Emergency Care and Medical Management of Athletic Injury

1
Chapter 8

• Emergency Care and Medical Management of Athletic
  Injury

2
Overview

• The emergency plan
• First aid, emergency care, and cardiopulmonary
  resuscitation (CPR)
• First aid procedures for sudden illnesses
• The emergency care plan
• Legal and ethical issues in treatment
• Community-based EMS
• Emergency care equipment and supplies
• Referring the athlete for further care

3
The Emergency Plan

• Have an emergency plan practice it!
• Considerations in development
• Telephone access
• Keys
• Location/directions to facility
• Accompaniment
• Parent notification

4
First Aid, Emergency Care, and Cardiopulmonary
Resuscitation (CPR)

• ABCs, for a person possibly needing CPR
• A airway
• B breathing
• C circulation
• Organizations that credential first responders
• American Heart Association
• American Red Cross

5
First Aid, Emergency Care, and Cardiopulmonary
Resuscitation (CPR)

• Primary survey
• ABCs
• Secondary survey
• Spine and extremity evaluation
• Decisions to be made
• Seriousness of injury life-threatening?
• Type of first aid required?
• Medical referral required?
• Transportation necessary?

6
First Aid, Emergency Care, and Cardiopulmonary
Resuscitation (CPR)

• Secondary assessment
• Observationlook at em!
• Vital signs
• Trends over timewhat is happening to the BP,
  pulse, etc. through repeated measurements every
  1-2 minutes

7
First Aid, Emergency Care, and Cardiopulmonary
Resuscitation (CPR)

• Obvious orthopedic deformity
• May not be seem to be a medical emergency
• Check to see if something is torn or broken that
  may be causing bleeding you cannot see
• Internal structures may be bleeding if injured,
  and this bleeding must be controlled

8
First Aid, Emergency Care, and Cardiopulmonary
Resuscitation (CPR)

• Uncontrolled bleeding
• Use Universal Precautions
• Keeping patient breathing is first concern then
  control bleeding
• Ways to control bleeding
• Direct pressure
• Usually primary method of attempting control of
  bleeding
• Wear gloves!
• What if there are no gloves on the scene?
• Splinting
• Often not an obvious method of controlling
  bleeding, but can be effective in cases of open
  fractures
• Pressure over the major artery
• Tourniquet
• Last resort
• May mean sacrificing the limb
• Only trained emergency care provider should make
  the decision to use a tourniquet

9
First Aid Procedures for Sudden Illnesses

• General guidelines
• Look for warning signs
• Assess athlete or situation for idea of what is
  wrong (for example, know athletes history of
  illness, assess environmental temperature and
  humidity)
• Care for life-threatening conditions first treat
  symptoms if person's life is not in danger

10
First Aid Procedures for Sudden Illnesses

• Athletes with diabetes
• Look for warning signs
• Provide additional sugar, even if in doubt
• Athletes with bronchospasm/asthma
• Look for signs of hypoxia
• Transport if necessary

11
First Aid Procedures for Sudden Illnesses

• Sickle cell crisis
• Muscle pain, weakness, or fatigue
• Most prevalent among African Americans
• May lead to devastating rhabdomyolysis
• Epilepsy
• Keep safe and prevent further injury
• Heart conditions
• If in doubt, refer!

12
Musculoskeletal Assessment

• History and background information
• Subjective info feelings of patient
• Previous injury
• Mechanism of injury
• Anatomy and biomechanics
• Observation
• Palpation
• Special tests

13
Treatment Following Acute Injury

• RICE
• Rest
• Ice
• Compression
• Elevation

14
The Emergency Care Plan

• Game and practice coverage
• Sports with a high potential for serious injury
  should have medical coverage during practices and
  games
• Necessary emergency equipment also needs to be on
  hand
• Emergency services for games should be formulated
  each year before the season

15
The Emergency Care Plan

• Emergency procedure steps Plan ahead of time
• First responder assesses situation
• First provider begins providing needed injury
  management
• Second responder assists in injury management,
  directing other personnel, or both
• Team stabilizes the injury to allow for
  transportation

16
The Emergency Care Plan

• Communication systems
• Methods
• Telephone must be convenient written emergency
  instructions must be by phone
• Central dispatcher
• Meeting the ambulance
• On-site communication to emergency personnel,
  often athletic trainer's responsibility
• Notification of athlete's parents and school
  administrators

17
The Emergency Care Plan

• Equipment
• Important to have on hand in case it is needed
• Emergency medical technicians (EMTs) or
  paramedics should check all materials

18
The Emergency Care Plan

• Transportation
• Ambulanceprofessional service
• Personal carknow liability exposure
• Document circulatory and neurological status
• Once EMS arrives, care of patient will become the
  job of the ambulance personnel

19
The Emergency Care Plan

• Personnel training
• Yearly completion of CPR training
• Instruction and practice in preparing injured
  athletes for transport
• Annual meeting of all emergency response team
  members

20
The Emergency Care Plan

• Record keeping
• Necessity of documenting emergency care rendered
• If you did not document itlegally, you did not
  do it!
• Important for possible legal purposes

21
Legal and Ethical Issues in Treatment

• Consent
• Must be obtained before treatment is rendered
• Required by law for any medical treatment to a
  patient
• Often assumed, but consent-for-treatment forms
  should be signed
• Negligence
• Duty
• Breach of duty
• Physical or psychological injury
• Cause

22
Community-Based EMS

• Members of the EMS network (see table 8.1, page
  276 in textbook)
• Accessing the emergency network
• In the United States 911
• In other countries must know local emergency
  access numbers (United Kingdom 999 Australia
  000)

23
Community-Based EMS

• Transportation systems
• Ambulance, police, fire department
• EMS chain of command DPS (department of public
  safety) agency protocols and the orders of the
  physician with the emergency care team take
  precedence over the decisions of the sport team's
  physician

24
Community-Based Emergency Care Facilities

• Availability and capabilities
• Much of the equipment of the EMS is very
  specialized and not available in many athletic
  facilities
• Stretchers, spine boards, and neck collars should
  be part of the athletic training inventory
• EMS response time varies by locale
• The need for special equipment may affect
  availability and response time
• May use different hospital than expected, based
  on type of injury

25
Community-Based Emergency Care Facilities

• Admission and treatment policies
• Roles and responsibilities
• First responders
• EMTs EMT-B and EMT-I
• Paramedics (EMT-P)
• Emergency room physician
• Ambulance crew guidelines responsible to medical
  director of their "home" hospital, not to the
  team physician

26
Emergency care equipment and supplies

• Principles regarding what to purchase
• Equipment that you are trained or skilled enough
  to use
• Useful to the majority of staff members
• Observe budgetary constraints

27
Emergency Care Equipment and Supplies

• Airway management
• Essential to manage airways
• Oropharyngeal airway, positive pressure
  ventilation, pocket mask, bag-valve mask
  resuscitators, supplemental oxygen

28
Emergency Care Equipment and Supplies

• Cardiac equipment
• AEDs utilized to manage ventricular fibrillation
  NOT cardiac arrest
• Automated external defibrillator
• Can be used by athletic trainers, coaches, and
  others trained to administer

29
Emergency Care Equipment and Supplies

• Providing and maintaining equipment
• Must ensure that proper materials are available
  and are in a designated place
• Whose job is it to maintain emergency equipment?

30
Emergency Care Equipment and Supplies

• Athletic trainer's kit
• Contents may vary according to sport, athletes
  with specific needs (e.g., diabetes), and
  location of medical assistance
• Handling various types of injuries

31
Referring the Athlete for Further Care

• Documenting and communicating
• Medical terminology
• Need consistency in medical terminology by all
  health care providers
• Difference between clinical signs and symptoms
• Sign Measurable findings, quantified (e.g.,
  temperature, range of motion of a joint)
• Symptom Something the patient reports (e.g., "my
  knee gave out")

32
Referring the Athlete for Further Care

• Clarity and accuracy in reporting
• If in doubt, write it out
• Medical terms have long been used and as such are
  often difficult to change
• Sometimes more than one proper description of a
  test, a structure, or a condition

33
Transmission of Bloodborne Pathogens

• A bloodborne pathogen is any infectious agent
  found in human blood for example, human
  immunodeficiency virus (HIV), hepatitis B (HBV)
• HBV vaccinations

34
Transmission of Bloodborne Pathogens

• Precautions potential causes of increased risk
• What is potentially infectious?
• Potentially infectious blood and body fluids
  containing visible blood, semen, vaginal
  secretions, tissues, and bodily fluids such as
  synovial fluid
• Not potentially infectious unless contain blood
  tears, nasal secretions, saliva, sputum, sweat,
  urine, feces, vomit
• Precautions
• Barriers gloves, mask, gown, eye protection
• Frequent hand washing
• Disposal of sharp instruments into impervious
  containers
• Disposal of soiled gloves, cloths, or gauze into
  biohazard bags

35
Transmission of Bloodborne Pathogens

• Precautions potential causes of increased risk
  (cont.)
• Increased risk due to behaviors Universal
  Precautions
• Transmission by direct physical contact Take the
  time to don gloves and dispose of gauze and
  cloths
• Transmission by direct contact with blood or body
  fluids Avoid recapping needles used in the care
  of an athlete's wound dispose of needles in the
  sharps container
• Transmission by indirect contact Indirect
  contact is unlikely to cause transmission

36
Transmission of Bloodborne Pathogens

• Perceptions of risk
• Athletes' perceptions
• Health care providers' perceptions
• Must treat every patient, every athlete with the
  best medical care you can provide