EXSS 288 Exam 1 Study set 2

athletic trainer

Most directly responsible for all phases of health care in an athletic environment

--Injury prevention

--Providing initial first aid and injury management

--Evaluating injuries

--Designing and supervising rehabilitation

Specific roles and responsibilities are defined by the specific work situation

team physician

-- athletic trainer works under the direct supervision of physician

-- Physicians have the final say

-- Deciding on disqualifications

-- Attending practice and games

-- It is imperative that the team physician promote and maintain consistently high quality care

How does the Fitness Professional relate to the Sports Med. Team?

-- Focus of the group is on improving performance

-- Argument can be made that by an athlete achieving a higher level of fitness, injuries are less likely to occur

-- The relationship between performance enhancement and injury prevention is essential

personal fitness trainer

Responsible for designing a comprehensive exercise program

Strength and Conditioning Coaches

Oversee fitness of an athlete

Often employed at the collegiate level for both team and individual training sessions

Early Activation of EMS

-- Lay responder calling 911 to activate EMS

-- Information to provide:

-- Your name

-- Describe the situation

_______

-- Location and directions

_______

-- Wait for the dispatcher to tell you what to do

Emergency Medical Services System (EMS)

Network of communicating resources and medical personnel

Purpose: being rapid medical care to a victim with a life threatening injury or illness

bystander effect

the tendency for any given bystander to be less likely to give aid if other bystanders are present

the survival and recovery of critically injured or ill victim depends on:

-- Early recognition and response

-- Early activation of the EMS system

-- Care provided until more advanced medical personnel take over

-- Pre-hospital care provided by advanced medical personnel

-- Hospital care

-- Rehabilitation

pre-hospital care

-- Arrival of emergency medical trainers

-- EMT's provide more advanced care and -- life-support techniques

-- EMT Basic

-- EMT Intermediate (more advanced techniques, esp airway)

paramedic

hospital care

-- Arrival at hospital and care by medical -- personnel, Physicians, Nurses, Medical specialist, Other health-care professionals

-- Once stabilized, the victim may be transferred to another department

care provided until advanced personnel arrive

-- Stay with the victim

-- Monitor the situation

-- Adjust care as needed

-- Inform advanced personnel

rehabilitation

Purpose: Return the victim to his or her previous state of health

Example: cardiac rehab

"The Cardiac Rehabilitation program is designed to help strengthen your heart after you have had heart surgery, a heart attack, and/or a coronary intervention. This program will enable the patient to return to the daily activities they enjoy"

EMS Summary

EMS is a network of people that includes lay responders, professional rescuers, and medical personnel

1. Recognition and response by the lay responder

2. Care provided until more advanced medical personnel take over

3. Pre-hospital care provided by advanced medical personnel

4. Hospital care

5 Rehabilitation

Scope of practice

Skills you are authorized to practice

- profession and state dictated

- The skills you are authorized to practice, limits the care you provide

ARC certification

(CPR, rescue breathing, CPR/AED, conscious/unconscious choking ALL for adult, child and infant)

MY scope of practice

what we learn from ARC in this class

Standard of care

requires that you act according to the standard of care of an individual with similar educational background or training would act

four components

4 components of standard of care

•Communicate proper info to prevent injury

•Recognize victim in need

•Attempt to rescue

•Provide emergency care

negligence (and 3 factors)

Failure to follow a reasonable standard of care OR providing care beyond scope of practice, thereby causing or contributing to injury or damage

3 components to be considered negligent

1. duty of care (failed your legal responsibility)

2. the standard of rasonable care (fell short, scope of practice, prevent further injury)

3. damages

Torts

wrongful acts for which an injured party has the right to sue

malfeasance, nonfeasance, misfeasance

*** an individual can be held liable in any of these instances

Nonfeasance

Act of omittance (you didn't do what you were supposed to do)

malfeasance

act of commission (doing something that you aren't supposed to do)

misfeasance

Incorrect (like if you prescribed the wrong drug)

Good Samaritan Laws

Protect people willing to give care when they receive nothing in return; not under contract (within scope of practice_

(applies when NOT on duty/no duty to provide care)

***does not apply when on duty

Good Samaritan:

- Act in good faith

- Are not negligent

- Act within the scope of training

- Do not expect anything in return

- Only when you are NOT on duty

Consent

- a victim's indication that a rescuer may provide care

- Conscious adult or parent of minor

State name

Steps to obtaining consent

1. State name

2. Level of training

3. Ask permission to help

4. Explain suspected condition

5. Explain plan of care

Duty to act

The duty to respond to an emergency and provide care if there is need (while on duty)

What if they are not conscious or parent is not available?

Consent is implied, provide care

What if they say no?

- Call EMS and document! Inform victim why they need care and what may happen if they do not receive it

- Always stay with them

- BUT if they go unconscious you can provide care because of implied consent

(may lead to battery charges if you do it anyway)

Battery

the unlawful, harmful, or offensive touching of a person without consent

Abandonment

Discontinuing care once it has begun; you must provide care (may be held legally responsible) until advanced medical personnel arrives UNLESS...

- scene becomes unsafe

- victim shows obvious signs of life

- you are too tired to continue

Confidentiality

The principle that information learned while providing care to a victim is to be kept confidential. This information should not be shared with anyone but advanced medical personnel.

Health Insurance Portability and Accountability Act (HIPAA) of 1996: Individually identifiable health information

Physical or mental health

Providing health care

Payment for providing health care

Important: you can tell the health provider

Documentation

Keep good records of injuries, care given, and facts after incident

Why?

Help medical personnel treat

Future preventative plans and protocols

Can protect you in the case of lawsuit

Ask what forms need to be filled out from hospital or EMS

Implied consent:

Given when the victim is unable to give consent due to being:

- Unconscious

- Confused

- Mentally impaired

- Seriously injured or ill

Refusal of care

A victim's indication that a rescuer may not provide care

witness documentation

Includes:

• Time and date

• Location of where you are

• Individuals involved

• What happened?

• Consent (Did the person involved refuse assistance?)

• What did you do afterwards? Call EMS or step back?

What must happen to prove negligence?

Harm caused by the rescuer and willful (purposeful) misconduct; providing care outside of your capabilities

Why is obtaining consent important?

To protect yourself and to be respectful/responsible to that person

If you are providing care out of the goodness of your heart, what protects you?

Good Samaritan Laws

What are bloodborne pathogens?

Viruses present in the blood and body fluids that can cause diseases in humans

Ex. CSF, saliva, blood, semen, urine, feces

What are the diseases of primary concern?

Hepatitis B, Hepatitis C, and HIV

What are blood borne pathogens?

Bacteria and viruses present in blood and body fluids that can cause disease in humans

Diseases of primary concern:

Hepatitis B

Hepatitis C

HIV

Hepatitis B

Liver infection caused by the hepatitis B virus

- Has a 3 part vaccination

Hepatitis C

Liver infection caused by the hepatitis C virus

- Most common chronic blood borne infection

- #1 cause for a liver transplant

- No vaccine and no treatment

HIV

Virus that causes AIDS

- Attacks WBCs and destroys the body's ability to fight infection

How blood borne pathogens spread (4 conditions):

1. A pathogen is present

2. There is enough of the pathogen present to cause disease

3. A person is susceptible to the pathogen

4. The pathogen passes through the correct entry site

Different (4) ways a blood borne pathogen can spread:

1. direct transmission

2. indirect transmission

3. droplet transmission

4. vector-borne transmission

Direct transmission:

infected blood from one person enters another person through an entry site/mucus membranes (ex. eyes, mouth, nose)

Indirect

touching something and then touching a mucus membrane (ex. hand to eye)

Droplet transmission

inhales droplets from a cough or sneeze

Vector-borne transmission

transmitted by the bite of infected animal or insect

Prevention of blood borne pathogens:

- OSHA Standard on Bloodborne Pathogens

- Use of safeguards

- Exposure Control Plan

- Universal precautions

- Standard precautions

OSHA stands for:

Occupational Safety and Health Administration

OSHA regulations

1. Apply to employees who may come into contact with blood or other body fluids that could cause infection

2. Require employers to have an exposure control plan

3. Use of safeguards

Universal Precautions

Treat all human blood and body substances as if known to be infectious

Standard Precautions

Safety measures that combine universal precautions and body substance isolation (BSI) precautions and are based on the assumption that all body fluids may be infections

Ex: Personal protective equipment (PPE), hand hygiene, engineering controls, work practice controls, proper equipment cleaning, and equipment cleaning and disinfecting

Steps to preventing infection

1. Avoid contact with blood and other body fluids

2. Use CPR breathing barriers when giving ventilations

3. Wear disposable gloves when providing care, as well as protective coverings

4. Use gloves appropriate for the task and provide an adequate barrier

5. Cover any cutes, scrapes, or sores and remove all jewelry.

6. Avoid handling any personal items when wearing soiled gloves

7. Change gloves before providing care to a different victim

8. Remove disposable gloves without contacting the soiled part of the gloves and dispose of them properly.

If you are exposed to an infection, take these actions:

- Clean contaminated area with soap and water.

- When splashed around mouth or nose with blood or other bodily fluids, flush the area with water

- If the eyes are infected, irrigate them with clean water or saline for 20 minutes

1. Clean the area of contact

2. Write down what happened

3. Notify your supervisor

4. Immediately seek medical attention

After any exposure incident, you should:

1. Report incident to appropriate person and EMS

2. Write down what happened. Include time and date of exposure, as well as circumstances of exposure. Also include any actions taken after exposure.

3. Seek immediate follow-up care

Without oxygen, brain cells can begin to die in _____ to _____ minutes

4-6

brain damage possible

4-6 minutes

before giving care

Understand the steps in taking action

Know how to perform an initial assessment

Know when to call or care first

victim definition by age

Respiratory: Adult 12+, child 1-12, infant < 1

cardiac/AED: Adult 9+, child 1-8, infant < 1

Taking action in an emergency:

What steps should you follow in an emergency?

1. Size-up the scene

2. Perform primary assessment

3. Summon EMS if needed

How to size-up the scene:

1. ensure safety

2. identify necessary PPE

3. Determine mechanism of injury

4. Determine number of victims

5. identify if additional help is necessary

6. initial impression: how victim appears as you size up the scene (visually what we are seeing as we approach the victim)

Primary assessment general

1. Check for responsiveness/unconsciousness

2. absence of breathing or absence of pulse

3. severe bleeding

brain damage likely

6-10 minutes

irreversible brain damage certain

over 10 minutes

signs of a neck injury

tingling, numbness, head pain, paralysis

how long do you check to see if breathing/how?

Look, listen, and feel for breathing (No longer than 10 seconds)

Agonal gasps do not count as healthy breathing

which pulse do you check for an adult? child? infant?

Carotid pulse for adults and children

Brachial pulse in infants (so you don't block blood flow to head)

what do you do if the victim is not breathing?

Give 2 ventilations for the following patients

1. Drowning victims

(Many will vomit; Turn victim on side if necessary and clear the victim's airway by wiping the mouth out using a finger sweep)

2. Victims of hypoxia

3. Children and infants

if the victim is not breathing but has a pulse

Position and seal resuscitation mask

Open the airway and blow into the mask

Performing a primary assessment-adult

1. Size up the scene for safety, then:

2. Check for responsiveness

3. If no response, summon more advanced medical care

4. Open the airway and check for breathing and a pulse

5. Quickly scan for severe bleeding

6. Provide care as needed

performing a primary assessment- child and infant

1. Size up the scene for safety, then:

2. Check for responsiveness

3. If no response, summon more advanced medical care

4. Open the airway and check for breathing and a pulse

5. *** if the victim is not breathing, give two ventilations

6. Quickly scan for severe bleeding

Provide care as needed

How to check for responsiveness:

AVPU

1. Alert: able to respond to questions

2. Verbal: Able to react to sounds, may need to be stimulated to respond

3. Painful: Responds to painful stimuli

4. Unresponsive: Does not respond to any stimuli

3 ways to open the airway

1. Head-tilt/chin-lift

2. Jaw thrust w/ head extension

3. Jaw thrust WITHOUT head extension (Only use this if a head, neck or spinal injury is suspected)

What age range does the ARC consider to be a child to perform care?

Anyone younger than 12 is a child.

What age does the ARC consider to be an infant?

Anyone younger than 1 year

What to do if victim vomits when given ventilations, you should:

1. Turn victim on side (Support head and neck, and turn body as a unit)

2. After vomiting stops, clear victims airway by wiping victim's mouth out using finger sweep

3. Turn victim on back and continue ventilation

What age range/weight range classifies someone as a child when operating an AED?

1-8 year olds or anyone weighing 55 lbs or less is considered a child

Before providing care to someone who could have a spine/neck/head injury, check for these signs.

1. Changes in LOC

2. Severe pain or pressure in head, neck, or spine

3. Loss of balance

4. Partial or complete loss of movement of any body part

5. Tingling in hands, fingers, feet, or toes

6. Persistent headache

7. Unusual bumps/bruises/depressions on head, neck, or back

8. Seizures

9. Blood/fluids in ears or nose

10. External bleeding of head/neck/back

11. Impaired breathing or vision

12. Nausea or vomiting

13. Brusing or head (around eyes or behind ears)

H.A.IN.E.S position

high arm in endangered spine

Respiratory distress

Victim who is having difficulty breathing

Respiratory arrest

Victim who has stopped breathing

Causes of breathing emergencies:

- obstructed airway

- injury to head or chest, lungs or abdomen

- illness

- drowning

- shock

- drugs

- allergic reactions

- heart attack

- Nonfatal submersion injury

- poisoning

- drugs

- emotional distress

Respiratory distress and respiratory arrest are life threatening conditions (T/F)

True

Hypoxia

condition in which insufficient oxygen reaches the cells

Hypoventilation

slow (Bradypnea)

Signs of respiratory distress:

- Slow or rapid breathing

- Unusually deep or shallow breathing

- Shortness of breath or noisy breathing

- Gasping for breath

- Wheezing, gurgling or high-pitched noises

- Changes in level of consciousness

- Increased heart rate (greater than 100 BPM in adult)

- Skin that is flushed, pale, ashen or bluish

- Skin is unusually moist or cool

- Inability to speak in full sentences

- Sudden silence

- Dizziness, drowsiness, light-headedness, shortness of breath, tingling sensation at digits and extremities, anxiety, chest tightness

Hyperventilation

fast (Tachypnea)

Breathe faster than normal which upsets oxygen and carbon dioxide balance

What is the "normal" resting respiratory rate for the average adult?

12-18 breaths per minute

30-40 for new born

Caring for respiratory arrest

- Loosen tight clothing, comfortable position, and provide fresh air

- Get someone to call 911

- reassure the victim

- check for other life-threatening conditions

- If victim has a pulse but is not breathing, give ventilations

Respiratory arrest

Respiratory arrest is a life-threatening condition in which breathing stops

If uncared for, respiratory arrest can lead to cardiac arrest

Body systems will progressively fail

Asthma

Narrows the air passages and makes breathing more difficult

- Attack involves spasm of bronchi muscles

- controlled with meds

- triggered by many things

- place in position that helps breathing

without oxygen, brain cells can begin to die in ______ minutes

4-6 brain damage possible

6-10 brain damage likely

over 10 mins: irreversible danage certain

Emphysema

A disease in which the lungs lose their ability to exchange carbon dioxide and oxygen effectively

Caused by smoking

S&S: shortness of breath, restlessness, confusion, weakness

Bronchitis

Condition resulting in inflammation of the lining of the trachea, bronchi and bronchioles

The inflammation causes a build up of mucus that obstructs air passages

S&S: persistent cough, tightness in chest, trouble breathing

advanced S&S: restless, confused, weak