Sudden Death in Sport, EAPs, Vital Signs & Shock

What is the purpose of position statements?

To educate and give ATCs best practice recommendations to avoid legal repercussions.

What are the top 10 causes of sudden death in athletes?

Cardiac, Exertional Heat Stroke, Traumatic Brain Injuries, Exertional Sickling, Cervical Spine Injury, Traumatic Injuries, Lightning, Asthma, Exertional Hyponatremia, and Shock

What are the FOUR H’s? How many of these make up sudden death cases?

Cardiac (**Heart**), Exertional Heat Stroke (**Heat**), Traumatic Brain Injuries (**Head**) and Exertional Sickling (**Hemoglobin**). These make up **90% of all sudden death cases**.

What does the Korey Stringer Institute (KSI) do?

Advocate for certain things such as ATCs in all high schools nationwide, nationwide heat acclimatization and EAP policies in high schools, etc.

What is the best global strategy to prevent sudden death in sport?

Education!!!

Emergency Action Plan (EAP)

a written document that defines the standard of care for the management of emergencies in athletics

What are the core principles of an EAP?

establish a written plan and distribute, sudden cardiac arrest (SCA) awareness training, annual CPR & AED training, rehearse the plan yearly

What are the two most important needs for an EAP?

1. define a standard of care (what needs to be done)


1. should be discussed with ENTIRE sports med staff and created in consultation with local EMS
2. avoid being held liable for claims based on negligence


1. legal implications that will come up if certain aspects of EAP are not done or if an EAP in general does not exist at your venue

What is the medical time out?

Prior to sporting event, entire sports medicine team should come together so Head AT of host site can make everyone aware of what to do if an emergency arises

What are the components of the EAP?

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

emergency personnel

ATCs, AT students, coaches, PTs, etc.

emergency communication

phone and cell numbers, local line to EMS police department public safety on-campus emergency line, certain signals (EX: get EMS, bring spine board, etc.), emergency contact info of athlete if in high school

emergency equipment

AED, trauma/AT kit \[c-spine collar, spine board, vital signs monitors\]. Define roles so people know where things are

medical emergency transportation

address, campus security, parking, agreement on closest hospital for transportation, average ETA time of EMS from the station

venue directions with map

point out EMS entrances on map, each file named or numbered with signs in person, AED on map, quickest way for AT to get from one field to another

emergency documentation

Who is responsible for documenting the events of emergency, follow up documents on eval of response to emergency, documentation of periodic rehearsal of EAP and institutional personnel training

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* DOCUMENT EVERYTHING
* done for legal purposes but also need to have injury reports for other medical professionsals

What is the primary purpose of a PPE?

identify an athlete who may be at risk, not just for emergencies but also for those who are predisposed to re-injure themselves

When should PPEs be done?

EVERY YEAR prior to the start of athletics, usually in July/August

Pros of a PPE done by Personal Physician

1-on-1, more personable. More common in HIGH SCHOOL/LOWER SCHOOL settings

Cons of a PPE done by a Personal Physician

not doing a comprehensive exam, no standardized form across medical providers/insurance

Pros of a Station Exam PPE

done with multiple professionals (school sports med team) in a large space with different stations for tests. more common in the COLLEGE setting. athletes will be tested by same medical professionals they’ll be interacting with for the entire season

Cons of a Station Exam PPE

many individuals being tested at once, time constraints - need an entire day to test \~400 athletes

What do PPEs establish?

A BASELINE -- what’s normal for a person that AT can use to compare when athlete gets injured

What are the components of a PPE?

1. Medical and Family Hx
2. Physical Exam
3. Orthopedic Screening
4. Wellness Screening

Medical and Family Hx of PPE

identify any past or present medical problems, updated ANNUALLY, participation release forms for minors, insurance info

Physical Exam of PPE

height, weight, body comp, BP & HR, vision, skin, dental, ENT, heart and lung (by physician), abdomen, lymphatics, urinalysis (separate from drug test), blood work, CV screening, maturity assessment (minors)

Orthopedic Screening of PPE

ROM, strength, stability. Usually normal unless athlete is suffering from injury and/or has history of injury

Wellness Screening of PPE

healthy lifestyle behaviors (tobacco, alcohol, exercise, mental heath, etc.)

Purpose of a Primary Survey, in a potential emergency situation

not as much are about diagnosis BUT trying to determine the severity of situation and immediate courses of action such as moving off the field when safe, sitting with player on field waiting for EMS if needed, etc.

Components of a Primary Survey

* Check scene for anything that would pose risk or interfere with quality of care
* Check consciousness using AVPU scale
* Check ABCs
* Check for signs & Sx of shock

AVPU Scale

* A - ALERT: awake, conscious, responsive, understand situation. Best case scenario
* V - VERBAL STIMULI: able to respond to verbal stimuli but this does NOT mean the injured athlete can verbally respond to YOU.
* P - PAINFUL STIMULI: patient can respond to painful stimuli such as a poke to the leg invoking a twitch/involuntary movement
* U - UNRESPONSIVE: Unconscious, no verbal or painful response. Doesn’t necessarily mean heart has stopped.

ABCs

done whether a person is conscious or not

* if conscious, you know they have a pulse and are breathing but dont know how well they are doing these things
* if unconsciou, pt can still be breathing with heart beat but also may NOT.

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A - AIRWAY: inspect, clear, open, maintain

B - BREATHING

C - CIRCULATION

What are some injuries that have the potential to become life threatening even if during the initial survey everything seems normal?

Cardiac, EHS, Fractures, Basic orthopedic injuries

What are the three most vital signs?

Pulse (HR), Respiration (RR) and Blood Pressure (BP)

Pulse (HR)

direct extension of heart;

adults = 60-100, resting = 60-80

Respiration (RR)

norm for adults = 12-20 breaths/min

bradypnea = less than 12

tachypnea = more than 20

blood pressure (BP)

systolic = contraction of LEFT ventricle, diastolic = residual pressure when heart is between beats (more important than systolic)

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norm = 120/80 mmHg

hypertension = 140/90

hypotension = 90/60

Temperature as a Vital Sign

rectal temperature is the only accurate method to gain immediate reading, especially if exercising

Pupils as a Vital Sign

extremely sensitive to situations affecting the nervous system

PEARL = Pupils are Equal, Active and Reactive to Light

Skin Color as a Vital Sign

norm for exercise = pink/red

abnormal = blue (hypoxia), pale (shock)

pale, ashen, white skin = insufficient circulation, shock (most common), fright, hemorrhage, heat exhaustion, insulin shock

yellow, jaundice = liver disease or dysfunction

Movement as a Vital Sign

inability to move one side = hemiplegia, may be result of head injury or stroke

bilateral UE numbness/weakness = possible c-spine injury

bilateral LE weakness = injury below the neck

limited use of UE and/or LE may be caused by pressure on spinal cord

compensated shock

best case scenario, CV is starting to fail but still trying to correct

most prominent signs = increased HR and RR, attempting to prevent BP from falling by supplying body with more blood and oxygen

* victim does NOT have to be at 90/60 to show signs of shock → if higher than 90/60, dont think shock won’t happen or is in the process of beginning

decompensated shock

occurs when HR and RR can no longer compensate for decrease in BP

* low HR means BP can NOT be restores
* ==**low BP, RR and HR on INITIAL VITAL SIGN CHECK**==

irreversible shock

everything in the body is failing, death is inevitable.

* perfusion to organs cannot be rescued, cell/organ damage