Outcome 4

1. Management and treatment of injuries that can occur during recreation activities and sporting events Outcome 4

2. Responding to Injuries • When an injury occurs, there is particular protocol for responding to the injured person. • In this presentation we will explore responding to the following injuries: • neck and spine injuries • internal injuries, including ruptured spleen, bruised kidney and testicular trauma • respiratory illnesses, including asthma and hyperventilation • circulatory illnesses, including angina, heart attack and stroke • hyperthermia, including heat cramps, heat exhaustion and heat stroke • hypothermia and frostbite • diabetic coma and insulin shock • seizures and convulsions • nose injuries, including nosebleeds and broken noses • eye injuries, including contusions, lacerations and foreign bodies in the eye • dental injuries, including loose, chipped and avulsed teeth • fractures, including open, closed and stress fractures • joint injuries, including dislocation and subluxation injuries • soft tissue injuries, including muscle, tendon, ligament, bursae and cartilage injuries • skin wounds, including blisters, abrasions and lacerations

3. Unconsciousness • Call or tell someone to call 911. • Check the person's airway, breathing, and pulse frequently. If necessary, begin rescue breathing and CPR. • If the person is breathing and lying on the back, and you do not think there is a spinal injury, carefully roll the person toward you onto the side. Bend the top leg so both hip and knee are at right angles. Gently tilt the head back to keep the airway open. If breathing or pulse stops at any time, roll the person on to his back and begin CPR. • If you think there is a spinal injury, leave the person where you found them (as long as breathing continues). If the person vomits, roll the entire body at one time to the side. Support the neck and back to keep the head and body in the same position while you roll. • Keep the person warm until medical help arrives. • If you see a person fainting, try to prevent a fall. Lay the person flat on the floor and raise the feet about 12 inches. • If fainting is likely due to low blood sugar, give the person something sweet to eat or drink when they become conscious.

4. Neck and Spine injuries First Aid for a Severe Injury • Do not move the person unless his or her life is in danger. If so, log roll the person, place tape across the forehead, and secure the person to a board to keep the head, neck, and back areas from moving at all. • Call 9-1-1! • Check for a response. If giving rescue breaths, do not tilt the head backward. Pull the lower jaw open instead. • To Immobilize the Head, Neck, and/or Back • Tell the person to lie still and not move his or her head, neck, back, etc. • Log roll as listed above or place rolled towels, etc. on both sides of the neck and/or body. Tie in place, but don't interfere with the person's breathing. If necessary, use both of your hands, one on each side of the person's head to keep the head from moving. • Monitor for Bleeding and Shock. Keep the person warm with blankets, coats, etc.

5. Internal injuries, including ruptured spleen, bruised kidney • A person suspected with internal bleeding should seek medical attention as soon as possible.

6. Cont’d • Diagnosed via a physical examination, concentrating on the area of the body where the internal bleeding may have occurred. • Blood tests are completed • Imaging test will help to look for the bleeding source. • In some situations in which the patient is critically ill from internal bleeding, the decision may be made to undergo emergency surgery to find and repair the bleeding site. This may occur in trauma victims with abdominal or chest injuries who have unstable vital signs (decreased level of consciousness, low blood pressure, and other signs of shock) and are at risk for bleeding to death if they were to wait for diagnostic tests.

7. Respiratory illnesses, including asthma and allergic reaction • EMERGENCY PROTOCOL: CALL 911 • Check airway patency, breathing, respiratory rate, and pulse • Administer medications (EpiPen, and/or albuterol) per standing order • Determine cause as quickly as possible • Monitor vital signs (pulse, respiration, et cetera.) • Contact parents immediately and physician as soon as possible • Any individual treated for symptoms with epinephrine at school will be transferred to medical facility • STANDING ORDERS FOR RESPONSE TO LIFE-THREATENING ASTHMA OR ANAPHYLAXIS: • The order of medication administration is dependent upon the severity of symptoms: Administer an IM EpiPen-Jr. for a child less than 50 pounds or an adult EpiPen for any individual over 50 pounds

8. Circulatory illnesses, including heart attack • Heart Attack Warning signs are:1) uncomfortable pressure, fullness, squeezing or pain in the center of the chest that lasts more than a few minutes, or goes away and comes back2) pain that spreads to the shoulders, neck or arms3) chest discomfort with lightheadedness, fainting, sweating, nausea or shortness of breath4) unaccustomed fatigue (especially in women) can be an early warning.Not all these warning signs occur in every heart attack, but we novices are ill-prepared to distinguish between real heart attacks and these discomforts. • Traditional advice is that, if you feel the onset of some signs, give heed; the sensation may build or it may pass quickly. If you suspect a heart attack, don’t wait; heart attack is a medical emergency. Taking an aspirin, if your body allows it, may improve your chances of survival and recovery. • And conventional advice is this: Do not drive yourself to the hospital. Seek another since you don’t want to lose consciousness while driving.

9. Circulatory illnesses, including angina • Angina: is of lesser severity but is also due to a heart muscle not receiving enough blood and oxygen. • If symptoms are brief and resolved in a few minutes by rest or nitroglycerin plus rest, it is considered to be angina, • But, if your angina is becoming worse, then likely you should discuss this with your doctor. • By 'becoming worse' I mean: (1) developing new symptoms or (2) a change in your usual pattern of symptoms, such as (a) having symptoms after not having any for a long time, (b) symptoms coming on more often or during rest or sleep, or (c) symptoms lasting longer at a time or requiring additional nitroglycerin for relief

10. Circulatory illnesses, including a stroke • If you see someone in apparent difficulty, you can quickly assess the likelihood he is experiencing a stroke.1) Ask him to smile; if facial muscles are affected the smile will be crooked, one side only.2) Ask him to raise both arms; only one will work well and the other may be weak or limp.3) Ask him to voice a simple sentence; speech is likely to be difficult and may be difficult to understand. • If the person has difficulty with even one of these, please take them to the hospital. Stroke Heroes Act FAST

11. Hyperthermia, including heat cramps, heat exhaustion and heat stroke • Mild hyperthemia caused by exertion on a hot day might be adequately treated through self-care measures, such as drinking water and resting in a cool place. When the body temperature is significantly elevated, • Passive cooling techniques, such as resting in a cool, shady area and removing clothing can be applied immediately • sponging the head, neck, and trunk with cool water, remove heat from the body and thereby speed the body's return to normal temperatures. • Drinking water and turning a fan or dehumidifying air conditioning unit on the affected person may improve the effectiveness of the body's evaporative cooling mechanisms (sweating). • Sitting in a bathtub of tepid or cool water (immersion method) can remove a significant amount of heat in a relatively short period of time • When the body temperature reaches about 40 C, or if the affected person is unconscious or showing signs of confusion, hyperthermia is considered a medical emergency that requires treatment in a proper medical facility.

12. Diabetic coma • To be administered by a medical professional • Treatment depends upon the underlying cause: • Ketoacidotic diabetic coma: intravenous fluids, insulin and administration of potassium and sodium. • Hyperosmolar diabetic coma: plenty of intravenous fluids, insulin, potassium and sodium given as soon as possible. • Hypoglycaemic diabetic coma: administration of the hormone glucagon to reverse the effects of insulin, or glucose given intravenously.

13. Insulin Shock • Also known as Diabetic hypoglycemia is a low blood glucose level occurring in a person with diabetes mellitus. • Oral intake of glucose • The blood glucose can usually be raised to normal within minutes with 15-20 grams of carbohydrate, although overtreatment should be avoided if at all possible. It can be taken as food or drink if the person is conscious and able to swallow. • Intravenous glucose • If a person cannot receive oral glucose gel or tablets, such as the case with unconsciousness, seizures, or altered mental status, then emergency personal (EMTs/Paramedics and in-hospital personnel) can establish a peripheral or central IV line and administer a solution containing dextrose and saline • Glucagon • Glucagon is a hormone that rapidly counters the metabolic effects of insulin in the liver, causing glycogenolysis and release of glucose into the blooden

14. Nose injuries, including nosebleeds and broken noses • If your nose is bleeding. Pinch your nose and lean slightly forward. Keep your head above your heart to stop the bleeding. • Minor nasal fractures are allowed to heal on their own. Doctors may prescribe ice, pain medication, and nasal decongestants to ease discomfort during the healing process. • For nasal fractures where the nose has been deformed, the doctor may attempt to realign the broken bone and cartilage pieces. This can be done manually, or, for more serious breaks, with an outpatient surgical procedure.

15. Eye injuries, including contusions, lacerations and foreign bodies in the eye • A Medical professional should be contacted whenever there is concern about your eye. • Emergency • An emergency must be treated within minutes. This would include chemical burns of the conjunctiva and cornea. • Urgent • An urgent case must be treated within hours. This includes penetrating globe injuries; corneal abrasions or corneal foreign bodies; hyphema (must be referred)' eyelid lacerations that are deep, involve the lid margin or involve the lacrimalcanaliculi; radiant energy burns such as arc eye (welder's burn) or snow blindness; or, rarely, traumatic optic neuropathy. • Semi-urgent • Semi-urgent cases must be managed within 1–2 days. They include orbital fractures and subconjunctival hemorrhages.

16. Dental injuries, including loose, chipped and avulsed teeth • A dentist should be contacted as soon as possible to minimize the long term damage to your teeth or gums. • Ice and oral pain reducers can be used to make the injured person as comfortable as possible until they can be seen by a doctor or dentist.

17. Fractures, including open, closed and stress fractures • It is best if the injured person seeks medical attention as soon as possible. • If the bone needs to be reset, it is best for this to happen before the bone heals and need to be re-broken in order for the bone to be reset properly.

18. Joint injuries, including dislocation and subluxation injuries • RICE should be implemented immediately • Prolonged immobilization delays the healing of a sprain, as it usually leads to muscle atrophy and stiff joint. • The components of an effective rehabilitation for all sprain injuries include increasing range of motion and progressive muscle strengthening exercise. • If the injury is prolonged or re-occurs, the athlete should consider physiotherapy.

19. Soft tissue injuries, including muscle, tendon, ligament, bursae and cartilage injuries • If severe pain persists after the first 24hours it is recommended that an individual consults with a professional who can make a diagnosis and implement a treatment plan so the patient can return to everyday activities • These are some of the tools that a professional can use to help make a full diagnosis; • Nerve conduction studies may also be used to localize nerve dysfunction (e.g., carpal tunnel syndrome), assess severity, and help with prognosis. Electrodiagnosis also helps differentiate between myopathy and neuropathy. • Ultimately, the best method of imaging soft tissue is magnetic resonance imaging (MRI), though it is cost-prohibitive and carries a high false positive rate.

20. Skin wounds, including blisters, abrasions and lacerations • The treatment depends on the type, cause, and depth of the wound as well as whether other structure beyond the skin are involved. Treatment of recent lacerations involves examination, cleaning, and closing the wound. Minor wounds like bruises will heal on their own with skin discoloration usually disappears in 1–2 weeks. Abrasions which are wounds with intact skin usually require no active treatment except keeping the area clean with soap and water. • Cleaning • For simple lacerations cleaning can be accomplished using a number of different solutions including tap water, sterile saline solution, or antiseptic solution. • Closure • If a person presents within 6 hours of a laceration they are typically closed immediately. After this point in time however there is a theoretical concern of increased risks of infection if closed immediately. Thus some may delay closure while other may close immediately up till 24 hours. • If closure of a wound is decided upon a number of techniques can be used. These include bandages, a cyanoacrylate glue, staples, and sutures. • Antibiotics • Most clean open wounds do not require any antibiotics unless the wound is contaminated or the bacterial cultures are positive. Excess use of antibiotics only leads to resistance and side effects. All open wounds should be cleaned at least twice a day with warm water and soap. Once the wound is cleaned, it should be covered with moist gauze. This should be followed by application of dry gauze and then the wound covered with a bandage.

21. When can I return to play? • Concussions • The following guidelines are only a reference to consider--each patient who sustains a concussion must be evaluated by their physician before being cleared to return to activity! In general, athletes will be allowed to return to play according to the following schedule: • For Grade I Concussions: The athlete can return if they are asymptomatic for at least 15 minutes.

22. When can I return to play? • For Grade II Concussions:The athlete can return to play after one week, if asymptomatic during that time period. • For Grade III Concussions:The athlete is removed from competition and transported to the emergency department. Length of time out of competition can be discussed with the physician. • All patients who sustain a concussion must not return to play until cleared by someone trained in management of these injuries (e.g. the team physician). Foremost, any athlete should not return to play until ALL symptoms have resolved. Even a mild headache should exclude a player from returning to competition. Athletes who sustain multiple concussions must not return to play until properly evaluated. • In general, athletes who sustain three concussions, no matter what grade, will be removed from competition for at least one season. The dangers of multiple concussions are not well understood, but athletes, coaches, and team doctors must be willing to play it safe.

23. Return to Play? • Fractures • The return to play will be once the injury is fully healed and will be decided by the sports medicine team (Physician, athletic trainer, coach, and athlete)

24. Rehabilitation and the first-aider • The role of the first-aider will depend on their relationship to the athlete. • If the injury occurs during their athletic activity, the first-aid responder will be one of the members of the sport medicine team and will be very involved in the rehabilitation. • If the first-aider is a by-stander, then they may relinquish the responsibility to the sports medicine team or emergency responders, depending on the situation.

25. Don’t forget to document • As mentioned before, it is imperative that the first aider document what happened and the necessary steps for recovery. • Why is this necessary again?