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233 Cards in this Set
- Front
- Back
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Roles and responsibilities of the athletic trainer?
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1.) injury prevention 2.) injury evaluation 3.) immediate and emergency care 4.) organizational qualities |
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1.) injury prevention?
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- provide safe environment - provide care when injury occurs - ensure that athlete conditioned to participate - equipment |
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2.) injury evaluation?
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- recognize nature and extent of injury - understand pathology of sport related injuries - injury management - know when to refer |
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3.) immediate and emergency care?
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- administration if appropriate first aid - avoid delaying injury management - be aware of coaching/peer pressure - do not allow minor injuries to become major - activation of EAP |
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4.) organizational qualities?
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- education coaches and athletes - developing confident medical team - consistency - cooperate with coaching staff - establish rapport with team - SOAP - subjective (patient history), Objective (observation), Assessment (examination), Plan (rehab) |
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Personal and professional qualities of trainer?
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- timeliness - professional appearance - effective communication - lack of bias and ethical practice - polite to referees - sense of fair play - gossiping and relationships |
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what are the expectations of you?
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- recognize limitations - prevent unnecessary delays - link btw athletic program and medical community for implementation of injury |
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What are your limitations?
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DO NOT: - diagnose - share info without consent - prescribe meds - reduce fractures - move anybody who can not move |
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What are modifiable and non-modifiable intrinsic risk factors? example?
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Mental and psychological aspects that can result in injury or harm towards individual eg modifiable - skill level, motivation, discipline, previous experience in sports, risk taking behaviours eg non-modifiable - age, sex, previous injuries, innate intelligence other eg. strength, endurance, joint, structural ****, reaction time, timing, speed, agility |
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Extrinsic risk factors?
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aspects of a competition from which a person exposes themselves to harm or injury modifiable eg. type of equipment, amount of time played, environment (crowd control, footwear) non-modifiable eg. time of season, weather conditions, time of day |
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Why do research?
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collection of large amounts of data helps to identify trends can help reduce injuries - data is used to modify rules - assisting coaches and players to understand risks |
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Definition of emergency?
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an unforeseen combination of circumstances or the resulting state that calls for immediate action - sudden bodily alteration likely requiring immediate medical attention - eg. ruptured appendix - usually distressing event or condition, can often be anticipated |
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How do you prepare for an emergency?
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- set up EAP b4 EMG - review it - personnel and roles - location and contact info - call sheet |
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How do you determine an emergent situation?
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determined by mechanism of injury, player movements on field and observation upon approach
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What must be done immediately upon on field injury?
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On field assessment - first step for proper injury management
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What consists of an on field assessment?
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1. Primary survey - determine presence of life threatening injuries or conditions 2. secondary survey - determines presence of other issues that are not life threatening NOW, but may become so |
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Some life threatening conditions? |
- Airway obstruction - no breathing - no circulation - profuse/deadly bleeding - shock |
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Some conditions that require immediate action?
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- Hyperthermia - Hypothermia - Head injury - Fracture or dislocation of spine or long bone - Athlete unwilling to move or cannot support own body weight |
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What is shock?
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Heart not able to exert enough pressure to circulate oxygenated blood to vital organs due to: - damaged heart - low blood volume - blood vessels dilation which causes pooling away from vital organs that takes oxygen away from cells |
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Types of shock?
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hypovolemic - dec. blood vol and BP respiratory- lungs cannot supply enough O2 neurogenic- dilate of peripheral vessels due to CNS truma metabolic- complication of untreated diabete psychogenic- temp dilation of blood vessels & decreased blood to brain cardiogenic- heart incapable of cycling blood septic- severe infection anaphylactic*- dilation of peripheral blood vessels due to severe allergic reaction. hypotensive but tachycardic |
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signs and symptoms of shock?
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- rapid, weak pulse - shallow, rapid breathing - pale, cool, clammy skin - drowsy, sluggish - dizzy - dilated pupils - thirsty |
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How manage shock?
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- activate EMS - obtain and maintain open airway - manage complications or conditions - maintain body temp - elevate legs in MOST situations - reassure and keep calm - monitor and record vital signs |
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When do you activate an EAP?
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when its beyond your scope of knowledge - unconscious - no circulation - spinal, eye injury - internal trauma - head trauma - deadly bleeding |
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What type of decisions do u need to make when doing an on field assessment?
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Injury severity? is it life threatening? What type of first aid required? Is a medical referral necessary? |
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What is primary survey protocol?
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- safety first - safe enviro? stabilize head - check- unresponsiveness/airway, mouthguard? - call- activate EAP, provide dispatcher with maximal info possible - care- cpr? bleeding? |
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Major bleeding?
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Hemorrhage - excessive discharge of blood internally or externally - venous- dark red; continuous flow - capillary- bubbles up; oozes redish flow - arterial- bright red spurting flow |
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How do you manage bleeding?
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RED - rest - elevation - direct pressure and treat for shock |
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Secondary survey?
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- vital signs - conduct SAMPLE - head to toe examination - conscious vs unconscious perform basic neurological exam - MSC - motor sensory circulation |
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SAMPLE?
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- Sign and symptoms - Allergies - Medications - Past medical history - Last meal - Events prior |
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How do you check level of consciousness? |
AVPU - awake? - does the patient respond to verbal stimulus? - does the patient respond to painful stimuli? - is the patient completely unresponsive? |
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when doing a secondary survey what do you do if the patient is unconscious? |
Do vitals |
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When doing a secondary survey what do you do if the patient is conscious? |
Do SAMPLE followed by a set of vitals |
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What are vital signs of a secondary survey? |
- AVPU - Pulse check - respiration rate and quality - unresponsive- check by look,listen, feel - responsive- check unobtrusively - skin colouration/temp - pupil responsiveness - if pupils dont accomadate to light, probs brain damage - blood pressure but not really |
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What are you scanning for in an head to toe body scan? |
depressions, contusions, abrasions, penetrations, bruising, lacerations, swelling, tenderness, instability, crepitus, blood |
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MSC? |
motor sensory circulation test - grip strength, wiggle toes - numbness and tingling - pinch nail beds |
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What is risk? |
Potential of something happening that will have an impact |
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How to manage risk? |
- Goal is not only to prevent harm, but to educate and promote good - Priority 1 is to ensure participant safety - Consult those around you - Should be a group effort amongest players, staff, coaches, refs, medical team |
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2 types of legal action? |
1. Criminal suit - robberies, assaults, murder 2. Civil suit - non-premeditated offences - most common litigation in sport |
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Liability? |
Being legally responsible for the harm one causes another person |
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Tort? |
A legal wrong May emanate from: -Nonfeasance- fail to perform legal duty(fail to refer) -Malfeasance- performs action that is not his/hers to legally perform -Misfeasance- performs an action incorrectly that the person has legal right to do |
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Commission? |
an act unlawful and intended to cause harm |
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Omission? |
failure to perform a specific legal duty |
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Negligence? |
Not providing reasonable or ordinary care when people in the same situation as u would |
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Foreseeability? |
condition where danger is apparent or should have been apparent which ultimately resulted in unreasonable, unsafe conditions |
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What does shared responsibility mean? |
The athlete has a responsibility to report injuries that occur and provide relevant medical history |
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What is needed for a negligence suit to be successful? |
- prove that there was a duty to exercise reasonable care - prove that there was duty that was breached - establish a connection to link the breach of duty and the injury |
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What are some potential areas of negligence? |
- Supervision - Instruction - Unsafe facilities - Defective equipment - Transportation |
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Ways to avoid negligence? |
- Fulfilling duty of care and contractual obligations - Establish and follow an EAP and initiate emergency process if required - Communicate - Be familiar with athletes' medical histories - Know your limitations - Maintain confidentiality |
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Do you need consent from someone before doing first aid? |
yes, ensure athlete wants treatment and explain what the treatment is - Legal consent may only be granted by persons 19 years and older, otherwise parental consent required |
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Informed consent? |
You explain ALL the risks and benefits of the treatment/assessment before u begin |
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Explicit consent? |
Athlete comes to you for assistance or they agree to first aid |
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Implied consent? |
Individual is unable to give explicit consent but required it bc of an emergency - unconscious/unresponsive |
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Good samaritan act? |
Protects person providing emergency care to individual from being liable for negligence if something goes wrong - doesnt apply to people employed or paid to provide care |
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Skull fracture? |
Etiology: direct blow or indirect force that travels from mandible to skull usually creates epidural, subdural hematoma or intra-cranial hemorrhaging |
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Signs and symptoms of skull fracture? |
- severe headache and nausea - palpation may reveal defect or deformity - may be blood in middle ear, ear canal, nose, around eyes or behind ear (battle sign) - cerebrospinal fluid may also appear in ear and nose - inability to see or smell IMMEDIATE HOSPITALIZATION |
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Cerebral contusion ? |
Etiology: focal injury to brain that involves small hemorrahages or intracranial bleeding in cortex, generally when head strikes stationary object Signs: depends on extent - dizziness, nausea, LOC followed by talkative state management: hospital, physician clearance |
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Epidural Hematoma? |
Etiology: direct blow to head for fracture, damages superficial tissue and meningeal artery - blood accumulation and hematoma formation occurs rapidly due to arterial pressure Signs: LOC followed by lucidity, showing few sign - gradual progression of: head pains, dizziness, nausea, dilation of one pupil, deterioration of consciousness, neck rigidity Management: requires urgent neurosurgical care; relieve pressure to avoid disability |
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Subdural Hematoma? |
Etiology: result of acceleration/deceleration forces that tear vessels that bridge dura mater and brain - can be acute (rapidly progressing) or Chronic(due to venous bleeding) Signs: LOC does not occur - sometimes LOC and dilation of 1 pupil - headaches dizziness Management: immediate medical attention |
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Malignant brain edema syndrome? |
Etiology: occurs in young within mins to hours following head injury - intracranial clot resulting in diffuse brain swelling - swelling result of hyperemia or vascular engorgement - results in increased pressure signs: rapid neurologic deterioration, then coma management: immediate hospitalization |
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Decorticate posturing? |
- indicative of damage to neural pathway btw brain and spinal cord - posturing may be uni or bilaterall - FLEXED POSTURING, START FLEXING BODY TOGETHER - stiff body with bent arms and clenched fists - legs internally rotated |
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Decerebrate posture? |
- typically associated with severe brain trauma - severe muscle spasming of neck and back - posture may be uni or bilateral, just in arms - extension of body - FOREARMS AND ARMS PRONATED FISTS - feet planterflexed MORE SEVERE |
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Most frequent facial fracture? |
nasal |
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Mandibular dislocation? |
Etiology: TMJ joint - MOI is generally a blow to an open mouth from the side signs: dislocated jaw present in locked or open position w/ROM minimal along w/poor occlusion(sealing) Management: cold application, elastic wrap immobilization and reduction - physician clearance needed before return |
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Mandibular fracture? |
Etiology: direct blow signs: deformity, loss of occlusion, pain with biting, bleeding around teeth management: immobilization with elastic wrap and ice - refer to hospital for reduction and fixation |
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Maxillary and zygomatic fractures? |
MOI- direct blow signs: deformity, nosebleed, double vision, numbness M: controls swelling and maintain airway - manage open wounds - assume potential concussion |
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Orbital fracture? |
E: blow to cheek or eyeball forcing it posteriorly S: diplopia, restricted eye movement, downward displacement of eye, swelling M: ice and advise not to blow nose |
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Nasal fracture? |
E: direct blow or from side S: profuse bleeding, pain, crepitus(crackling of bones), swelling M: control bleeding - rule out concussion |
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Dental fracture? |
E: impact to jaw or direct trauma S: uncomplicated fractures produce fragments without bleeding - complicated fractures produce blood with lots of pain M: bleeding can be controlled with gauze - no biggie just chill nigga can get fixed later - mandibular fractures and concussion must be ruled out |
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Lacerations? |
E: result of a direct impact and indirect compressive force or contact with sharp object S: profuse bleeding, localized swelling, localized pain M: REDs to control bleeding - clean wound and prevent contamination - look for skull fracture - ster-istrips |
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Tooth subluxation, Luxation or avulsion? |
E: direct blow S: tooth may be loose Sublux- loose within socket, lil/no pain Luxation- tooth displacement w/o fracture avulsion- knocked out M: sub- referral with 48 hours sublux- immediate follow up avul- milk or saline within 2 hours, if tooth driven inwards refer to dentist immediately |
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Eye injury assessment and observation? |
assessment: - transport in recumbent position - both eyes should be covered, movement in unaffected eye will cause movement in the other eye observation: swelling discolouration, hemorrhaging, deformity |
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Orbital Hematoma? |
E: blow to area surrounding eye S: swelling and discoloration M: ice for 30 mins - dont blow nose after acute eye injury - monitor concussion |
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Hyphema? |
E: blunt blow to eye, can lead to serious problems with lens, retina S: blood collect in anterior eye, blood may turn pea green - vision partially or completely blocked - drowsiness M: physician immediately |
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Ruptured tympanic membrane (eye injury)? |
E: fall or slap to unprotected ear or sudden underwater pressure variation S: complaint of loud pop, followed by pain in ear, nausea, vomitting M:physician, infection can occur so gotta monitor |
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Auricular hematoma? (cauliflower ear) |
E: compression or shear injury to ear S: tearing of overlying tissue away from cartilage - Hemorrhaging and fluid accumulation M: proper ear protection to prevent - ice |
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How to prevent spinal injuries? |
Cervical - strengthening of cervical or para spinal musculature - maintain functional ROM Thoracic/lumbar - avoid repetitive stresses - correct biomechanical abnormalities - correct technique spine injuries occur when forced beyond normal ROM |
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Muscular strains? |
E: usually with hyperflexion/rotational force or hyperextention/rotational force - chronic strain associated with posture S: pain may be diffuse or localized - pain with active motion and/or stretching, spasms, disability M: RICE, activity modification, gentle stretching/ROM |
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Ligamentous sprains? |
E: generally same as strain, more violent (eg. whiplash) S: same as muscle strain but lasts longer - Localized pain and tenderness over transverse and spinous processes - decreased passive and active ROM M: RICE, NSAIDs |
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Cervical fracture? |
E: generally axial load w/ some degree of cervical flexion S: neck point tenderness, restricted motion, cervical muscle spasm, cervical pain M: stabilize, spine board |
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Lumbar fracture? |
E: compression fracture or of spinous or transverse processes - compression fractures are usually the result of trunk hyperflexion or falling from a height
- point tenderness - palpable defects localized swelling and guarding M: X-ray - transport with extreme caution and care to minimize movement |
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Brachial plexus neuropraxia? |
E: stretching or compression of brachial plexus S: burning sensation, numbness, tingling and pain from shoulder to hand - some loss of function in arm and hand M: strengthening and stretching program, return to activity ones signs are normal, padding to limit neck ROM |
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Spondylolysis and Spondylolisthesis? |
E: lysis refers to degeneratio of vertebrae due to congenital weakness (stress fracture) listhesis- slipping of one vertebrae above or below another, often associated with each other S: lysis begins unilaterally - pain and persistent aching, low back stiffness with increased pain after activity, frequent change in position, localized tenderness M: strengthening and stabilization exercises - increased susceptibility to lumbar sprains and strains |
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Define a concussion? |
- Results from complex pathophysiological process process affecting brain - subset of a traumatic brain injuries - functional injuries- perturbations of cellular or physiological function - iconic shifts, metabolic changes, impaired neurotransmission |
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Mechanism of injury for concussion? |
Cause by biomechanical forces to body - direct or indirect blow, to head, neck or face - stumbly, clumsy, unsure of game situation, can recall event before or after contact |
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What does the acute and persistent phase consist of? |
Acute: 0-10 days post injury - increased calcium levels - decreased oxidative metabolism - cells cannot repair until Ca normalizes Persistent: - axonal damage - cell death if Ca level remain elevated - glucose metabolism can be decreased for up to month |
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Define neuroautonomic disruption |
- uncoupling of autonomic NS and cardiovas system - uncoupling can be monitored with HRV - dec. in HRV due to increase to SNS - dec. in cerebral blood flow |
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What are the 3 categories of Signs and symptoms? |
somatic cognitive neurobehavioural |
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Somatic signs and symptoms of concussions? |
- headache - nausea - sensitive to light and/or noise - numbing or tingling - balance/coordination probs Somatic- relating to the body |
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Cognitive S&S of concussions? |
- Feeling slowed down - feeling in a fog - difficulty concentrating - difficulty remembering Mental aspects |
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Neurobehavioural S&S of concussions? |
- Sleeping more or trouble sleeping - Drowsiness - Fatigue - Sadness/depression - nervousness - irritable |
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What is the Glasgow coma scale? And the 3 categories? |
Used to determine conscious state of person 3 categories: - eyes response - verbal response - motor response the higher the score the better off the person is |
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What is a secondary impact syndrome? |
Occurs when athlete suffers a concussion before the first one is fully resolved Can be catastrophic: - Increase symptom severity - increase duration of symptoms - permanent brain damage - death |
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What to do when concussions occurs? |
- Remove player from play ASAP - SCAT/KD - wait 15 mins to let the player calm down - let coaching staff know - refer for medical follow up - document injury |
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What concussions symptoms are an emergency? |
- Seizures - Unusual behaviour - repeated vomitting - Slurred speech - Increase confusion - Cant recognize people or places |
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After concussion occurs what information should you provide to the injured athlete in terms of recovery? |
- Limit mental and physical activity as this can prolong recovery - Limit screen time (texting, tv, computer, video games) - avoid loud stimulating places - no alcohol - get cleared by doctor before RTP |
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When can an athlete RTP? |
- Gradual RTP protocol - starts once athlete is asymptomatic - 6 steps, if an S&S arises, rest for 24 hours and retry the step |
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How to help prevent a concussion? |
- ensure proper fitted equipment - equipment in good condition - mouth guards - fitness level - proper technique |
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Where does the 1st rib lay? and from where is it best palpated? |
Below the clavicle and from a superior approach |
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Which rib protects the spleen? Which rib protects the Kidney? |
10 12 |
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What is happening to the ribs when we inhale? |
Ribs are pulled up and forward; increase in overall A/P diameter - ribs 1-6 increase in anteroposterior dimension - ribs 7-10 we mainly see an increase in lateral dimension |
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How many quadrants are the abs divided into? |
4 right and left upper quadrant right and left lower quadrant |
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How many regions are the abs divided into? |
9 right/left hypochondriac, epigastric regions right/left lumbar, umbilical region right/left iliac, hypogastric region |
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What consists of a general assessment of abdominal injuries? |
Check for discoloration, swelling, and deformities - protusions, bloat, swelling? - are abs tight and guarded? monitor vitals |
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S&S of thoracic pain? |
- Cyanosis (bluish color of lips, skin, fingers) - dyspnea - chest pain with breathing - distended neck veins - reduced chest movement - shifting of trachea with breath - couching blood - shock |
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S&S for abs and pelvis? |
- severe ab or pelvic pain - point tenderness - spasm of ab muscles - blood in urine or stool - nausea - sensation of weakness palpable defect or deformity |
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Rib fractures? |
E: direct blow - prolonged repetitive movements - violent muscular contraction (coughing/sneeze) S: pain with INSPIRATION - point tenderness - deformity with palpation - coughing up blood M: refer for x rays - monitor for complications - support and rest; brace |
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Whats a flail chest? |
When 3 consecutive ribs r injured |
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Pneumothorax? |
Pleural cavity becomes filled with air, negatively pressurizing cavity, causing lung to collapse |
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Tension Pneumothorax? |
Pleural sac on one side fills with air displacing lung and heart, compressing opposite lung |
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Hemothorax? |
Blood in pleural cavity causes tearing or puncturing of lungs or pleural tissue |
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Traumatic asphyxia? |
result of violent blow or compression of rib cage |
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Common S&S of lung injuries? Management? |
- Difficulty breathing (dyspnea) - breathing cessation (Apnea) - Cyanosis, pain, hemoptysis and shock M: medical emergencies - treat for shock - monitor vitals, perform rescue breathing or CPR |
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Hyperventilation? |
E: rapid rate of overbreathing due to anxiety or asthma - less CO2 compared to O2 S: rapid breathing that induces panic - belching, bloating, confusion, light headed M: calm person down - breath through 1 nostril or pursed lips |
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Hypertrophic cardiomyopathy? |
Thickening of cardiac muscle w/no increase in chamber size |
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Marfan's syndrome? |
Abnormality in connective tissue results in weakening of aorta and cardiac vessels |
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Sudden cardiac death syndrome? |
E: Coronary artery and peripheral artery disease - right ventricular dysplasia(enlargement); cardiac conduction abnormalities, aortic stenosis (narrowing of aorta) - drugs, alcohol, intracranial bleeding, obstructed respiratory disease S: usually no signs prior to death - chest pain, heart palpitations, syncope, nausea, profuse sweating, SOB, fever M: Counseling and screening are critical in early identification and prevention - history of heart murmurs, chest pain during activity |
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Commotio Cordis? |
E: cardiac arrest due to impact to chest - young athletes at risk bc chest pliability S: ventricular fibrillation M: resuscitation is rarely successful - AED |
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Kidney contusion? |
E: result of external force S: shock, nausea, vomitting, muscle guarding M: advice to check for hematuria(blood in urine) |
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Ruptured spleen? |
E: direct blow - mononucleosis S: shock, ab rigidity and spasm, pain, nausea - Kehr's sign M: Medical emergency - treat for shock |
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Contusion of abs?(solar plexus) |
E: direct blow to ab or indirectly from falling - diaphragm going into temporary spasm S: localized tenderness, swelling, difficulty breathing M: calm individual - rule out internal injuries - short breaths in and long out - loosen tight clothes - DO NOT PUMP LEGS INTO ABS |
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Ab pain- "side stitch"? |
E: most common cause of ab pain with exercise - worst after eating S: described as ache or stitch on either costal angle M: stop activity and stretch arm overhead - forced expiration again pursed lips |
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Hernias? |
E: Protusion of ab viscera through portion of ab wall - heavy lifting or ab blow S: prolonged pain and discomfort, deformity that appears w/ coughing - weakness or pulling sensation in groin M: refer to physician for surgical consult |
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Appendicitis? |
E: chronic or acute inflammation of appendix - starts as gastric complaint, then develops to red swollen vessel S: mild to severe pain in lower ab, w/ nausea, vomitting and low grade fever - pain in lower right ab M: surgery |
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Scrotal contusions? getting sacked lol it hurts so bad |
E: result of blunt trauma S: hemorrhaging, fluid effusion, muscle spasm, severe pain, nausea M: flex knees up and breathe in short breathes - check if both nuts are there LOOOL |
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Ruptured bladder? |
E: force to lower ab - hematuria often associated with contusion of bladder during running S: pain, discomfort of low ab, ab rigidity, nausea - inability to urinate will present in case of ruptured bladder M: physician - encourage to urinate frequently |
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Radiation? |
Heat loss from warmer object to cooler object - indirectly |
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Conduction? |
Warmer body gives off heat to cooler object, directly |
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Convection? |
Cooler air blowing over body will cool off the body |
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Evaporation? |
perspiration from on surface of skin and evaporates, carrying the heat with it |
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What is the primary way to dissipate heat in temperatures greater then 20 degrees c? |
Evaporation |
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Primary way to dissipate heat in temps less then 20 degrees? |
conduction and evaporation |
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Who is at risk for heat illness and hyperthermia? |
- Very young and old - obese or large muscle mass - poor conditioning and acclimatization - previous history of heat illness - sleep deprived - dehydration - acute illness (fever) - chronic illnesses (alcoholic, cardiac disease) - wheelchair athletes |
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Heat syncope? E,S,M? |
E: individual abruptly stops exercising and blood pool - blood not being returned to brain or heart S: lightheadedness or fainting M: elevate legs, cool down with cold towels, rehydrate and remove from heat |
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Muscle cramp? |
E: lack of hydration or imbalance btw water and electrolytes - results in involuntary muscle spasm - painful involuntary skeletal muscle contraction S: painful/violent muscle ramp in calf or abs M: rehydrate, ice cramp, passive stretch |
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Heat exhaustion? |
E: bodys ability to dissipate heat compromised and core temp increases S: extreme weakness, sweating, light headed, tachycardia, cramping M: rehydrate frequently, cool towels, sponges, ice packs on groin, weak pulse |
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Heat stroke? |
E: body's inability to dissipate heat and results in core temp > 40 S: sudden collapse, LOC, flushed, hot skin, shallow breathing M: 911, lower core temp, cold towels, remove from heat, DO NOT IMMERSE IN WATER, strong pulse |
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What is exertional hyponatremia? |
Disorder involving fluid-electrolyte imbalance - results in low sodium concentration - disrupts osmotic balance across the blood brain barrier and causes rapid influx of water into brain - brain swelling and weird neurological responses |
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S&S of exertional hyponatremia? |
- confusion, seizure or coma - can eventually lead to death bc braintem ruptures - bloating or nausea - headache, nausea, vomitting, wheezy breathing, swollen hands and feet, fatigue - respiratory arrest, coma, permanent brain damage and death |
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What factors have an affect on hypothermia? |
- Low temp factors - chill factor - dampness factor temp in conjunction with wind and dampness can increase chances heat lost exceeds heat production |
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Hypothermia? ESM? |
E: bodys ability to produce heat impaired and core temp falls less the 35 degrees S: shivering, numbness, lack of coordination, confused or unusual behaviour, slurred speech M: may be medical emergency, remove from cold, remove wet clothing, re-war slowly, give warm liquids and monitor vitals |
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Degrees of hypothermia? |
- intense, uncontrollable shivering - violent shivering, difficulty speaking if conscious - less shivering, muscular rigidity, decreased coordination, confusion to amnesia - unconscious and unresponsive, pulse erratic - heart and lungs fail, hemorrhaging and death |
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Frost bite or nip? |
E: fluid btw cells crystalizes and expands causing damage to tissues and vessels S: swelling, pain and tingling, numbness later, skin appears waxy, hard, discoloured (blue) or feels cold M: remove from cold, rewarm SLOWLY, DO NOT rub area |
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Altitude sickness? |
- As height increases, O2 uptake decreases and results in decrease in performance - body compensates through tachycardia and hyperventilation |
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Acute mountain sickness? |
- Anorexia - nausea - vomitting - insomnia - dizziness |
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High altitude cerebral edema? |
- headache - disorientation - loss of coordination - memory loss |
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High altitude pulmonary edema? |
- Chest tightness - persistent cough - frothy sputurm - suffocation |
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Where is the best place to shelter during lightening storm? |
Indoors and avoid large trees, flag/light poles, standing water, pools, telephones, showers and metal objects - last resort find a car, ditch, valley |
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Diabetes ESM? types of diabetes? |
Type 1- insulin dependent - typically occurs in individuals under age 35 type 2- non insulin dependent - occurs in all ages, becoming more prevalent in younger kids due to obesity E: decrease in insulin secretion M: monitor and control glucose levels - insulin - vigorous exercise increases peripheral insulin action and enhances glucose tolerance |
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Insulin shock? |
E: to much insulin, not enough blood sugar S: tingling in mouth, hands, physical weakness, headaches, ab pain - normal or shallow respiration, rapid heart rate M: adhere to careful planned diet, snacks before exercise |
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Diabetic coma? |
E: loss of sodium, potassium and ketone bodies through excessive urination (ketoacidosis) S: labored breathing, fruity smelling breath, nausea, thirst, dry mucous membranes, confusion M: Early detection is critical as this is life threatening - insulin injection may help |
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Epilepsy? |
Paroxysmal disorder (physical dysfunction), periods of altered consciousness, motor activity E: sometimes genetics - brain injury or altered brain metabolism S: periods of altered consciousness, motor activity, sensory phenomena or inappropriate behavior M: physician clearance prior to participation - must be careful with activities involving changes in pressure |
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Exercise induced asthma? |
E: bronchocontriction - aggravated in cold, dry, polluted or allergenic filled air S: coughing, wheezing, excessive spitting, dyspnea, chest tightness M: avoid triggers and warm appropriately - cover nose and mouth to warm and humidify air |
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Runners' anemia (hemolysis)? |
E: caused by impact of foot as strikes the surface - impact destroys normal erythrocytes within vascular system S: mildly enlarge cells, increase in immature RBCs and negatively affect hemoglobin M: reduce distance or mileage |
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Female athlete triad? |
E: relationship btw disordered eating, amenorrhea and osteoporosis - seen in females driven to meet standards of sport or to meet a specific athletic image to attain goals S: disordered eating- bulimia and anorexia - osteoporosis- premature bone loss in young women, inadequate bone development M: prevention is key; identify and educate |
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What are the pain qualities for nerve pain, bone, fracture, vascular? |
nerve- bright, burning, specific distribution Bone- deep, boring, localized, nagging fracture- sharp, severe, intolerable vascular- diffuse, throbbing, generalized, may be referred |
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Pain qualities for muscle, neuropathic, ligament, somatic? |
Muscle- dull, aching, generalized, aggravated neuropathic- injury or pathology PNS or CNS ligament- dull/ aching somatic- chronic, aching pain that is inconsistent or inexplicable |
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What are some possible red flags? |
- Severe unremitting pain - pain unaffected by meds or position - severe night pain - severe pain with no history or trauma - severe spasm - bowel/bladder changes - changes in vision - swallowing or speech changes - falling down - SOB, heavy chest |
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Ideal posture? |
- Slightly anterior to lateral malleolus - slightly ant to fibular head - at greater trochanter - at acromion - at external auditory meatus (EAM) |
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What does active-examining test? |
- Willingness to move - Tests function of both contractile and inert tissues through available ranges - motion control - patterns of restriction - muscular power and adopted adaptations - ask for permission - clear joints above and below - examine unaffected side first and painful movements last |
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What does passive examining test? |
Assessment done by trainer - patient must be relaxed Goal is to note any limitation or presence of pain Passive ROM examines inert structures - bones, ligaments, fascia, bursae, nerves, nerve roots |
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Passive-normal end feels? |
bone to bone soft tissue approximation firm/capsular (tissue stretch) - abrupt, hard, firm endpoint |
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abnormal end feels? |
- Springy block (rebound) - boggy (swelling) - Empty (non or arrested) - Spasm (guarding) - loose (extreme hypermobility) |
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Benefit of resisted examination? |
Manual muscle testing is one to determine if contractile structure have been affected
- also exams innervation |
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Contractile tissue - what are the 4 classic patterns? |
1.) movement is strong and pain free - muscle and nervous tissue intact and not cause of discomfort 2.) Movement is strong and painful - Local lesion in muscle or tendion (1/2nd degree strain) 3.) Movement is weak and painful - severe lesion around joint - caused by reflex inhibition secondary to pain 4.) movement is weak and pain free - 3 degree strian or neural involvement |
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Sources of muscular weakness? |
- strain - pain inhibition - peripheral nerve injury - nerve root lesion (myotome) - upper motor neuron lesion - tendon pathology - avulsion - psychological affect |
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Why palpate? |
can differentiate btw tissue quality - determine joint tenderness - determine variations in temp - note any alterations in sensation or presence of crepitus begin away from injury and move towards |
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Define trauma?
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Physical injury or wound produced by internal or external force |
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What is mechanical injury a result of? |
Force or mechanical energy that changes the state of rest or uniform motion of matter |
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Common MOIs? |
- all out exertion - contact - striking or throwing projectiles - propulsion of the body through the air - repetition of movement |
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Load? |
external force acting on body causing internal reactions within tissues |
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Stiffness? |
Ability of tissue to resist load |
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Stress? |
internal resistance to load |
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Strain? |
Internal change in tissue (length) resulting in deformation |
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Direct impact? |
Injury occurs at the point of impact |
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Indirect impact? |
injury occurs at point away from contact |
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what are the 5 types of tissue loading? |
Compression Tension Shearing Bending Torsion |
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Describe compressive tissue loading |
force that results in tissue crush - aka compression - 2 forces applied towards each other eg. standing, burst fracture of spine |
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Describe tension tissue loading |
Forces that pulls and stretches tissue eg. ligaments or muscles, hamstring strain |
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Shearing |
Force that moves across the parallel organization of tissue Stress causing 2 opposing bones that displace one each other eg. Spondylolisthesis |
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Bending tissue loading? |
4 points- 2 forces act at opposite ends of structure
3 points - 3 forces, 2 on ends and 1 in middle eg. bone |
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Torsion? |
twisting in opposite direction from opposite ends twisting force that causes tissue to fail eg. ACL |
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When does an injury become chronic? |
When it doesnt heal properly |
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Impingement? |
Pinching of intervening tissue btw 2 bony structures eg. subdeltiod bursitis |
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Friction? |
Reptitive frictino btw 2 structures or an intervening structure (bursa) eg. illiotibial band friction syndrome |
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injuries are classified according to what? |
- Stage of injury or healing - Severity of the injury - Type of tissue damaged/injured - type of mechanism |
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1st degree muscle strain? |
Some fibers stretched or torn, Full ROM but painful |
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2nd degree muscle strain? |
multiple fibers torn - active contraction painful - divot is palpable, some swelling and discolouration |
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3rd degree strain? |
Complete rupture of muscle or musculotendinous junction - significant impairment - great deal of pain |
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Abnormal muscle contraction is the result of...? |
Failure in reciprocal coordination of agonist and antagonist Electrolyte imbalance due to sweating or strength imbalance |
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Muscle gaurding? |
muscles within effected area contract to immobilize area to minimize pain - involuntary muscle contraction |
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What is a clonic and tonic muscle spasm? |
Clonic- alternating involuntary muscular contractions and relaxations in quick succession Tonic- rigid contraction that lasts a period of time |
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What is a contusion? |
Bruise that results from a sudden traumatic blow that compresses the soft or boney tissues - creates hemorrhaging - chronically inflamed and contused tissue may result in generation of calcium deposits (myositis ossificans) |
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Tendinitis? |
tenderness due to repeated microtrauma and degenerative changes - inflammation of tendon RESTTTT |
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Tendinosis/tendonopathies? |
due to improper healing of tendinitis - visibly swollen with stiffness and restricted motion |
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Tenosynovitis? |
inflammation of synovial sheath Acute- rapid onset, crepitus and diffuse swelling Chronic - thickening of tendon with pain and crepitus often occurs in flexor tendon of digit and biceps tendon |
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How does a ligamentous sprain occur? |
Traumatic joint twist that causes stretching or tearing of connective tissue |
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Grade 1 sprain? |
Some pain, minimal loss of function, no abnormal motion, mild point tenderness |
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Grade 2 sprain? |
Pain, moderate loss of function, swelling and instability with tearing and separation of ligament fibers |
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Grade 3 sprain? |
Extremely painful - loss of function - severe instability and swelling |
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Subluxation? |
Breif, transient injury involving partial dislocation and spontaneous joint relocation |
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Dislocation? |
disarticulation of joint - stablizing structures of joint are disrupted - common in fingers and shoulder |
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Separation? |
separation of fibrous joint due to stretching or tearing of supporting tissues |
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Bone fracture S&S? |
S: deformity, pain, point tenderness, swelling, pain on active and passive movements |
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stress fractures? |
overload due to muscle contraction, altered stress distribution due to muscle fatigue, changes in surface |
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3 types of bone fractures? |
linear - line parallel to bone transverse- line perpendicular to bone spiral oblique |
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3 major stages of healing? |
1. inflammatory phase: 1-4 days 2. fibro-plastic repair phase : 3 days- 6 weeks 3. maturation- remodeling phase: upto 3 years |
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Goal of leukocytes and phagocytic cells? |
- protect - localize - decrease injurious agents - prepare for healing and repair |
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inflammatory phase is characterized by SHARP. What does sharp stand for |
- swelling - heat - altered function - redness - pain |
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Process of clot formation? |
injury to cell -> chemical mediators liberated -> vascular reaction -> platelets and leukocytes adhere to vascular wall -> phagocytosis |
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What does histamine do? |
First to arrive at wound - causes vasodilation and changes cell permeability owing to swelling |
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Chemical mediators? |
- impact adherence along cell wall - increase permeability locally for fluid and protein passage - facilitates exudate formation and neutrophil entrance to injured site |
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vascular response of inflammatory phase |
- vasocontriction, coagulation - chem mediators are released - vasodilation later |
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3 stages of clot formation? |
1. thromboplastin is formed 2. prothrombin is converted to thrombin due to interaction with thromboplastin 3. thrombin changes from soluble fibrinogen to insoluble fibrin coagulating into a network localizing the injury |
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What ends the inflammatory stage? |
Fibrin clot: Leukocytes phagocytize the remaining debris |
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What causes chronic inflammation? |
Occurs when acute inflammatory response does not eliminate injuring agent - tissue not restored to normal physiologic state |
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How does the fibroblastic repair phase begin? |
Commences when macrophages have finished - cap buds begin to proliferate - reactino to hypoxia - create revascularization |
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What signals the beginning of stage 3? |
tensile strength increases, fibroblastic activity slows |
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Maturation and remodeling is characterized by..? |
Remodeling of scar tissue according to tensile forces - tissue will gradually assume normal appearance |
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What should u do actively during the remodeling phase? |
Controlled activity should be added - work towards regaining normal flexibility and strength |
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Factors that impede healing? |
- extent of injury - edema - hemorrhage - poor vascular supply - separation of tissue - muscle spasm - atrophy - infection - health, age, nutrition |
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Tell me about cartilage healing boi |
- Limited capacity to heal - little or no direct blood supply |
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Tell me about dat ligament healing my n*gga |
similar to vascular tissues, 3 phases - repair will involved random laying down of collagen which will mature and realign in reaction to joint stresses and strain |
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What types of factors affect the healing of ligaments? |
- surgically repaired ligaments r stronger due to decreased scar formation - exercised ligaments r stronger as opposed to immobilized |
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what is required for good tensile strength of tendon healing? |
an abundance of collagen - initially injured tendon will adhere to surrounding tissues |
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5 stages of acute fractures? |
- hematoma formation - cellular proliferation - callus formation - ossification - remodeling |
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short term goals of injury rehab? |
- control pain - maintain/increase flexibility - increase/restore strength - maintain cardiorespiratory fitness |
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Long term goals of rehab? |
return to practice/competition as quickly and as safely as possible |
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factors to consider when developing a RTP plan? |
- Mechanism of injury - age - anatomical structures involved - injury severity |
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Acute management goals? |
Manage injury site - bleeding, pain, inflammation - Prevent secondary complications - support and stabilize injury - implement a home program (RICE, basic ROM) |
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Effects of cold? |
Vasoconstriction or vessels - decrease blood flow, inflammation, cellular waste production |
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Hunting response? |
bodys reaction ice when temp reaches 10 degrees - vasodilation followed by vasoconstriction |
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fibroplastic repair phase goals? |
control pain, reduce swelling - scar is forming and pain is decreasing with active and passive ROM |
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Goals of maturation and remodeling? |
- Return to activity - collagen fibers need stresses and strains to align - functional training - strengthening exercises |
