Preventative Care.2

infectious disease

infectious disease

invasion or infection of a person (host) by microorganisms called pathogens. transmission can be direct or indirect

pathogens

causes disease by either disrupting a vital body process or stimulating the immune system to mount a defensive reaction

pathogen entrance sites

• skin

• respiratory system

• digestive system

• reproductive system

transmission of disease

direct transmission

• contact between body surfaces

• droplet spread (sneezing)

• fecal-oral spread

Indirect transmission

• via inanimate object (food,towels)

• via vectors (living things)

Stages of infection

1. incubation

   • pathogen entry -→ signs + symptoms appear

2. prodromal

   • presence of signs/symptoms; pathogens continued to multiply

   • host is contagious; should be isolated

3. acute

   • disease reaches greatest development

   • highest likelihood of transmission

4. decline

   • first signs of recovery; signal end of infection

5. recovery

   • apparent recovery

   • susceptible to other pathogens

immune defense

mechanical defense: skin, mucous membrane, nasal hairs

cellular defense: WBC (leukocytes)

bloodborne pathogen

pathogenic microorganisms that can potentially cause disease.

most common- hep b, hep c, HIV (human inmmunodefiency virus)

transmission-

• semen

• vaginal secretions

• cerebrospinal fluid

• synovial fluid

• blood

HBV Hepatitis B Virus

viral infection through body fluids.

swelling, soreness, loss of normal liver function

• flu like symptoms (can have HBV w/out showing)

vaccinations are available

HCV Hepatitis C Virus

acute and chronic form of liver disease

most common bloodborne infection in US

s&s

• 80% have no s&s

• loss of apetite

• jaundice

• abdominal pain

• nausea

• fatigue

• muscle joint pain

HIV Human Immunodefiency Virus

is a retrovirus ( a virus that enters host cell and changes its RNA to a proviral DNA replica)

affects large number of cells in immune system leading to decrease ability to prevent disease

S&S

• fatigue

• weight loss

• muscle joint pain

• swollen glands

• night sweats

• fever

no treatment to cure

AIDS (acquired immunodeficiency syndrome)

a syndrome is a collection of signs and symptoms that are recognized as the effects of an infection.

vulnerable to

• illness

• opportunistic infections

• cancers

no treatment to cure

Prevention in Athletics of Blood borne Pathogens

remove athlete from game

keep athlete on sideline till bleeding has stopped and cleaned

remove jersey/change uniform

clean playing surface

dispose of contaminated materials

Emergency Action Plan

individualized for each sport/activity/facility (access points for ambulance, address,etc)

First priority:

maintain cardiovascular function (first 10min/golden minutes 1hr/golden hour)

indirectly CNS function

accurate evaluation is key

Piss Poor Planning = Piss Poor Performance

Training sessions should be held annually to practice emergency medical care.

Cooperation/Professionalism is must

EMT has final say. AT has more emergency training than PA

All EAP Must Address

1. Personnel on Site

2. Equipment Available

3. Specific policies/procedures for equipment removal

4. ensure proper communication to emergency medial system

5. ensure all gates/padlocks can be opened

6. ensure everyone knows their roles

7. have someone accompany injured athlete to hospital

8. carry all insurance/contact info for athletes at all times

9. have a plan to manage all possible situations

Primary Survey

assess life threatening conditions

• airway obstruction

• absence of breathing

• absence of circulation

• profuse bleeding

• shock

• massively deformed joints/structures

treatment of life threatening injuries take precedence

first necessary to note body position and level of consciousness

Secondary Survey

performed after life-threatening condition ruled out

assessment/monitor vital signs

• pulse

• respirations

• blood pressure

• temperature

• skin color

• pupils

• level of consciousness

• movement

• abnormal nerve response

Unconscious Athlete

a state of insensibility in which the athlete exhibits a lack of consciousness awareness

injury to neck & cervical spine should always be considered a possibility

must be considered life threatening → call EMS

CAB’s should be established

• circulation

• airway

• breathing

Unconscious Athlete To DO

1. immediately note head neck or spine injury

2. immediately expose the airway by removing any protective equipment that could interfere with CPR

3. was the athlete wearing a helmet

   • facemask must be removed to completely allow CPR

   • never remove helmet until head/neck/spine injury is ruled out

4. upon determining position and level of consciousness, determine appropriate care

5. once athlete is stabilized → can be secondary survey

emergency CPR

Follow Check-Call-Care

Check- the scene to see if it is safe; identify other to assist

Call- 911 to activate EMS

Care- initiate to patients

Ensure CPR trained individuals on site

Time is critical for the patient needing CPR/AED

• each minute that passes without AED survival drops 10%

establishing unresponsiveness

1. Make sure there is no chance of additional injury and check for any potentially life threatening conditions

2. Check Responsiveness

   1. ask athlete “are you okay” gentle tapping

   2. avoid shaking or moving due to possible neck injury

   3. if no response call 911

3. Assess CAB’s

   1. if no response → get AED

   2. Breathing → recovery position

   3. no breathing → administer CPR

4. Continue to monitor CAB’s

establishing circulation

• locate carotid artery & palpate puse

• maintaining head tilt position/airway

• if available, the AED should be used ASAP

• if no AED is available and there are no signs of circulation chest compressions should be given after 2 rescue breaths

• place heel of hand, closest to head on sternum

• place other hand on top with fingers parallel

• keep elbows locked with shoulders directly above patient

• maintain rate of 30 compressions: 2 breaths

• speed 100/minutes

• In children depth at -1.5”

establishing breathing

• place ear over victims mouth

• observe chest

  • look, listen, feel for breathing

• place your hand on the victims forehead to hold it back, pinch the victim’s nose

• take deep breath and create seal around victims mouth

• gently give two breaths

• if breath does not go in, re-tilt and ventilate

• if airway continues to be obstructed, perform 30 chest compressions and look for object

• repeat until ventilation occurs

witnessed sudden collaspe

• immediately open airway and begin continuous compressions

• speed of compressions should be at a rate 100/minute

• in children, compressions should occur depth 1-1.5”

• do not stop unless scene is unsafe, AED arrives, EMS personnel takes over

AED automatic external defibrillator

device that evaluates rhythm of victims experiencing cardiac arrest. can deliver electrical charge to heart

Obstructed Airway Management

when obstructed individual cannot breath, speak, or cough and may become cyanotic

• call 911

• determine the consciousness level

the heimlich maneuver (abdominal thrusts) can be used to clear the airway

Choking- Conscious

• state your name and that you can help

• 5 back blows (between scapula)

• 5 standing abdominal thrusts technique

  • heimlich maneuver

• how long to continue?

  • until lose consciousness or piece comes out

Choking- Unconscious

• call 911

• open airway

• 2 rescue breaths

• perform 30 chest compression

  • like CPR

• check for object

• if you see object, perform finger sweep

Supplemental Oxygen

depletion of oxygen to the brain and rest of body can leave the body at risk to sudden cardiac arrest or brain damage

supplemental oxygen can be administered by an athletic trainer who is trained in delivery

requires the use of the bad valve mask and cylinder containing O2

canister is green with a yellow oxygen label

• normal breathing= 21% O2

• rescue breathing= 16% O2

• during oxygen administration= 90%

• rate of 10-15 liters minute

Hemorrhage

abnormal discharge of blood

venous- dark red with slow continuous flow

capillary- exudes from tissue and is reddish

arterial- flows in spirt, bright red (most ASAP + dangerous)

control hemorrhage

can usually be managed through pressure points, elevation, direct pressure.

• direct pressure with hand over sterile gauze

• elevate limb to reduce blood pressure and slow bleeding

• place direct pressure over large blood vessels

  • 2 most common sites: femoral, brachial artery

  • lots of pressure. arteries are deeper. should feel like touching bone

internal hemorrhage

usually not easily identified

• blood does not cause pain or irritation

must use diagnostic tools to identify- MRI, CT, X ray

may be life or death situation depending upon location of bleeding'

• brain, viscera (within body cavity)

• if suspected monitor blood pressure

all severe hemorrhage may result in shock if not treated accordingly

shock

occurs when limited amount of blood is available in the circulatory system

signs:

• decreased blood pressure (sys= <90mmHG)

• weak rapid pulse

• drowsiness/sluggishness

• increasing shallow respiration

• moist, pale, cold, clammy

• irritability or excitement

• potentially thirst

hypovolemic shock

decreased blood pressure

respiratory shock

limited oxygen to circulating blood due to trauma to lungs

neurogenic shock

dilation of blood vessels; does not allow typical 6 liters of blood to fill system

cardiogenic shock

inability of heart to pump enough blood

psychogenic shock

temporary dilation of vessels reducing blood flow to brain

septic shock

results of bacterial infection where toxins cause smaller vessels to dilate

anaphylactic shock

results of severe allergic reaction

metabolic shock

occurs when illness goes untreated (diabetes) or when extensive fluid loss occurs

pulse/heart rate

taken at carotid (neck) or radial (wrist) arteries

• should assess for >10s

• 15s x 4

• norm= 60-80 bpm

• athlete tend to have lower resting HR

pulse should evaluate for

presence vs absence (indicated cardiac arrest)

rate & rhythm/regularity

strength of contraction (volume/amplitude)

grading scale

• 0= absent, no pulse

• +1= not easily felt, thready, weak

• +2=difficult to palpate stronger than 1

• +3= normal easily felt

• +4=strong, bounding

• tachycardia= fast HR (>100 bpm)

• bradycardia= slow HR (<50 bpm)

respiratory patterns

normal rates: 12-20 min

ID rate, rhythm, o2 saturation levels

• pulse ox norm = 90-100

apnea- temporary cessation of breathing

tachypnea- rapid breathing

bradypnea- slow breathing

hyperventiliation-labored breathing

• lose too much co2

obstructed- blocked airway caused by either partial or complete obstruction

blood pressure

a lowered bp could indicate

• hemorrhage

• shock

• heart attack

• internal organ injury

systolic BP- the pressure caused by heart pumping

diastolic BP- the residual pressure when heart is between beats

mmHg- milimeters of mercury

norm- 120/80

temperature

norm- 98.6 F

determined by thermometer

many methods/locations

• oral

• rectal

• axillary

• tympanic

rectal may be most accurate but least used

• bc of invasiveness

• used in emergency

skin color

red- elevated temperature, heat stroke, high blood pressure

white- insufficient circulation, shock, fright, hemorrhage, heat exhaustion, insulin shock

blue- airway obstruction or respiratory insufficiency

yellow- typically from livers disease

pupils

PEARL

pupils

equal

and

reactive to

light

Unequal/unresponsiveness pupils could indicate an athlete has suffered:

• a head injury

• heat stroke

• hemorrhage

• alcohol/drug poisoning

level of consciousness

AVPU Scale

• alertness

• verbal

  • responding to voice

• painful

  • responding to painful stimulus

• unresponsive

  • no response to pain

ACDU Scale

• Alert

• Confused

• Drowsy

• Unresponsive

musculoskeletal assessment

immediate treatment- PRICE

• protect

• rest

• ice

• compression

• elevation

splinting and bracing

emergency splinting

• vacuum, air, sam splints, half ring traction splint

Steps

1. splint in position found

2. immobilize joint above and below joint/fracture

3. ensure no movement (have access to distal pulse)

transporting the injured athlete

• spine board

• ambulatory aid and manual conveyance (carrying athlete)

• stretcher

  • best and safest. may be necessary if seated position isn’t comfortable

• chair

• crutches

  • NWB- non weight bearing

  • PWB- partial weight bearing

  • TDWB- touch-down weight bearing

must be executed with techniques that will not result in additional injury

eitiology

cause of an injury or illness

mechanism

mechanical description of the cause

pathology

structural & functional changes that result from an injury

symptoms

change that indicated injury/illness (subjective to patient)

sign

indicator of a disease

diagnosis

name of specific condition

prognosis

predicted outcome of an injury (functional capacity, not time)

sequela

condition resulting from disease or injury

syndrome

group of symptoms that indicate a disease or condition

H-O-P-S

history, observation, palpation, special tests

history

• past injury history

• current symptoms

• mechanism of injury

• pain/profile

• injury location

actively listen. patient should be doing the majority of talking

observation

• demeanor

• movement

• asymmetries

• deformity

• swelling, redness, warmth

• appearance

• gait

• facial expression

• posture

palpation

• touching with fingers/thumb

• abnormalities

• swelling

• bony palpation

• soft-tissue palpation

should not be done until history is taken

• always evaluate contralateral limb

• palpation may increase/decrease pain and after symptoms experienced

should be performed systematically

• light→greater pressure

• away from site of injury→ closer to site

• must know anatomy to effectively palpate

point tenderness

muscle tonicity

deformity

crepitus

• unusual crackling, grating sensation

muscle spasms

swelling/edema/effusion

special tests

movement assessment (ROM)

neurological assessment

• reflex, nerve function, cranial nerve

joint stability

postural, anthropometric (body measurements)

functional testing and performance screenings

Range of motion

goniometer

• fulcrum= align with axis of joint

• stationary arm= align with proximal bone

• movement arm= align with distal bone

girth/circumference measurements

measure circumference of extremity to determine:

• swelling or atrophy

determine points of measurements around or near joint

compare results bilaterally

neurological: reflexes

utilize reflex hammers to determine neurological status of nerve root.

common sites

• biceps tendon

• triceps

• brachioradialis

• patellar

• achilles

reflexes= pathological reflex options

diagnostic tests

x ray- used primarily for bone tissues or joint abnormalities

Computed tomography- multiple view x ray. better defined structures

bone scans- radioactive tracer injection followed by scan

dexa scans- bone mineral density

mri scans- electromagnet process that can identify soft tissues with extremely clear images $$$

ultrasound- sound waves produce pictures of structures. can show “live” images

arthoscopy- fiberoptic scope used in surgery

therapeutic modalities

doesnt heal injury. it creates optimal healing environment. hopefully stimulates better healing. decrease pain and swelling

classification-

• electromagnetic

• acoustic

• mechanical

electromagnetic

thermotherapy, crythotherapy, electrical stimulating currents

thermotherapy

-hydrocollator packs

-whirlpool bath

-paraffin bath

physiological effects of heat

• increase extensibility of collagen tissues

• decrease joint stiffness

• reduce pain

• relieve muscle spasm

• increase blood flow

• decrease edema, inflammation after 72 hours

considerations-

temp never above 116 F

exposure less than 30 mins

should not use when- pregnant, passed out before with heat, diabetes, pace maker, open wounds, sensory issues

cryotherapy

-ice packs

-ice massage

-immersion

-vapocoolant sprays

-cryokinetics

physiological effects of cold

• causes vasocontriction (reduced blood flow)

  • does not decrease swelling that is already present

• decrease metabolic rate of cells

• decrease nerve sensitivity/excitability

• decreased muscle guarding

other considerations

cold allergies, sensory issues, superficial nerves (can freeze them)

electrical stimulating currents

• pain modulation

• muscle contraction

• muscle re-education

• low-intensity stimulators

• Iontophoresis (medicine with stim)

short wave diathermy

-good for larger areas and want depth

low level laser therapy

-not enough data/parameters

acoustic

ultrasound therapy, phonophoresis

ultrasound therapy

ways to use

• thermal and non thermal

can treat area = (x2 diameter of ultrasound head)

phonophoresis

ultrasound with medication

cream with anti-inflammatory properties

not great evidence supporting

mechanical

traction

• used with cervical/lumbar

intermittent compression

• blow up compression

• helps with blood and inflammation

• nortrek recovery boots

manual therapies/massage

philosophy of rehab

goal= to return to injured activity as soon as SAFELY possible

• often a fine line between too soon and safe

• coaches are limited to the extent of legal supervision and designing of rehab programs

• Progression is #1 in rehab

goals of rehab

1. provide immediate first aid- limit swelling

• ICERS

• (PRICE)

2. reduce/control pain + swelling

• using modalities

3. restore neuromuscular control

• must retrain the brain to control and facilitate muscle movement

4. restore stability

• provide dynamic postural control of body through kinetic chain

5. restore ROM/flexibility

• AROM/PROM (active/passive)

6. improve strength, endurance, power

7. restore proprioception + coordination

8. restore/maintain cardiorespiratory endurance

• can start deconditioning within 2 weeks

9. restore function/sport specific skills

• gradual progression in functional activities to prepare athlete for return to play

• incorporate sport skills into rehab

return to activity

functional progression testing

must meet ALL rehab goals before returning

must work towards full functional movements

design functional test specific to sport/activity

rehab plan w/ goals then → execute

• then change/reflect if needed

mechanical injuries

caused typically by external forces (loads) directed on the body that results in internal alteration in anatomical structures that are sufficient magnitude to cause injury

how the various tissues respond to the application of an external load is determined in large part by mechanical properties of the tissue

internal forces can lead to injury

• built up swelling, enlargement or organs,rib fracture

trauma

• a physical injury or wound sustained in sport or activity

• an injury sustained from an internal or external force

load

an external force acting on the body causing internal reactions within the tissues

stiffness

ability of a tissue to resist a load

stress

the internal resistance of the tissues to an external load

strain

extent of deformation of the tissue being loaded

tissue properties

body tissues are viscoelastic and contain both viscous and elastic properties

elastic- allows a tissue to return to normal following deformation

viscous- thicker

yield point

• point at which elasticity is almost exceeded is the yield point

• if deformation persists, following release of load permanent or plastic changes occur

• when yield point is far exceeded - mechanical failure occurs resulting in damage

creep

the deformation in the shape and/or properties of a tissue that occurs with the application of a constant load over time

mechanical failure

the ability of the tissue to withstand stress & strain is exceeded

results in damage to the tissue

tissue stresses

1. compression

2. tension

3. shearing

4. bending

5. torsion

Acute vs Chronic

acute

• caused by trauma

  • sudden onset = short duration

  • Ex. bang

chronic

• results from overuse from repetitive movements/actions

  • long onset = long duration

  • cumulative overload of tissue or cumulative microtrauma to tissue

Traumatic vs Overuse

nature of physical activity dictates that over time injury will occur

Traumatic- a direct blow

Overuse- repetitive dynamic use over time

Musculotendinous injuries

you strain a muscle, sprain a ligament

most muscle injuries occur at

• attachment points (musculotendinous junctions)

• muscle belly

strain

Grade 1- no tissue deformation but has localized pain

Grade 2- partial or moderate tear. bruising/swelling

Grade 3- complete tear. most likely need surgery

muscle cramps

most likely because dehydration or overuse

muscle guarding

will protect against movement that muscle to associated with

Ex. pain in hip flexor → hurts to flex hip → will stop flexing hip

muscle spasms

clonic- alternating contraction and relaxation (twitch)

tonic- rigid muscle contraction

muscle soreness

acute: onset muscle soreness

delayed: onset muscle soreness (DOMS) lasts 2-3 days, rigor state

• get lactate out, move around, light activity