On-Field Evaluation of Head and Neck Injuries

1
On-Field Evaluation of Head and Neck Injuries

• Orthopedic Assessment III Head, Spine, and
  Trunk with Lab
• PET 5609C

2
On-Field Evaluation

• Equipment Considerations
• Suspected spinal injury ? helmet should NOT be
  removed
• Airway is accessible (facemask removal)
• Cervical collar can be applied with helmet and
  shoulder pads on
• Athletes head can be secured to spine board
• Helmet removal without removing the shoulder pads
  ? cervical spine extension

3
On-Field Evaluation

• Facemask Removal
• Facemask is attached to the helmet by thick
  plastic fasteners
• Can be cut off or unscrewed
• Most helmets have four fasteners
• Can cut all four or cut the bottom two and
  retract the mask

4
On-Field Evaluation

• Facemask Removal
• Common tools for helmet removal
• Hand held screwdriver
• Anvil Pruner
• Trainers Angels
• FM Extractor

5
On-Field Evaluation

• Chest Exposure
• Shoulder pads and jersey should be left in place
  along with the helmet
• To access the chest for CPR, cut the jersey,
  shoulder pad stings and straps, and spread the
  pads apart so the chest is exposed

6
On-Field Evaluation

• Initial Inspection
• Encumbering circumstances
• Diver still in the water
• Football player lying on a pile
• Movement
• Note any athlete movement
• Position of athlete
• Alignment of arms, legs, cervical spine relative
  to trunk
• Splayed extremities must be aligned prior to
  spine-boarding or log-rolling the athlete
• Lesion of cervical or thoracic spinal cord
• Priapism

7
On-Field Evaluation

• Initial Action Cervical Spine Stabilization
• Primary goal Maintain the head and neck in
  alignment with the long axis of the body
• Kept from time of initial assessment, through
  transportation, and to the hospital
• Assign one person whose only responsibility is to
  secure and position the head and neck
• Usually the person with the most training and
  experience
• In-control directs others

8
On-Field Evaluation

• Initial Action Primary Survey / LOC
• Determine level of consciousness
• Can you hear me
• Response to painful stimulus
• Determine ABCs
• Clear the airway and assess breathing
• Remove mouthpiece
• Check Circulation
• Inspect ears and nose
• CSF
• Secondary Survey
• Signs of trauma (fracture, dislocations, bleeding)

9
On-Field Evaluation

• Management of Unconscious Athlete
• Airway
• Permanent brain damage within 4 minutes after
  oxygen deprivation
• Assess airway
• Look, listen, feel for breathing
• Emergency Roll
• No pulse / not breathing and not in supine
  position
• Maintain in-line stabilization
• Expose chest
• Remove facemask
• Jaw thrust to open airway
• 2 quick breaths
• Circulation
• Carotid pulse
• Not breathing with pulse Rescue breathing
• No pulse CPR

10
On-Field Evaluation

• Modified Jaw Thrust
• Grasp each side of the mandible at the angle and
  pull upwards
• Must be careful not to disturb the c-spine
• May not always open the airway
• Should be done by a professional rescuer or
  athletic trainer
• Essentially dislocating the jaw

11
On-Field Evaluation

• Management of Unconscious but Breathing Athlete
• C1 Lesion ? Altered brain stem function and
  cardiac arrest
• C2 C4 ? phrenic nerve interruption
• Respiratory distress

12
On-Field Evaluation

• Management of Unconscious but Breathing Athlete
• Cervical spine evaluation
• Palpate for gross bony deformity
• Blood pressure
• Palpation of pulse and minimum Systolic BP
• Carotid artery 60 mmHg
• Femoral artery 70 mmHg
• Radial artery 90 mmHg
• Pupil responsiveness
• Open athletes eyelids
• Open eyelids pupil constriction
• Absence brain not receiving oxygen / brain
  damage
• Continue monitoring
• Every 5 minutes

13
On-Field Evaluation

• Management of Conscious Athlete History
• Loss of consciousness
• Does athlete describe blacking out or seeing
  stars
• Mechanism of injury
• Symptoms
• Pain in cervical spine
• Numbness, tingling, burning pain radiating
  through upper or lower extremities
• Sensation of weakness in cervical spine, upper
  and/or lower extremities
• Burning or aching in the chest secondary to
  cardiac inhibition

14
On-Field Evaluation

• Management of Conscious Athlete
• Inspection
• Cervical vertebrae
• Alignment
• Cervical musculature
• Presence of spasm
• Palpation
• Cervical spine
• Spinous and transverse processes
• Alignment, crepitus, tenderness
• Cervical musculature
• Spasm in upper trapezius, levator scapulae, SCM
• Unilateral spasm cervical vertebral dislocation
  when skull is rotated and tilted to opposite side

15
On-Field Evaluation

• Management of Conscious Athlete
• Neurological Testing
• Sensory testing
• Motor Testing
• Active motion
• Wiggle toes and fingers
• Movement of ankles, wrists, knees, elbows, hips,
  and shoulders

16
On-Field Evaluation

• Removing the Athlete from the Field
• Walking athlete off the field
• Lying ? standing ? BP (risk of fainting /
  unsteadiness)
• Allow athlete to adjust to position changes

17
On-Field Evaluation

• Removing the Athlete from the Field
• Using a Spine Board Supine Athlete
• Place the extremities in axial alignment
• Arm on side toward which athlete rolled abducted
  to 1800 (if not wearing shoulder pads)
• Place the spine board close to the side of the
  patient
• Other responders position along the side of the
  athlete, according to the captains (person at
  the head) directions
• Ideal to have 4 or 5 additional helpers,
  depending on the size of the patient
• Each person is responsible for one body segment
  trunk, hips, thighs, lower legs

18
On-Field Evaluation

• Removing the Athlete from the Field
• Using a Spine Board Supine Athlete
• No matter how distorted it may appear, the neck
  MUST be stabilized in the position it is found
• Put the spine board close to the patients side
• Roll together on the captains signal
• Ask if anyone has questions before proceeding
• Example well roll on 3. ready 1,2,3

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On-Field Evaluation
20
On-Field Evaluation
21
On-Field Evaluation

• Removing the Athlete from the Field
• Using a Spine Board Supine athlete
• Continue to stabilize head and neck throughout
  the roll and on the spine board
• Use chin straps and foam blocks to secure the
  head on the board
• Secure the limbs with straps
• Distribute help personnel and lift together

22
On-Field Evaluation

• Removing the Athlete from the Field
• Using a Spine Board Prone athlete
• One person takes charge and immobilizes the head
• Hands should be placed so that the head and neck
  can maintain their position as the body moves
• Assistants kneel and reach across patients body
• Each person is in charge of a different part,
  such as the trunk, hips, and legs
• Their arms should cross each other for stability
  and synchronization
• Limbs are placed at athletes sides
• On the captains call, the body is turned in
  unison onto the board