Chapter 2 Recognition, Evaluation & Management of Athletic Injuries Recognition of Injuries
Jan 17, 2018
Chapter 2Recognition, Evaluation & Management of Athletic Injuries
Recognition of Injuries
Recognition of Injuries
Primary function of an athletic trainer are to recognize when an injury has occurred, determine the severity of the injury, and
apply proper evaluation/treatment procedures and protocols.
Recognition of Injuries
Recognition of Injuries
Two Major Considerations in Emergency Evaluation:
1. Control Life Threatening conditions and activation of Emergency Medical Service.
2. Management of non-life threatening Injuries.
Recognition of Injuries
Refer to a Physician When:• Loss of respiratory function (breathing)• Severe bleeding• Suspicion of intracranial bleeding and/or bleeding from the ears, mouth
and/or nose• Unconsciousness• Paralysis• Circulations or neurological impairment• Shock• Obvious deformity Suspected Fracture• Pain, tenderness, or deformity along the vertebral column• Significant swelling and pain• Loss of sensation (motor or sensory)• Loss of Motion• Doubt about the severity of the injury
First Aid / Emergency Care
The athletic trainer must maintain certification in Professional Rescuer.
Which includes:• (CPR)• AED Training• First Aid
Emergency Transportation Procedures
2 main Points to Consider:
1st – the availability of emergency ambulance service.2nd – the severity of the injury
Emergency Transportation Procedures
Never transport an athlete in a private vehicle because of liability issues.
Evaluation of Life Threatening Injuries
When a serious Injury is suspected:Survey the Scene
A irwayB reathing
C irculation
Note: Unless you see the injury assume ALWAYS it is Life Threatening
Evaluation of Life Threatening Injuries
Primary Survey:• Approach athlete in a calm & reassuring manner• Maintain a clear & open airway free of potential
obstructions such as blood, vomitus, and foreign matter
• Position patient in the most comfortable position for breathing
• Be prepared for Rescue Breathing &/or CPR
Evaluation of Life Threatening Injuries
Secondary SurveyOnce determined the athlete’s condition is non-life
threatening
History:Examiner Questions the Athlete
History• Mechanism of Injury• Onset of Symptoms• Location of Injury• Quantity and Quality of pain• Type and location of any abnormal sensations• Progression of signs and symptoms• Activities that make the symptoms better or worse• Nausea• Weakness• Dyspnea (shortness of breath)
Evaluation of Non-Life Threatening Injuries
Physical Examination is the next step.• Note: findings may vary tremendously from
athlete to athlete– Factors such as physical activity & exercise
may account for this variance– Examples that may vary are: respiratory rate,
moistness, color and temperature of skin, & pulse rate.
Evaluation of Non-Life Threatening Injuries
• Physical Examination cont.– Essential to evaluate & monitor VITALS:
• Abnormal Nerve Response• Blood Pressure• Movement• Pulse• Respiration• Skin color• State of Consciousness• Temperature
Evaluation of Non-Life Threatening Injuries
Once a life threatening injury has been r/o, medical evaluation of the injury must be comprehensive.
In Athletic Training 2 formats of evaluation are commonly utilized:
1. H.O.P.S.2. S.O.A.P.
H.O.P.S.
History, Observation, Palpation, Special Test (Stress)
The 1st purpose of an evaluation is to determine if a serious injury has occurred. Initially a fx should always be suspected.
H.O.P.S.
Signs of Fracture:• Direct or Indirect Pain• Deformity• Grating sound at injury site• Some fx are NOT accompanied by swelling or pain.
If a fx is suspected extremity should be splinted for transport.
H.O.P.S.
Note: • Young athletes are especially susceptible
to fractures• Often Ligaments and Tendons/Muscles
are stronger than the bones
H.O.P.S.(H) HistoryInvolves questioning the athlete to determine
Mechanism of Injury.1. Mechanism of Injury (How did it Happen?)2. Location of Pain (Where does it Hurt?)3. Sensations Experienced (Did you hear a “pop” or
a snap?)4. Previous Injury (Have you been hurt here
before?)
H.O.P.S.
(O) ObservationThe athletic trainer should compare the
uninvolved to the involved anatomical structure
• Look for Trauma– Bleeding, deformity, swelling, discoloration,
scars, and other signs of trauma
H.O.P.S.(P) PalpationThe physical inspection of the injury.1. Palpate the anatomical structures/joints
above and below the injured site.2. Palpate the affected area.
1. The entire area around the injury may be sore but the ATC should try to pinpoint the site of severe pain.
H.O.P.S.
(P) PalpationKnowledge of the anatomy and injury
mechanism, the type and extent of the injury can be evaluated.
Involve the athlete in the evaluation as much as possible.
H.O.P.S.(P) PalpationUse bi-Lateral comparison:• Neurological Stability (motor/sensory)• Circulation Function (pulse and Capillary
Refill)• Anatomical Structures (palpate)• Fracture Test (Palpation, compression,
and distraction)
H.O.P.S.(S) Special Test
With a all special test, the ATC is looking for joint instability, and pain.
It is possible to further damage an injury through manipulation
To determine if damage has been done to the anatomical structures, the ATC use special test and functions test to access disability.
H.O.P.S.
(S) Special Test
These Test Include:• Joint Stability• Muscle/Tendon • Accessory Anatomical Structures• Inflammatory Conditions
S.O.A.P.S ubjective
O bjective
A ssessment
P lan
S.O.A.P.Subjective Assessment (History)• Requires the athletic trainer to ask detailed
questions of pre-existing or existing injuries.– Previous Injury– How it Happened– When did it happened– What did you feel– Types of pain– Where does it hurt– Sounds/noises “pop”
S.O.A.P.Objective AssessmentInvolves visual, physical, and functional inspections. Items to assess are:
– Swelling– Deformity– Ecchymosis– Symmetry– Gait/walk– Scars– Facial expressions
– Circulation– Neurological test– Bone– Soft Tissue– ROM– Sport Specific
Movements
S.O.A.P.
Assessment• Reviews the probable cause and
mechanism of the injury, impression of the injury site, severity of injury, and treatment goals.
S.O.A.P.Plan• Should outline appropriate action that
should be taken to care for the injury. • Initial Actions Include:
– Immediate Action– Referral– Modalities Utilized– Preventative Techniques (Bracing/Tape)– Rehab Considerations– Criteria for Return
Basic Treatment ProtocolFollowed by referral to a physician when necessary all
treatment protocol should follow the Acronym PRICES
P rotection
R rest
I ce
C ompression
E levaltion
S upport
PRICESProtection• After the injury Protect injury from further
damage by removing the athlete from participation
Rest• After the evaluation, rest the injury.
– Depends on severity
PRICESIce• Apply Cold to the injured area.
– This will aid in controlling bleeding/swelling.
Two Methods:1. Ice Packs (ice bag, gel pack) 15 to 20 min. at
least 1 to 2 hours apart.2. Cold Water Immersion Bath (Whirlpool, bucket,
tub) H2O Temperature between 50 – 60 degrees.– Same protocol as Ice Packs– Careful with patients with circulation
issues, sucha as diabetics & elderly.
PRICESCompression• Using a compression wrap to control
swelling.– When possible wrap site distal to proximal.– Always check circulation (signs of poor
circulation are?)– Do not sleep with wrap.
Elevation• Keep the injured body part elevated higher
than the heart.– Allows the use of gravity to aid in swelling
prevention.
PRICESSupportTo include splinting and/or crutches or slings.• Splints are intended to protect an injury from
further damage.Splinting Equipment• Fixation Splints
– Most common (board, SAM, pillow, blankets) • Vacuum Splints
– Most common usage is for dislocations, deformed or misaligned fx
• Traction Splints– Used for long bones like the Humerus/Femur– Prevent lfx ends from touching (major arteries are
protected)– Medical Training required (EMS personnel)
10 Key Points to Consider When Splinting
1. Inspect injury for open wounds, deformity, swelling, and ecchymosis.
2. Check – Pulse, Motor, Sensations (PMS) and capillary refill of the injured site distal to the injury.
3. Cover all wounds with a dry sterile dressing before applying a splint
4. Do not move the athlete before splinting extremities unless there is an immediate hazard to the athlete or you.
5. Select proper splint in which length and size should cover the immediate injured area, along with all joint structures above and below.
10 Key Points to Consider When Splinting
6. Place splint beside the injured extremity and then smooth out the contents of the splint. The larger end of splint should be placed proximal to the injury.
7. When applying the splint, use your hands to minimize movement. Also, support the injury above and below when applying the splint on the extremity. For stabilization purposes, apply gentle traction to the limb.
8. Secure splint with straps by applying firm compression/
9. Again, check PMS, and capillary refill at a point distal to the site of injury.
10. Apply cold to the injured area and document time.• X-rays can be taken withour removing MOST
splints.
In all injury management protocols, make sure that
you know the proper techniques and work within
your knowledge base.