain temperatures 3. set heat acclimatization schedule 4. water/rest breaks often 5. monitor weight before/after practices 6. educate 7. pre-participation exams thorough

List one to two alternative cooling strategies you would use (in order of priority and most effective) if cold-water immersion was not available for you to use with exertional heat stroke victims

1. douse pt. continuously with cold water (or in river/large pond) 2. rotation of wet, ice-cold towels

Provide four predisposing factors to exertional hyponatremia and a prevention strategy for each.

1. large volume of hypotonic fluid consumed within few hours: do not exceed 2% of weight loss through fluids and measure sweat rate 2. sodium or sodium chloride losses in sweat and urine not replaced adequately by dietary food or fluids: consume ample sodium 3. absence of heat acclimatization predisposes active individuals bc of large sodium loss in sweat and urine: 8-14 day training 4. exercise duration: give large vol. of fluids, consume salty foods, and water during long-duration events

List five commons signs and symptoms associated with symptomatic hyponatremia.

1. nausea 2. vomiting 3. headache 4. dizziness 5. muscular twitching

Describe the steps you would take to return an athlete to play following an exertional heat stroke if resources/money were no obstacle.

1. no exercise 7 days post-collapse 2. blood analysis 3. gradual progression of exercise intensity 4. heat tolerance testing 5. Ingestible pills to monitor internal body temp 6. Clear pt. to play

Explain preventative measures that should be taken for athletes with SCT

1. set their own pace 2. gradual intensity and longer breaks 3. no high intensity exercise without some sort of break 4. if feel fatigued or cramped must cease activity 5. avoid exercise in heat or high altitude, drink plenty of fluids 6. staff should be educated about recognition

If glucose levels are below which of the following, it is recommended the athlete ingest additional carbohydrates prior to exercise.

100 mg/dL

In the management of mild hypoglycemia, the athlete should be removed from exercise and given how much of a fast-acting carbohydrate?

15 to 20 g

Type 1 diabetics avoid exercise if their glucose levels are above which of the following and there is evidence of ketosis?

250 mg/dL

Approximately how long should RTP process take after the athlete first presents as symptom free, assuming there are no setbacks in symptom reporting?

5-7 days

Define apoptosis

A programmable cell death response in CN tissue following injury

Provide the definition for catastrophic cervical spine cord injury:

A structural distortion of the c-spine column has occurred and is associated with actual or potential damage to the spinal cord

Who should be included in the rehearsal of an emergency action plan?

ATC's local EMS, school safety officials, coaches, school administrators, and other employee who is expected to serve as on-site first responder

Explain the difference between acclimatization and acclimation:

Acclimatization is a complex of adaptive responses to natural environments (e.g., hot, cold, high altitude, underwater) that demonstrate improved homeostatic balance in multiple organs. When the particular climatic factor is artificially induced, the process of adaptive responses is called acclimation

Diabetic athletes may need to change their glucose and/or insulin needs depending on the planned exercise factors:

All answers correct: duration of exercise, intensity of exercise, environmental conditions, and type of exercise

List those who should be certified in CPR and first aid and should therefore also be knowledgeable of the EAP

All athletic personnel associated with practices, competitions, skill instruction, and strength and conditioning: ATC, AD, coaches, on-site first responders, nurse, team doc, S&C coach

Briefly describe the components of an emergency action plan:

An emergency action plan (EAP) should include information pertaining to management of life-threatening injuries. The EAP should be written out and distributed to all personnel. It should be specific to each venue and include maps and directions for access to the venue, equipment that may be needed in an emergency situation; names and responsibilities of personnel for carrying out the EAP; chain of command; facility address, location, and contact information; and specific actions to be taken. The EAP should be reviewed and rehearsed annually, and health care professionals who will provide the medical coverage for the venue should be included in the EAP

List who should be included in the formation of an emergency team

Any medical provider, coaches, equipment managers, officials (school administrators)

Briefly explain the roles of athletic trainers

Athletic trainers are health care professionals who specialize in providing a safe sports environment, evaluating injuries, implementing rehabilitation programs for the return to activity following injury, and developing policies and procedures for safe sports participation

Explain your rationale for hiring athletic trainers in the secondary school athletic programs:

Athletic trainers are licensed medical professionals who are trained to give on-site medical coverage and are specialized in prevention, recognition, diagnosis, and treatment of life-threatening emergency situations in sports. In addition, the Inter-Association Task Force for Preventing Sudden Death in Secondary School Athletics Programs has endorsed the placement of athletic trainers in the secondary school athletic programs. Nearly 66% of all secondary schools have access to an athletic trainer; it is starting to become one of the expectations for schools to provide appropriate on-site medical care.

List the basic information on concussion that should be included in the preseason education for personnel, coaches, athletes, and parents:

Basic information on concussion should cover signs and symptoms, treatment, return to play, and appropriate knowledge on prevention and management: standard helmets should be certified regularly and fit properly, helmets should NEVER be modified, helmets ONLY prevent catastrophic injuries NOT concussions, S&S of concussion, if they have gradual loss of consciousness they should see a physician immediately, oral and written instructions for home care, R-T-P protocol!!

List methods to determine hydration status or monitor hydration changes

Body weight changes (pre- and postpractice, but also over the course of days), urine color, urine specific gravity.

Which of the following is a possible sign of a basilar skull fracture?

CSF rhinorrhea

Explain the pathophysiology that occurs with someone who has hypervolemic symptomatic hyponatremia. Include the movement of fluid within the body's compartments and the events that can lead to death.

Consumption of hypotonic fluid flows into the extracellular fluid. The extracellular tonicity falls, which causes the water to flow into cells, causing them to swell. This swelling will cause the pulmonary edema and potentially pulmonary arrest. Brain edema may also occur, leading to herniation of the brain structures leading to death

What is the difference between a direct and indirect catastrophic injury in sport?

Direct: result from participation in the skills of a sport Indirect: result from systemic failure secondary to exertion while participating in a sport

What major rule change occurred in 1976 that resulted in a dramatic decrease in the number of direct football fatalities?

Elimination of initial head contact while tackling and blocking

Explain what EAP stands for and where it should be used.

Emergency Action Plan: it should be implemented at any institution or organization that sponsors athletic activities

T/F: A person must be dehydrated to succumb to EHS.

False

T/F: About 75% of concussions involve loss of consciousness of any duration

False

T/F: Accuracy of a peak flow meter is not dependent upon user technique

False

T/F: Hyperresonance to percussion is a symptom of hemothorax

False

T/F: Hypothermia can only occur in cold (<32°F) conditions.

False

T/F: Liver injuries are the most common intra-abdominal organ injury in sport

False

T/F: On average, recovery from concussion takes longer in collegiate athletes than high school athletes

False

T/F: Paget-Schroetter syndrome (PSS) most occurs in the non-dominant arm of overhead athletes

False

T/F: Retrograde amnesia can be assessed by asking the athlete about the first thing they remember after sustaining the injury

False

T/F: Splenic injury cannot occur spontaneously

False

T/F: The Colorado Medical Society concussion grading scale has been shown to be the most accurate and is widely recommended by concussion experts

False

T/F: The clinician can test cranial nerve II by asking the athlete to track a moving object with the eyes

False

T/F: Ultrasonography is a reliable tool for diagnosing injuries to solid viscous organs

False

T/F: Chest pain is the first clinical manifestation of cardiac disease in 60% to 80% of athletes who suffer sudden cardiac death

False: SCA is usually the first sign (the first collapse)

T/F: Nine hundred meters is considered the threshold for altitude-induced conditions.

False: above 2500 meters is threshold

T/F: Hispanic athletes have higher asthma prevalence than black athletes

False: black athletes have highest probability

T/F: in a case of negligence, youths are owed a lower duty of care and can assume all risks

False: duty of care is increased for a minor ; children often do not appreciate all risks so it is harder to raise this defense

T/F: Swimmers appear to have a higher asthma prevalence rate due to their breathing patterns in the water.

False: high because exposed to chlorinated air

T/F: If an automated external defibrillator (AED) does not recommend a shock after evaluating the rhythm, this indicates that the victim is not in cardiac arrest so CPR can be stopped while waiting for an ambulance to arrive

False: if no shock is advised then a nonshockable SCA is still possible anf CPR and life support measures should be continued until the patient becomes responsive or noncardiac etiology can be clearly established

T/F: Indoor pollution is a definitive factor for developing asthma exacerbations.

False: indoor/outdoor pollution remains inconclusive as a factor in the development of asthma exacerbations but has been shown to decrease lung function in exposed areas

T/F: an agreement consists of an offer, acceptance, and signatures agreeing to the contract by both parties

False: it is the "meeting of minds" in a legal contract where there is an offer and acceptance and the terms need to be specific and understood by both parties

T/F: a noncompete clause allows an employee to leave their current employer and start work with competing business as long as the four elements of a contract were made

False: it prohibits an employee from leaving his or her current employer and starting a competing business in a specific area for a specific time period

T/F: People struck by lightning carry a temporary electrical charge, and rescuers must be careful of being electrocuted

False: most are indirect so all energy isn't transferred to the victim

T/F: nonprofit immunity and government immunity are two totally different types of immunity

False: nonprofit immunity provides the same basic protection as government immunity, but it is applied ONLY to nonprofit organizations

T/F: primary assumption of risk is not between co-participants but rather between a player and another party such as a coach, athletic trainer, or event manager

False: often involves a situation in which two participants play together in a sport and one gets injured by the other ; not intentional but rather part of the game

T/F: Adrenergic symptoms of hypoglycemia are triggered by the direct effect of diminished glucose supply to the brain.

False: symptoms are triggered by the release of the counter-regulatory hormone epinephrine

T/F: Athletes with exercise-induced asthma will commonly experience their symptoms during exercise, not after.

False: they experience their symptoms after exercise

T/F: Athletes who survive a sudden cardiac arrest from commotio cordis are not allowed to return to playing competitive sports

False: up to the physician

Explain important steps you would take with an athlete who suffered from symptomatic hyponatremia but has no resulting morbidity in order to return him/her to play and to help prevent any reoccurrence

Following physician clearance, perform a gradual increase in activity. Educate the athlete on proper hydration strategies, teach athletes to measure their individual sweat rate and drink accordingly, determine the factors contributing to the case of hyponatremia, and avoid these circumstances in the future.

List or briefly explain how the symptoms of heat cramps differ from exertional sickling

Heat cramping: has prodrome, pain is excruciating, hobble or halt, cramping visible Sickling: no prodrome, pain is mild, slump to a stop and become weak, lie fairly still, no visible cramping

Describe the differences between hypovolemic hyponatremia and hypervolemic hyponatremia with specific regard to the extracellular fluid volume, hydration status, and clinical edema.

Hypovolemic: reduced extracellular vol. with deficits of total body sodium (sodium loss with intake of hypotonic fluid, water deficit, and edema is absent Hypervolemic: excess of total body water (fluid overload) and expanded extracellular fluid vol. and increased whole-body sodium (usually extreme edema and dehydration is absent)

If the cooling rate for ice-water immersion is 0.33F/minute, about how long would you need to cool an athlete who is 108F to an acceptable level? Provide justification to how long you would cool the athlete.

If the patient has a starting temperature of 108F, I would want to get them down to an acceptable temperature of 102F after full immersion cooling. If you subtract 108F - 102F you get a difference of 6 degrees. You then divide the 6F by the rate of 0.33F/minute to get about 18 minutes of immersion to cool down the body temperature.

In which country did an integrative screening protocol that included ECG result in a tenfold reduction in the incidence of sudden cardiac death in young competitive athletes?

Italy

Explain the different treatment protocols for mild versus severe hyponatremia. Define the category of hyponatremia via plasma Na+ concentrations.

Mild: 130-135 consumption of salty foods, small vol. of oral hypertonic solution until spontaneous diuriesis anf correction of blood sodium concentration Severe: 125 or less ; hypertonic saline via IV, rapidly correcting symptoms. discontinue after reaches 128-130

What does NOCSAE stand for?

National Operating Committee on Standards in Athletic Equipment

Briefly explain how WBGT is calculated for outdoor exercise participation and indoor exercise participation.

Outdoor exercise: WBGT = 0.7 (wet bulb temperature) + 0.2 (black globe temperature) + 0.1 (dry bulb temperature). Wet bulb temperature comprises 70% of the WBGT, black globe is 20%, and dry bulb is 10%. Indoor exercise: WBGT = 0.7 (wet bulb temperature) + 0.3 (dry bulb temperature). Wet bulb temperature comprises 70% of the WBGT and dry bulb is 30%

Explain the difference between physiological hyponatremia and symptomatic hyponatremia

Physiological hyponatremia: involves serum/plasma sodium level of 135-145 and may not result in distinct S&S Symptomatic hyponatremia: serum/plasma sodium level of 130 or LESS with distinct S&S

List the 3 things the patient's pulse should be evaluated for:

Quality (strong/weak) Rate (tachycardia/bradycardia) Rhythm (normal, abnormal, asynchronous)

What are the policies secondary schools can implement to maximize the use of an AED?

Secondary schools can require all coaches to be CPR/AED certified; to attend annual training on emergency and medical conditions in sports; to have the AEDs easily accessible within 1 minute of any athletic venue; to have an AED on-site at each athletic venue; to have the locations of AED publicly known; to incorporate the use of AED as part of the emergency action plan; and to have the device inspected by designated personnel on a periodic basis.

T/F: A clot in a deep vein that breaks off and travels through the bloodstream to the lungs is known as a pulmonary embolism

True

T/F: Airway inflammation is almost always persistent with asthma patients, even when there is no asthma attack

True

T/F: Asthma exacerbation can lead to fatality in patients with asthma

True

T/F: Children are at an increased risk for thoracic and abdominal injury

True

T/F: Clothing, nutrition, and cold acclimatization are forms of hypothermia prevention.

True

T/F: Complete disruption of the popliteal artery can result from posterior shearing

True

T/F: Diabetes requires subcutaneous insulin infusion either by daily injections or an insulin pump.

True

T/F: Each step in the stepwise RTP process should take 24 hours for the athlete to complete

True

T/F: HAPE and HACE are both caused by a reduction in tissue oxygen saturation.

True

T/F: Hypothermia is classified as mild, moderate, or severe.

True

T/F: Insulin sensitivity is also increased as an athlete becomes more fit.

True

T/F: Metered dose inhalers with a spacer and nebulizers to deliver medications are equally effective for mild asthma exacerbations

True

T/F: Most athletes who suffer sudden cardiac arrest are asymptomatic, and sudden death may be the first clinical event of their disease

True

T/F: Patients with multiple-ligament knee injuries should be assessed for neurovascular injury

True

T/F: Previous number of concussions has been shown to be a predisposing factor associated with subsequent concussion

True

T/F: Prolonged use of a long-acting beta agonist causes tachycardia

True

T/F: Rectal temperature is the only accurate temperature-assessment method for exercising individuals that can be quickly obtained

True

T/F: Respiratory distress can be defined as a breathing rate greater than 30 breaths per minute and a heart rate greater than 120 beats per minute

True

T/F: The most common manifestations of an anaphylactic reaction are hives and welts.

True

T/F: VCD (vocal cord dysfunction) often responds when a person practices breathing/relaxation techniques

True

T/F: Varus stress is a common mechanism of peroneal nerve injury

True

T/F: When evaluating a brain-injured athlete, a primary survey involving basic life support should be performed first

True

T/F: after it is established that a duty exists, the plaintiff needs to show that a duty was breached in order to prove breach of duty

True

T/F: defenses do not prevent a negligence claim but can be used by the defendant to minimize damages or dismiss a claim

True

T/F: laws can be developed by legislative bodies or by courts

True

T/F: some senior citizens are owed a heightened duty of care, as well as those with disabilities

True

T/F: the plaintiff is the person or persons who start the lawsuit by filing the complaint against another party

True

T/F: An individual's core body temperature can actually lower while exercising in rainy conditions if the intensity is low

True?

What is the most common mechanism of injury in sports leading to a cervical spinal cord injury?

axial loading

Conduction is a pathway for

both heat gain and loss

Convection is a pathway for:

both heat gain and loss

Which of the following is generally defined as a blood glucose level less than 70 mg/dL and the athlete is conscious, coherent, and able to follow directions?

mild hypoglycemia

What can be done to further evaluate the cause of a sudden cardiac death if the initial autopsy is negative?

postmorten genetic testing also known as molecular autopsy

What is the name of the specific arrhythmia associated with long QT syndrome that results in syncope and/or death?

torsades de pointes

When should athletes be able to RTP?

when they are asymptomatic, with full pain-free ROM