Chapter 7: Handling Emergency Situations and Injury Assessment

© 2007 McGraw-Hill Higher Education. All rights reserved.

Chapter 7: Handling Emergency Situations and Injury Assessment


General Considerations• Most injuries DO NOT result in life-

or-death emergencies, but when such situations do occur, prompt and appropriate care is essential.

• EMERGENCY = an unforeseen combination of circumstances and the resulting state that calls for immediate action.


General Considerations• Time is a critical factor in emergency

situations• ATCs must be able to figure out the

problem, know how to handle it, and arrange for proper medical care & transportation for the injured person

• There is NO room for uncertainty, indecision, or error


The Emergency Plan• Of prime concern in any emergency

situation is the maintenance of cardiovascular function and, indirectly, central nervous system (CNS) function. Failure of either of these will result in death

• The key to successful emergency aid is the initial evaluation of the injured athlete


• Emergency Action Plans– Separate plans should be developed for each facility

• Outline personnel and role• Identify necessary equipment

– Established equipment and helmet removal policies and procedures

– Availability of phones and access to 911– All staff should be familiar with community based

emergency health care delivery plan• Be aware of communication, transportation, treatment

policies


– Do coaches, ATCs, AD’s, and other school personnel know the plan and what their responsibilities are?

– What information should be given to EMS personnel on the phone?

– It should include…• name & title of caller• exact location of the injured person• type of emergency/injury• care being given and by whom• ALWAYS hang up last!!

The Emergency Plan


Parent Notification• When athlete is a minor, ATC should try to obtain

consent from parent prior to emergency treatment (based on HIPAA)

• Consent indicates that parent is aware of situation, is aware of what the ATC wants to do, and parental permission is granted to treat specific condition

• When unobtainable, predetermined wishes of parent (provided at start of school year) are enacted

• With no informed consent, consent implied on part of athlete to save athlete’s life


Recognizing Vital Signs

• The ability to recognize the physiological signs of injury is essential to the proper handling of critical injuries.

• There are 9 vital signs that ATCs, coaches, and physicians must be aware of and they include...


Pulse• A direct extension of the

functioning of the heart– usually determined at the

carotid artery in the neck or radial artery in wrist

– normal pulse rate is 60-80 bpm in adults and 80-100 bpm in children/infants

– highly trained athletes have much slower heart rates than average people


Pulse• An abnormal pulse may indicate the presence

of a pathological condition– rapid, weak pulse may mean shock, bleeding– rapid, strong pulse may indicate heat stroke or

fright– slow, strong pulse may mean stroke or head injury– no pulse means cardiac arrest


Respiration• Normal breath rate is 12-20 breaths per

minute in adults and 20-25 in children.• Breathing may be shallow, irregular, gasping,

wheezing, etc.– ex. Shallow breathing indicates shock

• Frothy blood from the mouth indicates a chest injury, like a fractured rib.


The Unconscious Athlete• Provides great dilemma relative to treatment

– When acting alone, should contact EMS first• Must be considered to have life-threatening

condition– Note body position and level of consciousness– Check and establish airway, breathing, circulation

(ABC)– Assume neck and spine injury– Remove helmet only after neck and spine injury

is ruled out (facemask removal will be required in the event of CPR)


Blood Pressure• Measured by a sphygmomanometer

• Indicated by 2 pressure levels– Systolic Blood Pressure = occurs when the heart is pumping blood– Diastolic Blood Pressure = occurs when the heart is resting between

beats• “Normal” BP is 115-120/75-80 or 120/80


Blood Pressure• Systolic pressures above 140 should be considered “high”

while those below 110 should be considered “low”• Diastolic pressures above 90 should be considered “high”

and those below 60 “low”• Low blood pressure could indicate a heart attack,

hemorrhage, shock, etc.


Temperature• Maintained in the body

by water evaporation and heat radiation

• Normal body temp. is 98.6o F.

• Measured with a thermometer under the tongue, armpit, or in rectum


Temperature

• Changes in body temperature can usually be seen in the skin – Hot, dry skin can indicate heat illness, infection,

etc. – Cool, clammy skin may reflect shock, trauma, etc.

• With lowered body temperature you will often also see chills, chattering teeth, blue lips, goose bumps, pale skin, etc.


Skin Color• Can be very useful in determining the state

of health of a person• 3 colors are commonly identified in medical

emergencies…– Red - heat stroke, high BP, CO poisoning – White (pale) - insufficient circulation, shock,

fright, bleeding, insulin shock– Blue (cyanotic) - lack of blood to an area or lack

of oxygen in the blood


Pupils (Eyes)• Extremely sensitive to

situations involving the CNS

• Most people’s pupils are basically the same, but ATCs should be aware of any athletes who have abnormal eyes

• A constricted (smaller) pupil may indicate use of CNS drugs, a head injury, or shock

• Dilated pupils indicate CNS injury


Pupils (Eyes)• Pupils response to light

should always be noted. They should constrict with light and they should constrict equally. (A good way to remember this is PERL. Pupils Equal and Reactive to Light.

• When examining eyes, you should note the presence of contact lenses or artificial eyes.


Level of Consciousness• Does the athlete know what is going on?• Does the athlete respond to these 3 basic

questions:– Do they know who they are?– Do they know where they are?– Do they know what time it is?

• If the answer is “yes” to all 3, that are said to be “conscious and alert times three”.


Movement• Can the athlete move their body in

general ways• Can the athlete move the injured part(s)• Inability to move may indicate an injury

to the Central Nervous System (CNS) or the Peripheral Nervous System (PNS)


Abnormal Nerve Response

• Athletes who experience neurological signs and symptoms that are not normal may be suffering from a spinal cord, brain, or cold injury


Internal Hemorrhage• Invisible unless manifested through body

opening, X-ray or other diagnostic techniques• Can occur beneath skin (bruise) or contusion,

intramuscularly or in joint with little danger• Bleeding within body cavity could result in

life and death situation• Difficult to detect and must be hospitalized for

treatment• Could lead to shock if not treated accordingly


Managing Shock

• Generally occurs with severe bleeding, fracture, or internal injuries

• Result of decrease in blood available in circulatory system– Vascular system loses capacity to maintain fluid

portion of blood due to vessel dilation, and disruption of osmotic balance

• Movement of blood cells slows, decreasing oxygen transport to the body


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

• 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


SHOCK

• With any injury, shock is possible but it is a certainty with severe bleeding, fractures, or deep internal injuries

• Shock occurs where there is a diminished amount of fluid available to the circulatory system. The result of this is that there are not enough O2 carrying cells available to the body tissues, particularly the CNS.

• This causes the collapse of the circulatory system, leading to tissue death.

• Things like extreme fatigue, exposure to heat or cold, dehydration (lack of water), and illness predispose a person to shock

© 2007 McGraw-Hill Higher Education. All rights reserved.Signs

and

Symptoms of Shock

• Pulse is rapid, very weak• May appear drowsy and

sluggish• Respiration is shallow

and extremely rapid• Skin will be pale or

cyanotic (blue)• Irritability, restlessness,

or excitement• A feeling of impending

doom• BP is low w/systolic

pressure below 90mm Hg


Type

s of S

hock

• Hypovolemic = caused by enormous loss of blood

• Respiratory = occurs when the lungs are unable to supply enough O2 to circulating blood

• Neurogenic = caused by a general dilation of blood vessels within the cardiovascular system. The blood can no longer fill the “pipes” and body tissues don’t get enough O2


Type

s of S

hock

• Psychogenic = commonly known as fainting. Occurs with a momentary loss of normal blood flow to the brain.

• Cardiogenic = inadequacy of the heart to pump blood to the body

• Septic = occurs as a result of a severe infection in the blood and/or body tissues causing blood vessels to dilate.


Types of Shock • Anaphylactic = results

from a severe allergic reaction to insect stings or other allergens like foods, flowers, plants, etc.– Can usually be controlled

with the use of an Epipen or Ana-Kit

– ATCs should be familier with student-athletes who are allergic to insects, foods, and other allergens

– ATCs should know how to properly use the Epipen or Ana-Kit if the student needs assistance in an emergency


Types of Shock

• Metabolic = occurs when a severe illness like diabetes goes untreated. Can also be caused by diarrhea, vomiting, etc. where there is a severe loss of body fluids over a short period of time.

Sports MedicineUnit 9, Part C

The Unconscious Athlete

The Unconscious Athlete

It is extremely important that you be careful when examining an unconscious athlete, due to the possibility of a head or neck injury

Ideally, it is best not to move an unconscious athlete until they have regained consciousness This is not realistic in most casesOfficials, coaches, and others should

never be allowed to rush medical personnel

Musculoskeletal Injuries

• Of major importance in musculoskeletal injury is the initial control of hemorrhage (bleeding), early inflammation, muscle spasm, and pain.

• The easiest way to do this is through the use of REST, ICE, COMPRESSION, and ELEVATION or R.I.C.E.

ICE (Cold Application)• An effective first aid agent that

reduces pain and spasm in the first 4-6 hours after an injury.

• There is much debate about how cold works physiologically. – It is the subject of on-going research. – It does constrict blood vessels, thicken the

blood, and reduce blood flow. – Also reduces tissue demand for O2 &

reduces HYPOXIA (lack of O2 in blood).

COMPRESSION• While cold is placed on the injury

intermittently, compression should be maintained throughout the day.

• The wrap should be applied distally to proximally, which prevents swelling from moving into more distant parts of an extremity.– This is usually the result of gravity.

• Care should be taken to not wrap too tightly. – It is important to caution athletes and also advise

them that, if they start to experience numbness or tingling in the extremity, they should loosen or remove the wrap immediately.

ELEVATION

• Along with ice and compression, it is important that the injured body part be elevated above the level of the heart for the first 48-72 hours after injury.

• This elevation will help reduce swelling and internal bleeding.

• It also enhances venous return, by making it easier for blood to get back to the heart.

REST

• Essential for musculoskeletal injuries.• This can be achieved by telling the person

not to move the body part, or by applying tape, wraps, splints, casts, or putting the person on crutches.

• Immobilization helps to insure proper healing without complications.

HEMORRHAGE• Defined as an abnormal external or

internal discharge of blood.• May be venous, capillary, or arterial

and the bleeding may by on the inside or outside of the body.

HEMORRHAGE• Arterial bleeding is exhibited with the

forceful spurting of bright, red blood.

HEMORRHAGE• Venous bleeding is usually dark and

flows continuously

HEMORRHAGE• Capillary bleeding is usually exhibited

by an oozing of bright, red blood.

External Bleeding• Stems from an open skin wound

such as abrasions, lacerations, incisions, punctures, avulsions, etc.

• There are several methods that can be used to control external bleeding, including…

External Bleeding Direct Pressure - applying direct

pressure over the wound with your hand and sterile gauze. The pressure is firmly applied against the resistance of the bone.

Elevation - in combination with direct pressure, you should elevate the body part above the heart. This reduces blood pressure to the area and slows bleeding.

External Bleeding Pressure Points - can be used when pressure

and elevation do not work. There are 11 major pressure points on each side of the body. These are areas that have superficial arteries and veins that can be compressed. Most common are the brachial and femoral arteries.

External Bleeding Tourniquet - if all other attempts

to stop bleeding fail, then your last resort is to apply a tourniquet. This is a method seldom used in sports. If you apply a tourniquet you must… Note the time you put the

tourniquet on on the forehead of the patient.

DO NOT release the tourniquet at any time unless told to do so by a doctor.

Remember you are cutting off all circulation to that body part. Athlete may lose it because of this.

14:30

Internal Bleeding• Invisible to the eye unless seen by x-

ray or other means.• The danger with internal bleeding is

that it’s difficult to detect and can be overlooked.

• Can be as simple as a contusion under the skin to filling a body cavity like the thorax or skull.

• If you suspect severe internal bleeding, refer to the hospital immediately.

Chapter 7: Handling Emergency Situations and Injury Assessment

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