Cyprian Enweani MD Slide 2 Introduction Focus in literature is
quite academic and medico-legal Guidelines suggest sideline
physician should be up to date with ATLS & ACLS while
comfortable with emergency procedures (ie intubation) This would
exclude many GPs/FPs Slide 3 Introduction Objective today keep it
simple Assume most physicians are not in the ER Target to the
mother&father family physician who is volunteering Slide 4 If
in doubt keep out At a minimum safety Sideline physicians main
responsibility is to protect the athlete from further injury,
re-injury, & permanent disability The pressure will be to let
the athlete continue and not delay the game Dont rush If in doubt
keep out Slide 5 ABCS Rarely needed but ABCs still essential Know
how you will activate EMS If an athlete collapses dont move them
log roll to there back (c-spine protection) then ABC Airway /
C-spine is the airway clear am I protecting the neck Breathing is
the athlete breathing Circulation is there a pulse (usually
carotid) Slide 6 The Bag CASM full bag with airway supplies, resus
meds,IVs etc for those interested Mom &Dad could bring no
equipment to the sideline but will be very stressful as really
limits what you can do to help Suggest at minimum a small black bag
Slide 7 The Black Bag AIRWAY/BREATHING Cell phone -activate EMS
One-way mask-mouth to mouth Oral airway keep tongue forward 14
gauge cathlon-surgical airway Stethoscope Tongue depressor Pen
light Ventolin inhaler &spacer -asthma Slide 8 The Black Bag
CIRCULATION Epipen/Twinject- anaphylaxis Automated BP cuff-useful
in heat stroke-concussion etc Digital thermometer heat
exhaution/stroke Suture kit (optional) Slide 9 Suture kit Stopping
bleeding /repairing laceration is one area physician can have a
significant impact on immediate return to play Disposable suture
tray Lidocaine 4-0 /6-0 novafil 22guage 3cc syringe 30 gauge needle
Cleaning solution/saline Plastic bottle for sharps Slide 10 The
Black Bag Other Equipment Tuning fork assess for fractures Gauze
2x2s 4x4s Tape Screw driver/allen-wrench/bolt cutter for face mask
removal Gloves sterile/non sterile Slide 11 GENERAL ASSESSMENT
Triage to hospital finished for the day; clinic f/u ok to return
Slide 12 INITIAL ASSESSMENT Airway & C-Spine
unconscious/minimally responsive; assume neck injury may have to
take face mask off log roll Slide 13 Slide 14 Slide 15 Slide 16
Slide 17 Slide 18 INITIAL ASSESSMENT Breathing breathing ?
stridor/hoarseness? suggest laryngeal injury present Pneumothorax?
deviated trachea, SOB, breath sounds, subcutaneous emphysema Slide
19 INITIAL ASSESSMENT Circulation carotid pulse Slide 20 INITIAL
ASSESSMENT Disability Brief survey Neurologic deficit? Slide 21
INITIAL ASSESSMENT Exposure Check extremities Slide 22 Airway
Unconscious/minimally responsive assume neck injury Activate EMS
Ensure airway- log roll to back; remove face mask Remove mouth
guard; teeth; vomit Jaw thrust; oral airway Slide 23 Airway If
anterior neck injury consider laryngeal fracture or edema
stridor/difficulty speaking Consider needle cricothyroidotomy with
14 gauge needle in the cricothyroid membrane between thyroid
cartilage and cricoid cartilage. Slide 24 Slide 25 Breathing Once
airway open, often all needed. If not mouth to mouth/mouth to bag
mask. Anaphylaxis Epinephrine (EpiPen; Twinject) Asthma Ventolin +
spacer Epinephrine Slide 26 Breathing Pneumothorax from:
penetrating trauma rib # spontaneous Slide 27 Tension Pneumothorax
If compressing rest of lung tissue - tracheal deviation -
hypotension - breath sounds - distended neck veins - dyspnea Tx: 14
gauge, 2 nd intercostal space, midclavicular line Slide 28
Circulation No pulse CPR EMS AED Slide 29 SPECIFIC CONDITIONS Neck
Injury Concussion Stinger/Burner Bony Injury Soft Tissue Teeth Heat
Injury Slide 30 Neck Injury: Unconscious Assume neck injury
Activate EMS/support C-spine/ABCs/transport Immobilization in
helmet/pads Slide 31 Neck Injury: Conscious neck pain over C-spine
neurologic symptoms no pain, no numbness, no tingling, no weakness
can get up otherwise immobilize and transport Slide 32 Concussion:
Recognition Any head and any neurologic symptoms Review check list
key symptoms/signs - Amnesia - Memory testing - Balance Slide 33
Slide 34 Concussion: Return to play First Concussion: Grade I
symptoms 15 min no until 1 week symptom free at rest and no
exertional symptoms Grade III LOC (other than brief) no until 2
weeks symptom free at rest and no exertional symptoms Slide 35
Concussion: Return to play Second concussion double rest period
Third concussion 1 year rest Some new thought symptoms may not
present for 24- 36 hours?? Any doubt sit out Slide 36
Stinger/Burner usually football usually a shoulder blow tingling,
numbness, weakness, one arm if both arms assume C-spine injury if
symptoms resolve, not recurrent, ok to return to play wait until no
appreciable weakness/numbness any doubt sit out EMG can help sort
out when resolved Slide 37 Bony Injury hard to assess if pretty
good, no deformity, no swelling, stable and tuning fork negative,
likely ok to return to play Slide 38 Bony Injury: major deformity
Risk of neurovascular compromise. Try to reduce if delay in
transport. hip dislocations hospital could reduce knee if trained
reducing patella, shoulder, elbow, finger will be easier early and
decrease pain for patient. ok to reduce if dont suspect bony
fracture Slide 39 Soft Tissue biggest impact you can likely make
for the outcome of a game and safe return to play is to be able to
suture a wound and control bleeding. Slide 40 Teeth: complete
avulsion (entire tooth knocked out) completely avulsed teeth can be
replanted ideally within a few minutes No rough handling No
touching root rinse teeth in tap water to remove loose debris
re-insert into socket patient bites on gauze gently to hold in
place Slide 41 Teeth: complete avulsion (entire tooth knocked out)
if cant re-insert: keep tooth in patients mouth buccal vestibule;
or Hanks Balanced Saline Solution (Save the tooth); milk; saline;
tap water as last resort. Slide 42 Luxation of tooth (in socket but
wrong position) Extruded hanging down upper or raised lower teeth
reposition with firm pressure stabilize by biting gently on gauze
or towel Lateral Displacement pushed back/pulled forward try to
reposition (may need local anesthetic) stabilize Slide 43 Luxation
of tooth (in socket but wrong position) Intuded Tooth pushed in do
nothing after first aid transport to Dentist Slide 44 Fracture
Tooth if broken tooth, save as for avulsed tooth
rinse/moisten/transport to Dentist Stabilize remnant in mouth by
biting on gauze/towel Slide 45 Heat Injury Prevented by drinking
enough water Cramps typically calf sodium depletion/dehydration tx
fluids/salty drinks local heat to blood flow Slide 46 Heat
Exhaustion core temp less than 104 0 F, 40 0 C + sweating flushed
orthostatic syncope tx cool environment/oral hydration Slide 47
Heat Stroke core temp greater than 104 0, 40 0 C Hallmark CNS
changes mental status; seizures; coma Often no sweating, hot dry
Eventually multi-symptom organ failure High morbidity if temp
greater than 107 0 F Tx rapid cooling over arteries (neck, axilla,
groin); hospital; IV Slide 48 Conclusion Keep it simple ABCs Have
basic tools along IF IN DOUBT SIT OUT! UNSURE, THEN REFER!
