Transcript REC 3020 Injury Mangament Powerpoint

FIELD
On the field Acute Care and Emergency Procedures
Emergency Action Plan
 Needs to be implemented immediately
 Determine personnel that will be at the event (coaches,
athletic therapists, students, doctors)
 Make sure the personnel know what their roles are
(charge, call, control)
 Describe and determine what emergency equipment is
available (AED, spine board, oxygen)
EAP
 Make sure there is a phone accessible (call person)
 Be familiar with contact information for nearest hospital or
medical center (address, phone number)
 Know the address for the location you are at and what the most
accessible entrance for EMS is
 Charge: head person, takes control of the situation & decides
what actions need to be taken (call ambulance)
 Call: Calls EMS,makes contact with medical authorities and
otherwise assists the person in charge, either creates access for
EMS if locked, or contacts front desk/ facility attendant
 Control: controls the scene, crowd, athletes, can also assist
person in charge or Call person with access for EMS
Scene Survey
 Is the scene safe to enter? (Has the play stopped, are
there any hazardous materials around)
 How many injured athletes are there?
 Are there any noticeable fractures or dislocations?
 Any blood?
 Patients face: skin color, eyes tracking, level of distress
Primary Survey
 Assessing life-threatening injuries
 Determines the existence of potentially life-threatening
situations, including problems with level of
consciousness, airway, breathing, circulation, severe
bleeding, and shock
 Primary survey takes precedence over all other aspects
of the assessment
 Any patient who has a life-threatening situation should
be transported ASAP
Primary Survey
 Life-threatening Conditions:
 Airway obstruction
 No breathing
 No circulation
 Profuse bleeding
 Shock
Primary Survey
 Functional Signs of Evaluation:
 LOC
 Pulse
 Respiration
 Skin Color/ Condition
 Convulsions
 Breath
LOC
 Level of Consciousness: AVPU
 Alert- patient is alert, awake, responsive to voice, and
oriented to person, time and place
 Verbal- patient responds to voice but is not fully
oriented to person, time, or place
 Painful- patient does not respond to voice but does
respond to painful stimulus
 Unconscious/unresponsive- patient does not respond
to verbal or painful stimulus
Primary Survey- ABC’s
 Establish Airway, Breathing and Circulation
 Airway: use head tilt/ chin lift- lift under chin with one
hand while pushing down on the patient’s forehead with
the other
 Tongue is most common cause of obstruction
 ONLY use modified jaw thrust if there is a suspected
cervical injury
 Perform a finger sweep to remove any objects in the
mouth
ABC’s
 Breathing: maintain open airway place ear over mouth,
observe chest, look listen and feel for breath sounds 510 seconds
 Listen for rate (how fast they are breathing), rhythm
(regular, deep, shallow), and quality (wheezy, regular,
gurgling)
 Normal rate for adults= 12-20 breaths/ minute
 If airway is obstructed, repeat finger sweep
 Rate may be normal but breath may be shallow, labored,
or noisy could indicate shock
ABC’s
 Circulation: feel for a pulse in the carotid artery along the
side of the neck or in the radial artery at the wrist, feel for 510 seconds
 Feel for rate (how fast the pulse is), rhythm (regular, thready,
irregular), quality (weak, strong)
 Normal rate for adults= 60-100 beats/ minute
 Rapid and weak pulse could mean shock, bleeding, diabetic
coma, or heat exhaustion
 Rapid and strong pulse could mean heatstroke or severe
fright
 Strong but slow pulse could mean skull fracture, stroke
 No pulse= cardiac arrest or death
Skin Temperature
 Skin Temperature: normal= 36.8*C- 37*C, use a
thermometer to get accurate readings (under tongue or
rectal), changes in in body temperature can be
reflected in the skin
 Hot, dry skin can be infection/ disease, or overexposure
to environmental heat
 Cool, clammy can reflect trauma, shock, or heat
exhaustion
 Cool, dry skin can result from overexposure to cold
Skin Color
 Skin Color: Normal= pink or brown
 Flushed or red= heatstroke, sunburn, allergic reaction, HBP,
or elevated temp
 Pale, ashen, or white skin can mean insufficient circulation,
shock, fright, hemorrhage, heat exhaustion, insulin shock
 Skin Bluish in color in lips, fingernail beds= airway
obstruction
 Yellowish color may indicate liver disease or dysfunction
 Dark skinned person in shock= grayish color outside of
mouth, nose, and bluish color in nail beds, tongue, inside of
mouth
Pupils
 Pupils are extremely sensitive to situations affecting
nervous system
 Normal- both round, equal in size, reactive and
accommodating to light
 Need to know which athletes have irregular and
unequal pupils, or if they are on nervous system
depressant drugs
 If one or both eyes dilated= head injury, shock,
heatstroke, hemorrhage, stimulant drug
 Failure to accommodate= brain injury, alcohol/drug
poisoning
Blood Pressure
 Blood Pressure: Amount of pressure exerted on arterial
walls, systolic- heart pumping blood, diastolic- residual
pressure between heart beats
 Normal: Males 120/ 80 mm Hg, females are 8-10 mm Hg
lower
 Lowered blood pressure= hemorrhage, shock, heart
attack, or internal organ injury
 High Blood Pressure: Hypertension Primary= 90% all
cases with no disease associated with it. Secondary=
underlying causes: kidney disorder, overactive adrenal
glands, tumors, meds, pregnancy, narrowing of aorta=
coronary artery disease, congestive heart failure, stroke
 High= Sys >/= 140-160, Dias >/=90-100
Shock
 Occurs when a diminished amount of blood is available
to the circulatory system- dilation of blood vessels in
vascular system= collapse of vascular system leading
to tissue death
 More likely to happen to severe injuries: severe
bleeding, fractures, internal injuries, or certain
conditions= extreme fatigue, extreme exposure to heat
or cold, extreme dehydration, or illnesses ‘
 Different types of shock: hypovolemic, respiratory,
neurogenic, psychogenic, cardiogenic, septic,
anaphylactic, and metabolic
Shock
 Signs and Symptoms:
 Moist, pale, cool, clammy skin, weak and rapid pulse,
increased and shallow breathing, decreased blood
pressure, and if severe, urinary retention and fecal
incontinence
 Blood pressure- systolic is < 90 mm Hg
 Patient may seem drowsy or sluggish
Shock
 Management:
 Maintain body temperature as close to normal as
possible
 Elevate feet 8-12 inches for most situations (depends
on type of injury)
 CALL EMS!!!
AED
 Automated External Defibrillator
 Evaluates heart rhythm of a victim of sudden cardiac arrest
(patient is not breathing and has no pulse), capable of
delivering an electrical charge to the heart
 To prevent human error, the machine evaluates heart rhythm
and decides if employment is appropriate
 Apply two electrodes to the right apex and the left base of
the chest
 Wait for instructions from the AED- machine will shock if
necessary
 If shock, no pulse- start CPR (30 compressions; 2
breaths)for 2 mins and the AED will deliver another shock
 If pulse returns, place patient into recovery position
Injury
Primary Survey
Scene Survey
LOC
Conscious
Unconscious
Secondary
Survey
Stabilize Csp
LOC, ABCD’s
TX Decision
CALL EMS, Stay
and Stabilize
Vitals
History
SAMPLE/ PQRST
Musculoskeletal
Evaluation
Transport off field
or Call EMS
Conscious
 Secondary Survey
 Vitals- HR, BR, BP, Pupils, Skin (Temp, Color, Condition)
 History (HOPS- history, observation, palpation, special
tests) and SAM- Skeletal, Articular, Musculoskeletal
 SAMPLE
 PQRST, Expose and observe site
 Musculoskeletal
 Evaluation
Focused History #1
 Did you hit your head?
 Do you have any neck pain?
 Did you lose consciousness?
 Do you have any numbness or tingling? (bilateral?)
 Are you having difficulty breathing?
 If yes to any of these, call for help (AT, physio, EMS) if
you don’t know
Focused History #2
 Chief Complaint (CC)
 Mechanism of Injury (MOI)/ position of limb at time of
injury
 Type and location of Pain/symptoms
 Sounds or sensations- snap /crackle/ pop
 Do you hurt anywhere else?
 Previous injury (areas involved/ uninvolved)
SAMPLE
 S- Symptoms
 A- Allergies
 M- Medications
 P- Past medical history
 L- Last meal
 E- Events prior
PQRST
 P- provokes
 Q- quality of pain
 R- radiates
 S- Severity
 T- time
Observation- SHARP/D
 S- swelling
 H-heat
 A- altered function
 R- redness
 P- pain
 D- deformity
 Fracture test (SAM- Skeletal)
Palpation
 TOP- tender on palpation
 Start at either joints above or below
 Bones, ligaments, joints, muscle
Special tests
 Articular tests- ligament testing (SAM- Articular)
 Muscle/ strength testing (SAM- musculoskeletal)
 Any testing specific to joint/ muscle injured
Evaluation + Treatment
Decision
 Seriousness of injury
 Type of first aid and immobilization necessary
 Does the injury warrant immediate referral to physician
for further assessment
 The manner of transportation from the injury site to the
sidelines, training room, or hospital
 RICE
 Splinting
Unconscious
 Stabilize CSP/ Spine
 Complete Primary Survey (ABCD’s) + LOC
 EMS activation
 Secondary survey + vitals
LOC
 Evaluate LOC
 Complete AVPU
 Verbal- see if they can answer questions from History
 Painful/ Unconscious= EMS activation
Primary Survey
 Complete ABCD’s
 Check airway/ breathing
 Check circulation
 Check for any deadly bleeds
 Can have circulation and no breathing but not
breathing with no circulation
 Activate EMS (if haven’t already)
Vitals + Secondary Survey
 Complete a round of vitals- pupils, HR, BR, BP, Skin
temp, color and condition
 Complete Secondary survey while waiting for EMS to
arrive
 Complete another round of vitals to see if anything has
changed
 Vitals are important for establishing condition- ex.
shock
Deadly Bleeds
 Hemorrhage- abnormal discharge of blood
 Can be venous, capillary, arterial, internal or external
 External Bleeding- open skin wounds- abrasions,
incisions, lacerations, avulsions, open fractures
 Use Direct pressure, elevation and pressure points
Deadly Bleeds
 Direct Pressure- Pressure is directly applied with
gloved hand over a sterile gauze pad, apply firmly
against resistance of a bone
 Elevation- elevation part against gravity reduces
hydrostatic blood pressure and facilitates venous and
lymphatic drainage, which slows bleeding
 Pressure Points- 11 pts on body help control external
bleeding. 2 most commonly used brachial artery
(compressed against medial aspect of humerus) for
upper limb and femoral artery for lower limb (detected
within femoral triangle)
Internal Hemorrhaging
 Invisible to the eye, danger in difficulty of diagnosis due to
obscure symptoms
 Subcutaneous- bruise or contusion
 Intramuscularly- bruise, contusion, joints
 Bleeding within a body cavity- skull, thorax, abdomen, is a
life and death situation
 If suspected- monitor vitals closely, especially blood
pressure
 Require hospitalization under complete and constant
observation by medical staff
 All severe hemorrhaging will eventually lead to shock