Ballpark Triage and Ballpark Triage and First AidFirst Aid

C. Michael Remoll, MD FACEPC. Michael Remoll, MD FACEP

Safety and Insurance CoordinatorSafety and Insurance Coordinator

Broadneck Baseball and Softball Broadneck Baseball and Softball ClubClub

Objectives:Objectives:

To present medical scenarios most To present medical scenarios most likely to be encountered in role as BBSC likely to be encountered in role as BBSC manager/coachmanager/coach

To provide terminology and definitions To provide terminology and definitions associated with some common associated with some common “ballpark” injuries and illnesses“ballpark” injuries and illnesses

To provide basic triage and first aid To provide basic triage and first aid principles for such injuries and illnessesprinciples for such injuries and illnesses

VS

Specific TopicsSpecific Topics Spine injuriesSpine injuries Closed Head InjuriesClosed Head Injuries Facial InjuriesFacial Injuries Extremity InjuriesExtremity Injuries Blunt Force Internal Blunt Force Internal

InjuriesInjuries Heat-Related Heat-Related

Illnesses Illnesses Allergic ReactionsAllergic Reactions Lightning InjuriesLightning Injuries

Spine InjuriesSpine Injuries

High potential for significant High potential for significant disabilitydisability

Most commonly result from collision, Most commonly result from collision, fallfall

Immediate recognition and initial Immediate recognition and initial treatment most importanttreatment most important

When suspected, immediately seek When suspected, immediately seek medical attention: 911medical attention: 911

Spine InjuriesSpine Injuries Spinal cord extends from the base of the skull to Spinal cord extends from the base of the skull to

the mid-backthe mid-back Spinal Cord is protected by the spinal vertebral Spinal Cord is protected by the spinal vertebral

bones (neck and back bones), ligaments, musclesbones (neck and back bones), ligaments, muscles Injury to vertebral bones, ligaments (fractures, Injury to vertebral bones, ligaments (fractures,

dislocations) may lead to injury of the spinal corddislocations) may lead to injury of the spinal cord Level of spinal cord injury determines severity of Level of spinal cord injury determines severity of

disabilitydisability Neck injuries can lead to quadroplegia; back Neck injuries can lead to quadroplegia; back

injuries can lead to paraplegiainjuries can lead to paraplegia

Spine Injuries: Spine Injuries: Signs/SymptomsSigns/Symptoms

Neck and/or back painNeck and/or back pain Abnormal Sensation: numbness, Abnormal Sensation: numbness,

tinglingtingling Inability to move extremitiesInability to move extremities Shock: pale, sweaty, mental status Shock: pale, sweaty, mental status

changechange

Spine Injuries: First AidSpine Injuries: First Aid

Call 911 immediatelyCall 911 immediately Immobilization: If patient is on the ground, Immobilization: If patient is on the ground,

keep him/her perfectly stillkeep him/her perfectly still If patient is standing, gently help him/her to If patient is standing, gently help him/her to

ground, lying on background, lying on back Place objects around patient to ensure Place objects around patient to ensure

immobilizationimmobilization Leave batting helmet onLeave batting helmet on Place blanket/jacket over patient for warmthPlace blanket/jacket over patient for warmth

Head InjuriesHead Injuries

May be open or closedMay be open or closed Beware of associated spine injuryBeware of associated spine injury Most often are minor, but can be Most often are minor, but can be

serious and life-threateningserious and life-threatening

Head Injury: DefinitionsHead Injury: Definitions

Concussion: Head injury associated Concussion: Head injury associated with no injury identifiable on CT scanwith no injury identifiable on CT scan

Epidural/Subdural Hematoma: “blood Epidural/Subdural Hematoma: “blood clot on the brain”clot on the brain”

Greenwich High School, Salt Lake City, UT

All-State Baseball Player

Captain of High School Baseball Team

ConcussionConcussion

From blunt head trauma: fall, collision, From blunt head trauma: fall, collision, direct blow (pitched ball, baseball bat)direct blow (pitched ball, baseball bat)

Signs/Symptoms: may have brief loss of Signs/Symptoms: may have brief loss of consciousness, headache, dizziness, consciousness, headache, dizziness, confusion, amnesia, nauseaconfusion, amnesia, nausea

If any of these symptoms present, If any of these symptoms present, victim should receive medical attentionvictim should receive medical attention

Epidural/Subdural Epidural/Subdural HematomaHematoma

UsuallyUsually occurs with more significant trauma occurs with more significant trauma Direct blow causes bleeding from a vein or Direct blow causes bleeding from a vein or

artery inside the skull; exerts pressure on artery inside the skull; exerts pressure on brainbrain

May be impossible to distinguish from May be impossible to distinguish from concussion initiallyconcussion initially

Rapid deterioration is suggestive of Epidural Rapid deterioration is suggestive of Epidural HematomaHematoma

Require immediate medical attention: 911Require immediate medical attention: 911 Consider associated spine injuryConsider associated spine injury

Facial InjuriesFacial Injuries

Nasal InjuriesNasal Injuries Eye InjuriesEye Injuries Jaw InjuriesJaw Injuries Dental InjuriesDental Injuries Usually from direct blow or collisionUsually from direct blow or collision Consider associated spine/closed Consider associated spine/closed

head injuryhead injury

Nasal InjuriesNasal Injuries

Signs/Symptoms: bleeding, swelling, Signs/Symptoms: bleeding, swelling, deformity, paindeformity, pain

Treatment: Control bleedingTreatment: Control bleeding– Have patient sit leaning slightly forwardHave patient sit leaning slightly forward– Apply direct pressure Apply direct pressure – Seek medical attention Seek medical attention

Eye InjuriesEye Injuries

Usually from thrown ballUsually from thrown ball Most often the eye is protected by the Most often the eye is protected by the

boney orbitboney orbit If there is any associated eye pain or If there is any associated eye pain or

problems with vision, must seek problems with vision, must seek immediate medical attentionimmediate medical attention

Foreign body (sand, grass, bug) in eye: Foreign body (sand, grass, bug) in eye: irrigate with water; if symptoms persist, irrigate with water; if symptoms persist, may have a corneal abrasion (seek may have a corneal abrasion (seek medical attention)medical attention)

Jaw InjuriesJaw Injuries

Usually from direct blow or collisionUsually from direct blow or collision Signs/symptoms: pain, tenderness, Signs/symptoms: pain, tenderness,

swelling, distortion of bite swelling, distortion of bite (malocclusion), bleeding of gums, (malocclusion), bleeding of gums, loose teethloose teeth

Require medical attentionRequire medical attention

Dental InjuriesDental Injuries

Fractured tooth: Contact dentist Fractured tooth: Contact dentist ASAPASAP

Avulsed tooth: Tooth dislodges from Avulsed tooth: Tooth dislodges from the jawthe jaw– Important to reimplant tooth ASAPImportant to reimplant tooth ASAP– Transport tooth in milk or salivaTransport tooth in milk or saliva– Dental/Medical attention ASAP for Dental/Medical attention ASAP for

reimplantation (50% success when reimplantation (50% success when within 50 minutes)within 50 minutes)

Extremity InjuriesExtremity Injuries

May be contusion, May be contusion, abrasion, sprain, abrasion, sprain, strain, dislocation, strain, dislocation, fracturefracture

Most commonly Most commonly involve wrist, involve wrist, ankle, hand, leg, ankle, hand, leg, armarm

DefinitionsDefinitions

Contusion: bruise; occurs when blood Contusion: bruise; occurs when blood vessels are damaged as a result of a vessels are damaged as a result of a direct blowdirect blow

Abrasion: scrape; injury that rubs off Abrasion: scrape; injury that rubs off the surface of the skinthe surface of the skin

Laceration: a cut or tear of body Laceration: a cut or tear of body tissue; may be superficial or deeptissue; may be superficial or deep

DefinitionsDefinitions

Sprain: injury of a ligament (tough Sprain: injury of a ligament (tough fibrous tissue connecting bone to fibrous tissue connecting bone to bone)bone)

Strain: injury of either muscle or Strain: injury of either muscle or tendon (attaches muscle to bone)tendon (attaches muscle to bone)

Tendons, muscles, and ligaments Tendons, muscles, and ligaments may be torn-more significant injurymay be torn-more significant injury

DefinitionsDefinitions

Fracture: a break in Fracture: a break in a bone; may be a bone; may be partial or completepartial or complete

Dislocation: Dislocation: displacement of a displacement of a bone (or bones) in bone (or bones) in a jointa joint

Extremity Injuries: BoneExtremity Injuries: Bone May result from collision, fall, direct blowMay result from collision, fall, direct blow Wrist, ankle, hand, fingers, arm, legWrist, ankle, hand, fingers, arm, leg Signs/Symptoms include hearing a “snap” Signs/Symptoms include hearing a “snap”

or “pop”, deformity, swelling, or “pop”, deformity, swelling, discoloration, pain, inability to move the discoloration, pain, inability to move the extremityextremity

If there is significant swelling, If there is significant swelling, discoloration, pain, or if any deformity discoloration, pain, or if any deformity seek immediate medical attentionseek immediate medical attention

Immobilize extremity, control any Immobilize extremity, control any bleeding, apply icebleeding, apply ice

If practical (hand, wrist, ankle, foot), If practical (hand, wrist, ankle, foot), elevate extremityelevate extremity

Extremity Injuries: Soft Extremity Injuries: Soft TissueTissue

May result from collision, fall, direct May result from collision, fall, direct blowblow

Abrasions should be gently cleaned Abrasions should be gently cleaned with warm water and soapwith warm water and soap

Contusions should be treated with iceContusions should be treated with ice Lacerations: apply pressure, dressing; Lacerations: apply pressure, dressing;

elevate if possible; seek medical elevate if possible; seek medical attentionattention

Consider underlying boney injuryConsider underlying boney injury

Blunt Force Internal InjuriesBlunt Force Internal Injuries

Usually result from collision, direct Usually result from collision, direct blow, fall blow, fall

Organs at risk: liver (right), spleen Organs at risk: liver (right), spleen (left), kidney (flanks)(left), kidney (flanks)

Signs/Symptoms: pain which usually Signs/Symptoms: pain which usually persists, then signs of blood losspersists, then signs of blood loss

If organ injury suspected, seek If organ injury suspected, seek medical attention immediately: 911medical attention immediately: 911

Signs of Blood LossSigns of Blood Loss

Increased heart rate Increased heart rate DizzinessDizziness PallorPallor SweatingSweating ConfusionConfusion Syncope (passing out)Syncope (passing out)

SHOCK

Heat-related IllnessesHeat-related Illnesses

Heat ExhaustionHeat Exhaustion HeatstrokeHeatstroke Heat CrampsHeat Cramps

Heat ExhaustionHeat Exhaustion

From exposure to high temperature and From exposure to high temperature and dehydrationdehydration

Symptoms/Signs: Weakness, malaise, Symptoms/Signs: Weakness, malaise, headache, dizziness, nausea, vomiting, headache, dizziness, nausea, vomiting, muscle aches, sweating, flushed skin, muscle aches, sweating, flushed skin, high heart rate, fast breathinghigh heart rate, fast breathing

Treatment: Remove from heat, hydrate Treatment: Remove from heat, hydrate (avoid caffeine), rest, fanning (avoid caffeine), rest, fanning

HeatstrokeHeatstroke

Progression from Heat ExhaustionProgression from Heat Exhaustion Diagnosis: No sweating (usually), Diagnosis: No sweating (usually),

confusion (or seizures, confusion (or seizures, unconsciousness), body temperature unconsciousness), body temperature > 104 degrees> 104 degrees

Requires immediate medical attention: Requires immediate medical attention: 911911

Extreme cooling measures: ice packs, Extreme cooling measures: ice packs, wet sheetwet sheet

Heat CrampsHeat Cramps

Painful, involuntary contractions of Painful, involuntary contractions of muscles in those who have been muscles in those who have been sweating and not replacing electrolytessweating and not replacing electrolytes

Occur during or (more commonly) during Occur during or (more commonly) during rest period after activityrest period after activity

Usually involve calves, thighs, shouldersUsually involve calves, thighs, shoulders Treatment/Prevention: fluids, Treatment/Prevention: fluids,

electrolytes (sports drinks) electrolytes (sports drinks)

Insect StingsInsect Stings

Bees, wasps, yellow jackets, hornetsBees, wasps, yellow jackets, hornets Cause 500 deaths/year in U.S.Cause 500 deaths/year in U.S. Localized Reaction: pain, redness, Localized Reaction: pain, redness,

swelling; treat will cool compress, swelling; treat will cool compress, elevationelevation

System Reaction (Anaphylaxis):System Reaction (Anaphylaxis):– Serious and may be life-threateningSerious and may be life-threatening– Hives, “throat closing”, shortness of breath, Hives, “throat closing”, shortness of breath,

lightheadedness, passing outlightheadedness, passing out– Requires immediate medical attention: 911 Requires immediate medical attention: 911 – Benadryl, Epi-penBenadryl, Epi-pen

LightningLightning From direct strike or “Splash Injury”From direct strike or “Splash Injury” May cause variety of injuriesMay cause variety of injuries Anyone with symptomatic lightning injury Anyone with symptomatic lightning injury

requires immediate medical attention: 911requires immediate medical attention: 911 Prevention:Prevention:

– If you hear thunder, you are in range If you hear thunder, you are in range – Avoid open spacesAvoid open spaces– Don’t stand in groups Don’t stand in groups – Don’t carry or hold tall metal objectsDon’t carry or hold tall metal objects– Catcher’s stanceCatcher’s stance– Car provides good shelterCar provides good shelter

Thank YouThank You

Questions?Questions?