SPORTS INJURIES

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SPORTS INJURIES
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OBJECTIVES

• Understand how EMTs/paramedics and athletic
  trainers work together in the field
• Assessment tool for athletes who sustained a head
  injury and their ability to return to competition
• Discuss the changes in athletes that may affect
  how health care providers care for them

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Who Are Athletic Trainers?
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• Bachelors degree from an accredited
  college/university
• Fulfilled requirements for certification as
  established by the NATABOC
• Work in different settings including clinics,
  hospitals, industry and schools/colleges
• Work under the supervision of a doctor

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The Role of the Athletic Trainer
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• Injury prevention
• Maintain/fit equipment
• Supervise weight training session
• Assess injuries and determine return to play
• Rehabilitation of injuries

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HEALTH CARE AT SPORTS EVENTS

• Athletic trainer assesses the injury
• If there is a serious injury,the doctor (if
  present) is called out
• Ambulance crew
• Emergency Dept.
• Possible surgery
• Rehabilitation
• Return to play

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Policy and Procedures

• Know the area
• Know the event policy for emergency
• Phones?
• Other health care providers present?
• Equipment provided?
• Whos in charge of the event?
• 3. Weather policy

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What we know about return to play after a hit on
the head
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• VERY LITTLE

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But Seriously.

• There have been many conferences on head injury
  and return to play
• November 1991 1st International Symposium on
  Concussion in Vienna

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Concussion defined..

• A complex pathophysiological process affecting
  the brain, induced by traumatic biomechanical
  forces.
• May be caused by either a direct blow to the
  head, face, neck, or elsewhere on the body with
  an impulsive force to the head
• Rapid onset of short-lived impairment of neuro
  function that resolves spontaneously

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Definition contd..

• May result in neuropathological changes
• Result in a graded set of clinical syndromes that
  may or may not involve loss of consciousness

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CONCUSSION GRADING SCALES

• There are not scientifically validated return to
  play guidelines at this time.
• The Vienna Conference recommended adapting the
  Canadian Academy of Sports Medicine Guidelines
• Important to note that the standard orientation
  questions of place, time , person have been shown
  to be unreliable in the sports setting when
  compared to memory tests

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Signs and Symptoms of Acute Concussion

• Cognitive features unaware of period, opposition
  or score confusion amnesia LOC and unaware of
  date, time or place
• Typical Symptoms Headache, dizziness, nausea,
  unsteadiness/loss of balance, feeling dinged or
  stunned or dazed, having my bell rung,
  seeing stars or flashing lights, ringing in the
  ears, and double vision
• Other symptoms like sleepiness, sleep
  disturbance, subjective feeling of slowness and
  fatigue

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Signs and Symptoms continued

• Physical Signs LOC/impaired conscious state
  poor coordination or balance concussive
  convulsion/impact seizure gait unsteadiness/LOB
  slow to answer questions or follow directions
  easily distracted or poor concentration
  displaying unusual or inappropriate emotions
  nausea/vomitting vacant stare/glassy eyed
  slurred speech personality changes
  inappropriate playing behavior

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ANY Acute Signs and Symptoms

• No return to play/practice
• Do not leave athlete unattended and monitor
  regularly
• Medical evaluation
• Return to play in a step by step process after
  medical assessment

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On the Field Assessment.

• Observation
• Primary Assessment
• History of previous concussions
• Signs and symptoms Vomiting
• Eyes
• Upper extremity strength

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Assessment7. Lower extremity strength 8.
Neurological testsOrientation, retrograde
amnesia, memory, detailed concentration 9.
Minimum of 15 minutes of observation 10.
Provocation tests11.Recheck frequently
Fairview
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RETURN TO PLAY GUIDELINES..

• Same Day
• Signs and symptoms clear w/i 15 min.
• or less
• Normal neuro evaluation
• No loss of consciousness

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Return to Play..

• Delayed Return to Play
• Signs and Symptoms did not clear in 15 minutes
• Documented loss of consciousness
• Step by step process for return to play

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Currently developing a sideline computerized test
for cognition following a head injury
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Fairview
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Developing Concerns in the Sports World

• Athletes are bigger, but not necessarily stronger
• Most are not eating properly for their activity
  level
• Dehydration
• Supplements
• Extremists
• Couch potato want to bes

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Questions to Consider During Assessment

• How hard do you work out in practice?
• How much did you have to drink/eat the past week?
• How hard was your practice the last 2-3 days?
• Have you done this event before? Did you practice
  it?
• Chronic problem?

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Conclusion