ON-FIELD PHYSIOTHERAPY
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Transcript ON-FIELD PHYSIOTHERAPY
ON-FIELD PHYSIOTHERAPY
CONTENTS
Roles
of on-field physiotherapist
Basic assessment procedures
Prevention and assessment of heat & cold
injuries
Management of acute soft tissue injuries
Why we need
on field
physiotherapy?
ON FIELD
PHYSIOTHERAPIST
Roles
On-field services in
Hong Kong
Team Physiotherapist
Domestic, National
and International
Level
ON-FIELD PHYSIOTHERAPY
SERVICES
1996
International Masters Hockey
Tournament
1996 Seoul International Women’s Road
relay
Hong Kong Cricket team - Bangladesh
Cricket Tournament
Standard Chartered Shenzen - Hong Kong
Marathon
Swire
Group Tsing Ma Bridge 10 km and
Marathon
Hong Kong - Beijing Relay
Standard Chartered International
Marathon (1997-2002)
Sports Physiotherapy in Elite level
SDB,
5 full time physiotherapists
Hong Kong Team physiotherapists
1987 Asian Athletic Championship
1992 Barcelona Olympics, 1994
Commonwealth and Asian Games, 1996
Altanta Olympics (3)
2002 Busan Asian Games: 8
physiotherapists
KNOW THE
SPORT
ON FIELD
SERVICES
KNOW THE
VENUE
PREPARATION
Deployment
Equipment
of manpower
Types of injury
Cases
Muscle soreness/strain
175
Ligamentous sprain
112
Tendonitis
44
Joint problems
41
Contusion
42
Laceration
7
Haematoma
3
Concussion
1
Others
6
Types of services
Number
IFT
44
US
158
TENS
34
HVG
7
ICE
98
Manual technique
210
Massage
211
Strapping and taping
70
Dressing
13
Education and advice
85
ON-FIELD MANAGEMENT
ASSESSMENT
VENUE
PERSON
PROCEDURES
SYSTEMATIC APPROACH
Scene Survey
Is the scene safe?
It
is frequently better to
remain uncertain about a
diagnosis and feel mildly
folish than to be constantly
certain and confirm that you
are an absolute fool.
PRIMARY SURVEY
OF THE PATIENT
LOC
Talk to the patient and assess
his level of consciousness
A Alert
V Response to vocal stimuli
P Response to pain
U Unresponsive
AIRWAY + C-SPINE CONTROL
Is the victim able to maintain his
airway
If he can talk, the airway is OK
Open airway by jaw thrust if
necessary
Do not use head tilt as this may
affect the C-spine
BREATHING
Assess if victim is breathing
adequately. Is it too fast? too slow?
too shallow?
Oxygen, if available, should be given
if breathing is laboured.
Feel for any tenderness
BREATHING
Auscultate the chest for unequal
air entry
Check if the trachea is central
CIRCULATION
Arrest any visible haemorrhage using direct
pressure
Check both carotid and radial pulse
If radial pulse is weak or not palpable, the
patient is probably in shock
Capillary refill is less than 2 second normally
CIRCULATION
If the patient is unresponsive and with
no carotid pulse==> this is cardiac
arrest. you should start
cardiopulmonary resuscitation
immediately
DECISION POINT :
SEND FOR THE AMBULANCE
IMMEDIATELY
Impaired
conscious state
Airway obstruction
Breathing difficulties
Significant external bleeding especially
when control by external pressure is
ineffective
DECISION POINT :
SEND FOR THE AMBULANCE
IMMEDIATELY
feature
of shock: thready pulse, cold
clammy hands, delayed capillary refill
unstable pelvis
major fracture of limb bones
CARDIOPULMONARY
ARREST
PROBABLE
CAUSES:
HEAD TRAUMA
Cx INJURY
MAXILOFACIAL OR THORACIC
TRAUMA
CVA
MYOCARDIAL INFARCTION
HAEMORRHAGE
INTERNAL: COLD
RAPID
PULSE AND RESPIRATION
PALPABLE PAIN AND TENDERNESS
RESTLESSNESS
EXCESSIVE THIRST
BLOOD IN THE URINE OR STOOL
OBSERVE FOR SHOCK OR ARREST
HAEMORRHAGE
External
Direct Pressure
Arterial Pressure Pt. Compression
Area should be elevated
SECONDARY ASSESSMENT
Chief
Complaints
Behaviour of symptoms
Location & radiation of the symptoms
Mode of onset
Mechanism of injury
Functional alterations
Related symptoms
Past injuries
LOOK AND PALPATION
Location
of Pain
Degree & type of swelling
Temperature & texture of the area
Muscle spasm
Tissue continuity & deformity
Neuromuscular function
Abnormal Motion or sensation
MOVEMENT
Active
& Functional Motions
Resistive Motion
Specific Stress Test
Sport Specific Function
Return to activity
HEAT INJURY
Metabolic Heat Stress
Metabolic heat production
Exercise
Shivering
Thryoxine
Sympathetic stimulation
Exercise 20-25x
25% efficiency
Heat Production
Heat Balance
Radiation
Conduction
Convection
Evaporation
Heat loss
WBGT
0.1: 0.7: 0.2
CONVECTION
Responsible
for transferring heat from
working muscles and the skin surface
Temp differential between skin and
environment
Heat transfer coefficient, body surface
area and wind velocity
Minimal body fat and loose-fitting clothing
CONDUCTION
Minimal
effect on body heat transfer
Direct contact between skin and an
object
RADIATION
Solar
radiation and radiation from
tracks, roads, and surrounding
structures
Can be a major contributor to heat
load
EVAPORATION
Most
important heat dissipation
mechanism in warm environments
Sweating – a fit athlete can produce
up to 30 ml of sweat per min
Evaporation depends evaporative heat
transfer coefficient – air velocity and
water vapor pressure gradient
(relative humidity)
WBGT
Wet
Bulb Globe Temperature
Three monitors:
Dry bulb (Tdb) air temperature
Wet bulb (Twb) relative humidity
Black globe (Tg) solar radiation
WBGT = 0.1Tdb + 0.7Twb + 0.2Tg
Without adaptive mechanisms, moderate exercise
could elevate temp by 1C every 5-6’
Fluid/electrolyte
Loss of
solutions
Sodium andadded
Prevention:
Potassium
salt
to food, high
K+ diet
HEAT INJURY
Heat Cramp
Warm, humid
conditions,
inadequate
Cool fluids
fluid
pre-hydrate
replacement
Dehydration
Red, Hot and Dry skin
Heat exhaustion
Strong & Rapid pulse
LackMedical
of sweating, CNS
symptoms
unsteady
Emergency
!! gait
Heat Stroke
confusion, combative
behaviour, coma
Profuse Sweating
Clammy & Cool
Shading
Skin
remove
excess
Headache
&cloth
cooling
with ice,
Weakness
sponges
Nausea &
hydration
Weakness
monitor
Rapid vital
Pulsesign
&
hospital
Disorientation
PREVENTION
Conditioning
sweat rate
Acclimatization
3-4
Thirst:
hrs/day,
poor
indicator
60-70% load
core
temperature
Intake: 400-600 ml 15-20’
5-10
days volume
Fluid replacement 2-3%;
plasma
200-300 ml every 15-20’
exercise
heat storage
Venue and schedule intense
3L/hr
Every L loss, 0.3 C
Q 1L/min
HR 8
CHILDREN AND HEAT
INJURY
Sweat less effectively;
produce metabolic heat
for given workload;
acclimatize more slowly
than adults;
larger M/A;
renal tubular filtration
rate;
self perceive;
BUT HOW ABOUT COLD
INJURY?
Heat
loss also depends on air movement,
humidity, evaporation (sweating) and
ambient temperature
Wind velocity exacerbates heat losses
Adequate clothing
High energy bar
Avoid wind
exposure
Medical
Emergency !!
Mild
Hypothermina
Moderate
Hypothermia
Severe
Hypothermia
Shivering, cold,
hunger
Confusion
muscle spasm
Slow pace
Semi-conscious
confused actions
Extremely tired
Poor coordination
Muscle stiffness
Slurred speech
Disorientation
Loss of consciousness
Faint heartbeat
Acute Sports Injuries
Treatment that comes with
PRICE!
MANAGEMENT OF ACUTE
SOFT TISSUE INJURIES
PRICE
HARM