Prevention/Care athletic injury: On and Off Field Eval

What is an emergency?

• unexpected occurrences that require immediate attention

• time is key factor

What can mistakes in the initial injury management cause?

• prolong the length of time required for rehabilitation

• cause life-threatening situations to arise

When an injury is predictable it’s said to be____

• manageable

What is an emergency action plan?

• a written plan that explains what to do during an emergency to protect people, provide quick care, and reduce further harm or injury

What are the most important factors when managing an emergency?

• proper planning

• rapid response time

• communication

What is the purpose of an on-filed assessment?

• determine nature of injury

• provides information regarding direction of treatment

• divided into primary and secondary survey

What is being assessed in the primary survey?

• life-threatening injuries: injuries requiring cardiopulmonary resuscitation, profuse bleeding, shock, trauma to head or spinal column

• level of consciousness

Steps of CPR

1. shake and shout

2. Call 911

3. Check for breathing

4. place hands at center of chest

5. push hard and fast - twice per second

6. If you’ve had training, repeat cycles of 30 chest pushes and 2 rescue breathing

What does an AED do?

• evaluates heart rhythms of victims experiencing cardiac arrest

• can deliver electrical charge to the heart

Steps of using AED

1. turn on device and follow audio instructions

2. expose the person’s bare chest, including bra

3. apply electrode pads to the person’s dry skin

4. allow the AED to analyze the heart rhythm

5. make sure no one touches the person as the AED delivers a defibrillation shock

6. continue hand only CPR after the shock has been delivered

What is the preferred method of transport for spine injuries?

• scoop stretcher

What is assessed during the secondary survey?

• fractures

• joint dislocation

• peripheral nerve injury

• other soft tissue trauma

Are vitals taken during an on the field secondary survey?

• NO

When can the secondary survey begin?

• once the patient is deemed stable

When palpating, where should you start?

• away from the injury

Why is palpating done?

• determine nature of injury

• determine extent of point tenderness, affected structures, and other deformities that aren’t visible

What are you trying to determine during the on field musculoskeletal evaluation?

• seriousness of injury

• type of first aid and immobilization required

• need for immediate referral

• type of transportation from field to sideline, to athletic training room, hospital/team physician

When should splinting be done?

• always for a suspected fracture

Where should you splint?

• above and below the broken bone

Rapid from vacuum immobilizer (A)

• Styrofoam chips sealed in airtight sleeve

• moldable with Velcro straps to secure

• air can be removed to make splint rigid

SAM splint (B)

• thin sheet of pliable aluminum covered with padding

What occurs during a sideline evaluation?

• hands on assessment of ligaments, muscles

• determine a diagnosis

• risk of re-injury

• assessment of function

What do ATs look for during the function assessment?

• full strength and ROM

• able to manage pain

• proprioception

• functional activity progression

• does athlete want to return to play

What are the 4 distinct evaluations?

• preparticipation (prior to start of season)

• on-field assessment

• sideline evaluation

• off the field evaluation (in clinic/ATR)

What basic knowledge requirements are required for evaluations?

• Surface anatomy

• body planes and anatomical directions (points of reference)

Etiology (MOI)

• cause of injury or disease

Symptoms

• perceptible changes in body or function that indicate injury or illness (subjective)

Sign

• objective, definitive, and obvious indicators of specific condition

Diagnosis

• denotes name of specific condition

Degree

• grading for injury/condition

Differential diagnosis

• systemic method of diagnosing a disorder

• refers to a list of possible causes, prioritizing of possibilities

What are the 4 components of the off-the-field evaluation?

• Subjective

• objective

• assessment

• plan

HOPS

• history

• observation

• palpation

• special tests

After an off-the-field evaluation, what does the AT assess?

• seriousness of injury

• type of first aid necessary

• need for immediate referral or further care

• manner of transport

• make a clinical diagnosis

What is the goal of obtaining the history of the injury?

• obtain subjective information relative to how the injury occurred, extent of injury, and mechanisms of injury (MOI)

What is collected during the subjective phase?

• chief complaint/general complaints

• previous injuries and past treatments

• ask what the problem is, how and when it occurred, did they hear/feel anything, which direction did joint move

Pain assessment: sharp/burning pain

• nerve pain

pain assessment: achy/pain that subsides with activity

• chronic inflammation

pain assessment: sharp/stabbing pain

• muscle injury

pain assessment: clicking/popping in joint

• labral, meniscal injury/tear

What are you looking for during your observation?

• asymmetries

• how athletes moves, look for limp

• body position

• facial expressions

• redness, swelling, discoloration

During your observation, why do you palpate?

• identify bony and soft tissue

Why are special tests used during observation?

• to detect specific pathologies

• compare inert and contractile tissues and their integrity

How should special tests be made?

• bilaterally

What are the types of ROM test during your observation?

• active

• passive (normal vs. abnormal endpoints, manual muscle tests, goniometric measures vs. digital inclinometers)

Dermatome

• area of skin innervated by a single nerve

Myotome

• muscle or group of muscles innervated by a specific motor nerve

What’s being tested during the neurological and circulation assessments?

• brain

• sensory and motor funciton

• reflex testing

• referred pain

Deep tendon reflex

• caused by stimulation of stretch reflex

Superficial reflex

• stimulation of skin that causes reflexive muscle contraction

Pathological reflex

• superficial reflex indicative of upper motor neuron lesion

• Babinski’s sign, chaddock’s, oppenheim’s. gordon’s

How is the Babinski’s test performed?

• stoke the lateral (outside) portion of the bottom of the foot, moving the heel toward the toes and then across the ball of the foot

Positive Babinski’s test response

• the big toe extends upward and the other toes may fan outward

what does the Babinski test indicate?

• possible upper motor neuron dysfunction

How to preform Chaddock’s test?

• stroke the skin around the outside of the ankle, below the lateral malleolus (ankle bone)

Positive response to Chaddock’s

• big toe extends upward, sometimes with fanning of other toes

What does Chaddock’s test indicate?

• possible upper motor neuron dysfunction

How is Oppenheim’s test performed?

• apply firm pressure while moving downward along the front of the shin bone (tibia)

How is Gordon’s test preformed?

• squeeze calf muscles

Positive response to Oppenheim’s and Gordon’s

• big toe extend upwards

What does the Oppenheim and Gordon’s tests indicate?

• possible upper motor neuron dysfunction

Who makes the clinical diagnosis?

• Physicians

Who makes the ultimate determination of the patient’s physical condition?

• physician

Plan

• type of intervention/modalities

• when you would like to see pt again for follow up care

• any self-care or at home instructions

• referral to MD ( if necessary)

• rehab plan