Injury Management Strategies LESSON OBJECTIVES At the conclusion of this lesson, the student will be able to: ? describe steps in managing a life-threatening injury on the field ? outline the process for managing a non-life threatening injury on the field ? define terms commonly used in the description on injuries & illnesses ? list & explain steps in the evaluation of a non-life threatening injury on the sideline ? describe the process for documenting injuries & illnesses ? explain how to prevent the spread of blood borne pathogens AGENDA ? Is this a killer? ? Could this leave a permanent mark? ? The lingo. ? Figure out what?s wrong. ? Paperwork makes the world go ?round. ? It?s in the blood. MANAGING IMMEDIATE LIFE THREATENING INJURIES ?first priority with any injury is to determine if it is immediately life threatening ? any loss of consciousness ? any difficulty with respiration ? any difficulty with circulation ?presence of obvious life threatening conditions is determined through a PRIMARY SURVEY ? LOC-ABC ?determine level of consciousness (LOC) ? AVPU ? patient is Alert ? eyes are open when you arrive at the scene ? answers your questions clearly ? follows or attempts to follow your commands ? patient responds to Verbal stimulus ? responds to your voice in some way ? opens eyes, moves, speaks or makes sounds ? patient responds to Painful stimulus ? responds to pain in some way ? pain is most elicited by pinching the inside of the forearm ? opens eyes, moves, speaks or makes sounds ? patient is Unresponsive ? not alert & does not respond to verbal or painful stimuli ?determine status of respiration & circulation ? ABCs ? assess Airway ? lift lower jaw up while keeping neck still ? assess Breathing ? look to see if chest rises during inspiration ? listen for breathing in & out ? feel for breath on your cheek ? assess Circulation ? feel for carotid pulse at neck ? check for major bleeding from chest, abdomen & extremities ?activate your Emergency Action Plan (which you have practiced ALOT!) ? personnel ? remember that the captain is in charge ? role of each person ? everyone must know & do their job ? equipment ? have good equipment that is with you & that works ? communication devices ? have one that you can get to & that works ? have a backup ?all coaches should have current First Aid & CPR training ? Adult Rescue Breathing ? 1 breath every 5 seconds ? Adult CPR ? cycles of 30 compressions & 2 breaths ? Conscious Choking Adult ? encourage coughing ? Unconscious Choking Adult ? cycles of 30 abdominal thrusts & 2 breaths MANAGING NON-IMMEDIATE LIFE THREATENING INJURIES ?second priority with any injury is to determine if it is potentially life threatening ? major bleeding ? abnormal blood pressure ? abnormal pulse ? abnormal respiration ? abnormal temperature ?third priority with any injury is to determine if it is limb threatening ? major bleeding ? loss of distal pulse ? loss of distal sensation ?presence of non-immediate life threatening & limb threatening conditions is determined through a SECONDARY SURVEY ? vital signs ? other ?emergency? signs ? head to toe evaluation ? SAMPLE history ?assess vital signs ? pulse (normal resting rate = 80) ? distal to the injury ? presence ? rate (count for 30 seconds & multiply by 2) ? quality ? DON?T use thumb ? pulse increases during activity ? respiration (normal resting rate = 12-14) ? put hand on back to feel chest rise & fall ? presence ? rate (count for 30 seconds & multiply by 2) ? quality ? respirations increase during activity ? blood pressure (normal resting BP = 120/80) ? use blood pressure cuff on R arm ? BP increases during activity ? 130/90 is typical cutoff for high blood pressure ? either number can be elevated ?assess other ?emergency? signs ? pupil response ? Pupils should be Equal, Round, & Reactive to Light (PERRL) ? R & L pupils should be same size ? both pupils should be round ? both pupils should respond in the same way to light ? dilate in response to darkness ? constrict in response to light ? eye movement ? should be able to smoothly follow an object in all directions (side to side, up & down and diagonal) with both eyes ? peripheral vision ? should be able to see an object in the same position on either side of body without moving head or eyes ? skin color ? skin color should be consistent ? red indicates active inflammation ? blue & white both indicate lack of blood supply ? skin temperature ? assess with back of hand ? should be consistent with other parts of body ? heat indicates active inflammation ? cold indicates lack of blood supply ? body temperature (normal resting T = 98.6°F) ? assess with oral thermometer ?conduct a head to toe evaluation ? observe for ? blood or other fluid from nose or ears ? ?Blood out of any orifice is NOT COOL.? ? major bleeding ? obvious deformity ? swelling ? skin wounds ? discoloration (ecchymosis) ? feel (palpate) for ? obvious deformity ? swelling ? presence of distal pulse in all 4 extremities ? DON?T use thumb ? in the upper extremities assess the Radial pulse on the anterior aspect of the thumb side of the wrist ? in the lower extremities assess the Posterior tibial pulse on the medial aspect of the ankle, behind the medial ankle bone ? presence of capillary refill in all 4 extremities ? when you push on fingernail or toenail, it should go white & then color should return within 1-2 seconds after you release the pressure ? check for ? distal sensation in all 4 extremities ? can the patient feel you touching his fingers ? can the patient feel you touching his toes ? distal motor function in all 4 extremities ? can the patient wiggle his fingers ? can the patient wiggle his toes ? be prepared to deal with athlete?s equipment ? may need to remove facemask, helmet, shoulder pads, etc. ? removal of this equipment requires training ? cut jerseys, pants, straps, shoelaces, etc. ? take care of problems as you find them ? control major bleeding ? cover wounds ? splint areas of deformity ? REMEMBER: ?splint it as it lies? ? be prepared to treat for shock ? keep patient warm ? do not give fluids ? be prepared to do rescue breathing or CPR ?take a SAMPLE History ? Symptoms ? what are the patient?s chief complaints ? Allergies ? especially medication, food & environmental ? Medications ? any current prescription or OTC medications ? Previous history ? similar events to patient or in patient?s family ? Last meal ? when was it ? Events preceding the injury or illness ? what is the mechanism of injury ?based on findings from primary survey and secondary survey you will have to make a decision about transportation of the athlete ?it is NEVER a good idea to transport an athlete in your personal vehicle ? you open yourself to significant liability ? ACTIVATE EMS if problems exist with ? the primary survey ? these are LOAD & GO SITUATIONS ? ACTIVATE EMS if problems exist with ? vital signs ? the other ?emergency signs? ? if there is obvious deformity ? if there is loss of distal pulse ? if there is loss of distal sensation ? if there is loss of distal motor function ?if you are in doubt about whether or not to activate EMS, activate EMS ? there is no negligence in sending an athlete is an ambulance when it isn?t necessary ? there is negligence in not sending an athlete in an ambulance when it was necessary INJURY CONDUCT PRIMARY SURVEY UNCONSCIOUS? CONSCIOUS? CONDUCT SECONDARY SURVEY IMPLEMENT EAP & ACTIVATE EMS DECIDE ON TREATMENT v. TRANSPORT The Terminology of Injury Evaluation ?mechanism of injury (MOI): action that caused the injury; how the injury occurred ?symptom: a complaint reported by the patient, it is subjective in nature ?sign: an indicator of injury or illness that can be measured, it is objective in nature ?diagnosis: determination of the problem based on the entire evaluation process ? an ATC makes a clinical diagnosis ?prognosis: the predicted outcome of an injury or illness ?syndrome: a collection of signs & symptoms The Injury Evaluation Process ?the evaluation process for injuries must be methodical & logical ?it must be consistent from evaluation to evaluation in order to prevent missed information ?the purpose of the evaluation process is to arrive at a clinical diagnosis ?the HOPS acronym guides the evaluation process ? History ? Observation ? Palpation ? Stress HISTORY ?an injury history is gained by asking questions of the patient, other people familiar with the injury & perhaps through a review of existing medical records ?the patient history incorporates the present injury, history of past injury & relevant medical or family histories ? past injury history ? any previous injury at all? ? if this is the 1 st injury ever, they have no point of comparison for pain, etc. ? previous injury to this body part? ? if so, what was it? ? how bad was it? ? how was it treated? ? previous injury like the current one? ? does the current injury feel like the previous one? ? present injury history ? what was the mechanism of injury? ? acute onset (traumatic) v. chronic (overuse) ? did equipment play a role? ? what is location of injury? ? general (knee, ankle, etc.) ? specific (anterior knee, lateral ankle, etc.) ? have patient ?put 1 finger where it hurts the most? ? what is the patient?s biggest symptom? ? how much pain is there? ? rate on scale of 1-10 ? what is the type of pain? (shooting, throbbing, stabbing, etc.) ? where is the pain? ? deep v. superficial ? stationary v. moving ? were there any sounds or sensations (?pops? or ?snaps? heard or felt) at the time of injury? ? DON?T PUT WORDS IN THEIR MOUTH! ? are there any sounds or sensations now (?giving way?, ?locking?) ? DON?T PUT WORDS IN THEIR MOUTH! OBSERVATION ?the observation phase of an injury evaluation includes ALL of the things that you see related to a specific injury ?ideally observation begins with the injury occurrence itself ?you should observe when the athlete is & is not aware that you?re observing ? items for observation ? what was the mechanism? ? how does the athlete move? ? quality AND quantity of movement ? is there limping or guarding? ? is there loss of movement? ? is there obvious pain with movement? ? do you hear sounds during movement? ? is there obvious deformity? ? is there discoloration? ? is there swelling or effusion? ? swelling = localized ? effusion = swelling inside a joint capsule (like there is a water balloon inside the joint) ? is muscle tone & development symmetrical from side to side? PALPATION ?palpation is the examination of the injured area by touch ?always take the age & gender of the athlete into account ? when in doubt, have another adult present during palpation ?the goal is to evaluate the integrity of structures, not to cause pain ?palpation is always done bilaterally ? bilateral = both sides ? palpate the uninjured side first, it is what is ?normal? for the athlete ?always begin palpating away from the ?known? area of pain ? if H & O indicate a lateral ankle injury, begin palpation on the medial side of the ankle ? begin with light pressure & progress to deeper pressure ? palpation should be systematic & logical ?items for palpation ? palpate distal pulse FIRST ? palpate all of every bone in the area ? obvious deformity? ? crepitus (cracking & grinding sensations)? ? palpate all soft tissues in the area ? obvious deformity? ? spasm? ? does palpation cause pain? STRESS ?stress is the application of some type of stress to specific tissues to assess their integrity &/or function ?the goal is to evaluate the integrity of structures, not to cause pain ?stress tests are always done bilaterally ? test the uninvolved side first, it is ?normal? ?tissues are stressed in a specific order ? bones ? muscles & tendons ? ligaments ? specialized structures (cartilage, bursa, etc.) ? nerves ? bones ? manual fracture tests ? if a bone hurts on all sides, it is broken until proven otherwise ? you can move a joint & STILL have a fracture ? muscles & tendons ? active range of motion (AROM) ? athlete moves joint in all possible motions ? passive range of motion (PROM) ? you move athlete?s joint in all possible motions ? ligaments ? tests are specific to body part & ligament ? specialized structures (cartilage, bursa, etc.) ? tests are specific to body part & structure ? nerves ? sensation ? movement ? reflexes Documentation ?all injuries should be documented using some formal process ?documentation provides legal protection & helps ensure continuity of quality care ?injury documents are legal, medical documents (HIPPA) ? confidential ? must be kept in a secure location ?the SOAP acronym guides the initial injury evaluation & injury follow up documentation processes ? Subjective ? Objective ? Assessment ? Plan ? Subjective ? information from the history portion of the evaluation ? this is information reported to you by the patient or other person (coach, parent, etc.) ? Objective ? information from the O, P & S portions of the evaluation ? this is information which is measurable & repeatable ? Assessment ? the clinical diagnosis based on the entire evaluation ? Includes suspected severity of the injury (Grade I, II or III) ? Plan ? treatment provided ? physician referral ? short-term plan for injury care ? statement about when follow up evaluation will occur Blood Borne Pathogens ?blood borne pathogens are viruses, bacteria, etc. that are carried in the blood & in body fluids that contain blood ? Hepatitis B Virus (HBV) ? Human Immunodeficiency Virus (HIV) ?body fluids containing blood ? blood ? semen ? vaginal secretions ? cerebrospinal fluid ? synovial fluid ?federal law requires that protections be provided to workers whose normal, expected job duties involve exposure to blood or body fluids containing blood ? MDs, Dos, DMDs ? nurses ? ATCs, PTs, OTs ? EMTs ? physical education teachers ? coaches ? equipment managers ?compliance with this law (& other workplace safety regulations) is monitored by OSHA (Occupational Safety and Health Administration) ?employer must provide AT NO COST TO THE EMPLOYEE ? personal protective equipment (PPE) ? HBV vaccination ? exposure control plan ? treatment in the event of exposure ? PPE ? gloves ? latex or non-latex ($$$) if employee has a latex allergy ? goggles ? face shield ? gown ? HBV vaccination ? 3 shot series ? employee can opt-out of vaccination if desired, this choice must be documented ? exposure control plan ? biohazard materials containers ? red bags ? sharps boxes ? mechanism for notifying superiors if exposure does occur ? treatment in the event of exposure ? if the exposure control plan was followed & exposure still occurred, employer must pay for testing & follow up treatment ?we limit exposure by following/observing UNIVERSAL PRECAUTIONS ? use gloves (& other PPE as appropriate) ? GLOVES SHOULD ALWAYS BE WORN ? wash hands following any patient contact ? dispose of biohazardous materials in approved biohazard containers ? red bags ? red step cans ? puncture-proof, leak-proof sharps containers ?appropriate management of open wounds also helps prevent the spread of blood-borne pathogens ?ALL open wounds should be covered before practices & games ? WEAR GLOVES WHEN TAKING CARE OF ANY WOUND ? bandages should be leak-proof ?when a wound occurs DURING practice or game ? WEAR GLOVES WHEN TAKING CARE OF ANY WOUND ? it MUST be covered immediately ? blood on clothing must be cleaned using peroxide or other germicide ? saturated clothing must be removed ? must be individually bagged ? must be washed with bleach/hot water ? THIS INCLUDES TOWELS ?DO NOT ALLOW ATHLETES TO SHARE TOWELS ? can spread BBP ? EXCELLENT way to spread other infectious agents such as Staph & ringworm ? good way to spread illnesses such as mono & flu dleaver Microsoft PowerPoint - Injury Management Strategies.ppt
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