Emergency Procedures 2/14/2016

Transcription

1 Opening Comments: Professional Team Chiropractor is part of a Healthcare Team. Other professionals are more trained / experienced. Stay out of the way until athlete cleared for chiropractic care. Opportunity to develop interprofessional relationships. Potential opportunity to attend emergency training practice which should be ongoing. Emergency Procedures Like other elite athletics Olympics, World Games, Colleges BUT! What if you re the only doc on the field at the time? High School / Middle School / PeeWee / Pop Warner /Clubs Know your roll by contract. I ll be your sports doc. Know your responsibilities. Who s in charge if you are not. If you accept primary responsibility. Be prepared. Malpractice. Activating EMS. Location. Entry. Ambulance Your job, KNOW when EMS necessary. In our profession, err on the side of caution recommended. Rare occurrences Our job recognize rare and dangerous conditions. Stabilize, manage and, if necessary, transport. Safely avoid transport saves $$$ Emergency Procedures unlike other types of healthcare. No time to consider various alternative actions No time to research correct procedures or ask Siri / Google Requires protocol development and practice. Scrutiny guaranteed if an incident occurs. Perhaps Deposition. 1

2 Develop written Emergency Action Plan (written & practiced) Athlete down: Trauma vs Non-Trauma Conscious: breathing / dyspnea / communicative / pain Unconscious: breathing / airway / facemask &/or helmet removal? AED: document training, maintenance (charge, pad expiration, software updates) Prescriptions? Exertional Dehydration Heat Stroke: Fluids available? Exertional Hyponatremia: Electrolyte replacements available Facemask Removal helmet Steven Rosen Virginia Tech 2

3 Emergency Response First Step: Survey the Scene vs. Deep Breath In a sea of CHAOS, calm prevails. Approach the athlete Stabilize the neck, establish communication & cooperation NATA: Preventing Sudden Death in Sports Not to be considered comprehensive. Preparation should include complete sports injury program like CCSP / DACBSP. Asthma Catastrophic brain injuries Cervical spine injuries Diabetes Exertional heat stroke Exertional hyponatremia Exertional sickling Head-down contact in football Sudden cardiac arrest Head / Neck Trauma Helmet to helmet contact. Helmet to ground contact. Etc. Or just a really hard hit without helmet contact. Can this cause concussion? How do you know that s only a concussion? What other concerns do you have? Player not moving / Or grasping head or neck, writhing in pain Healthcare team rushes onto the field WHAT DO YOU DO? 3

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5 Head Trauma Protocol 1. Clear the Cervical Spine Golden Rule: Assume cervical fracture until proven otherwise. First Contact: Establish communication + cooperation while stabilizing cervical spine. Athlete unconscious or not communicative Follow the Golden Rule stabilize spine and emergency transport Activate EMS with risk of morbidity & mortality Head Trauma Protocol 1. Clear the Cervical Spine (continued) Severe cervical pain or spasm follow the Golden Rule Observable deformity - follow the Golden Rule Upper extremity neuro testing Any BL positives - follow the Golden Rule Persistent UL positives - follow the Golden Rule Discuss Stingers / Burners Lower extremity neuro testing any positives - follow the Golden Rule Head Trauma Protocol 1. Clear the Cervical Spine (continued) Spinous Process Palpation in 2 stages follow the Golden Rule Gentle Isometric Testing follow the Golden Rule Assist first movement with cervical stabilization Cervical Spine is cleared. Move to sidelines for further evaluation Can t Clear the Cervical Spine: What does that mean? What do you say to the athlete? OMG, you broke your neck No! Why? It doesn t mean the neck is broken. Burning Hands Syndrome / Transient Quadraplegia Probably due to a spinal cord concussion We need to make sure it is safe before you move your neck. Encourage cooperation / you can t force cooperation. 5

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7 Head Trauma Protocol 2. Head / Brain evaluation Skull Fracture Helmets protect skull from fracture pretty well. Regardless, palpate entire skull for severe T2P or depressions. Include orbit Observe for fluids from nose or ears. Raccoon eyes. Battle sign. Halo sign, Hemotympany, Save fluids for lab Beta -2 transferrin Extra-ocular ROM facial fxr. 7

8 Head Trauma Protocol 3. Brain evaluation concussion / increasing ICP Infrascan 2000 if you ve got it. Repeated vital signs Red Flag = Increasing Pulse Pressure Repeated evaluation of brain function over several domains SCAT3, ImPACT, King Devick, Reaction Time Expect steady improvement from test training No return to play that day When in doubt, sit them out! Period of vulnerability Prevention Strategies Value of Cervical Strengthening Exercises Decreases cervical fracture risk Decreases concussion risk Concussion vs. Cervical Proprioceptive Injury Girls vs. Boys / Relative Testosterone Deficiency / Teens vs. Adults 8

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12 SCAT3 and Return to Play Protocols 12