Transcript Blister treatment (eg, Moleskin, 2nd Skin, Glacier Gel)

AAYFL Coaches Clinic 2014
Houston Methodist
Orthopedics and Sports
Medicine
July 23rd, 2014
Who we are
 The only facility in Northwest Houston with the
expertise to care for all the needs of the athlete of any
age
 Primary Care Sports Medicine
 Sports Orthopedic Surgery
 On site x-ray
 Physical therapy
 Outpatient Surgery
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Houston Methodist
 All in one place
Agenda
 Emergency Action Plans and First aid kit
 Common injury principles in young athletes
 Common injuries in collision sports
 Concussion recognition and management and neck
injuries
 Heat, hydration and Nutrition
 Pearls for coaches from our coach for keeping kids safe
and motivated.
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Emergency Action Plans
 A written document that details what actions are done
by whom in the case of an emergency
 Applies to medical emergencies, environmental
emergencies and anything else you want
 Lets everyone know who does what
 Common in many organizations
 Schools, large companies and any other organization
where groups of people gather
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Activating Emergency Action Plan
 Know who is going to call the ambulance
 What do they need to say
 Who is bringing the first aid kit
 Who will direct the ambulance to the field
 Who is going to take care of the other athletes
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Calling the ambulance
 Identify yourself
 Know your exact location
 Know the age of the athlete and the type of
injury
 Know the status of the athlete
 Conscious
 Breathing
 Bleeding
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Calling the ambulance
 Know the best approach to the field
 Answer all the questions from the dispatcher
 Don’t hang up until the dispatcher does
 Have someone designated to meet the
ambulance
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Caring for the downed
athlete
 Remain calm
 If there is any concern for a spine injury, leave
the athlete on the ground with the helmet on
 Support the head
 Apply direct pressure to any bleeding areas
 If the athlete is unresponsive, assess need for
CPR and attach AED
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Practice Emergency Drills
 Schedule a drill prior to the season
 Plan a scenario for the drill
 Critique the staff’s response, duties &
actions
 Obtain support and guidance from your
local EMS
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Summary
 Emergency Action Plans Save Lives
 Use common sense and remain calm
 Don’t do more than you should
 Practice your plan!
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First aid Equipment and
Supplies
Equipment and Supplies Available at
Practices and Games for trainer or
Paramedic
 Splints
 Crutches
 Bandages
 Automated Defibrillator
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First Aid Kit Supplies

Think about what you need to treat common
injuries

Remember personal protection
 Latex or nitrile gloves
 Antiseptic towels
 Hand sanitizer
 Breathing barrier

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See the list in your handout.
Houston Methodist
First aid kit supplies
 Antiseptic wipes (BZK-based wipes preferred;
alcohol-based OK)
 Antibacterial ointment (e.g., bacitracin)
 Assorted adhesive bandages (fabric preferred)
 Butterfly bandages/adhesive wound-closure
strips
 Gauze pads (various sizes)
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 Nonstick sterile pads
Injury recognition in youth
sports overview
Bruce Moseley, M.D.
Objectives
 Discuss how kids are different
 Describe some common injuries
 Discuss Treatment principles
 Return to play criteria for common injuries
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Kids are different!!!
 Bones are pliable
 Every bone has a growth plate
 Growing bones are susceptible to injuries.
 Ligaments commonly stronger than bones
 Immature brains heal slower than mature brains
 Kids dissipate heat more slowly
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Bones Grow from the Ends
 Growth plates at the wrist and ankles are most
commonly injured
 Every bone has a growth plate
 Point tenderness near the end of the bone raises
concern for bone injury
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Injury Treatment Principles
 Rest
 Immobilize anything that hurts at the end of a bone
 Ice
 First 2 days for most any injury
 Compression
 Ace wrap
 Elevation
 Higher than the heart.
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Definitions
 Fracture = break
 Open fracture = break in the skin
 Closed fracture = no break in the skin
 Strain
 Small muscle tear or tear where muscle turns to tendon
 Sprain
 Ligament (holds joints together) stretched or torn
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Injury Evaluation
 History
 Be able to describe what happened

Simple descriptions

“Hit in knee, heard a pop”

“Tackled and hit back of head on ground”
 How bad was the injury initially?
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
Able to walk off the field

Pain with bearing weight
 Any previous injury like this
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Injury Evaluation
 Inspection
 Begins immediately after an injury
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
Limping

Holding injured body part

Bleeding

Deformed arm / leg
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Injury Evaluation
 Palpation
 Gently

Tender over a bone or joint

Is there any deformity

Blood flow

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
“Capillary refill”

“Run back the Kickoff”
Numb or tingling
Houston Methodist
Injury Evaluation
 Functional testing
 Pain is a defense that protects the body
 DO NOT disregard a players complaint of pain.
 Compare strength and range of motion with the
uninjured side.

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IF the 2 sides are different, err on the side of caution
and don’t return to play until seen by physician or
symptoms clear
Houston Methodist
Injury Evaluation
 Lower extremity injuries
 To return to play

Bear weight without pain

Walk without a limp

Duck walk without pain

Jog then run without pain

Do position specific drills
 If they can’t do the things necessary for a position,
don’t return to play
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Injury Reporting
 Most clubs have specific protocols
 If your club does not --- develop one
 Protects the athlete
 Protects the organization
 Improves communication between coach, parent
and physician
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Reporting Protocol
 Should include
 Athlete name
 Date of injury
 Type of injury
 Cause or mechanism of injury
 First aid applied
 Parents notified
 Documentation of others who witnessed the event
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Houston
Methodist
person
filling out the form
Injury Log
 Helps track type of injury
 Tracks the athlete who gets recurrently injured
 Shows length of time lost by injury type
 If used well, can show change in injury rate if
you institute a prevention strategy.
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Common Injuries in Collision
Sports
John Seaberg, M.D.
Common Injuries in Collision Sports
 Collar Bone fracture
 Joint dislocation
 Buckle fracture
 Long bone fractures
 Mallet finger
 Abdominal injuries
 Jersey finger
 Abrasions and
lacerations
 Muscle strain
 Knee ligament injuries
 Ankle sprain
 Muscle contusions
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Collar Bone Fracture
 Fall on shoulder or
outstretched hand
 Usually breaks in the
middle
 Treated with a sling or
figure of 8 splint
 Usually out at least 8
weeks
 Younger and not
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may
return
Houston
Methodist
Buckle Fracture
 Fall on an outstretched
hand
 Point tenderness usually
on the thumb side of of the
end of the forearm
 Sometimes swollen
 Collapse of one side of the
bone
 Usually casted for 3-6
weeks
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Mallet Finger
 Struck on the end of the
finger by ball or helmet
 Tendon pulls a bone
fragment off
 If not treated right,
permanent deformity
 Extension splint for at least
6 weeks
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Jersey Finger
 Tendon pulls away
from the palm side of
the end of the finger
 Severe pain
 Often needs surgery
 Season ending injury
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Muscle Strain
 Pull or tear
 Stretch beyond its limit
 Treatment is ice, rest,
compression
 Return when pain free and
muscle strength is normal
 Few days to few weeks
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Ankle Sprain
 Usually the outside of the
ankle
 Ice, Compression,
elevation
 If unable to walk 4 steps or
tender over the ankle
bumps, needs an x-ray
 Need to do position
specific drills without pain
before return
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Muscle Contusion
 Most common in the
thigh and upper arm
 Treat with ice,
compression and
stretch
 May heal with a
calcium deposit in the
muscle
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Joint Dislocation
 Fall on outstretched hand
or forced pulling back on
the arm
 Severe pain
 Do not try to relocate on
your own
 Splint and transport to an
ER for reduction
 Finger may return in a
week, all others, usually
season ending
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Long Bone Fractures
 Forearm, upper arm,
leg or thigh
 Usually grossly
deformed
 May have nerve and
blood vessel damage
 Splint for support and
send to ER.
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Abdominal Injuries
 Spleen is the organ we worry
about the most
 Left upper part of abdomen
 Will cause shoulder pain of
damaged
 Kidneys also easy to damage
 Severe stomach pain after a
blow
 Needs to be evaluated in an
emergency room
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Abrasions and Lacerations
 All bleeding stops
 It stops faster with direct pressure
 Remember to wear gloves.
 If the edges of the wound are apart without being
touched, it needs stitches
 If bleeding is controlled, in general the athlete can
continue to play if the wound is covered.
 Don’t expose other athletes to patients blood
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Knee Ligament Injuries
 ACL and meniscus tears can
happen in young kids
 Most commonly plant and
twist or blow to a knee with
the foot planted
 Often feel a pop
 Almost always requires
surgery to be a competitive
athlete
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Tendon Attachments
 Achilles tendon
 Severs disease
 Patellar tendon
 Osgood Schlatter disease
 Pain that is worse with activity. Sometimes has
swelling
 Treat with rest and stretching activities. Ice
after games
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Concussion recognition and
management
Greg Seelhoefer, MD
Concussions
 A brief alteration in brain functioning caused by
trauma.
 Does not have to be a blow to the head
 Does not require a loss of consciousness.
 Imaging tests (CT scan, MRI) are normal
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Concussions
 Grading concussions does not help and can
make a serious injury seem mild
 Returning to play before symptoms have cleared
increases chances for recurrent concussion and
second impact syndrome
 No evidence protective gear (headgear,
mothgaurds) prevents concussions
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Concussions
 How do you know if someone has had a concussion?
 All based on symptoms

Dazed

Confused

Slow to respond

Dizzy

Headache

Nausea

Vomiting
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Texas Sports Medicine Center
new things
8/30/14  Unable to remember
Houston Methodist
Initial evaluation
 ABC
 Just say hi
 Consider C-spine injury in any athlete with a
head injury and altered level of consciousness or
any neck pain
 Ask them what happened
 IF they don’t remember, ask someone else
 Memory for the event may never return
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Assess Brain Function
 Orientation
 Who they are
 Where they are
 When they are
 Responsiveness
 Alert
 Groggy
 Pupils equal?
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On the Field
 Ask if they have any neck pain
 Immobilize first, then ask
 Just use hands initially
 Ask them to move arms and leg
 Don’t move any extremity or body part for them.
 IF no neck pain, able to move all extremities and
answers questions well, allow them to stand
slowly and walk off the field with assistance
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On the Sideline
 Continually reassess
 Repeat the questions you asked on the field.
 Take away his helmet
 If symptoms are worsening, send to the
emergency room
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When to Return
 No child who gets a concussion should return to
play the same day.
 Nope not ever
 Very little research is done on children younger
than 12 with concussions
 We know high school age kids are more
susceptible and take longer to recover than
college or pro athletes
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When can the Athlete
Return
 No symptoms at rest and with exertion
 Return to play slowly
 Jogging
 Running
 Non contact drills
 Contact drills
 Full activity
 Drop back if symptoms recur at any level
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When in Doubt
Hold them out
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The unconscious athlete
The Unconscious Athlete
 An unconscious athlete has an unstable neck
fracture until proven otherwise
 Assess ABC’s
 IF breathing and has a pulse

Stabilize the neck and do not move the patient.

Wait for EMS arrival
 If not breathing or no pulse
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
Log roll while stabilizing the neck

Begin CPR until help arrives.
Houston Methodist
Cervical Spine Injuries
 Contact sports place the cervical spine at risk
 Incidence has decreased since rules outlawed
spearing
 Most injuries are still due to axial load
 Fracture of the neck can cause paralysis, death
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Neck Injury Symptoms
 Pain in neck
 Decreased range of motion
 Pain, numbness or weakness in the arms
 Spasm of neck muscles
 Bowel or bladder problems
 Unequal grip strength
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Neck Injury Treatment
 If concerned about a fracture, immobilize and
transport for evaluation
 Whiplash
 Strain of the ligament going down the back of the neck
 Stinger
 Stretch of the nerves supplying the arm
 Shooting pain or arm may feel dead for a few seconds
 May return if symptoms completely clear
 Needs eval if recurrent
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Heat Injuries
 Christian Schupp, MD
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Heat Injuries
 A completely preventable injury
 A very common injury
 Usually bothersome, but can be deadly
 3 different phases:
 Heat cramps
 Heat exhaustion
 Heat stroke
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Heat Cramps
 Dehydration causes localized electrolyte
problems
 Adequate hydration is usually preventative
 Can occur in any muscle, but most
common in the calf
 Stretch, ice and hydration are the keys to
successful treatment
 Muscles that are cramping are more
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susceptible toHouston
tearsMethodist
/ strains
Heat Cramps:
Hydration
 Daily weights (pre- and post- exercise)
 Fluid replacement
 20-24 fluid ounces of water or sports drink for
every pound lost
 >5% weight loss = serious dehydration
 Urine color
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Heat Exhaustion
 More serious, but not life threatening
 Usually caused by volume loss from sweating
that is not replaced
 Body cannot maintain adequate blood flow to
brain, heart, kidneys
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Heat Exhaustion
 Symptoms
 Headache
 Nausea / vomiting
 Irritability
 Cool, clammy or hot and sweaty skin
 Muscle cramps
 Thirst
 Low blood pressure
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Heat Exhaustion
 Treatment
 Cool place
 Loosen clothes
 Fans, wet towels, Ice
 Elevate legs
 Encourage fluids

Electrolyte solutions are better absorbed.
 Acclimatize more slowly
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 Return
to playMethodist
1-2 days, but should have a doctor’s note
Houston
Heat Stroke
 Rare
 Deadly
Korey Stringer
(1974-2001)
 Most common cause of death in the high school and
NCAA
 Body’s ability to regulate heat is gone
 Risk factors

Temp over 95 with 75% humidity

Can occur at much cooler temps
8/30/14  Out of shape
Houston
Methodist
athlete,
poorly acclimatized, prior problems
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Symptoms of Heat Stroke
 Extreme body temperature
 Altered level of consciousness is key!

Irritability, incoherent, glassy stare, etc

Rapidly progresses to seizures and coma
 Definition = core temperature >104

Rectal temp is the only reliable source
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Houston Methodist
Steve Bechler
(1979-2003)
Treatment of Heat Stroke
 MUST COOL THEM DOWN IMMEDIATELY
 Shade or air conditioning
 Remove clothes
 Ice to groin, arm pits
 Treat for shock by elevating the legs
 Nothing to drink
 Get to the hospital as soon as possible.
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Nutrition principles for
adolescent athletes
 Christian Schupp, MD
Nutrition Basics
 Athletes need a balanced diet
 55-60% carbohydrates

Starches like breads

Fruits and vegetables

Most readily available fuel source
 No more than 30% fat

Fats contain more than twice as many calories per gram as
protein or carbs
 10-15% protein
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What about protein
supplements?
 Not necessary and not helpful
 Bodies can use no more than about ½ gram per
pound
 100 lb boy can use about 35-40 grams of protein per
day
 Too much protein causes bowel trouble and
dehydration.
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Pre-Game Meals
 Pre-Game meals should be part of a sound
nutritional program and contain foods that are
well tolerated by the athletes.
 There is no particular food that will magically
give an athlete special energy, strength, or
endurance
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Goals of a Pre-game Meal
 Provide adequate energy intake
 Allow for an empty stomach & upper bowel at
time of play
 Provide an optimal state of hydration
 Cause minimal upset of G.I. tract
 Provide familiar foods
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What to Avoid?
Fatty foods
Roughage / high fiber
Protein
Caffeine/Carbonation
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Fat

 Fat delays empting of
the stomach
Click to edit the outline
text format

Second Outline
Level

Third Outline
Level

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Fourth
Outline Level
 Fifth
Outline
Level
Roughage / fiber
Increase the need for defecation
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Protein
 Slower to digest
 Must be metabolized into fuel in the liver
 Not an efficient fuel source
 Can lead to dehydration
 GI upset
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Caffeine/Carbonation
May increase urine
output and upset the
G.I. tract
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Ideal Pre-game Meal



Complex carbohydrates
 Pasta, breads and fruits
Small portion of veggies
Small portion of lean meat
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Houston Methodist
Conclusion
Encourage a balanced diet throughout the season
Focus on hydration
Make the pregame meal at least 2-3 hours before the
game
Do not encourage protein supplements
Focus on hydration
Athletes’ plate – TEAM USA (google)
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Houston Methodist
Questions???