Emergency Care of the Injured Athlete Athletic Trauma Survey T IC T E L H R T A NCY CARE GE G EME N I N R I A ES TB . AT E C 9 Athletic Training Emergency Care.
Download ReportTranscript Emergency Care of the Injured Athlete Athletic Trauma Survey T IC T E L H R T A NCY CARE GE G EME N I N R I A ES TB . AT E C 9 Athletic Training Emergency Care.
Emergency Care of the Injured Athlete Athletic Trauma Survey T IC T E L H R T A NCY CARE GE G EME N I N R I A ES TB . AT E C 4 9 19 Athletic Training Emergency Care Athletic Training Emergency Care Emergency Situations in Athletics • well documented that emergency situations may occur in athletic competition • sports medicine providers must be skilled in performing emergency evaluation • first responder typically ATC or EMT Athletic Training Emergency Care Emergency Assessment • based upon assessment, first responders make decisions regarding: – extent and seriousness of injuries – treatment options – packaging – transportation Athletic Training Emergency Care Emergency Assessment • EMTs often dispatched where injury/illness has already occurred and emergency assistance has been requested – often unfamiliar with MOI and medical HX – may have multi-trauma or multiple patients requiring triage Athletic Training Emergency Care Emergency Assessment • EMTs use organized process to quickly obtain information vital to patient’s care – primary-secondary survey – assess LOC-ABC – provide immediate basic life support measures as needed – quickly make decision regarding transportation Athletic Training Emergency Care “The Golden Hour” • definitive care cannot be provided for the critical trauma patient in field • time is of essence • pre-hospital care, stabilization in ED, and surgical intervention must all be provided within first critical postinsult “golden hour” Athletic Training Emergency Care “Load and Go” • Patients exhibiting difficulty with respiration, circulation, and/or decreased LOC Athletic Training Emergency Care Emergency Assessment • ATC generally familiar with medical HX of athlete and often witnesses MOI • many athletic injuries, as opposed to multi-trauma patients, involve one organ system or anatomical area – may isolate injury rapidly and address accordingly – may use abridged or modified primarysecondary survey Athletic Training Emergency Care Emergency Assessment • athletic event medical coverage may differ • important for all sports medicine providers to understand importance of organized initial assessment and the ability to work together as a team when an emergency situation arises Athletic Training Emergency Care ATS Case Study One • College basketball guard intercepts pass at midcourt; breaks for basket • Fouled from back; pushed headlong into basketball standard • Falls to floor motionless • ATC and team MD approach athlete – Lying supine, motionless, moaning, eyes closed Athletic Training Emergency Care ATS Case Study One • ATC provides c-spine stabilization and evaluates airway; MD checks breathing and circulation • Athlete breathing; equal carotid and radial pulses • Responsive to pain • After 30 seconds, opens eyes and responds to voice: “What happened ?” Athletic Training Emergency Care ATS Case Study One • Unsure of MOI; however, oriented to surroundings • c/o HA, dizziness; denies nausea • Denies neck pain; no other complaints • NV screening WNL • “Can I try to sit up ?” – helped to sitting position – after brief observation, assisted from court; helped to arena TR for further evaluation Athletic Training Emergency Care ATS Case Study Two • HS football fullback – carries ball in practice – tackled by two defenders simultaneously coming from opposite directions • As players unpile, several hurriedly call for ATC • Approaching athlete, ATC observes writhing in pain, screaming “my leg…my leg” • ATC observes compound tib-fib fracture Athletic Training Emergency Care ATS Case Study Two • ATC dispatches one coach to go to fieldhouse and activate EMS system; second coach to open gate and direct ambulance • Student manager sent to retrieve emergency equipment Athletic Training Emergency Care ATS Case Study Two • Using universal precautions, sterile gauze placed over bleeding wound with direct pressure • Shoe/sock removed • Distal pulses intact; motor and sensation intact Athletic Training Emergency Care ATS Case Study Two • Ambulance arrives; ATC provides HX to EMTs • Vital signs assessed • Compression dressing/ immobilizer placed on athlete’s leg; NV reassessed • Athlete transported; coach accompanies to hospital • ATC contacts parents and team orthopedic surgeon • ATC remains at practice Athletic Training Emergency Care Athletic Trauma Survey (ATS) • Evaluation and management plan for assessing athletic emergencies – Scene Survey – Primary Survey – Secondary Survey Athletic Training Emergency Care Scene Survey • • • • Scene safe ? PPE needed ? Mechanism of injury ? C-spine stabilization required ? • # of athletes injured ? • Additional help needed ? Athletic Training Emergency Care Primary Survey: LOC-ABC • General impression • Chief complaint; apparent life threats • LOC-ABC – ABC: correct any problems identified as you go • Identify priority athletes/transport decision Athletic Training Emergency Care Level of Consciousness • AVPU – Alert – responds to Verbal – responds to Pain • sternal rub • modified jaw thrust • pinch web space – Unresponsive Athletic Training Emergency Care Primary Survey • Airway – patent ? – maintain by jaw thrust – airway management as appropriate Athletic Training Emergency Care Primary Survey • Breathing – assure adequate ventilation – oxygen therapy as appropriate Athletic Training Emergency Care Primary Survey Athletic Training Emergency Care Primary Survey Athletic Training Emergency Care Primary Survey Athletic Training Emergency Care Primary Survey • Circulation – assess pulse at radial and carotid arteries • if pulse present at both, systolic pressure > 80 mm Hg – assess for and control major bleeding – assess skin (color, temperature, and condition) – assess capillary refill Athletic Training Emergency Care Primary Survey • Circulation – – – – cardiac arrest major bleeding vascular compromise shock Athletic Training Emergency Care Secondary Survey • • • • • Baseline vital signs Head-to-toe survey SAMPLE history Focused exam Manage secondary injuries • Reassess LOC/mental status and vital signs Athletic Training Emergency Care Baseline Vital Signs • Absolute – plse – blood pressure – respiration • Relative – O2 saturation – peak expiratory flow rate (PEFR) – temperature • oral, tympanic, rectal Athletic Training Emergency Care Head-To-Toe Survey • Areas of injury should be inspected both visually and by palpation • DCAP-BTLS – – – – – – – – Deformities Contusions (bruising) Abrasions Punctures/Penetrations Burns Tenderness Lacerations Swelling Athletic Training Emergency Care Head-To-Toe Survey • Head – inspect head • eyes: PEARL • discharge from ears, nose, mouth • deformity • Discoloration/ecchymosis – Battle’s sign, raccoon eyes – palpate head Athletic Training Emergency Care Head-To-Toe Survey • Neck – palpate neck – inspect neck • jugular vein distension (JVD) and/or tracheal deviation – tension pneumothorax – pericardial tamponade Athletic Training Emergency Care Head-To-Toe Survey • Chest – inspect – palpate Athletic Training Emergency Care Head-To-Toe Survey • Chest – auscultate lung sounds • mid-axillary line 4th-5th intercostal space • Landmark: “nipple line” – auscultate heart tones Athletic Training Emergency Care Head-To-Toe Survey • Abdomen – inspect – palpate Athletic Training Emergency Care Head-To-Toe Survey • Pelvis • Genitalia/perineum – assess as appropriate Athletic Training Emergency Care Head-To-Toe Survey • Extremities – tenderness/deformity – PMSC • • • • Pulse Motor Sensation Capillary refill Athletic Training Emergency Care Head-To-Toe Survey Athletic Training Emergency Care Head-To-Toe Survey Athletic Training Emergency Care Head-To-Toe Survey • Back – inspect – palpate Athletic Training Emergency Care SAMPLE History • • • • • • Symptoms Allergies Medications Past medical history Last meal Events preceding accident Athletic Training Emergency Care Secondary Survey • Focused examination on areas identified in secondary survey • Manage secondary injuries • Reassess LOC/mental status and vital signs Athletic Training Emergency Care Packaging Athletic Training Emergency Care Emergency Transportation Athletic Training Emergency Care Athletic Trauma Survey • assessment and management of an injured athlete demands a systematic approach • follow steps in orderly and progressive manner to ensure a comprehensive assessment • requires rapid and precise thinking under pressure Athletic Training Emergency Care