Acute Care

CORE CONCEPTS IN ATHLETIC TRAINING AN THERAPY

SUSAN KAY HILLMAN

Acute Care

Objectives Explain the eight steps to include in developing an emergency action plan.

Identify the elements of “vitals,” or vital signs, and explain each.

Explain the American College of Surgeons’ ranking of trauma hospitals.

Explain the numbers given as the blood pressure reading—what they are and what they represent.

Explain methods used in controlling bleeding.

Explain the sterile technique and compare and contrast it to Universal Precautions.

Explain the difference between the head-squeeze and the trapezius-squeeze techniques of manual stabilization of the cervical spine.

Explain the two techniques for moving the patient onto a spine board from a supine position

Planning Foundations for Acute Care Situations

The Emergency Care Plan Created to ensure all members of coaching and medical

staff are prepared to handle emergency situation See next slide on items to consider Emergency plan should be rehearsed on a regular basis

Role of the Athletic Trainer Provide immediate care or first aid Skilled in acute management of sprains, strains,

lacerations, contusions, fracture, dislocation As well as CPR and rescue breathing

• Pass on information to Ems Personnel

Planning Foundations for Acute Care Situations

Role of the EMS team EMT, Paramedic, Fire Fighters

Paramedics have specialized training in IV care and delivery of medicines

Load and transfer of patient to medical facility

Role of Hospital AT should be aware of local hospitals and what they are equipped to handleTrauma level capabilities

Items to Consider when Creating an Emergency Care Plan

Essentials of the Acute Examination

Primary Survey Airway, Breathing and Circulation

Vital signs and severe bleeding Secondary Survey

Rapid examination of seriousness of injury Decision to move the patient or not

Vital Signs: measures of bodily functions Information should be passed on to Ems Personnel Vary depending on age and condition of patient

Vital Signs

Pulse: indication of the rate and quality of heart beat Tachycardia: rate higher than normal

Heart chambers don’t have enough time to fully fill, each beat sends less blood and O2 to to the body and heart itself

Bradycardia: rate lower than normal Heart not pumping fast enough to supply body and itself with

sufficient blood Heart may stop over time

Weak pulse might indicate heart not working at full capacity

All of these should alert you to the fact things are not normal and EMS is needed

Vital Signs

Pulse AT should be trained to accurately measure heart rate

Use index and middle finger (Not thumb) Carotid: at neck

• Care should be taken to perform properly Radial: at lateral wrist (palmar side) Brachial: inside of upper arm

• If pulse not felt should move fingers and lessen pressure• Count number of beats by 15, 30 or 60 seconds

Longer the more accurate

Vital Signs

Blood Pressure Measure in peripheral vessels during the function of

the heart Combination of the amount of blood (cardiac output)

and resistance of peripheral vessels Abnormal is indication of change in cardiac output

Hypertension: higher BP• High enough pressure can cause rupture in blood vessels• Stroke (brain) heart attack (heart)

Hypotension: Lower BP• Heart and brain may not receive enough blood (O2)• Can lead to syncope (fainting)

Blood Pressure

Requires use of sphygmomanometer (BP cuff) and stethoscope BP cuff inflated to 130-150 mmHG then released

slowly while clinician listens for heart sound with stethoscope Systolic: first sound heard

Pumping phase of heart Diastolic : sound disappears

Pressure during refilling of the heart chambers

Vital Signs

Respiratory Rate: rate and quality of patients breathing Respiratory Rate =# breaths per minute Quality of breaths should also be noted

Asthma, Chronic Obstructed Pulmonary Disease Hypoxia: If patient is breathing to fast or too slow

amount of O2 in blood will be insufficient Tissue will be damaged

Vital Signs

Temperature: indicate body's internal heat Increase in temp. may damage body's organs and

must be reduced Oral temp > 99 degrees is considered to have fever Rectal thermometer most accurate

Immediate Care for Emergency Problems

Call to the victim and ask questions Verbal response indicates airway is open and person is

breathing Determine Level of consciousness

Unconscious: heart stops beating body cannot sustain brain activity• Also caused by head trauma

Shock

O2 supplied to the brain by circulating blood is insufficient Fainting occurs, one sign of shock Shock caused by internal or external bleeding, spinal

cord injury, heart conditions, dehydration, or severe allergic reactions

Signs and Symptoms Low BP (key sign) Rapid or shallow respirations Cold clammy skin Rapid weak pulse Dizziness or fainting

Can be life threatening, requires immediate medical attention• Call 911

Severe Bleeding Hemorrhage: bleeding may occur internally or externally

Internal Bleeding: A.T. should learn to recognize and obtain proper medical attention Results in drop in blood pressure and possible fainting

External Bleeding Universal Precautions

• Limit risk of infection via bloodborne pathogens• Treat all bodily fluids as potentially infected• Protect yourself and the patient

Wear protective barriers: Gloves, masks, eye protectionRemove and dispose appropriatelyDispose of sharps and soiled material per recommended OSHA

guidelinesIf exposed to potentially infected blood or body fluids file

exposure report form

Severe Bleeding

Controlling Visible Bleeding• Direct Pressure

Apply pressure with soft, sterile cloth or bandage• Slow flow of blood enough to allow clot formation

• SplintingKeep broken bones from damaging blood vesselsLimit damage to soft tissue

• Pressure over major arteryWhen direct pressure over wound does not control

bleedingKnowledge of arterial system: most proximal major

vessel• Tourniquet

Last resort to control bleedingDecision to save the persons life over their limbTrained professional only and only removed by doctor

Severe Bleeding

• Sterile Technique• Keep open wound as clean as possible• Prevent contamination by minimizing contact with nonsterile

surfaces• Used in surgical rooms

Includes sterile fields, clothing, equipment and “scrubbing” in

Non serious Acute Injuries

Sprain, strain, Contusion R: Resting from any use of injured area I: Ice applied to constrict blood vessels, decrease

pain, and reduce cell death due to hypoxia by decreasing cell need for O2

C: Compression of injured area. Best way to limit swelling by decreasing space for fluid to accumulate

E: Elevate injured area above level of the heart to limit blood flow to the area and help reduce swelling

Spinal Fractures

If potential spinal cord injury care should be taken to stabilize the patient prior to transporting Head squeeze

In-line (C-spine ) immobilization Apply hands to both sides of patients head, ulnar side

touches mastoid process Trapezius Squeeze

Grab trapezius on both sides and stabilize head in between forearms at levels of patients ears Application of extrication collar can provide

immobilization Patient then stabilized on spine board

Posttraumatic Head Injury

Blow to the head common mechanism for brain and cervical spine injury

Greatest concern with trauma to head is Traumatic brain injury (TBI) Should always check cervical spine also Symptoms

Somatic: e.g., headache Cognitive: e.g., feeling in a fog Emotional: e.g. sadness

Physical Signs Loss of consciousness, amnesia

Cognitive impairment Slowed reaction times

Sleep Disturbances drowsiness


Player should be medically evaluated using standard concussion management principles

Player should be safely removed from practice or play and evaluated in timely manner

Assessment of concussion using SCAT2 or similar tool

Player should not be left alone and should be monitored for deterioration over next couple hours

Player should not be allowed to return to play that day


Clinical Evaluation of Concussion SCAT2 standardized method of evaluating concussion for age

10 and upNeuropsychological assessment has the highest clinical value in

concussion managementReturn to Play Parameters

Majority of concussions resolve over a period of a few days During recovery minimize lights sounds and activity Cognitive rest includes limiting or eliminating mental activities

including TV. computer and phones Once patient is asymptomatic can retest on neurocognitve tool

and when a at baseline levels can start progression back 5 day progression of increasing activities Re check symptoms after every change in activity level Some states have legislation on return to play

A.T. should be aware of laws

Heat Illness

Hyperthermia: core temperature above normal range Heatstroke is true medical emergency

Call EMS Cool patient down immediately

Remove heavy clothing and submerge in ice bath or pack patient with ice packs in groin, neck, axilla, and head

Asthma and Other Forms of Bronchospasm

Air enters lungs through bronchial tree Bronchioles and then alveoli

If any part of bronchial tree become blocked breathing becomes difficult and O2 in blood decreases

Irritants and allergens can cause bronchospasm or constriction of bronchioles Medical conditions Environmental conditions Medications

• Signs of respiratory distress include shortness of breath, use of intercostal and neck muscles to assist with breathing, difficulty blowing air out of lungsAssist patient with inhaler, rest, control environment If persist call EMS

Anaphylaxis

Severe and rapidly developing reaction affecting multiple body systems at once Allergen is ingested or injected into body and thus

into blood streamLife threatening emergency

Call 911 Assist with use of epinephrine pen if they are aware of

their injury and have one Exercised induced anaphylaxis is a rare disorder that

occurs after physical activity Cessation of activity should immediately improve

symptoms

Care Principles for Musculoskeletal Injuries

Majority of injuries seen in physically active people are musculoskeletal: Bones, muscle,& joints Treat using RICE principles May require use of splint or crutches

Splinting Immobilize above and below the fracture spanning joints

if possible Use a variety of materials Avoid pressure on superficial nerves Check Circulation, sensory and motor function before and

after splint is applied Splint in the position you find the injury, do not try to

move Crutches

May be needed to assist ambulation Size and fit correctly and instruct on proper use

Moving and Transporting Injured Patients

Moving the Injured Patient Onto a Spine Board Moving the Patient From a Prone Position Moving the Patient from a Supine Position Moving the Injured Patient Off the Field Manual Carry Techniques Transporting the Injured Patient From an Unstable

Surface Swimming Pool Gymnastics Foam Pit

Transporting the Injured Patient to a Campus Health Center

Transporting the Injured Athlete to a Hospital

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Acute Care