Completing the Loop: Management of the Adolescent Sports Injury. Adam Thomas, PT, DPT, ATC

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1 Completing the Loop: Management of the Adolescent Sports Injury Adam Thomas, PT, DPT, ATC

2 MeSYc Completing the Loop

(locked gates for ex.) Post at locations Phone numbers, address, etc.

3 Where do we start? First Step - EAP General and Location(s) specific Route to the field (locked gates for ex.) Post at locations Phone numbers, address, etc. Personnel Team MDs, ATC (and students), campus police/emts, responding EMT/paramedic unit coaches, facility workers.. Completing the Loop

4 Equipment Medical kits (eg. Banyan), bag valve mask, O2, splints & cervical collars, backboard (?), Towels (ice) First aid supplies Wraps, tape Emergency information for players (& others) Facemask removal tools Cordless and manual screwdrivers, FM extractor (current) Completing the Loop

Steps to take make sure gate is open, grab info packet Who is

5 Procedures Hand signals Specific roles for each person involved What if they re not there? Steps to take make sure gate is open, grab info packet Who is in charge? Discuss often Before games With new people (EMT crew for ex.) Completing the Loop

6 Assistance Needed Summons on field assistance from MD, host ATC & staff Hold hand over head STILL Urgent Care/Transport Needed Activates EAP Summons Ambulance, MD, host ATC, Emergency Supplies Hold hand over head making circular motion

7 Two major scenarios for head and neck injuries (generally): 1. Unconscious player down on the field Or suspicion of spine injury 2. Concussed player conscious and mobile Walked off the field Obviously a lot of grey... Plan everyone falls down supine and face up (?) Completing the Loop

8 Primary Survey Algorithmic approach to tx Assess ABCs and Consciousness Unconscious athlete is ALWAYS treated as a spine injured pt until proven otherwise Conscious athlete Unconscious athlete

9 Completing the Loop

10 Unconscious Airway, breathing, circulation Remove mouth guard Conscious Verbal response indicates ABC ok Begin secondary exam while stabilizing c-spine Completing the Loop

11 Heightened suspicion of catastrophic injury if: Unconscious or altered state Bilateral neurologic symptoms or complaints c/o midline spine pain Pain with midline palpation Obvious visible or palpable deformity Establish MOI Coaches, officials, other players if necessary Completing the Loop

12 With C-spine immobilized: Palpate the spine Assess peripheral sensation and strength Test isometric neck strength Test active ROM Gentle compression/spurling Completing the Loop

13 CLEAR! r/o other significant injury Sit up Stand up Walk off field! Continue sideline care SUSPICION of Catastrophic Injury Activate EAP Re-establish control of the head Person at head is in charge Steps, timing, etc. ATC/MD/EMS must agree on protocol BEFOREHAND

14 Only if: NO increase in pain, neurologic symptoms, ms. Spasm. NO Resistance is encountered Completing the Loop

15 Establish airway as soon as possible With stabilization maintained of course While EAP is being activated Or before moving pt to spineboard Facemask Removal? Completing the Loop

16 Remove helmet AND shoulder pads if: Facemask cannot be moved easily Helmet doesn t fit well One has already been removed (helmet) Completing the Loop

17 Completing the Loop

18 Sideline assessment of a Concussion

19 Sideline Assessment Let s assume we have consciousness History Mechanism of Injury Asses level of alertness, speech Amnesia Graded symptom Checklist SCAT3

20 Sideline Assessment Physical Exam Vital Signs often skipped and shouldn't be Cervical Spine Do it acutely on field as well as on the sideline too Neurological Exam Cranial Nerves, strength, sensation

21 Sideline Evaluation begins with before athlete makes it to the sideline Before arriving on Sideline MOI May be blow to head, head comes in contact with ground or force transmitted to head through contact with body. Any significant acceleration-deceleration-type force These athletes should be thought to have sustained a concussion and be thoroughly evaluated. Completing the Loop

22 o o o It should be stressed that sideline presentation may vary widely from athlete to athlete, depending on the biomechanical forces involved, specifically affected brain areas, prior history of injury, and numerous other factors. In reviewing the common signs and symptoms of concussion, it is imperative to not that an athlete may present with only one symptom or potentially a myriad of symptoms. A thorough assessment of all common symptoms associated with concussion should be conducted with the concussed athlete Completing the Loop

23 Completing the Loop

24 Completing the Loop

The following symptoms REQUIRE a trip to the emergency room: Medical changes in alertness and consciousness Convulsions (seizures) Muscle weakness on one of

25 The following symptoms REQUIRE a trip to the emergency room: Medical changes in alertness and consciousness Convulsions (seizures) Muscle weakness on one of both sides Persistent confusion Persistent unconsciousness (coma) Repeated vomiting Unequal pupils Unusual eye movements Walking problems Completing the Loop

26 STAYING THE SAME/IMPROVING Monitor symptoms daily DECLINING NEXT DAY/MAJOR SYMPTOMS PCP visit

27 Recommendations BASELINE TESTING Cut-off scores have not been established for any of the above tests Utilize a comprehensive test battery There is no gold standard test Zurich panel: SCAT3 Balance Assessment Neuropsychological Assessment

28 Return To Play RTP guidelines are currently based off of symptom resolution and neuropsychological testing results Absolutely no RTP the same day of injury 80-90% of concussions resolve in 7-10 days, with athletes typically returning 1-2 weeks post-injury Treatment should be more conservative the younger the patient is Two popularly used protocols: Cantu s and the Graded RTP *****Marisa Frank to include more in her section regarding RTP*****

Return To Play 105 CMR 201.000: HEAD INJURIES AND CONCUSSIONS IN EXTRACURRICULAR ATHLETIC ACTIVITIES 8-1-2014 (A) Only the following individuals may authorize a student to return to play: 1.

29 Return To Play 105 CMR : HEAD INJURIES AND CONCUSSIONS IN EXTRACURRICULAR ATHLETIC ACTIVITIES (A) Only the following individuals may authorize a student to return to play: 1. A duly licensed physician; 2. A duly licensed athletic trainer in consultation with a licensed physician; 3. A duly licensed nurse practitioner in consultation with a licensed physician; 4. A duly licensed physician assistant under the supervision of a licensed physician; or 5. A duly licensed neuropsychologist in coordination with the physician managing the student's recovery. Completing the Loop

Resources may not be immediately at your disposal longer wait to get in to

30 High School Classes to think about accommodations, missing class? Part time job? Resources may not be immediately at your disposal longer wait to get in to specialists/pcp/md Need to get in touch with/educate their parents/guardian. Think about private schools too need to include roommates Completing the Loop

31 College Classes to think about accommodations, missing class? Part time job? Not the best recovery environment Need to get in touch with/educate their GF/BF, roommates Still no return to play day of with symptoms no question

in touch with/educate their GF/BF/Husband/Wife,

32 Professional More resources of MDs, specialists, facilities Service provided immediately Need to get in touch with/educate their GF/BF/Husband/Wife, roommates Still no return to play day of with symptoms no question

33 Cantu s Protocol

Maryville R-II School District Emergency Action Plan. Maryville, Missouri

Maryville R-II School District Emergency Action Plan Maryville, Missouri Football Practice Field Location: Entrance off east side of South Munn by bus barn. Emergency Personnel: If certified athletic trainer