Acute Care

1. Acute Care Core Concepts in Athletic Training an therapy Susan Kay Hillman

2. Objectives • Explain the eight steps to include in developing an emergency action plan. • Identify the elements of “vitals,” or vital signs, and explain each. • Explain the American College of Surgeons’ ranking of trauma hospitals. • Explain the numbers given as the blood pressure reading—what they are and what they represent. • Explain methods used in controlling bleeding. • Explain the sterile technique and compare and contrast it to Universal Precautions. • Explain the difference between the head-squeeze and the trapezius-squeeze techniques of manual stabilization of the cervical spine. • Explain the two techniques for moving the patient onto a spine board from a supine position

3. Planning Foundations for Acute Care Situations • The Emergency Care Plan • Created to ensure all members of coaching and medical staff are prepared to handle emergency situation • See next slide on items to consider • Emergency plan should be rehearsed on a regular basis • Role of the Athletic Trainer • Provide immediate care or first aid • Skilled in acute management of sprains, strains, lacerations, contusions, fracture, dislocation • As well as CPR and rescue breathing • Pass on information to Ems Personnel

4. Planning Foundations for Acute Care Situations • Role of the EMS team • EMT, Paramedic, Fire Fighters • Paramedics have specialized training in IV care and delivery of medicines • Load and transfer of patient to medical facility • Role of Hospital • AT should be aware of local hospitals and what they are equipped to handle • Trauma level capabilities

5. Items to Consider when Creating an Emergency Care Plan

8. Essentials of the Acute Examination • Primary Survey • Airway, Breathing and Circulation • Vital signs and severe bleeding • Secondary Survey • Rapid examination of seriousness of injury • Decision to move the patient or not • Vital Signs: measures of bodily functions • Information should be passed on to Ems Personnel • Vary depending on age and condition of patient

9. Vital Signs • Pulse: indication of the rate and quality of heart beat • Tachycardia: rate higher than normal • Heart chambers don’t have enough time to fully fill, each beat sends less blood and O2 to to the body and heart itself • Bradycardia: rate lower than normal • Heart not pumping fast enough to supply body and itself with sufficient blood • Heart may stop over time • Weak pulse might indicate heart not working at full capacity • All of these should alert you to the fact things are not normal and EMS is needed

10. Vital Signs • Pulse • AT should be trained to accurately measure heart rate • Use index and middle finger (Not thumb) • Carotid: at neck • Care should be taken to perform properly • Radial: at lateral wrist (palmar side) • Brachial: inside of upper arm • If pulse not felt should move fingers and lessen pressure • Count number of beats by 15, 30 or 60 seconds • Longer the more accurate

12. Vital Signs • Blood Pressure • Measure in peripheral vessels during the function of the heart • Combination of the amount of blood (cardiac output) and resistance of peripheral vessels • Abnormal is indication of change in cardiac output • Hypertension: higher BP • High enough pressure can cause rupture in blood vessels • Stroke (brain) heart attack (heart) • Hypotension: Lower BP • Heart and brain may not receive enough blood (O2) • Can lead to syncope (fainting)

13. Blood Pressure • Requires use of sphygmomanometer (BP cuff) and stethoscope • BP cuff inflated to 130-150 mmHG then released slowly while clinician listens for heart sound with stethoscope • Systolic: first sound heard • Pumping phase of heart • Diastolic : sound disappears • Pressure during refilling of the heart chambers

14. Vital Signs • Respiratory Rate: rate and quality of patients breathing • Respiratory Rate =# breaths per minute • Quality of breaths should also be noted • Asthma, Chronic Obstructed Pulmonary Disease • Hypoxia: If patient is breathing to fast or too slow amount of O2 in blood will be insufficient • Tissue will be damaged

15. Vital Signs • Temperature: indicate body's internal heat • Increase in temp. may damage body's organs and must be reduced • Oral temp > 99 degrees is considered to have fever • Rectal thermometer most accurate

17. Immediate Care for Emergency Problems • Call to the victim and ask questions • Verbal response indicates airway is open and person is breathing • Determine Level of consciousness • Unconscious: heart stops beating body cannot sustain brain activity • Also caused by head trauma

18. Shock • O2 supplied to the brain by circulating blood is insufficient • Fainting occurs, one sign of shock • Shock caused by internal or external bleeding, spinal cord injury, heart conditions, dehydration, or severe allergic reactions • Signs and Symptoms • Low BP (key sign) • Rapid or shallow respirations • Cold clammy skin • Rapid weak pulse • Dizziness or fainting • Can be life threatening, requires immediate medical attention • Call 911

19. Severe Bleeding • Hemorrhage: bleeding may occur internally or externally • Internal Bleeding: A.T. should learn to recognize and obtain proper medical attention • Results in drop in blood pressure and possible fainting • External Bleeding • Universal Precautions • Limit risk of infection via bloodborne pathogens • Treat all bodily fluids as potentially infected • Protect yourself and the patient • Wear protective barriers: Gloves, masks, eye protection • Remove and dispose appropriately • Dispose of sharps and soiled material per recommended OSHA guidelines • If exposed to potentially infected blood or body fluids file exposure report form

21. Severe Bleeding • Controlling Visible Bleeding • Direct Pressure • Apply pressure with soft, sterile cloth or bandage • Slow flow of blood enough to allow clot formation • Splinting • Keep broken bones from damaging blood vessels • Limit damage to soft tissue • Pressure over major artery • When direct pressure over wound does not control bleeding • Knowledge of arterial system: most proximal major vessel • Tourniquet • Last resort to control bleeding • Decision to save the persons life over their limb • Trained professional only and only removed by doctor

22. Severe Bleeding • Sterile Technique • Keep open wound as clean as possible • Prevent contamination by minimizing contact with nonsterile surfaces • Used in surgical rooms • Includes sterile fields, clothing, equipment and “scrubbing” in

24. Non serious Acute Injuries • Sprain, strain, Contusion • R: Resting from any use of injured area • I: Ice applied to constrict blood vessels, decrease pain, and reduce cell death due to hypoxia by decreasing cell need for O2 • C: Compression of injured area. Best way to limit swelling by decreasing space for fluid to accumulate • E: Elevate injured area above level of the heart to limit blood flow to the area and help reduce swelling

25. Spinal Fractures • If potential spinal cord injury care should be taken to stabilize the patient prior to transporting • Head squeeze • In-line (C-spine ) immobilization • Apply hands to both sides of patients head, ulnar side touches mastoid process • Trapezius Squeeze • Grab trapezius on both sides and stabilize head in between forearms at levels of patients ears • Application of extrication collar can provide immobilization • Patient then stabilized on spine board

29. Posttraumatic Head Injury • Blow to the head common mechanism for brain and cervical spine injury • Greatest concern with trauma to head is Traumatic brain injury (TBI) • Should always check cervical spine also • Symptoms • Somatic: e.g., headache • Cognitive: e.g., feeling in a fog • Emotional: e.g. sadness • Physical Signs • Loss of consciousness, amnesia • Cognitive impairment • Slowed reaction times • Sleep Disturbances • drowsiness

30. Posttraumatic Head Injury Player should be medically evaluated using standard concussion management principles Player should be safely removed from practice or play and evaluated in timely manner Assessment of concussion using SCAT2 or similar tool Player should not be left alone and should be monitored for deterioration over next couple hours Player should not be allowed to return to play that day

31. Posttraumatic Head Injury • Clinical Evaluation of Concussion • SCAT2 standardized method of evaluating concussion for age 10 and up Neuropsychological assessment has the highest clinical value in concussion management • Return to Play Parameters • Majority of concussions resolve over a period of a few days • During recovery minimize lights sounds and activity • Cognitive rest includes limiting or eliminating mental activities including TV. computer and phones • Once patient is asymptomatic can retest on neurocognitve tool and when a at baseline levels can start progression back • 5 day progression of increasing activities • Re check symptoms after every change in activity level • Some states have legislation on return to play • A.T. should be aware of laws

37. Heat Illness • Hyperthermia: core temperature above normal range • Heatstroke is true medical emergency • Call EMS • Cool patient down immediately • Remove heavy clothing and submerge in ice bath or pack patient with ice packs in groin, neck, axilla, and head

38. Asthma and Other Forms of Bronchospasm • Air enters lungs through bronchial tree • Bronchioles and then alveoli • If any part of bronchial tree become blocked breathing becomes difficult and O2 in blood decreases • Irritants and allergens can cause bronchospasm or constriction of bronchioles • Medical conditions • Environmental conditions • Medications • Signs of respiratory distress include shortness of breath, use of intercostal and neck muscles to assist with breathing, difficulty blowing air out of lungs • Assist patient with inhaler, rest, control environment • If persist call EMS

39. Anaphylaxis • Severe and rapidly developing reaction affecting multiple body systems at once • Allergen is ingested or injected into body and thus into blood stream • Life threatening emergency • Call 911 • Assist with use of epinephrine pen if they are aware of their injury and have one • Exercised induced anaphylaxis is a rare disorder that occurs after physical activity • Cessation of activity should immediately improve symptoms

40. Care Principles for Musculoskeletal Injuries • Majority of injuries seen in physically active people are musculoskeletal: Bones, muscle,& joints • Treat using RICE principles • May require use of splint or crutches • Splinting • Immobilize above and below the fracture spanning joints if possible • Use a variety of materials • Avoid pressure on superficial nerves • Check Circulation, sensory and motor function before and after splint is applied • Splint in the position you find the injury, do not try to move • Crutches • May be needed to assist ambulation • Size and fit correctly and instruct on proper use

42. Moving and Transporting Injured Patients • Moving the Injured Patient Onto a Spine Board • Moving the Patient From a Prone Position • Moving the Patient from a Supine Position • Moving the Injured Patient Off the Field • Manual Carry Techniques • Transporting the Injured Patient From an Unstable Surface • Swimming Pool • Gymnastics Foam Pit • Transporting the Injured Patient to a Campus Health Center • Transporting the Injured Athlete to a Hospital