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Injury Report Injury Report
57

Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

Dec 18, 2015

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Melissa Eaton
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Page 1: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

Injury ReportInjury Report

Page 2: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

HOPSHOPS

1.1. HistoryHistory

2.2. ObservationObservation

3.3. PalpationsPalpations

4.4. Special TestsSpecial Tests

Page 3: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

HistoryHistory Basic InformationBasic Information

– Name of athleteName of athlete– Date of birth & genderDate of birth & gender– Sport, position, year & seasonSport, position, year & season– Activity & groupActivity & group– Location, weather, & type of surfaceLocation, weather, & type of surface

Page 4: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

HistoryHistory Injury HistoryInjury History

– Date & time of injuryDate & time of injury– OnsetOnset

Acute, chronic, or re-injuryAcute, chronic, or re-injury

– Body part & sideBody part & side– Mechanism & how did it occurMechanism & how did it occur– Was there an existing injury and if yes, what & Was there an existing injury and if yes, what &

whenwhen– PainPain

Location, type, any soundsLocation, type, any sounds

– General condition of the athleteGeneral condition of the athlete

Page 5: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

HistoryHistory

Present historyPresent history What is the problem? What is the problem? How did it occur?How did it occur? When did it occur? When did it occur? Did you fall?Did you fall? How did you land?How did you land? Which direction did your joint move?Which direction did your joint move? Did you feel or hear something when it Did you feel or hear something when it

occurred?occurred? If so, what? If so, what?

Page 6: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

HistoryHistory

Present historyPresent history

Injury Location:Injury Location: Toes, Lower Leg, Hip, Lumbar, Toes, Lower Leg, Hip, Lumbar,

Shoulder, Forearm, Cervical, Foot, Shoulder, Forearm, Cervical, Foot, Knee, Pelvis, Thorax, Upper Arm, Knee, Pelvis, Thorax, Upper Arm, Wrist, Head, Ankle, Thigh, Wrist, Head, Ankle, Thigh, Abdomen, Thoracic, Elbow, Fingers, Abdomen, Thoracic, Elbow, Fingers, Face, MedicalFace, Medical

Page 7: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

HistoryHistory

Present historyPresent history

With one finger, point to the exact With one finger, point to the exact location of the injury: location of the injury:

Proximal, Distal, Superior, Inferior, Proximal, Distal, Superior, Inferior, Medial, Lateral, Anterior, Posterior, Medial, Lateral, Anterior, Posterior, RUQ, RLQ, LUQ, LLQ, MidlineRUQ, RLQ, LUQ, LLQ, Midline

Page 8: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

HistoryHistoryPresent historyPresent historyPain Type:Pain Type:

Nerve Nerve – Sharp, bright, burningSharp, bright, burning

Muscle Muscle – Dull, aching, referred to another areaDull, aching, referred to another area

BoneBone– Localized and piercingLocalized and piercing

Vascular Vascular – Poorly localized, aching, referred from Poorly localized, aching, referred from

another areaanother area

Page 9: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

HistoryHistoryPresent historyPresent history

Pain Location:Pain Location: DeepDeep

– more difficult to match the pain with more difficult to match the pain with the site of trauma, may cause the site of trauma, may cause treatment to be performed at the treatment to be performed at the wrong sitewrong site

Superficial Superficial – better elicited pain corresponding with better elicited pain corresponding with

the site of pain stimulationthe site of pain stimulation

Page 10: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

HistoryHistoryPresent historyPresent history

Does the pain change at different Does the pain change at different times?times?

Chronic inflammationChronic inflammation– indicated by pain that usually subsides indicated by pain that usually subsides

during activityduring activity Edema Edema

– pain that increases in a joint pain that increases in a joint throughout the daythroughout the day

Page 11: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

HistoryHistoryPresent historyPresent history

Does the athlete feel a sensation Does the athlete feel a sensation other than pain?other than pain?

Pressure on nerve roots can Pressure on nerve roots can produce pain or a sensation of “pins produce pain or a sensation of “pins and needles” (paresthesia)and needles” (paresthesia)

Page 12: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

HistoryHistoryPresent historyPresent history

If the injury is related to a joint:If the injury is related to a joint: Is there stability?Is there stability? Does it feel if it will give way? Does it feel if it will give way? Does it lock and unlock?Does it lock and unlock? Positive responses may indicate the Positive responses may indicate the

joint has a loose body catching or joint has a loose body catching or inhibiting the normal musculature inhibiting the normal musculature support in the areasupport in the area

Page 13: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

HistoryHistoryPresent historyPresent history

How long has the athlete had the How long has the athlete had the injury?injury?

Acute Acute – immediateimmediate

Chronic Chronic – over an extended period of timeover an extended period of time

Page 14: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

ObservationsObservations

Page 15: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

ObservationsObservations Usually taken during the historyUsually taken during the history What do you see?What do you see?

– SwellingSwelling– RednessRedness– EcchymosisEcchymosis– Scars, blisters, callusesScars, blisters, calluses– Limp or abnormal movementLimp or abnormal movement– Asymmetry, protrusions, malalignments, Asymmetry, protrusions, malalignments,

deformitiesdeformities– Guarding, facial expressions, etcGuarding, facial expressions, etc

Page 16: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

ObservationObservation

How does the How does the athlete move? athlete move?

LimpLimp Facial expressionFacial expression Asynchronous Asynchronous

MovementMovement No movementNo movement GuardingGuarding Slow movement Slow movement

SwellingSwelling RednessRedness DeformityDeformity InflammationInflammation EcchymosisEcchymosis AsymmetriesAsymmetries Abnormal SoundAbnormal Sound AtrophyAtrophy

Page 17: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

Elbow ObservationsElbow Observations

Cubitus RecurvatusCubitus Recurvatus– HyperextensionHyperextension

Page 18: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

Toe ObservationsToe Observations Morton’s ToeMorton’s Toe

– Abnormally short 1st metatarsal makes the second toe Abnormally short 1st metatarsal makes the second toe appear longer and putting more weight bearing on the 2nd appear longer and putting more weight bearing on the 2nd metatarsal metatarsal

Bunions (Hallux Valgus) or Bunionettes (Tailor’s Bunions (Hallux Valgus) or Bunionettes (Tailor’s Bunions)Bunions)

– In all bunions, both the flexor and extensor tendons are In all bunions, both the flexor and extensor tendons are malaligned, creating more angular stress on the joint.malaligned, creating more angular stress on the joint.

CornsCorns Hammer Toes or Clawed ToesHammer Toes or Clawed Toes

– Malalignment of the metatarsophalangeal joint and PIP jointsMalalignment of the metatarsophalangeal joint and PIP joints Toe Overlap Toe Overlap Ingrown NailIngrown Nail Subungual Hematoma Subungual Hematoma

Page 19: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

Foot ObservationsFoot Observations

Pes PlanusPes Planus– Flat feetFlat feet

Pes CavusPes Cavus– High arch High arch

Page 20: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

Knee ObservationsKnee Observations

Genu VarumGenu Varum– Bowed LegsBowed Legs

Genu ValgumGenu Valgum– Knock KneesKnock Knees

Genu RecurvatumGenu Recurvatum– HyperextensionHyperextension

Page 21: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

Lumbar ObservationsLumbar Observations ScoliosisScoliosis

– Lateral curvature of the spineLateral curvature of the spine KyphosisKyphosis

– Increased thoracic curvatureIncreased thoracic curvature LordosisLordosis

– Increased lumbar curvatureIncreased lumbar curvature Forward head postureForward head posture

– Head protrudes forward caused by kyphosisHead protrudes forward caused by kyphosis Flatback postureFlatback posture

– Flat posture caused by a decreased lumbar curvatureFlat posture caused by a decreased lumbar curvature Swayback posture Swayback posture

– Anterior shifting of the entire pelvis resulting in hip Anterior shifting of the entire pelvis resulting in hip extensionextension

Page 22: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

Postural MalalignmentsPostural Malalignments

A.A. KyphosisKyphosis

B.B. Forward Forward headhead

C.C. FlatbackFlatback

D.D. SwaybackSwayback

E.E. LordosisLordosis

F.F. Scoliosis Scoliosis

Page 23: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

PalpationsPalpations Bony & muscularBony & muscular

– Point tenderness (pain)Point tenderness (pain)– Differences compared to the able sideDifferences compared to the able side– Temperature (hot or cold)Temperature (hot or cold)– CrepitusCrepitus– PulsePulse– DermatomesDermatomes– Spasms or crampsSpasms or cramps

Page 24: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

Special TestsSpecial Tests Active range of motion (AROM)Active range of motion (AROM) Passive range of motion (PROM)Passive range of motion (PROM) Resistive range of motion (RROM)Resistive range of motion (RROM)

– Aka active resistive range of motion (ARROM)Aka active resistive range of motion (ARROM) Muscle grade (done with active range of motion)Muscle grade (done with active range of motion) Ligament testsLigament tests Special testsSpecial tests Functional testsFunctional tests Sports specific testsSports specific tests Neurological testsNeurological tests

– Reflexes and glascow coma scaleReflexes and glascow coma scale Vital signs Vital signs

Page 25: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

Suspected InjurySuspected Injury Write all suspected injuriesWrite all suspected injuries SeveritySeverity Immediate careImmediate care Service & initial treatmentService & initial treatment Status & restrictionsStatus & restrictions Instructions to the athleteInstructions to the athlete Athlete & evaluator must sign the Athlete & evaluator must sign the

documentdocument

Page 26: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

The unconscious athlete must always The unconscious athlete must always be considered to have a life-be considered to have a life-threatening injury, which requires an threatening injury, which requires an immediate primary survey.immediate primary survey.

Page 27: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

THE PRIMARY SURVEY THE PRIMARY SURVEY The athletic trainer should immediately note the The athletic trainer should immediately note the

body position and determine the level of body position and determine the level of consciousness and unresponsiveness.consciousness and unresponsiveness.

Airway, breathing, and circulation should be Airway, breathing, and circulation should be established immediately.established immediately.

Injury to the neck and spine should always be Injury to the neck and spine should always be considered as a possibility in the unconscious considered as a possibility in the unconscious athlete.athlete.

If the athlete is wearing a helmet, it should never If the athlete is wearing a helmet, it should never be removed until neck and spine have been clearly be removed until neck and spine have been clearly ruled out. However, the face mask must be cut ruled out. However, the face mask must be cut away and removed to allow for CPR.away and removed to allow for CPR.

If the athlete is supine and not breathing, airway, If the athlete is supine and not breathing, airway, breathing, and circulation should be established breathing, and circulation should be established immediately.immediately.

Page 28: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

THE PRIMARY SURVEY THE PRIMARY SURVEY If the athlete is supine and breathing, nothing If the athlete is supine and breathing, nothing

should be done until consciousness returns.should be done until consciousness returns. If the athlete is prone and not breathing, he or she If the athlete is prone and not breathing, he or she

should be log-rolled carefully to the supine position should be log-rolled carefully to the supine position and ABCs should be established immediately. and ABCs should be established immediately.

If the athlete is prone and breathing, nothing If the athlete is prone and breathing, nothing should be done until consciousness returns, then should be done until consciousness returns, then the athlete should be carefully log rolled onto a the athlete should be carefully log rolled onto a spine board because CPR could be necessary at spine board because CPR could be necessary at any time.any time.

Life support for the unconscious athlete should be Life support for the unconscious athlete should be monitored and maintained until emergency medical monitored and maintained until emergency medical personnel arrive.personnel arrive.

Once the athlete is stabilized, the athletic trainer Once the athlete is stabilized, the athletic trainer should begin a secondary survey.should begin a secondary survey.

Page 29: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

Controlling Bleeding Controlling Bleeding

Direct pressureDirect pressure Elevation Elevation Pressure points Pressure points Tourniquets (only for special Tourniquets (only for special

circumstances)circumstances)

Page 30: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

Shock:Shock:Signs and SymptomsSigns and Symptoms

1.1. Blood pressure is lowBlood pressure is low2.2. Systolic pressure is usually below 90 mmHgSystolic pressure is usually below 90 mmHg3.3. Pulse is rapid and weakPulse is rapid and weak4.4. Rapid BreathingRapid Breathing5.5. Athlete may be drowsy and appear sluggishAthlete may be drowsy and appear sluggish6.6. Altered level of consciousnessAltered level of consciousness7.7. Respiration is shallow and extremely rapidRespiration is shallow and extremely rapid8.8. Skin is pale, cool, and clammySkin is pale, cool, and clammy9.9. Restlessness or irritabilityRestlessness or irritability10.10. Nausea and vomitingNausea and vomiting11.11. A blue tinge to lips and nail bedsA blue tinge to lips and nail beds

Page 31: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

Shock:Shock:TreatmentTreatment

1.1. Make sure that 9-1-1 or the workplace Make sure that 9-1-1 or the workplace emergency number has been calledemergency number has been called

2.2. Continue to monitor the victim’s airway, Continue to monitor the victim’s airway, breathing, and circulation (ABCs)breathing, and circulation (ABCs)

3.3. Control any external bleedingControl any external bleeding4.4. Keep the victim from getting chilled or Keep the victim from getting chilled or

overheatedoverheated5.5. Help the victim rest comfortably. If the victim is Help the victim rest comfortably. If the victim is

not having trouble breathing or if it is not not having trouble breathing or if it is not expected that the victim has a head, neck, or expected that the victim has a head, neck, or back injury or broken bones in the hips or legs, back injury or broken bones in the hips or legs, elevate the legs about 12 incheselevate the legs about 12 inches

6.6. Comfort and reassure the victim until advanced Comfort and reassure the victim until advanced medical personnel arrive and take overmedical personnel arrive and take over

7.7. Do not give food or drink to the victimDo not give food or drink to the victim

Page 32: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

THE SECONDARY SURVEY:THE SECONDARY SURVEY:

Vital SignsVital Signs Pulse, respiration, blood pressure, Pulse, respiration, blood pressure,

temperature, skin temperature, skin temperature, skin temperature, skin moisture, skin color, pupilsmoisture, skin color, pupils, level of , level of consciousness, ability to move, consciousness, ability to move, reaction to pain, abnormal nerve reaction to pain, abnormal nerve response, and breath soundsresponse, and breath sounds

Page 33: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

THE SECONDARY SURVEY:THE SECONDARY SURVEY:PulsePulse

Adults range between 60 and 80 beats per Adults range between 60 and 80 beats per minuteminute

Children range between 80 and 100 beats Children range between 80 and 100 beats per minuteper minute

Infants range between 120 to 160 beats Infants range between 120 to 160 beats per minuteper minute

Trained athletes may be slowerTrained athletes may be slower Heart rate can be taken at the radial or Heart rate can be taken at the radial or

carotid artery for 30 seconds then multiply carotid artery for 30 seconds then multiply by twoby two

Page 34: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

THE SECONDARY SURVEY:THE SECONDARY SURVEY:PulsePulse

Fast & weakFast & weak– Shock, heat exhaustion, diabetic comaShock, heat exhaustion, diabetic coma

Fast & strongFast & strong– Fright, stress, Fever, HTN, heat stroke, Fright, stress, Fever, HTN, heat stroke,

stimulant drugsstimulant drugs Slow & weakSlow & weak

– Drug overdose, impending deathDrug overdose, impending death Slow & strong Slow & strong

– Stroke, head injury Stroke, head injury

Page 35: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

THE SECONDARY SURVEY:THE SECONDARY SURVEY:RespirationRespiration

Adult breathing rate is 12 breaths Adult breathing rate is 12 breaths per minuteper minute

Children breathing rate is 20 to 25 Children breathing rate is 20 to 25 breaths per minutebreaths per minute

Infant breathing rate is 24 to 50 Infant breathing rate is 24 to 50 breaths per minutebreaths per minute

Watch the chest rise and fall for 30 Watch the chest rise and fall for 30 seconds then multiply by twoseconds then multiply by two

Page 36: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

THE SECONDARY SURVEY:THE SECONDARY SURVEY:RespirationRespiration

Rapid & shallowRapid & shallow– Airway obstruction (partial), heart Airway obstruction (partial), heart

failure, chest or abdominal injury or painfailure, chest or abdominal injury or pain Rapid & deepRapid & deep

– Diabetic coma, head injury, stressDiabetic coma, head injury, stress Slow & shallowSlow & shallow

– Drug overdose, impending death Drug overdose, impending death Labored Labored

– Airway obstruction Airway obstruction

Page 37: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

THE SECONDARY SURVEY:THE SECONDARY SURVEY:Blood PressureBlood Pressure

Normal range 90/60 mmHg - 120/80 Normal range 90/60 mmHg - 120/80 mmHg mmHg

Borderline HTN 139/89 mmHgBorderline HTN 139/89 mmHg Hypertension is 140/90 mmHg or Hypertension is 140/90 mmHg or

higherhigher Top number represents the systolic Top number represents the systolic

pressurepressure Bottom number represents the Bottom number represents the

diastolic pressurediastolic pressure

Page 38: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

THE SECONDARY SURVEY:THE SECONDARY SURVEY:Blood PressureBlood Pressure

High or risingHigh or rising– Fright, stress, head injury, CNS Fright, stress, head injury, CNS

problems, poisoning problems, poisoning Low or fallingLow or falling

– Shock, internal bleedingShock, internal bleeding

Page 39: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

THE SECONDARY SURVEY:THE SECONDARY SURVEY:TemperatureTemperature

Oral = 98.6º ± 1ºOral = 98.6º ± 1º Axillary = 97.6º Axillary = 97.6º Rectal = 99.6ºRectal = 99.6º

– Core temperatureCore temperature Very HighVery High

– Heat stroke, infection, feverHeat stroke, infection, fever ElevatedElevated

– Heat exhaustion, infection, feverHeat exhaustion, infection, fever Low Low

– Hypothermia Hypothermia

Page 40: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

THE SECONDARY SURVEY:THE SECONDARY SURVEY:Skin TemperatureSkin Temperature

Warm is normalWarm is normal HotHot

– Hyperthermia Hyperthermia Cold Cold

– Hypothermia Hypothermia

Page 41: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

THE SECONDARY SURVEY:THE SECONDARY SURVEY:Skin MoistureSkin Moisture

Dry is normalDry is normal DampDamp

– Shock, fright, stress Shock, fright, stress Very sweaty Very sweaty

– Heart attack, insulin shock, shock Heart attack, insulin shock, shock

Page 42: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

THE SECONDARY SURVEY:THE SECONDARY SURVEY:Skin ColorSkin Color

Pink on thenar prominencePink on thenar prominence Normal capillary refill is less than 2 Normal capillary refill is less than 2

secsec Capillary refill longer than 2 sec is Capillary refill longer than 2 sec is

circulatory compromise circulatory compromise

Page 43: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

THE SECONDARY SURVEY:THE SECONDARY SURVEY:Skin ColorSkin Color

Red (Flushed) – Excessive Circulation to the skinRed (Flushed) – Excessive Circulation to the skin– Fever, diabetic coma, heat stroke, hypertension (HTN)Fever, diabetic coma, heat stroke, hypertension (HTN)

White (Pallor/Pale): circulatory insufficiencyWhite (Pallor/Pale): circulatory insufficiency– Stress, shock, hypoglycemia, heat exhaustion, heart Stress, shock, hypoglycemia, heat exhaustion, heart

attackattack Blue (Cyanosis): respiratory insufficiencyBlue (Cyanosis): respiratory insufficiency

– Airway obstruction, respiratory insufficiency, pump Airway obstruction, respiratory insufficiency, pump failure, shock, traumatic asphyxiafailure, shock, traumatic asphyxia

Yellow (Jaundice) – Liver FunctionYellow (Jaundice) – Liver Function– liver failure, hepatitis, chronic alcoholismliver failure, hepatitis, chronic alcoholism

Gray (Ashen): circulatory insufficiencyGray (Ashen): circulatory insufficiency– heart attackheart attack

Blotchy (Mottled): circulatory insufficiencyBlotchy (Mottled): circulatory insufficiency– shock, poor perfusion shock, poor perfusion

Page 44: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

THE SECONDARY SURVEY:THE SECONDARY SURVEY:PupilsPupils

Should be equal and reactive to light Should be equal and reactive to light ConstrictedConstricted

– Bright light, opiates/heroin overdose, some Bright light, opiates/heroin overdose, some poisoningspoisonings

Mid-pointMid-point– Dead (pupils are fixed and dilated) Dead (pupils are fixed and dilated)

Dilated Dilated – Stress, fright, coma, amphetamine/stimulant Stress, fright, coma, amphetamine/stimulant

overdose, CNS injury, overdose, CNS injury, – early stage of death early stage of death

One pupil dilatedOne pupil dilated– Head injuryHead injury

Page 45: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

THE SECONDARY SURVEY:THE SECONDARY SURVEY:Level of ConsciousnessLevel of Consciousness

Alert and oriented to Alert and oriented to Time Time What day is it?What day is it? PlacePlace Where are you?Where are you? PersonPerson What is your coaches What is your coaches

name?name? Purpose Purpose What are you doing today?What are you doing today?

Page 46: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

THE SECONDARY SURVEY:THE SECONDARY SURVEY:Level of ConsciousnessLevel of Consciousness

Glascow Coma Scale Glascow Coma Scale Normal Score is 15 Normal Score is 15

– Eye opening is 4 maximumEye opening is 4 maximum– Motor response is 6 maximumMotor response is 6 maximum– Verbal response is 5 maximumVerbal response is 5 maximum

Under 15 is considered alteredUnder 15 is considered altered Under 7 is considered a coma Under 7 is considered a coma

Page 47: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

THE SECONDARY SURVEY:THE SECONDARY SURVEY:Level of ConsciousnessLevel of Consciousness

Eye opening Eye opening 4 – Spontaneous4 – Spontaneous 3 – Verbal3 – Verbal 2 – Pain2 – Pain 1 – None1 – None

Page 48: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

THE SECONDARY SURVEY:THE SECONDARY SURVEY:Level of ConsciousnessLevel of Consciousness

Motor responseMotor response 6 – Obeys6 – Obeys 5 – Localizes to pain5 – Localizes to pain 4 – Withdraws to pain4 – Withdraws to pain 3 – Flexion (decorticate)3 – Flexion (decorticate)

– Flexion of arms Flexion of arms – Hyperextension legs Hyperextension legs

2 – Extension (decerebrate)2 – Extension (decerebrate)– Arms and legs extended Arms and legs extended – Internally rotated Internally rotated

1 – None1 – None

Page 49: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

THE SECONDARY SURVEY:THE SECONDARY SURVEY:Level of ConsciousnessLevel of Consciousness

Verbal response Verbal response 5 – Oriented5 – Oriented 4 – Confused4 – Confused 3 - Inappropriate words 3 - Inappropriate words 2 – Incomprehensible sounds2 – Incomprehensible sounds 1 – No verbal response 1 – No verbal response

Page 50: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

THE SECONDARY SURVEY:THE SECONDARY SURVEY:Ability to MoveAbility to Move

Normal is a full range of motion Normal is a full range of motion (ROM)(ROM)

Apparent inabilityApparent inability– Guarding due to trauma, fracture, or Guarding due to trauma, fracture, or

painpain True inability True inability

– ParalysisParalysis One sided – head injuryOne sided – head injury Below – spinal injuryBelow – spinal injury

Page 51: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

THE SECONDARY SURVEY:THE SECONDARY SURVEY:Ability to MoveAbility to Move

Inability to move a body part can indicate Inability to move a body part can indicate a serious central nervous system injurya serious central nervous system injury

Inability to move one side of the body can Inability to move one side of the body can indicate head injuryindicate head injury

Tingling or numbness of the upper Tingling or numbness of the upper extremity can indicate cervical injuryextremity can indicate cervical injury

Weakness or inability to move the lower Weakness or inability to move the lower extremity can indicate injury below the extremity can indicate injury below the neckneck

Page 52: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

THE SECONDARY SURVEY:THE SECONDARY SURVEY:Reaction to PainReaction to Pain

Normal is recognized abilityNormal is recognized ability LocalizedLocalized

– Injury or fractureInjury or fracture GeneralizedGeneralized

– Massive trauma, poisoningMassive trauma, poisoning Absent Absent

– (When injury is obvious) downer drugs, (When injury is obvious) downer drugs, alcohol, shock, spinal injury alcohol, shock, spinal injury

Page 53: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

THE SECONDARY SURVEY:THE SECONDARY SURVEY:Abnormal Nerve ResponseAbnormal Nerve Response

Numbness or tingling in a limb with or Numbness or tingling in a limb with or without movement can indicate nerve or without movement can indicate nerve or cold damagecold damage

Blocking of a main artery can produce Blocking of a main artery can produce severe pain, loss of sensation, or lack of a severe pain, loss of sensation, or lack of a pulse in a limbpulse in a limb

A complete lack of pain or of awareness of A complete lack of pain or of awareness of serious, but obvious injury may be caused serious, but obvious injury may be caused by shock, hysteria, drug usage, or a spinal by shock, hysteria, drug usage, or a spinal cord injury cord injury

Page 54: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

THE SECONDARY SURVEY:THE SECONDARY SURVEY:Breath SoundsBreath Sounds

Normal is clearNormal is clear StridorStridor

– Upper airway obstruction heard on inspirationUpper airway obstruction heard on inspiration high-pitched whistlinghigh-pitched whistling

WheezesWheezes– Lower airway obstruction heard on expiration Lower airway obstruction heard on expiration

high-pitched whistlinghigh-pitched whistling

RhonchiRhonchi– Lower airway obstruction heard on expiration Lower airway obstruction heard on expiration

coarse, loud, gurglingcoarse, loud, gurgling

Page 55: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

THE SECONDARY SURVEY:THE SECONDARY SURVEY:Breath SoundsBreath Sounds

CracklesCrackles– Lower airway obstruction heard on Lower airway obstruction heard on

inspirationinspiration fine cracklingfine crackling

GruntingGrunting– Upper airway obstruction heard on Upper airway obstruction heard on

expirationexpiration ““ugh” soundugh” sound

SnoringSnoring– Soft palate obstruction Soft palate obstruction

Page 56: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

THE SECONDARY SURVEY:THE SECONDARY SURVEY:

Immediate treatment of all Immediate treatment of all musculoskeletal injuries:musculoskeletal injuries:

R.I.C.E.R.I.C.E. Rest Rest Ice Ice CompressionCompression Elevation Elevation

Page 57: Injury Report. HOPS 1. History 2. Observation 3. Palpations 4. Special Tests.

Special TestsSpecial Tests

SOAP NotesSOAP Notes

S = SubjectiveS = Subjective What the athlete tells What the athlete tells youyou

O = ObjectiveO = Objective Trainer’s testsTrainer’s tests A = AssessmentA = Assessment Suspected conditionSuspected condition P = PlanP = Plan TreatmentTreatment

This can be used as an evaluation or a This can be used as an evaluation or a progress report.progress report.