Test 1

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?

define a standard of care (what needs to be done)should be discussed with ENTIRE sports med staff and created in consultation with local EMS

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avoid being held liable for claims based on negligencelegal 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 5 components of the EAP?

Emergency personnel

Emergency communication

Emergency equipment

Medical emergency transportation

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 EVERYTHINGdone 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?

Medical and Family HxPhysical ExamOrthopedic ScreeningWellness 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 ==**unconscious**==, pt can still be breathing with heart beat but also may NOT.

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) 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 restored
* slow 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

Shock Management Steps

1. keep athlete calm
2. sit/lie athlete down and avoid looking at injury
3. keep spectators away
4. reassure athlete and loosen clothing
5. do NOT give anything by mouth
6. support head if suspected c-spine injury

What are the two most important components of wound management?

(1) Stop the bleeding and (2) Prevent Infection

Wound Care Steps

1. Utilize universal safety precautions (GLOVES!!!!)
2. apply direct and indirect compressions
3. flush wound for 5-10 minutes with saline or water
4. clean wound with soap and water
5. debride with hydrogen peroxide if necessary
6. apply wound dresing or wound closures to approximate wound
7. check regularly for signs of infection

How to control severe bleeding?

1. Apply DIRECT pressure to wound, continuously adding new gauze rather than replacing, UNLESS the gauze is COMPLETELY SOAKED THROUGH.
2. Elevate extremity 8-12 inches above heart
3. If elevation does not stop bleeding, apply pressure to the PROXIMAL ARTERY of the injury
4. Tourniquet only when absolutely necessary
5. Clean all wounds with soap and water to minimize infection

80% of MOI of injuries in children in sports is from…?

BLUNT FORCE TRAUMA (BLT) injuries to the mediastinum, lung or heart or the pleura as well as injuries to the aorta and other major vessels

Injuries that occur to the abdomen are often associated with…?

high velocity impact injuries

What are some secondary injuries from high velocity impact injuries to the abdomen?

Intra-abdominal injuries, most notably the spleen, kidney and liver

Injuries to the LEFT and/or RIGHT REGION of the thorax and abdomen include….?

Lung contusions, pneumothorax (PTX), pneumomediastinum (PTM), and rib fractures as well as injuries to the spleen, liver, kidneys and adrenal glands rare injuries \= rupture of aorta, tracheobronchial tree or diaphragm

Why are children at an increased risk for thoracic and abdominal injury?

Their abdominal organs are lower and more anterior in position, have less developed muscles and their costochondral structures are more pliable. Increased pliability \= more force is needed for fractures to occur.

pulmonary contusion

brusie of the lung caused by chest trauma

s/sx of pulmonary contusion

manifests clinically as dyspnea and hypoxemia (low blood oxygen). other sx include hemoptysis (bleeding of airways), tachypnea, chest pain, and wheezing

sternal fracture

uncommon in sports but can occur as a result of blunt force trauma and is often associated with other intrathoracic injury more common in children dude to their chest wall being more compliantcommonly associated with PTX, pulmonary contusion and injury to the heart or aorta

s/sx of sternal fracture

chest pain made worse with direct palpations, shortness of breath, pleuritic pain

pneumothorax (PTX

air that has leaked into the pleural space, either spontaneously or as a result of traumatic tears in the pleura following chest injury or surgical procedures tx \= removing air from pleural space, re-expanding underlying lung and preventing reoccurance

s/sx of PTX

dyspnea, tachypnea, tachycardia, anxiety, diminished breath sounds, pleuritic chest pain, hyper resonance to percussion, air in pleural cavity

hemothorax (HTX)

collection of blood between chest wall and lung, most often resulting from blunt or penetrating forces to the thoracoadbominal area but can also be caused by injury to the aorta or myocardial rupture

s/sx of HTX

dyspnea, tachypnea, tachycardia, anxiety, diminished breath sounds, chest pain, dullness to percussion, blood in pleural cavity, labored breathing, pain, cyanotic appearance, coughing up frothy blood and signs of shock

80-90% of what intra-abdominal organ injuries are in sport?

splenic injuries when athlete is sick because the bottom of the enlarged spleen will sit below protection of ribcage

What is the most primary illness to be concerned when the spleen is enlarged?

MONO

s/sx of splenic injury

hypotension, abdominal pain with or w/o referral to left shoulder, abdominal dissension, tenderness, rebound along with guarding, syncope, or pre-syncope

What is the BEST and ONLY way to evaluate severity of splenic injury?

CT SCAN to exclude other injuries such as bony fracture of ribs, pelvis, spine and other abdominal organ injury sensitivity of CT with double contrast IV in detecting splenic injury \= close to 100%

acute appendicitis (AA)

appendix becomes inflamed due to a blockage of feces, foreign objects, or cancer; presents as general abdominal pain that lasts from a few hours to a day, then becomes more focused in the lower right quadrant

s/sx of acute appendicitis

deep tenderness at McBurney’s point, abdominal rigidity, guarding, loss of appetite, nauseam rebound tenderness, low grade fever

McBurney’s Point

point over right side of abdomen that is 1/3 the distance from the ASIS to umbilicus landmark sign for appendicitis

tx for acute appendicitis

removal because if left alone, appendix could rupture, releasing infectious material into abdominal cavity and blood

knee dislocations

ALL multiple ligament injuries to the knee should be treated as a medical emergency, regardless of the findings during on field exam

anterior shearing and popliteal artery injury

causes stretching and small intimal tearsp

posterior shearing and popliteal artery injury

associated with complete disruption of the artery which could result in amputation of lower leg

What knee motion is enough to cause popliteal artery damage?

isolated PCL injuries from hyperextension

86% amputation rate if integrity of PA is not restored within how many hours?

6-8 HOURS

89% salvage rate if integrity of PA is restored within how many hours?

8 HOURS

MOI of perineal nerve injuries

varus stress that causes traction type injury, usually seen in posterolateral injuries and avulsion fractures of fibular head

deep vein thrombosis (DVT)

blood clot that forms in a vein deep in the body, most typically in the lower extremity but possible in the UE

three most common causes of DVT

local venous damage as a result of trauma or previous surgeryvenous stasis as a result of immobilization and pressureeffect of being in a hyper coagulable state

s/sx of DVT

swelling, pain and tenderness, warmth, and red or discolored skin

pulmonary embolism

complication of a venous thromboembolism; a clot (embolus) breaks off and travels through blood to the lung, impeding blood flow

oral contraceptive use and DVT/PE

for those taking a combined OC containing both estrogen and progestin, the overall risk of venous thrombosis is TWICE AS HIGH as non-users

causes of HEAT CRAMPS (not a medical emergency but common)

large losses of water and sodium via sweat in addition to copious consumption of water and/or neuromuscular (NM) fatigue

s/sx of HEAT CRAMPS

involuntary spasms of skeletal muscles, usually during or after exercise

tx of HEAT CRAMPS

consumption of salty foods (EX:electrolyte drinks if cause is from sweat), stretching (if cause is from NM fatigue)

causes of HEAT SYNCOPE (not a medical emergency but common)

standing in a hot environment for a long period of time and/or immediately upon cessation of exercise most common environments \= military cadets, sports that require heavy equipment

s/sx of HEAT SYNCOPE

fainting caused by postural pooling of blood in legs/loss of vascular resistance

tx of HEAT SYNCOPE

place pt in supine position with legs elevated at least 12 in. above heart to promote venous return in a cool environment and provide fluids if needed important to keep walking, dynamic stretching to continue blood flow and avoid decrease of venous return and blood pressureRTP can occur when vital signs are restored

causes of HEAT EXHAUSTION (not a medical emergency but common)

fluid-electrolyte imbalance leading to CV insufficiency

s/sx of HEAT EXHAUSTION

inability to continue to work/exercise in the heat, nausea, vomiting, dizziness, difficulty catching breath, headache, fatigue

tx of HEAT EXHAUSTION

rest and restoration of fluids and electrolytes RTP timeline AT LEAST a 24-48 hour period

What are the top three causes of sudden death in sport during JULY-SEPTEMBER?

sudden cardiac deathexertional heat strokeexertional sickling

what sport population is commonly plagued by EHS and exertional sickling

collegiate conditioning sessions, high school football pre-season practice

Exertional Heat Stroke

occurs when core body temperature is elevated to a dangerous level, usually above 105 F (40.5 C), with concomitant signs of organ failure due to hyperthermia death can occur if not treated immediately and effectively

pathophysiology of EHS

occurs when thermoregulatory mechanisms are unable to dissipate the heat being gained and produced by the body

Heat Balance Equation

S \= M - (±Work) + E ± R ± C ± K

How can conduction (K) affect the heat balance equation?

HEAT GAIN: equipment, feet in contact with ground

How can radiation (R) affect the heat balance equation?

HEAT GAIN: outside in 85 F while sunny

convection (C) in heat balance equation

most effect; air movement, works together with evaporation HEAT LOSS IN BALANCE EQUATION: windy weather VS no wind in 90 F weather

evaporation (E) in the heat balance equation

most effect; works together with convection HEAT GAIN: if sweat is just dripping off the body, there will be NO heat loss. sweat MUST be EVAPORATED off the body by surrounding air (convection) to lose heat

Why are athletes more at risk for EHS in high humidity?

the air is super saturated with water which means sweat can't evaporate