Sports Medicine Emergency Care

Primary survey, bleeding, shock, secondary survey

Emergencies

Unexpected occurrences that require immediate attention

Golden hour in trauma care

The first hour after a traumatic injury/medical emergency

Why is “golden hour” so important in emergency care?

Increases patient survival chances & significantly improves recovery outcomes

What happens if mistakes occur during golden hour?

Can increase complication, extend rehabilitation time, or cause fatal outcomes

What is the purpose of on-field injury assessments?

Determine the nature & severity of an injury to establish the course of immediate care

What are the two parts of on-field injury assessments?

Primary survey & secondary survey

Primary survey

First assessment, identify & manage immediate life-threatening conditions

What does the primary survey look for?

ABCs (airway, breathing, circulation, shock)

What is considered a life threatening injury?

Injuries requiring CPR, profuse bleeding, or severe shock

What is the primary indicator that CPR is required

Absence of breathing or heartbeat

Where can you become CPR certified?

American Heart Association (AHA), American Red Cross , or National Safety Council (NSC)

What are the 2 branches for level of consciousness

Conscious or unconscious

What is the emergency protocol for unconscious patients?

Stabilize cervical spine, check ABCs, Call 911, & care for patient until rescue squad arrives

What is the management protocol for conscious patients?

Perform secondary survey, administer treatment, & remove from field or court

What do you assume for any unconscious patient?

Presume spine or neck injury until ruled out

When can you remove the protective helmet of an unconscious patient?

Only after neck/spine injury is ruled out

What to do if an unconscious patient is supine & not breathing?

Establish & manage ABCs immediately

What to do if an unconscious patient is supine & breathing?

Monitor until consciousness is resumed

What to do if an unconscious patient is prone & not breathing?

Log roll & begin CPR immediately

What to do if an unconscious patient is prone & breathing?

Nothing until consciousness resumes, then carefully log roll

What do you do once the patient is stabilized?

Perform secondary survey

What is the proper procedure to remove face masks?

Remove w/ a combo of an electric screwdriver & clip cutters (Anvil Pruner, Trainer’s Angel, FM Extractor)

What is the OSHA universal precaution regarding CPR?

The use of pocket mask/barrier to avoid exposure to blood borne pathogens

When should you remove an athlete’s helmet?

1. Head is not secure

2. Airway can’t be controlled

3. Face mask can’t be removed in reasonable time

4. Helmet prevents immobilization

Secondary survey

Perform more detailed evaluation of the patient’s condition to determine how to handle treatment

What vital signs are checked in the secondary survey?

1. Pulse

2. Consciousness

3. Respiration

4. Blood pressure

5. Temperature

6. Skin color

7. Pupils

8. Movement

Pulse

Direct extension of heart function

What does a rapid and weak pulse mean?

Shock, bleeding, diabetic coma, or heat exhaustion

What does a rapid and strong pulse mean?

Heatstroke or fright

What does a strong and slow pulse mean?

Skull fracture or stroke

What does no pulse mean?

Cardiac arrest or death

Average pulse for an adult

60 - 80 bpm

Average pulse for a child

80 - 100

State of consciousness

Alertness & awareness of environment, as well as response to stimulation

What are the two scales to assert states of consciousness?

AVPU & ACDU

AVPU scale

Alertness, Verbal (response to voice), Pain (responds to painful stimuli) & unresponsiveness (no response to pain)

ACDU scale

Alert, Confused, Drowsy, Unresponsive

What are examples of injuries that can affect consciousness?

Head injury, heat stroke, diabetic coma

Respiration

Breathing

Average respiration rate for adults

12 breaths per minute

Average respiration rate for children

20 - 25 breaths per minute

What does shallow breathing mean?

Typically shock

What does irregular or gasping breathing mean?

Cardiac compromise

What does frothy breathing w/ blood mean?

Chest injury

How to physically assess respiration functions?

Look for the chest rising while feeling & listening for airflow at the mouth & nose

Blood pressure

Systolic & diastolic pressure

Systolic blood pressure

Pressure created by ventricle contraction

Diastolic blood pressure

Residual pressure between beats

Average systolic rate in blood pressure

115 - 130 millimeters of mercury (mm Hg)

Average diastolic rate in blood pressure

75 - 80 millimeters of mercury (mm Hg)

How is blood pressure measured?

With a sphygmomanometer

How to measure blood pressure?

1. Inflate the cuff above the antecubital fossa up to 200 mm Hg

2. Slowly deflate cuff, listening for the first beat (systolic) & final sound (diastolic) with stethoscope

What are the 5 categories of blood pressure?

1. Normal

2. Elevated

3. High blood pressure stage 1

4. High blood pressure stage 2

5. Hypertensive crisis

What’s another word for high blood pressure

Hypertension

Normal blood pressure

Systolic: < 120 & Diastolic: < 80

Elevated blood pressure

Systolic: 120 - 129 & Diastolic: < 80

Hypertension (High blood pressure) Stage 1

Systolic: 130 - 139 & Diastolic: 80 - 89

Hypertension (High blood pressure) Stage 2

Systolic: 140+ & Diastolic: 90+

Hypertensive crisis

Systolic: 180+ & Diastolic: 120+

Temperature

Changes can be the result of disease, cold exposure, pain, fear, or nervousness

Where to measure temperature?

In mouth, under armpit, or against tympanic membrane (eardrum)

Where to measure core temperature?

Rectum

Average temperature

98.6°F

What are different flushes that skin color can take?

Red, white, blue

What can a red flush in the skin mean?

Elevated temp, heat stroke, or high blood pressure

What can a blue tone (cyanotic) in the skin mean?

Airway obstruction or respiratory insufficiency

What signs to look for in dark pigmented skin?

Examine the nail beds, inside lips, mouth, and tongue

What does shock look like on dark pigmented skin?

Skin around nose & mouth will have grayish cast, mouth & tongue will be bluish

How to tell if a patient is hemorrhaging based off skin tone?

Mouth and tongue will become gray

Pupils

Direct extension of the nervous system

What does constricted pupils mean?

Use of a depressant drug

What does dilated pupils mean?

Head injury, shock, use of stimulant

What does it mean when the pupils don’t react/fail to accommodate?

Brain injury, alcohol or drug poisoning

What is more important in diagnosing: pupil response or size?

Pupil response

What does an inability to move mean?

Serious CNS deficits impacting motor control

Hemiplegia

Inability to move one side

What does hemiplegia mean?

May be the result of brain trauma or stroke

What does bilateral upper extremity sensory motor deficits mean?

Cervical spine injury

Pressure on spine or injury can lead to?

Compromised function of lower limbs

What happens if one vertebra is damaged?

Every vertebra below it is compromised

What does numbness & tingling in a limb mean?

Nerve or cold damage

What are some signs of a blocked blood vessel?

Severe pain, lack of pulse, loss of sensation

Total loos of pain sensation

Hysteria, shock, drug use, or spinal cord injury

Generalized local pain

Indicator that spinal injury is not present (e.g. complains that their wrist hurts)

Average blood flow in adults

6 liters of blood

Significant blood loss in adults is?

1 liter of blood

Average blood flow in children

1.5 - 2 liters of blood

Significant blood loss in children is?

½ liter of blood

Average blood flow in infants

300+ mL of blood

Significant blood loss in infants?

100 mL

What is the body’s response to losing 15% of blood volume?

Vasoconstriction to maintain BP & homeostasis

What is the body’s response to losing 30% of blood volume?

Vasoconstriction & some blood is diverted from the urinary & digestive system towards vital organs

What is the patient’s response to losing 30% of blood volume?

• Restless & confused

• Vital signs: pulse increases, skin is pale cool & dry

What is the body’s response to losing 40% of blood volume?

Blood pressure falls as the body can’t maintain vasoconstriction, blood to vital organs decreases

What is the patient’s response to losing 40% of blood volume?

• Confusion, restlessness, & anxiety

• BP decreases, pulse > 100, breathing is rapid, temperature decreases, skin is cool & extremities damp

What is the body’s response to losing more than 40% of blood volume?

Blood pressure continues to drop → blood flow to organs & tissues decreases further

What is the patient’s response to losing more than 40% of blood volume?

• Unresponsive, drowsy

• Vital signs: BP decreases, P increases > 100, breathing is labored, temperature decreases, organ failure

What are the two types of bleeding?

Internal & external bleeding

External bleeding

Can be observed through a break in the skin

Internal bleeding

Patient can develop (and eventually die) shock