CHAPTER 2
I. REGOGNITION OF INJURIES
A. The primary functions of an athletic trainer are to:
1. recognize when injury occurred
2. to determine its severity
3. and to apply proper evaluation procedures and treatment protocols
B. There are 2 major considerations in emergency evaluation:
1. Control of life-threatening conditions and activation of emergency medical services
2. Management of non-life-threatening injuries
C. If any of the following situations exist, immediate referral is critical:
1. loss of breathing
2. severe bleeding
3. suspicion of intracranial bleeding and bleeding from ears, mouth, +/or nose
4. unconsciousness
5. paralysis
6. circulation or nerve impairment
7. shock
8. obvious deformity
9. suspected fracture/dislocation
10. pain, tenderness, or deformity along vertebral column
11. significant swelling and pain
12. loss of motor sensory sensation
13. loss of motion
14. doubt about severity of the injury
D. Student AT’s are NOT responsible for handling a seriously injured athlete.
1. Student trainers’ responsibilities in emergency situations:
a. become aware of the causes of serious injuries
b. make sure equipment and playing area are safe
c. alert ATC, coach, and team Dr. of potential dangers
d. recognize signs of serious injury
e. implement detailed plan to handle emergency transport
II. First Aid Emergency Care
A. Am. Red Cross and Am. Heart Association have established protocols that give the ATC guidance to administer first aid emergency care.
B. Current certification in CPR and first aid must be maintained by the ATC and coaches.
C. A written statement should be drafted by the team Dr. that
provides direction on how to handle specific injuries.
1. It should include protocol for handling:
a. Life-threatening injuries
b. non-life-threatening injuries
c. bloodborne pathogens
III. Emergency Transportation Procedures
A. 2 points to consider when deciding about transportation:
1. availability of emergency ambulance service
2. severity of injury
B. Athletic training staff or coaches should NEVER transport an athlete in a private vehicle.
C. EMT’s are skilled, practiced pros. who routinely provide advanced medical care and transport injured patients.
1. They have the proper equipment and training to prepare injured athletes for transportation.
IV. Evaluation of Life-threatening Injuries
A. Begin evaluation with the “Primary Survey”, which assesses:
1. airway
2. breathing
3. circulation
B. To conduct a primary survey:
1. approach athlete in a calm manner
2. be prepared to clear and maintain the airway free of potential obstructions such as blood, vomit, and foreign matter.
3. Assist the patient in finding the most comfortable position for breathing
4. be prepared to provide artificial ventilation or CPR and to activate the emergency medical system.
C. “Secondary Survey” is done after primary survey has determined there is no life-threatening condition. It consists of 2 elements:
1. History- ask questions of the athlete to determine:
a. mechanism of injury
b. onset of symptoms
c. location of injury
d. quantity and quality of pain
e. type and location of any abnormal sensations
f. progression of signs and symptoms
g. activities that make the symptoms better or worse
h. nausea
i. weakness
j. dyspnea (shortness of breath)
2. Physical Examination checks:
a. Respiratory rate
b. Moistness, color, and temp. of skin
c. Pulse rate
d. Evaluate Vital Signs:
1. abnormal nerve response
2. blood pressure
3. movement
4. pulse
5. respirations
6. skin color
7. state of consciousness
8. temperature
V. Evaluation of Non-Life-Threatening Injuries
A. First rule out life-threatening injury
B. 2 formats of evaluation are commonly used
1. HOPS
2. SOAP
C. HOPS evaluation is to determine if a serious injury has occurred.
1. Always suspect a fracture at first.
2. Signs of a fracture are:
a. direct or indirect pain
b. deformity
c. a grating sound at the injury site
d. may or may not be swelling or pain
3. If fracture is suspected, splint extremity and transport.
a. Young athletes are especially susceptible to fractures due to their immature bone structure. Often ligaments and muscles are stronger that the bones.
D. EVALUATION Process involves 4 steps: HOPS
1. HISTORY - ask questions to help determine the “mechanism of injury”.
a. How did it happen? (mechanism of injury)
b. Where does it hurt? (location of pain)
c. Did you hear a pop or snap? (sensations experienced)
d. Have you injured this anatomical structure before” (previous injury)
2. OBSERVATION – compare the uninvolved to the involved anatomical structure (bilateral comparison)
a. Look for:
1. bleeding
2. deformity (disfigurement)
3. swelling (edema)
4. discoloration (ecchymosis)
5. scars
6. and other sign of trauma
3. PALPATION- Physical inspection of an injury.
a. Palpate above and below injury site first.
b. Then palpate injury site.
c. Pinpoint the site of the most severe pain. (point tenderness)
d. Use bilateral comparison – compare good side to injured side.
4. Special Tests- Trainer looks for joint stability, disability and pain.
a. It is possible to further damage an injury through manipulation.
b. Years of training and experience are necessary for an ATC to be competent to perform special tests.
c. Should NEVER be attempted by a student trainer.
d. Special tests and functional tests are used to determine if damage has been done to the anatomical structures
e. These tests include testing for:
1. joint stability
2. muscle/tendon stability
3. accessary anatomical structures
example: synovial capsules, bursa
menisci
4. inflammatory conditions
5. range of motion
6. pain or weakness in the affected area
E. Evaluation format: SOAP
1. Subjective- asking question about pre-existing or existing injuries.
a. previous injury
b. How it happened?
c. When it happened?
d. What did you feel?
e. Types of pain
f. Where does it hurt?
2. Objective
a. Involves visual, physical, and functional inspection
b. Assessing for:
1. swelling
2. deformity
3. ecchymosis
4. symmetry
5. gait/walk
6. scars
7. facial expression
8. circulation
9. neurological tests
10. bone
11. soft tissue
12. range of motion
13. sports-specific movements
3. Assessment reviews:
a. Probable cause
b. Mechanism of injury
c. Impressions of injury site
d. Severity of injury
e. Treatment goals
4. Plan outlines appropriate action that should be taken to care for the injury.
a. Immediate action
b. Referral
c. Modalities utilized
d. Preventive techniques
e. Rehabilitation considerations
f. Criteria for return to active lifestyle
VI. BASIC TREATMENT PROTOCOL: PRICES ( followed by referral to a physician)
A. PROTECTION
1. Protect the injury from further damage by removing the athlete from participation.
B. REST
1. After evaluation is completed, rest injury for at least 24 hrs., but could be longer.
a. length of rest dependent on severity of injury.
C. ICE
1. Apply cold to injured area
a. to control bleeding and swelling
b. Two equally effective methods:
1. Ice packs-
aa. plastic bags filled with ice covered with a wet towel.
bb. Treatment lasts 15 min. , 6-8 times per day.
2. Cold water immersion bath-
aa. use bath tub/large basin with water temp. 50/60 degrees for 10 min., 6-8 times per day.
NOTE: Persons with any known circulation problems must avoid ice.
D. COMPRESSION
1. use compression wrap to control swelling
2. begin distally (farthest from heart)
2. spiral the wrap toward the heart
3. remove the wrap every 4 hours
4. things to look for if wrap is too tight:
a. extremities turning blue or pink
b. numbness & tingling of extremities
c. increased pain
E. ELEVATION
1. Keep injured body part elevated higher than the heart
a. allows gravity to keep excessive blood & swelling out of injured area.
F. SUPPORT
1. first aid splint
2. crutches for lower extremity injuries
3. sling for upper extremity injuries
VII. First Aid Splinting Equipment
A. Splints: intended to protect the injury from further damage by limiting movement
B. Types of splints:
1. fixation
a. most commonly used splints
b. board, wire, ladder, pillow, blanket are examples
2. vacuum
a. appropriate for dislocations or misaligned fractures
b. adaptable to any limb angulation
3. pneumatic (air)
a. best suited for nondisplaced fractures
b. easy to apply
4. traction
a. used for long bone fractures (femur/humerus)
b. prevents fractured bone ends from touching
c. advanced medical training is needed to bocome proficient in application of traction splints
C. 10 keys points to follow when using emergency splinting equipment:
1. Check extremity for open wounds, deformity, swelling, ecchymosis.
2. Check pulse, motor, sensation and capillary refill of injured site distal to injury.
3. Cover all wounds with a dry, sterile dressing before applying a splint. Notify receiving medical facility of all open wounds.
4. Do not move the athlete before splinting extremity injuries unless there is an immediate hazard to the athlete or to you.
5. Select proper splint in which length and size should cover above and below the injury site.
6. Place splint beside the injured extremity and then smooth out the contents of the splint. Larger end of splint should be place proximal to the injury.
7. When applying the splint, use your hands to minimize movement. Support the injury above and below when applying the splint on the extremity.
8. Secure splint with straps by applying firm compression.
9. Again, check pulse, motor, sensation and capillary refill distal to injury site.
10. Apply cold to the injured area and document time.
11. X-rays can be taken through some commonly used splinting equipment.