Emory Sports Medicine Injuries in Soccer 2018
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1 Emory Sports Medicine Injuries in Soccer 2018 Emergency Evaluation of The Downed Athlete Dr. Jim Kyle, MD, FACSM Team Physician, Concord University Executive Director, The Kyle Group Regional EMS Medical Director WVOEMS Marshall University School of Medicine Associate Clinical Professor
2 High Anxiety for SM Team Athlete Collapse SCA with Sentinel Seizure
3 IS THERE A DOCTOR ON THE SIDELINE?? Athlete Collapse SCA Commotio Cordis Head and Neck Trauma Second Impact Syndrome Heat Stress EHS Sickle Cell Trait Explosive Rhabdo Exercise Induced Asthma Allergic Reaction - Anaphylaxis Torso Trauma Chest and Abdomen Limb Threatening Joint Dislocations Top 10 Catastrophic Athlete Injuries
4 Downed Athlete Worse-case Scenario??
5 On The Field Collapse Worse-case Scenario??
6 2007 NATA Position Paper SCA in Athletes Summit (Courson, Drezner) Most cases occur with Basketball, Football and Little League Baseball 9 to 1 Male/Female! Athlete Collapse Suspect SCA! Sentinel Seizure awareness AED s with time to shock < 4 minutes Coach AED certification! Schools need a formal Emergency Action Plan Rapid ACLS availability
7 AED s in Sudden Cardiac Arrest Survival Overall: 71% When shock delivered onsite: 87% AED onsite: 80% AED brought by offsite EMS: 50% Schools with EAP: 79% Schools without EAP: 44% The single greatest factor affecting survival from SCA is the time interval from cardiac arrest to defibrillation. Drezner JA, et al. BJSM 2013
8 2010 AHA GUIDELINES ABC now Reversed CAB
9 SCA ROSC Survival Hospital D/C 2010 AHA Guidelines! PUSH HARD! PUSH FAST
10 SPORTS ARENA SCA Current Best Practice! WHEN TO SHOCK FIRST! CPR FIRST! CONTINUE CPR AFTER SHOCK! TIMING OF RESCUE BREATHING! DELAYED SCA WITH ECAST! SCHOOL SCA ADULTS > ATHLETES
11 Head Impact Worse-case Scenario??
12 International Symposia on Concussion in Sport! First ISC Vienna 2001! Second ISC Prague 2005 Simple vs Complex, SCAT2 sideline tool! Third ISC Zurich 2008 Removed Simple vs Complex grading, RTP based on progression! Fourth ISC Zurich 2012 SCAT3, Baseline NP, BESS, enhanced MRI! Fifth ISC Berlin 2016 SCAT 5 RTL, Rest FIFA, IOC, IIHA
13 Sports Concussion! NFL Independent Physician for RTP Media Early Dementia, CTE 2013 Sideline Independent Neuro Exam! College Neuro-Cognitive test Pre-Season Repeat Post-Injury; Targeting rule change, Medical Time Out - NATA! High School - 50 States with RTP Legislation Pre-Season Video, Second Impact Syndrome! Youth - CDC Coach / Parent Video ^ In Emergency Department visits 2015 Youth Soccer Heading restrictions USSF
14 Concussion in Soccer
15 Soccer Concussion Contact Type
16 Head to Head
17 Head to Post
18 Head to Ground & Other
19 Soccer RTP Concussion
20 Soccer Concussion Symptoms! 1. Headache! 2. Dizziness! 3. Foggy! 4. Confusion! 5. Light sensitivity! 6. Noise sensitivity
21 USSF RTP Protocol Post Acute Evaluation and Management Symptom free Neurocognitive Gradual progression Symptom free x 24 hours Symptoms re-emerge begin with previous step after being symptom free x 24 hours Athlete should only progress to next level when instructed to by team ATC or MD
22 USSF RTP Protocol Graded RTP: Based on Prague Guidelines 1. Rest until asymptomatic x 24 hrs. 2. Light aerobic exercise 3. Moderate intensity aerobic exercise 4. Sport specific training drills (No Heading) 5. Non contact training drills, including full exertion interval training 6. Begin heading training steps 1&2 7. Full contact training with heading steps 3&4 8. Return to competition
23 Sports Concussion! NFL Independent Physician for RTP Media Early Dementia, CTE 2013 Sideline Independent Neuro Exam! College Neuro-Cognitive test Pre-Season Repeat Post-Injury; Targeting rule change, Medical Time Out - NATA! High School - 50 States with RTP Legislation Pre-Season Video, Second Impact Syndrome! Youth - CDC Coach / Parent Video ^ In Emergency Department visits 2015 Youth Soccer Heading restrictions USSF
24 Youth Soccer! 50,000 High School Concussion 2010! 2015 US Soccer position statement: Age 10 and under - No Heading Age Limit Heading in practice
25 Protective Equipment Seton High School Cincinnati Ohio Saint Xavier HS Football Dr Julian Bailes
26 Q30 Collar Concussion Protection! Saint Xavier HS Football Cincinnati! 2016 Seton High School Girls Soccer! Dr Julian Bailes, Chairman Neurosurgery, North Shores Hospital! Reduce the brain slosh/slide with rapid acceleration and deceleration! Woodpecker Inspired
27 IS THERE A DOCTOR ON THE SIDELINE?? Athlete Collapse SCA Commotio Cordis Head and Neck Trauma Second Impact Syndrome Heat Stress EHS Sickle Cell Trait Explosive Rhabdo Exercise Induced Asthma Allergic Reaction - Anaphylaxis Torso Trauma Chest and Abdomen Limb Threatening Joint Dislocations Top 10 Catastrophic Athlete Injuries
28 Soccer Practice Venue EAP NATA Athletic Trainer Coach CPR AED ACLS EMS
29 Rule of 100
30
31 Sports Trauma Decisions Rule of 100 Initiate VS trending if: Pulse > 100 or Temperature > 100 or Systolic BP < 100
32 ! Initial Vital Signs! Rule of 100! Vital sign Trending - Heat stress - Unconscious athlete - Asthma attack! Pearls and When to Worry! Sideline Gadgets
33
34 Initial VS + VS Trending Over 30 minutes On the field Rule of 100 Team Physician Rule of ER
35 Heart Rate Trending Tachycardia: Heart rate > 100 Sinus Tachycardia Supra-ventricular ( SVT ) Ventricular ( VT ) sports tachycardia - sinus tachycardia response from exercise
36 Heart rate Trending Sports Tachycardia Pearl! Sinus tachycardia from vigorous sports play improves over 15 minutes in most cases! Persistent tachycardia is cause for concern Rule out hemodynamic instability! Cardiac monitoring will determine if supraventricular or ventricular tachycardia is present
37 Sideline Gadgets
38 IS THERE A DOCTOR ON THE SIDELINE?? Athlete Collapse SCA Commotio Cordis Head and Neck Trauma Second Impact Syndrome Heat Stress EHS Sickle Cell Trait Explosive Rhabdo Exercise Induced Asthma Allergic Reaction - Anaphylaxis Torso Trauma Chest and Abdomen Limb Threatening Joint Dislocations
39 Sideline Medications & Resuscitation Equipment
40 Greenbrier Sports Performance Center Rural High School Limited Sp Med Talent
41 Medical Time Out The Kyle Group
42
43 2018 ED Sport Concussion Shift! Most Sports Concussions without LOC! CTE risk for repetitive sub-concussive Hits! After First Concussion 3-6X risk second (SIS)! Defer RTP decision! Consider risk stratification for PPCS! Prescribe Neuro-Cognitive testing and symptom checklist! Offer RTL & RTA advice, Magnesium 400mg! Expect Biomarker testing to confirm in future
44 ED Discharge Checklist (GSC)
45 Emergency Department Predictors 1 Month Patient History 1. Age Sex Female 3. Prior Concussion 4. Migraine Hx Emergency Dept Findings 5. Answer Slow in ED 6. BESS test tandom 4* 7. Sensitivity to noise 8. Headache 9. Fatigue Zemek, R: JAMA March 8, Pediatric age 5-17, 30% PPCS
46 Community Best Practice Sports Concussion! Emergency Room: Head, C-spine evaluation-?ct BESS Testing, 72hr GSC at D/C! Pediatrician: Review Graded Symptom Checklist Neuro-Cognitive testing (ImPACT)! School/ Coach: Equipment check, 5 day progression Consult Physician RTP
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Diagnosis and Management of Concussion. Dr. Kathryn Giles MD, MSc., FRCPC Cambridge Ontario
Diagnosis and Management of Concussion Dr. Kathryn Giles MD, MSc., FRCPC Cambridge Ontario Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored,
6/20/2012. Concussion Michele Kirk, MD JPS Sports Medicine
1 2 3 4 5 6 7 8 9 10 Concussion Michele Kirk, MD JPS Sports Medicine Objectives Be able to recognize signs and symptoms of concussion Be familiar with sideline management Be aware of the Zurich Consensus