EXSS 288 Final
What is thoracic outlet syndrome (TOS) & how can you check it?
Definition: Compression of subclavian artery and brachial plexus; not life-threatening; more of a condition than overuse injury Caused by repetitive overhead motions Causes circulatory and neurological deficits in arm To test: Check pulse with arm out to side, then have them take deep breath and turn head out to the side, check pulse again, if it diminished then they have thoracic outlet syndrome
Signs of cheekbone fracture?
Deformity, or bony discrepancy Nosebleed Diplopia Double vision Cheek numbness
Cause of mandible fracture?
Direct blow (generally fractures at frontal angle) Mouth guard helps preserve teeth and keep mandible in line
Cause of spleen injury?
Direct blow to upper left quadrant Falling on Upper Left quadrant Infectious mononucleosis (mono) causes enlarged spleen putting athlete at risk because it is easier to injury due to large size
What happens during a supracondylar fracture?
Distal segment is pushed up and back & May appear as posterior dislocation (Volkmann's Ischemic Contracture)
What kinds of elbow sprains are possible?
Either ulnar/radial collateral ligament or anterior capsule
How can you avoid dehydration?
Establish a hydration protocol for athletes: 1. Determine individual sweat rate - Changes in body weight (pre-post weighings) 1 pound = 1 pint additional fluids during exercise; Goal: no weight loss (or < 2% wt loss) 2. Urine color or urine specific gravity Urine strips that you can run under urine stream to see the gravity Want clear or light yellow Emphasize continual fluid replacement: 1. Replace fluids as they are lost (rule of thumb: 1/2-1 cup per 10-15 minutes of exercise) 2. Practice fluid replacement (gradually increase fluids) 3. Use individual clear bottles for visual monitoring Understand each athlete's sport dynamics (rest breaks) Establish athlete's acclimatized state (work up to extrinsic/intrinsic factors)
Treatment for kidney contusion?
Have athlete urinate 2-3 times to determine if there is blood in urine Call 911 if necessary Treat for shock Don't give them any food or water Maintain normal body temperature Put in comfortable position: knees bent, usually lay on opposite of side of kidney contusion Check pupils, respiration, blood pressure Immediate physician referral there is hematuria 24 hour hospitalization for observation Gradual increase in fluid intake If hemorrhage fails to stop, surgical intervention 6-8 weeks of recovery Usually takes 2 weeks bed rest prior to return to activity
What is a costochondral separation?
Higher incidence than fracture Same signs and symptoms as Fx other than area of pain localization Pain at the costochondral junction Do refer to doctor or hospital with this injury
Signs & symptoms of spleen injury?
History of injury Signs of shock-dizziness, thirst, pale, sweating, rapid pulse/respirations Abdominal rigidity Nausea Vomiting Kehr's sign (left arm and left shoulder) Reflex (referred) pain that comes on about 30 minutes after injury where pain radiates to the left shoulder and 1/3 the way down the left arm **if you put one hand on top of the other and press down slightly and release on the individual, they will have a lot of pain during release
What are the hollow organs?
Hollow organs: stomach, small and large intestines, gallbladder, fallopian tubes, ureters, and uniary bladder,
Care for humerus fracture?
Humeral fracture- put in a sling, take to UC or ER for x-ray and pain meds; ice as long as circulation & innervation -If responding to the fracture on the field, or elsewhere, sling or strap to body, don't need ambulance, can take by car and bring pillow for them to rest their arm on, also bring ice (ice for 20 minutes every 2-3 hours for 48-72 hours)
Humerus fractures
Humerus: Shaft - Often significant deformity Surgical neck - Danger to neurovascular structures Avascular necrosis Proximal humeral epiphysis-Most common in young athletes
What are some worries with elbow dislocations? or any dislocations?
Involve rupturing and tearing of most of the stabilizing ligamentous tissue accompanied by profuse internal bleeding and subsequent swelling May be injury to nerves and blood vessels (neurovascular problems)
What is "frost nip" aka chilblains?
Involves, ears, nose, chin, fingers, and toes - Body parts furthest away from heart Occurs with high wind and/or severe cold for long period of time Skin appears firm with cold painless areas that may peel and blister (24-72 hours)
How do you treat cardiac tamponade?
It's a medical emergency b/c you need to relieve the pressure from fluid accumulation
What is the flash-to-bang method?
It's the Lightening-to-thunder count (see lightening then count how long until a thunder comes after), then divide by 5 to calculate milage distance 30s: inherent danger b/c you can be stroke from up to 10 miles away 15s: immediately clear the field
Where is heart pain region?
Kehr's area (left chest/arm) & between shoulder blades
What is the most commonly injured organ?
Kidney (right is slightly lower than the left one b/c of liver) & is protected by the ribs
What is the least severe & most severe heat illness?
Least: heat syncope Most: hyponatremia
Mechanism of injury & Care for rotator cuff injury
Mechanism: dynamic rotation at high velocity Care: PRICE
What is "game-keeper's thumb or skier's thumb?"
Metaphalangal joint sprain: Gamekeeper's thumb- pulled joint away from rest of the fingers/hand. Gamekeeper's- killing a chicken, skier's thumb- holding a pole Ulnar collateral ligament- the actual injury does not happen on thumb side. It happens on side closest to ulna
Where is stomach pain region
Middle of abdomen (right under breasts) & middle of back
Signs & symptoms of appendicitis?
Mild to severe cramps in lower abdomen Nausea, vomiting Low grade fever of 99-100 Later cramps localize to lower right quadrant McBurney's point: ½ way between belly button & appendix area Refer to physician immediately Surgery usually indicated to prevent rupture
What are the levels of dehydration?
Mild: <5% of weight loss Moderate: 5-10% weight loss Severe: 10-15% weight loss (requires immediate medical attention and can lead to death)
What is the most common cause of elbow dislocations?
Most are caused by falling on the outstretched hand with elbow hyperextension or by a severe twist while elbow is flexed "FOOSH: Fall on the outstretched hand
What is the most common elbow dislocation?
Most are posterior with olecranon process extending backward
Sign of cervical fracture
Neck point tenderness, restricted motion, cervical muscle spasm, cervical pain, pain in the chest and extremities, numbness in the trunk and or limbs, weakness in the trunk and/or limbs, loss of bladder and bowel control
How to handle a glenohumeral dislocation?
Not a medical emergency unless circulation is compromised. Use a sling & swathe, take individual to ER
What is smith's fracture?
Occurs at distal radius leading to palmar displacement of the radius typically because of hyperflexion **always check circulation: - radial/ulnar pulse, color, temp, capillary refill and innervation (dermatomes and wiggling fingers slightly)
What is colles fracture?
Occurs at the distal radius leading to dorsal displacement of radius because of hyperextension *Always check circulation: - radial/ulnar pulse, color, temp, capillary refill and innervation (dermatomes and wiggling fingers slightly)
What is sickle cell trait (AS) ?
Occurs when a person inherits a normal gene (A) from 1 parent & a sickle gene (S) from the other
What is ulnar neuropathy or "cyclist's palsy?"
Overuse/Compression/direct trauma of the ulnar nerve in the hypothenar eminence (squishy part of hand under pinky to wrist) -The little finger and half of ring finger will start to go tingly or numb or both!
What is a very common injury to the hand?
PIP & DIP sprain: "jammed" finger
Sign of mandible injury?
Pain with biting Deformity Loss of occlusion Close the mouth bleeding around teeth lower lip anesthesia
Signs of retinal detachment?
Painless Flash of light Curtain falling over the eye (Gets darker & darker until all dark) May report floating specks Blurred vision
What is pneumothorax?
Pleural cavity becomes filled with air, negatively pressurizing the cavity, causing a lung to collapse Will produce pain, difficulty with breathing and anoxia (absence of oxygen- bluish lips) Risk with compression to thorax (direct blow or squeeze)
What is tension pneumothorax?
Pleural sac on one side fills with air displacing lung and heart, compressing the opposite lung May cause shortness of breath, chest pain, absence of breath sounds on that side, cyanosis, distention of neck veins (bulge out), deviated trachea to one side
Signs & symptoms of rib fracture
Point tenderness Sharp Pain when breathing in Hurts to touch *rib contusion is similar but instead of pain when breathing; there's pain when touched
Treatment for chronic elbow injuries?
Prevent my ensuring the mechanics of throwing or hitting are correct and not creating unnecessary stresses/strains, stretch & strengthen muscles are joint
Signs of nasal fracture?
Profuse bleeding and hemorrhaging, Immediate swelling and deformity
Why is the bursa in the elbow frequently injured?
Prone to acute/chronic injury because of superficial location & results because of direct blow/fall
What is second impact syndrome?
Rapid brain swelling and herniation occurs following minor head injury in individuals who still have symptoms from a prior head injury; second head injury before symptoms from 1st have resolved
What is a risk to athletes with Sickle Cell Trait?
Red blood cells can sickle during intense exertion, blocking blood vessels- they become more like a disc and prevents blood flow -Cessation of activity with onset of symptoms such as muscle 'cramping', pain, swelling, weakness, tenderness; inability to "catch breath", fatigue.
What organs are in the right upper quadrant?
Right lobe of liver, gallbladder, right kidney, portions of stomach, small and large intestine
What are the red flags of a concussion?
S/S lasting longer than 7-10 days Extensive loss of consciousness or amnesia Deterioration over time instead of resolution Disorientation Compounded by multiple concussions Personality changes Other neurological disorders present
What does the surgical procedure called the "tommy john" repair?
Surgical procedure called "tommy john" is often used to repair the medial collateral ligament and joint capsule
T/F: heat illness can still occur in cold environments?
T: if body is unable to dissipate heat, it can cause heat illness, which is why it's so important to layer
T/F: Exertional Heatstroke is a medical emergency?
TRUE: need an ambulance ASAP b/c you're frying brain cells if core temp is above 104
How to care for mandible fracture?
Temporary immobilization w/ elastic wrap followed by reduction and fixation
what is subdural hematoma?
Usually venous and slower -you wake the person up ever little while to see if they are oka
How can someone fracture their scapula?
Very uncommon in athletes, but more car accidents Caused by direct blow to scapula from baseball or other hard ball
Cause of cervical dislocation?
Violent flexion and rotation of the head
How do rib fractures happen?
Violent muscular contraction Coughing or sneezing (holding in a sneeze creates excess pressure) Direct blow Typically more serious due to inward displacement of jagged fracture ends & worry about puncture wounds
How much of the body is made of water?
Women: 50% Men: 60% Water makes up 75% of muscle mass, but only 25% of fat, so a person with less fat will have a higher water percentage
Where do the wrist extensors originate?
Wrist extensors originate on lateral side of forearm
How to care for orbital fracture?
X-ray will be necessary to confirm fracture Antibiotics Decrease risk of infection (due to proximity of maxillary sinus and bacteria) Treat surgically or allow to resolve spontaneously
Common mechanism for shoulder dislocation
abduction & external rotation; flexed at 90˙ & rotated backward (handing something to someone behind you) Common in football, rugby & lax
Where is the urinary bladder referred pain area?
above private area, anus, & back of groin
What joint is associated with shoulder separation?
acromioclavicular joint (AC) Mechanism: FOOSH *When you push down on bone, it pops back up (dislocation) ~ Typically non-surgical *One clavicle sits higher than the other Care: Sling & Ice
Where is appendix pain point?
appendix area
What is a hill-sahs lesion?
articulating surface at top of the humerus is chipped or torn during dislocation
Where is small intestine pain region?
belly button
Where is the kidney referred pain area?
belt area
How does cardiac tamponade occur? What are signs and symptoms?
blunt trauma Signs/Symptoms: 1. pulse pressure decreases 2. chest pain
What are the signals of hypothermia?
body temp. below 95˙F Shivering (may be absent in the later stages of hypothermia: occurs & doesn't stop) Numbness. Glassy stare. Apathy. Weakness. Impaired judgment. Could be unconscious, have slow breathing or may feel stiff as muscles become rigid
What is volkamann's contracture?
brachial artery & median nerve get pinched in the fracture of the humerus & hand hangs down because of nerve/artery damage
Where do heat cramps usually occur?
calves, hamstrings, lower abdomen
What organs are in the right lower quadrant?
cecum, vermiform appendix, portions of small intestine, reproductive organs (right ovary in female & spermatic cord in male) & right ureter
What is the most common fracture in sports?
clavicle fracture
Cause of Zygomatic (cheekbone) fracture?
direct blow
Cause of a tooth subluxation, luxation or avulsion
direct blow
Cause of nasal fracture?
direct trauma
Cause of orbital fracture?
direct traumua to the eyeball
What type of injury usually happens to the phalanges?
dislocations at PIP jiont, but sometimes fractures Cause: "jammed" or caught in jersey, net, etc. Often associated with fracture Can be open dislocation
Signs of a black eye?
displayed as a subconjunctival hemorrhage (Part below the eye-inside of the bottom eyelid) Swelling and discoloration
What is bennett's fracture?
fracture of the 1st metacarpal at Intra-articular (carpal-metacarapal joint), which typically needs fixation
What is the Boxer's fracture
fracture of the 5th metacarpal b/c compression forces going straight though the bones
Where is ureter pain point?
groin
Cause of a tooth fracture?
impact to jaw or direct dental tramua
What is the cause of heat exhaustion?
inadequate fluid replacement
What results when there is hyperextension or a valgus force that twists the lower arm outward?
injury to the medial/ulnar collateral ligament of the elbow *hyperextension more common in females
What should you always check for in dislocations?
innervation & circulation
What is one of the most common problems of the elbow in sports?
lateral epicondylitis
Where is the ovary referred pain region?
left & right of belly button
Where is pancreas pain region?
left back area & to the right and down of left nipple
What organs are in the left upper quadrant?
left lobe of liver, stomach, pancreas, left kidney, spleen, portions of large intestine
Where is lung and diaphragm pain region?
left shoulder
What are the solid organs?
liver (most concerning/struck from front), spleen (very concerning/ usually injured in car accident), kidney (concerning/struck from back), pancreas, ovaries, uterus, and adrenal gland *They don't collapse when impacted because they are not hollow organs
Where is liver/gallbladder pain region?
liver area on front and back & right shoulder/neck below right scapula
What is the most commonly dislocated bone in the hand?
lunate & is caused by a fall in either direction (flexion & extension)
Where doe the wrist flexors originate?
medical side of the forearm
What organs are in the left lower quadrant?
most of small intestine, portions of large intestine, left ureter, reproductive organs (left ovary in females & left spermatic cord in male)
What is biceps brachii tendonitis?
occurs in Bicipital groove where the tendon is located Eccentric contractions May involve subluxation of tendon (Popping out: partial dislocation) because the ligament that is holding in the bicep tendon is torn
how do chronic elbow injuries occur?
the mechanics of throwing or hitting are not correct and are creating unnecessary stresses/strains
What nerve do you hit when you say "funny bone?"
ulnar nerve
Where does the median nerve track?
under retinaculum ~ carpal tunnel syndrome
What is the problem with a scaphoid fracture?
you can have necrosis. There isnt good blood supply to this particular bone and doesn't heal well. It has to be immobilized to heal properly
What does an avulsion fracture of the flexor digitorum profundus create?
"jersey finger" b/c finger is usually caught it in a jersey. It will just hang there. To tell if someone has jersey finger: ask them to flex their finger and they won't be able to.
What does an avulsion fracture of the extensor digitorum produce?
"mallet finger" happens when the finger is straight and there is a force on the end putting it in hyperflexion that leads to popping the extensor tendon out of place. You must splint the distal interphalangeal joint (DIP) straight immediately- put something underneath it and tape it so it stays straight. If you don't, there may not be reattachment.
What populations is sickle cell trait most predominant in ?
1. African Americans 2. Mediterranean 3. Middle Eastern 4. Indian 5. Caribbean 6. South & Central America ancestry
Cause of cervical fractures
1. Axial load 2. Rotation that may result in dislocation
Causes of spinal injury:
1. Axial loading: pine drive 2. Flexion, hyperextension or hyper rotation 3. Excessive lateral bending 4. distraction (pulling head away from trunk)
What are some training guidelines for athletes with sickle cell trait?
1. Building up slowly in training with paced progressions, allowing longer periods of rest and recovery between repetitions. 2. Participating in pre-season strength and conditioning programs to enhance the preparedness of athletes for performance testing which should be sport-specific.
How to prevent facial injuries?
1. Common sense 2. Wear proper protective equipment (face mask, helmet, mouth guard, googles/eyewear, headgear)
How do we manage heat stress?
1. Conduction: direct contact with a surface/other objects 2. Convection: Contact with cool air or water mass (ex: sitting in cold-tub) 3. Radiation: heat generated form metabolism (ex: digestion; moving from sun to shade 4. Evaporation: sweating - wiping off sweat with a towel
How can you get a concussion?
1. Direct blow or impulsive forces transmitted to head 2. Can get a concussion from transmittal forces (falling on your tailbone and the force is shot up the spinal cord)
What happens during a second impact syndrome?
1. Direct blow, followed by 15 sec. where athlete appears stunned, but does not initially lose consciousness 2. Within several sec. - 1 min. athlete collapses 3. Rapidly dilating pupils & loss of eye movement 4. Evidence of respiratory failure
What are common causes of exertional hyponatremia?
1. Excessive fluid consumption (too much water w/o electrolytes) 2. Too little Sodium in diet 3. Excessive sodium loss in sweat ("salty" sweaters" 4. Long periods of sweating, but not sweating out enough for amount your drinking **fluid intake should not exceed fluid losses
What are risk factors with exterional hyponatremia?
1. Heat stress environment 2. long durations (marathons) 3. Slower athletes 4. non-acclimatized athletes 5. Small body weight
How to treat heat cramps?
1. Prevention: stop activity 2. fluid ingestion: extra fluid and electrolytes; IV 3. Light stretching 4. ice massage 5. unlikely return to play until replenished
How to treat for spinal injury on the field?
1. Primary evaluation 2. evaluate neurological conditions 3. Immobilize athletes who are unconscious, numb, weak, paralyzed, or have neck pain
What are four overuse injuries?
1. Rotator cuff strain 2. Biceps brachii tendinitis 3. Impingement syndrome 4. Thoracic outlet syndrome
How can you prevent SIS?
1. SIS can be prevented by proper identification and management of concussions 2. Do not bargain with the athlete 3. Objective Management (don't take into consideration anything related to the sport field) Does the time of season matter? Does the opponent matter?
What kind of fractures are possible in the elbow?
1. Supracondylar fracture 2. Medial epicondyle fracture 3. Radial head fracture 4. Olecranon process fracture
How to evaluate a concussion?
1. Symptom score 2. Balance 3. Neurocognitive testing
How can we prevent concussion?
1. Teach proper technique 2. encourage good sportsmanship 3. wear proper equipment
How to prevent hypothermia?
1. appropriate apparel 2. Waterproof/windproof fabric 3. layering 4. proper warm-up
What are some problems that can arise with sickle cell trait?
1. blood in urine, occasionally 2. pain and discomfort at high altitudes 3. problems with extreme exercise in hot, humid weather
what are the signs and symptoms of exertional heatstroke?
1. collapse 2. seizures 3. loss of consciousness 4. flushed, hot skin 5. minimal sweating: sweat mechanism stops b/c they can't dissipate heat 6. Shallow breathing 7. core temp: 104+
Where is medial epicondyle fracture most commonly seen?
1. elbow dislocation 2. young throwing athletes
Treatment for heat exhaustion
1. immediate fluid replacement (IV) 2. cool environment 3. Wipe off sweat/change clothes so that they don't shiver when they cool down 4. don't return to play for 48 hours+ 5. Prevention
Care for a nosebleed?
1. lean forward (not al the way down) 2. pressure on the affected nostril (pinch nasal bone between eyes) 3. w/ a cold compress (ice constricts blood vessels & reduces bleeding) over the nose 4. Also gauze under nose 5. put gauze between the upper lip and gum & push up - limits blood supply (pressure point in the mouth) If bleeding does not cease in 5 minutes, use a gauze/cotton nose plug to encourage clotting
What are the signs and symptoms of heat exhaustion?
1. profuse sweating: could ring out a shirt with sweat 2. pale skin 3. increase temp. 4. dizziness 5. hyperventilation 6. rapid pulse 7. cramping 8. core temp: 102 9. decreased performance
What is the recommended fluid consumption for a pound of weight loss?
16-24 ounces & replace CHO and electrolytes (sodium & potassium) at same time to speed rehydration
How does the radial head of the elbow fracture?
1Repeated compressive stress: (Capitulum & radial head or Valgus stress during throwing (jamming) 2. Single bout, excessive compressive stress: (Direct blow or fall outstretched arm)
How much water does the average person lose each day?
2.5 liters
Tooth injury?
A: Uncomplicated fractures produce fragments w/out bleeding B: Complicated fractures produce bleeding, w/ the tooth chamber being exposed w/ a great deal of pain C: Root fractures are difficult to determine and require follow-up w/ X-ray
Treatment of a bursa?
Acute condition: ice/compression Chronic: protective therapy pad during competition
What is epidural hematoma?
Arterial bleeding & fast bleeding -no time to spare -individual would be unconscious, one pupil would be dilated and one is constricted
Signs of scalp injury?
Athlete complains of blow to the head Bleeding is often extensive even if the tiniest wound
What type of athletes are prone to injuring the ulnar nerve?
Athletes with pronounced cubitus valgus (outward angle) are prone to injurying the ulnar nerve an the elbow may develop friction problems
Why is the ulnar nerve subject to a variety of problems?
B/c the medical humeral condyle is largely exposed
What is hemothorax?
Blood in pleural cavity causes tearing or puncturing of the lungs or pleural tissue Painful breathing, dyspnea, coughing up frothy blood and signs of shock
What is subungual hematoma? How do you treat it?
Blood pooling pushes up on the nerve under the nail The pressure causes pain You need to release the blood if they have a really bad contusion- send them to hospital to aspirate.
What is often the cause of kidney contusion?
Blow to back
Cause of TMJ?
Blow to chin or violent opening of mouth
Cause of Orbital hematoma (black eye)
Blow to the area surrounding the eye
Cause of retina detachment?
Blow to the eye can partially or completely separate the retina from the underlying retinal pigment epithelium
What can abdominal injuries produce?
Blows to abdominal area can produce superficial or deep internal injury When there is a deep internal injury, we are most concerned with bleeding & then pathegons & infection *only comprise about 10% of sports injuries, but can be lifethreatening
Cause of skull fracture?
Blunt trauma Can have injury as small as a hairline fracture or as big as divot
Cause of scalp injury?
Blunt trauma or penetrating trauma Can occur in conjunction with serious head trauma
Signs of orbital fracture?
Blurred vision Diplopia (Double vision) Restricted eye movement Downward displacement of the eye If you tell athlete to look up & one or both eyes don't look up Soft-tissue swelling and hemorrhaging Numbness Infraorbital nerve entrapment
Treatment of spleen injury?
Call 911, monitor athlete, conservative, non-operative treatment with about 1 week of hospitalization At 3 weeks can engage in light conditioning Return to full activity at 4 weeks-6 weeks If surgical repair is needed athlete will return to activity at 3 months If surgical removal is necessary, return to activity at 6 months
Why is posterior sternoclavicular dislocations worrisome?
Can be life-threatening because of obstruction of airway and neurovascular structures (veins & nerves) ~ Call EMS Mechanism: FOOSH *Posterior dislocations & strains are rare Anterior dislocations: sling, swathe & take to ER
How do you care for an elbow ligament sprain?
Care: cold and pressure bandage for 24 hours with a sling Main concern: progressively aid the elbow in regaining a full range of motion
Cause of humerus fractures
Cause of injury: Direct blow, dislocation, falling on an outstreatched arm
How is appendicitis created?
Caused by a bacterial infection from: Fecal obstruction, lymph swelling, parasites, tumor Highest incidence between ages of 15-24 Early stages appendix becomes red & swollen Can't see it because so deep Later stages may become gangrenous, rupturing into bowels causing peritonitis
How are rib contusions formed & treated?
Caused by compression Treat with RICE & you can wrap with ACE bandage
How is liver contusions caused?
Caused by hard blow to right side of rib cage
How to care for hypothermia?
Check and care for life-threatening conditions. Check for pulse, breathing, level of consciousness Call 9-1-1 or the local emergency number asap. Carefully remove wet clothing and dry the victim. Warm the body in a consistently warm environment gradually Move the victim to a warm environment. If available, apply hot water bottles, chemical heat packs or other consistent heat sources to the body - cover head and neck Give warm liquids to drink if alert
Cause & symptoms of clavicle fracture
Clavicle fractures Mechanism:Fall on outstretched hand (FOOSH) Typically fractures at junction of middle & distal 1/3 Can be greenstick fracture in adolescents (bending) This fracture would most likely see a deformity because its so close to the surface Athlete usually supports the arm and tilts their head toward that side with the chin turned toward the opposite side
How to care for scalp injury?
Clean w/ antiseptic soap and water (remove debris) Cut away hair if necessary to expose area Apply firm pressure or astringent to reduce bleeding Wounds larger than 1/2 inch in length should be referred
How to care for a black eye?
Cold application for at least 30 minutes, 24 hours of rest if athlete has distorted vision Do not blow nose after acute eye injury - may increase hemorrhaging
Care for cheekbone fracture?
Cold application to control edema and immediate referral to a physician Healing will take 6-8 weeks and proper gear will be required upon return to play
Sign of ear drum rupture?
Complaint of loud pop, followed by pain in ear, nausea, vomiting, and dizziness Hearing loss, visible rupture - cut (seen through otoscope)
What is carpal tunnel syndrome?
Compression on the median nerve at the wrist Very common in 30-50 y.o. females Usually in dominant hand Can be caused from direct trauma (hyperextension) or overuse (laptop usage) Causes a lot of fluid in the tunnel, which causes pressure to impinge the nerve
Treatment for exertional heatstroke?
COOL FIRST, TRANSPORT SECOND Temp must be lowered within 45 min Need to get temp down as EMS is on the way Strip clothing Sponge cool water Ice bath plunge**** If not ice bath, put it in earpit, groin, neck
Signs of cervical dislocation?
Considerable pain, numbness, weakness, or bilateral paralysis Unilateral dislocation causes the head to be tilted toward the dislocated side with extreme muscle tightness on the elongated side
Care for nasal fracture?
Control bleeding and refer to a physician for X-ray, examination and reduction Refer Immediately or wait 3-5 days Uncomplicated and simple fractures will pose little problem for the athlete's quick return Splinting may be necessary
How can you tell if someone broke their scaphoid?
press the anatomical snuff box and if it's fractured, they'll scream
What does the annular ligament help with?
prevents radial head luxation; forms a sling around the radial head
How is medial epichondylitis "little league/pitcher's/golfer's/ javelin-thrower's/ racquetball elbow" caused?
repeated forceful flexion of the wrist leading to pain around medial epicondyle
How do acute elbow injuries occur?
result from direct blow or fall on an outstretched hand (football, baseball) - learn how to fall correctly
Cause of nosebleeds (epistaxis)
result of a direct blow sinus infection high humidity or dry air allergies a foreign body or some other serious facial injury
Where is the colon referred pain region?
right above bladder
Signs of a skull fracture?
-Severe headache and nausea -Palpation may reveal defect in skull -May be blood in the middle ear, ear canal, nose, ecchymosis around the eyes - bruise around the eye (raccoon eyes) or behind the ear (Battle's sign - bruise behind earr) -Cerebrospinal fluid (clear fluid) may also appear in ear and nose Terrible sign because leaking fluid from the brain
How to prevent all heat related illnesses?
-Sports drinks (Water, CHO, Electrolytes) -Rest -Adequate cooling -clothing & equipment -Fans/AC -monitoring equipment -acclimatization
What is deep frostbite?
-frozen skin requiring hospitalization -tissue will be blotchy red, swollen, painful and may become gangrenous (not viable tissue) -rapid re-warming is necessary (100-110˙F)
What is the cause of exertional heat cramps?
-overexertion -poor hydration & electrolyte replacement (fluid & electrolyte are not in balance)
What is the most commonly broken bone in the hand?
scaphoid b/c of extension of wrist (FOOSH)
Signs & Symptoms of kidney contusions?
signs of shock nausea vomiting rigidity of muscles of back Muscles are spasm (they are very firm) to protect hematuria (blood in urine) referred pain radiates forward around the trunk into the lower abdominal region (like a belt)
How is lateral epicondylitis ("tennis elbow") caused?
stems from a backhand strike involving repetitive overextension of the wrist; Irritation & inflammation of the insertion of the extensor muscle of lateral epicondyle Pain during activity with weakness
What is the most common type of elbow fracture?
supracondylar fracture
What is the primary mechanism for heat loss?
sweating
How can the ulnar nerve become dislocated?
Ulnar nerve can become dislocated b/c of structural deformity or impinged by a ligament during flexion
waht ligaments are most important for stability against a valgus/varus force in the elbow?
Ulnar/medial ligament: most important for stability to a valgus force Radiall/lateral ligament: stability to a varus force
Care of tooth fractures?
Uncomplicated and complicated crown fractures do not require immediate attention Fractured pieces can be placed in a bag, milk, or save-a-tooth solution DO NOT place the avulsed tooth portion in ice If not sensitive to air or cold, follow-up can wait orthodontist within 24-48 hours Cosmetic reconstruction of tooth
Guidelines for lightning storms?
-Avoid large trees, flag/light poles, standing water, telephones, pools, showers, metal objects -Last resorts - car, ravine, ditch, valley for safety -If your hair "stands up" there'simminent danger -Get down & lie flat so that it is more dispersed -commonly accompanied by thunder (2-40% of time when there's an atom disturbance)
what type of fracture is a medical epicondylar fracture usually?
-Avulsion Fracture (Common flexor tendon pulls it during Acceleration phase Ulnar collateral ligament pulls it Cocking & acceleration phases
What are the signs and symptoms of heat syncope "heat collapse"?
-Fatigue -Sweating a lot -heat overexposure f
What is superficial frostbite?
-Involves only skin and subcutaneous tissue (appears pale/blue, hard, cold & waxy) -it may blister and be painful for several weeks (ice crystals form under skin)
How do you treat heat syncope "heat collapse?"
-Move to cool environment -Cold liquid consumption -lay athlete down
Symptoms of a concussion?
-Nausea -Balance -Double or fuzzy vision -Sensitivity to light -headache -sluggish -foggy or groggy -concentration/memory problems -confusion -lose of consciousness -can't recall events before or after
Treatment for superficial frostbite?
-Rewarm in a warm environment where it won't refreeze - take off wet clothes & put on dry -when rewarming, area will feel numb, sting and burn -recovers well don't pop blisters
Care for tooth subluxation, luxation or avulsion
For a subluxed tooth, referral should occur w/in the first 48 hours You wanted it secured with a luxated tooth, repositioning should be attempted along w/ immediate follow-up Avulsed teeth should not be re-implanted except by a dentist (use a Save a Tooth Kit, milk or saline) Don't try to reposition it in the mouth
What types of athletes face impingment syndrome?
Found in overhead athletes Swimmers, throwers, volleyball, etc. * Pathologies can vary from Subacromial bursitis to Supraspinatus tendinitis to Bicipital tendinitis (long head) to Labral tears *shape of acromion process also affects athlete
What can elbow pain result from?
From internal organ dysfunction or referred from a nerve root irritation or nerve impingement or referred from the pain of the neck or shoulder
What are ganglion cysts?
Ganglion cysts are benign collections of tissues (too much tissue plus fluid), not cancerous Generally caused by a herniation- weak area of a structure, something bulges out because of the weakened area (inner tube, a weak area of the tube causes the sides to bubble through)
Cause of bone spurs
Spur is because of running and friction that results in extra calcium buildup
How do you tell whether its a stroke or cervical damage?
Stroke: unilateral problems Cervical: bilateral problems
sign of tooth subluxation, luxation or avulsion
Subluxed tooth: permanent tooth that is loose w/in socket w/ little or no pain Luxated tooth: no fracture has occurred, however, there is displacement Avulsion: the tooth is completely knocked from the oral cavity
What is a "stitch in side?"
Cramp like pain developing along costal angle (rib angle) during activity Usually seen in running sports Cause not clear; multiple possible etiologies One thought: if people are not exhaling well, it creates extra tension in abdominal cavity Relief by stretching arm on affected side or by forward flexion of trunk
How to care for a cervical dislocation?
Extreme care must be used - more likely to cause spinal cord injury than a fracture Keep head in position found Keep person calm (If they ask you how it looks, you can say you can't tell because you don't have that training)
Signs of TMJ?
Extreme pain, jaw will be "locked" open to one side, deformity (condyles will feel out of place), muscle spasm, athlete will grab mouth to keep it from moving
How are the lunate & scaphoid fractured?
FOOSH
What is the mechanism for wrist sprains?
FOOSH - Hyperextension, but can also happen in hyperflexion
Cause of rupture of tympanic membrane (ear drum)
Fall or slap to the unprotected ear or sudden underwater variation can result in a rupture Holding in a sneeze - less common
T/F: You must be lose consciousness to have a concussion
False: You DON'T have to lose consciousness to have a concussion
What happens if the spleen becomes injured/infected?
If I become injured or diseased, it may have to be removed through a medical procedure called a splenectomy. About 1% of the population is spleenless. You can live without it (although important, its not a vital organ), but your resistance to infection will be lowered, at least initially. some of your other organs like the liver (a real team player), will take over my responsibilities.
How to determine if individual should return to play after concussion?
If remain asymptomatic for 24-48 hrs. after exertional tests, & baseline or better on all tests: consider RTP If athlete becomes symptomatic within 24 hrs. after exertional testing or NP/ PS decline: more rest
How to care for a skull injury?
Immediate hospitalization and referral to neurosurgeon Stabilize head and spine with spine board Keep them awake, if you can - talk with them, ask questions More they stay awake , the better the prognosis Usually also on concussion protocol
How to care for retinal detachment?
Immediate referral to an ophthalmologist Bed rest, patches for both eyes (Heals pretty fast)
How to care for TMJ?
Send to ER for reduction or wire shut
What is the sickle gene?
Sickle gene (S) affects red blood cells, which carry hemoglobin & oxygen
What are signs of an ulnar nerve injury?
Signs: paresthiesia (lack of sensation) of 4th and 5th finger
Who is more susceptible to pneumothorax?
Slender adult male is more susceptible to pneumothorax
Care for an ear drum rupture?
Small to moderate perforations usually heal spontaneously in 1-2 weeks (don't do anything - no drops or meds) If large perforation, there are a variety of choices ear doctor will recommend Infection can occur and must be continually monitored
Treatment for clavicle fracture
This is not a medical emergency, but you should put the arm in a sling and take them to Urgent Care or ER for pain medications. Treatment is usually figure 8 brace & sling the arm with swathe; may need surgery, use ice as long as innervation is okay;
Care for a cervical fracture?
Treat like an unconscious athlete until otherwise rule out - use extreme care Stabilize the head so they cannot move forward, backward, side to side Check breathing & pulse Keep individual calm Call 911 Prevent shock
How are rib fractures treated?
Treat with a pad or bandage to increase the comfort of breathing
Treatment for "frost nip" or chilblains?
Treat with firm pressure, blowing warm air or hands in armpits DON'T rub b/c there could be ice crystals forming under skin and if you rub, you could peel skin
What is the treatment for lateral epicondylitis?
Treatment: PRICE & anti-inflammatory drugs & rehabilitation with ROM exercises, stretching
Treatment for medial epicondylitis?
Treatment: cryotherapy or heat through the application of an ultrasound, anti-inflammatories, counterforce brace, severe cases may have splinting for 7-10 days
how to treat "jersey finger?"
Treatment: splint it in anatomical position (slightly flexed). Balled up socks work wonderfully
True/False: lung injuries are medical emergencies?
True
True/False: Shoulder pointer contusion has the same signs & symptoms as 1˙ AC separation?
True: Happens b/c of fall on or blow to top of shoulder
How do you treat a jammed finger?
Try and see if finger goes side to side (if can't, jammed finger) First aid for jammed finger: splint finger, ice it, light compression, get it looked at
What type of joint is the radio-ulnar?
pivot -pronation/supination
