Chapter 12: On-the-Field Acute Care and Emergency Procedures

When injuries occur, while generally not life-threatening, they require prompt care

Emergencies are unexpected occurrences that require immediate attention - time is a factor

Mistakes in initial injury management can prolong the length of time required for rehabilitation or cause life-threatening situations to arise

Emergency Action Plan

Primary concern is maintaining cardiovascular and CNS functioning

Key to emergency aid is the initial evaluation of the injured athlete

Members of sports medicine team must at all times act reasonably and prudently

Must have a prearranged plan that can be implemented on a moments notice

Issues plan should address

Cooperation between Emergency Care Providers

To avoid problems, all individuals involved in plan should practice to familiarize themselves with all procedures (including equipment management)

Parent Notification

Appropriate acute care cannot be provided without a systematic assessment occurring on the playing field first

On-field assessment

Primary survey

Determine if threatening condition

Airway, breathing, circulation, shock and severe bleeding

Used to correct life-threatening conditions

Secondary survey
Life-threatening condition ruled out

Gather specific information about injury

Assess vital signs and perform more detailed evaluation of conditions that do not pose life-threatening consequences

Dealing with Unconscious Athlete

Primary Survey

Life threatening injuries take precedents

Emergency Cardiopulmonary Resuscitation

Establish Unresponsiveness

Equipment Considerations

ABCπs of CPR

–A - airway opened

–B - breathing restored

–C - circulation restored

–Generally when A is restored B & C will follow

Administering Supplemental Oxygen

Control of Hemorrhage

Universal precautions must be taken to reduce risk of bloodborne pathogens exposure

External Bleeding

Internal Hemorrhage

Extreme fatigue, dehydration, exposure to heat or cold and illness could predispose athlete to shock

Several types of shock

–Hypovolemic

–Respiratory

–Neurogenic

–Cardiogenic

–Psychogenic

–Septic

–Anaphylactic

–Metabolic

–Signs and Symptoms

–Moist, pale, cold, clammy skin

–Weak rapid pulse, increasing shallow respiration decreased blood pressure

–Urinary retention and fecal incontinence

–Irritability or excitement, and potentially thirst

Management

Secondary Survey

State of Consciousness

Must always be assessed

Alertness and awareness of environment, as well as response relative to vocal stimulation

Head injury, heat stroke, diabetic coma can alter athleteπs level of consciousness

Movement evaluations

History should be taken

Visual Observation

Palpation

Assessment Decisions

Immediate Treatment

–Primary goal is to limit swelling and extent of hemorrhaging

–If controlled initially, rehabilitation time will be greatly reduced

–Control via RICE

ÄREST

ÄICE

ÄCOMPRESSION

ÄELEVATION

Emergency Splinting

Air splint

Lower Limp Splinting

Upper Limb Splinting

Best splinted and moved with a spine board

Placing Athlete on Spine Board

Steps to follow for spine boarding

Requires 4-5 people (captain responsible for head and neck, 2 others for trunk and limbs, and 4th to slide the board)

Ambulatory Aid

Manual Conveyance

Used to move mildly injured athlete a greater distance than could be walked with ease

Carrying the athlete can be used following a complete examination

Convenient carry is performed by two assistants

Stretcher Carrying

Pool Extraction

Proper Fit and Use of Crutch or Cane

Walking with Cane or Crutch

Cane Tripod technique

Emergency Emotional Care