Injury Assessment & Evaluation Procedures

1. Injury Assessment & Evaluation Procedures Primary Survey -ABCs Secondary Survey - HOPS

2. Step One: SAFETY • Does the scene appear to be safe? • Is practice still going on? • What are others in the area doing? • Is there a shooter on the roof? Or what may have caused the player to drop down? • Look carefully around the scene!

3. Step Two: Primary Survey • Goal  recognize and evaluate all injuries for each individual patient. • This is systematic and follows a specific procedure. • A – Check LOC (level of consciousness) • Call the patient to elicit a response • Is the patient awake or unconscious? • If responsive, ask their name, what happened, the location, and what hurts. • If no response, “tap and shout” • If no response, pinch finger webs. If nothing, they are unconscious.

4. Step Two: Primary Survey • B – Check Airway, Breathing and Circulation (ABCs) • Airway – check for obstruction • Breathing – • Look for the chest to rise • Listen for breath sounds from the nose & mouth • Feel for the air on your cheek • Circulation – check for pulse gently on the side of the throat with first & second finger

5. Step Three: Secondary Survey • The “Evaluation” • Done once it has been established that the pt. does not have any life-threatening injuries • There are 3 different formats: • HOPS • HIPS • SOAP

6. Step Three: Secondary Survey H.O.P.S.=  History, Observation, Palpation/Physical Exam, Special Tests, which will be focus of today's lesson. • H.I.P.S. = History, Inspection, Palpation/Physical Exam, Special Tests • S.O.A.P.= Subjective information, Objective Information, Assessment, Plan is used to assist in documentation of injuries, daily treatments, weekly / Bi-weekly summaries PRN(as needed)** * We will focus on the HOPS Format for assessing injuries ** We will discuss S.O.A.P. notes in a later section.

7. H = HISTORY • In this portion of the evaluation the information comes mostly from the patient. It includes medical history (hx) of the patient and Sign & Symptoms (S/S). • What to find out: • Who they are? ………..Patient’s Name • What Happened?........How did injury occur • Where did it happen?.........Did it happen on a field, court, locker room etc • Any Previous Medical History (Hx)?....Has the body part ever been injured before • What is your primary Complaint?..... What is the worst thing about the injury

8. H = HISTORY cont. • Type / quality of Pain they are having?....Is it sharp, achy, throbbing etc • Location of pain?.....Have patient point to location of pain!; • Pain Scale 0 to 10. Have patient state a number giving a level of pain he/she is in: 0 = no pain ,  10 = Worse pain ever!!!; • Does pain increase with activity, if so what? • What has the patient done in the past to address his/her pain. • Any snapping/cracking/ popping sensations (this is called crepitus) • ACTIVITY- Pair up and ask your partner about an injury he/she sustained in the past. Have them answer the History questions.

9. O= OBSERVATION • O: Observation= Visually looking at the injury. This refers to physical signs of injury that are recognized by the ATC or other medical Professionals. • Why do you think that the athletic trainer still has not touched the injured athlete? Looking for: • Swelling (type, location, amount) • Discoloration • Deformities • Gait/weight-bearing • Posture • Scars from previous injuries • Bleeding • What should you do if you see bleeding?

10. O = OBSERVATION cont. • Discoloration/Ecchymosis: Black & Blue skin Yellowing in later stages • Position  / Posture of an Athlete • Holding / Guarding (protecting) a body part • Grasping a body part “SCREAMING USUALLY” • Decorticate, Decerebrate • ALWAYS Compare Involved side with Uninvolved (CONTRALATERAL) side whenever possible. • Why is this necessary?

11. O = OBSERVATION Cont. Bicep - partial tear Scapula Winging

12. O = OBSERVATION cont. What do you notice in the above pictures?

13. P = PALPATION • This is the first time you actually touch the athlete • You use the information you gained during the history and inspection to guide you • Now you are FEELING for clues about the injury • You always palpate the uninjured side first • Why? • Then you palpate the injured side starting away from the area of most pain. • Why?

14. P = PALPATION cont. • Remember to observe universal precautions if your observation revealed blood or body fluids • Things you are looking for during palpation • Temperature changes: hot or cold • Deformities • Point tenderness • Crepitus • Swelling (wet diaper vs. water balloon) • Rule out fractures

15. P = PALPATION cont.

16. S = SPECIAL TESTS • The tests used in this section will be different for each body part that we cover • Remember to perform each test bilaterally • In general the tests are used to determine • Joint range of motion • Muscle strength and function • Ligament stability • Nervous function/integrity

17. S = SPECIAL TESTS cont.ROM & Muscle Testing • Used to determine if the range of motion of a joint is within normal limits • Always test bilaterally • Three ways to test range of motion– test them in this order • Active—the athlete move the joint themselves • Passive– the athlete is relaxed and you move the joint through the ROM • Resistive-- you apply resistance while the athlete moves the joint

18. ROM/Special Testing cont.

19. Ligament Testing • Tests used to determine the integrity of specific ligaments • We will learn specific tests during future units • Results of these tests, along with the history, inspection and palpation will allow you to “grade” sprains

20. Grades of Sprains • Grade I • Ligament testing reveals solid endpoint (rope) • Little to no swelling/loss of function • Grade II • Ligament testing reveals soft endpoint (bungee) • Grade III • Ligament testing reveals no endpoint (nothing)

21. Grades of Sprains cont.