On-field emergencies- A Sports Physiotherapist's Perspective

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On-field emergencies- A Sports Physiotherapist’s Perspective

Dr. Neeraj Kumar PT BPT, MSPT Professor & Vice Principal, Dr.APJ Abdul Kalam College of Physiotherapy Pravara Institute of Medical Sciences (Deemed to be University) Loni , Dist.- Ahmednagar , Maharashtra, www.pravara.com

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Dr. A.P.J. Abdul Kalam College of Physiotherapy

9/14/2021

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BDUL

INSTITUTE OF MEDEAL

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Pravara Institute of Medical Sciences (Deemed to be University)

( Estd .- 1976 as Dept of Physiotherapy to provide patient care)

Dept of Orthopaedics PT Dept of Neuro PT Dept of Cardiorespiratory PT Dept of Community PT Dept of Paediatrics PT Smt. Sindhutai E. Vikhe Patil Spinal Cord Injury Rehabilitation Center Prosthetic and Orthotic Lab Kinesiotherapy lab Electrotherapy & Electrodiagnosis Lab

We impart: BPT (from 1997) MPT (from 2004) - in all above 5 depts PhD (from 2010) - in all above 5 depts

www.pravara.com , 02422-271489, contact@pmtpims.org , principal.cpt@pmtpims.org

www.pravara.com , 02422-271489, contact@pmtpims.org , principal.cpt@pmtpims.org

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Contents:

Preparation for emergencies Classification Assessment of Life threatening situation Procedure for unconscious athletes Assessment of serious injuries Minor injuries and their management Triage Criteria for return to play Medical bag to cater emergencies

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PREPARATION for EMERGENCIES.

1. Appropriate personnel , equipment for transport and stabilization. 2. Ensure appropriate communications – network on place prior to emergency. 3. Rehearse emergency responses to ensure system in place.

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PREPARATION for EMERGENCIES.

4. Cardiovascular – Basic life support qualified personnel. 5. Have a prepared emergency plan . 6. Neurological – Initial assessment – motor, sensory-immediate transport – treat as neck injury. 7. Anaphylaxis – Asthma, Bee sting.

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PREPARATION for EMERGENCIES .

8. Gastro _ intestinal – rupture Spleen , Bowel. 9. Genito -Urinary – Haematuria , then remove from field. 10. Hypoglycaemia . 11. Hyperthermia and Hypothermia. Dislocation s – Knee, Elbow, Ankle, Foot, Hip - neurovascular complications.

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CLASSIFICATION of the INJURED ATHLETE on the FIELD

Life threatening injuries which requires emergency management Injuries that prevent further participation Injuries that permit continuation of play after treatment

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LIFE THREATENING SITUATIONS are -

‘ Inju ries or Conditions that impair, or have the potential to impair vital function, of the CNS and Cardio-Respiratory system are considered Emergency situations’

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ASSESSMENT of LIFE THREATENING INJURIES – 4 phases.

Rapid primary evaluation– establish scene safety Emergency or immediate treatment after primary examination Detailed secondary evaluation Institution of definitive care based on secondary assessment

NB. There are 02 assessment phases and 02 treatment phases.

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INJURY

UNCONSCIOUS ATHLETE

CONSCIOUS ATHLETE

PRIMARY SURVEY

SECONDARY SURVEY

RESPONSIVENESS AIRWAY BREATHING CIRCULATION

VITAL SIGNS HISTORY EVALUATION

TREATMENT CONSIDERATIONS

TRANSPORTATION

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Cardio Pulmonary emergency. Unconscious athlete. Hemorrhages. Fractures. Shock. Hyperthermia – Heat stress. Hypothermia – Cold stress.

Other Emergency Situations in the Field -

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Primary EVALUATION – of Life Threatening Injuries.

The Protocol is:- Airway maintenance. Breathing. C-spine control. D. Disability and Neurological status. E. Expose complete (undress) patient.

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Airway and Cervical Spine.

Ensure patent down to level of larynx – clear foreign bodies, teeth. Possible co-existence of C-spine fracture - hyperextension should never occur , immobilize head and neck. Assume C-spine injury in any injury above Clavicle - Maintain Airway.

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Serious Airway and Chest Injuries.

Chest injuries that can prevent breathing- Tension Pneumothorax. Open Pneumothorax. Flail Chest.

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Injuries that affect Circulation

External bleeding – Direct pressure. Elevation. Pressure points. Internal Hemorrhage – shock.

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PROCEDURES for UNCONSCIOUS Patients.

Assess Unresponsiveness C-Spine control Proceed to ABC Open Airway . Head tilt/chin lift method - if no neck or head injury Jaw thrust method Heimlich maneuver or Abdominal thrust Finger sweep

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PROCEDURES for UNCONSCIOUS Patients.

Establish Breathing Assess by look, listen, feel principle Establish Circulation Carotid pulse Circulation maintained through chest compression CPR (15:2, with two rescuer)

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CONCUSSION.

Degree of Severity – on CANTU scale (Mild, moderate, severe). Monitor – suspected concussion. Guidelines for season. * First concussion – return to play if asymptomatic after 1 week. * Second concussion – out one month. * Third concussion – out for season.

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SERIOUS INJURIES INJURIES that PREVENT further PARTICIPATION

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PRINCIPLES OF ASSESSMENT OF SEVERE INJURIES

3. Complete Physical examination

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1. Follow correct sequence of priorities

2. Knowledge of injury mechanism

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Fingers – Assess, field side reduction, temporary return to play – must be individualized . Elbow – Shoulder Ankle or Foot – Field side reduction depends on experience of Team Physician then Emergency Transport.

Field side Assessment of Dislocations.

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Elbow Dislocation.

Shoulder Dislocation.

Finger Dislocation.

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Knee - may reduce field side, depends on experience, rule out vascular complications, immediate emergency transport.

Field side Assessment of Dislocations.

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Hip – Immediate transport.

Patella – Reduce field side depends on experience – rule out ACL injury.

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INJURIES that PERMIT PLAY after TREATMENT.

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Musculoskeletal injuries Strain Sprain Abrasion Teeth or mouth injuries Minor external eyes injuries Anterior chamber injuries Photophobia Nose injuries Fractures- Ear injuries External trauma

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These minor injuries includes:

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FIRST AID

PRICE Regime

Taping and Strapping

Basic knowledge of fundamentals

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FIRST AID.

Eye .

Anterior chamber injuries. Photophobia. Evaluation of visual activity – ROM.

Nose .

Stop bleeding before returning to play. Fracture –continue play in non contact sport.

Ears.

External trauma – suture, strapping. Loss of hearing – evaluate.

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Saline or milk preservation Transport to appropriate facility Evaluation of additional trauma – fracture mandible, mastoid.

Teeth .

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Sport Related Injuries are Assessed using the -

HOPS FORMAT . History of injury. Observation and Inspection. Palpation. Special Tests . ( Hops Format uses both – Subjective and Objective information)

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TRIAGE – Steps Assessment of injured persons quickly. Returning to most seriously injured and assess again. Immediate treatment to that person.

TRIAGE - Assessment of all injured persons to determine priority of care.

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TRIAGE – PROCEDURE.

Check surrounding area for objects or structures that can contribute to injury. Scan the body and note body positions or deformity. Unconscious patients summon medical assistance. Decerebrate rigidity-extension in all 4 extremities . Decorticate rigidity-extension of legs, flexion of elbows.

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WHEN CAN HE PLAY DOC ?

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CRITERIA for RETURN to PLAY.

No potential threat to life or limbs. Minimal potential for further injury. Painless weight bearing . Informed consent – with respect to potential for further injury where there is no threat to life or limb.

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The MEDICAL BAG to cater Emergency

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Medical Bag and Supplies to Cater for Emergencies.

Circulation supplies . * IV catheters. * IV fluids. * Tourniquet. * Defibrillator device .

Transport supplies . * Spineboard with head support. * Stretcher.

Airway & Ventilation . * Heavy Scissors or bolt cutters. * Oral Airways, Nasal Airways. * Cervical collar – rigid. * Ventilation masks – pocket type & ventilation bag. * Endotracheal tubes, Laryngoscope. * Portable Suction unit & Oxygen.

“MURPHY’S LAW – if anything can go wrong, it will go wrong.!”

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THANK YOU

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