Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

trauma > all > Flashcards

all Flashcards

1
Q

what are the benefits of developing standard operating procedures?

A

reducing stress for medical staff
minimising mistakes
minimising equipment failure through pre-activity checks
improving teamwork
improving player care
supports min standard of care
facilitates reflection, learning, significant event analysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

where is an emergency action plan needed?

A

for all locations where activities take place: home and away games, training

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is to recommeded to have a protocol for?

A 
players who are unconscious
have a head injury
a suspected cs spine injury
mid shaft fracture of tibia
sudden cardiac arrest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

when should protocols be practised in clubs?

A

at least once per month for the more common scenaries with everyone knowin their roles
min several times in a season

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are some simple measures to reduce cross and self inffection/

A 
hand cleansing
keeping personal wounds covered
wearing disposable nitrile gloves
carrying yelow clinical waste bags for contaminated items
sharps bin
maintaining immunisations: tetanus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

when should emergency action plans be reviewed?

A

minimally annually

often after an incident

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

describe the governance cycle and emergency action planning?

A 
emergency action planning
reflection
debrief
audit
re-evaluation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what should be contained in the pre-aranged plan for an injured player?

A 
the emergency action plan
roles and responsibilities
meeting min requirements of league and FA
PPE
route to medcial room
qualified HCP pitchside
emergency kit
pre-existing conditions
phone for contacting emergency services
directions to nearest ED
vehicle access to area
list of contact details for next of kin
major incidents
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

when can confidentiality be breached?

A

pre-participation screening

a danger to others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what information needs to be kept in medical records?

A

injury/illness
interventions and medication
players nae and dob
dated and signed by HCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how long are medical records kept?

A

7 years
for children until 25th bday
player has 10 years to bring a case forward

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

when might you bre required to educate the team?

A 
emergency care
drug awareness
PRICE
dietary monitoring
dangers of moving an injured layer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what handover pneumonic do the FA prefer?

A

ATMiST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the ATMIST pneumonic?

A 
age of player
time the incident occured
moi
injury sustained/presented with
signs and symptoms
treatment provided
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the SAMPLE pneumonic?

A 
signs and symptos
allergies
current medications
previous medical history
last food or drink
events leading to incident and after: moi, recall, concussion, time, first aid so far
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is included in the recommended trauma kit?

A

airway and breathing: OP airways 2-5 and NP 6-8mm, pocket mask, bag valve mask, non re breathe oxygen mask x2, portable suction kit plus catheter, pulse oximeter, oxygen cylinder, magills forceps, i gel 3-5, lubricating jelly

circulation: AED, stethoscope, sphygnomanometer, IV cannula, IV giving set, IV retaining dressings, IV fluids, pelvic binder, sharps bin, clinical waste bag, sterile gauze
dysfunction: blood glucose monitor, pen torch
extrication: long back board with head bloacks and straps, cervical collars, scoop stretcher with head blaocks and straps, basket stretcher, selection of fracture spints, kendrick splint
additional: cricothyrotomy set, intraosseuos access, towel, umbrella, crutchers, PPE, vacuum mattress, oral rehydration fluids, thermometer, nebulied chamber for non rebreather mask
drugs: adrenaline 1:1000 (1ml) and 1_10,000 (10ml), epipen, aspirin 300mg, chlorpheniramine 10mg, glucose gel/glucagon 1ml, hydrocortisone injectin, oxygen, entonox, penthrox, amiodarone, diazepam-is a controlled drug (rectal or IV), salbuatmol 5ml nebulised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are the steps in assessing a player?

A 
moi
safe approach
address catastrophic bleeding
MILS if indciated
assess response
ascertain signs of life
primary survey A_e
critical intervention/resus
secondary survey: may be in medical room
continued re-evaluation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

why is MILS usually always applied in football?

A

contact sport, MILS until can rule out cx spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what apneumonic for approach is sed in football?

A 
danger
responsiveness
catastrophic bleed
airway
cs spine: MILS
breathing
circulation
dysfunction
expose/everything else
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what needs to be considered in safety?

A

is it safe to approach-if ref calls in assume yes
if unsafe wait for ref to sort
may need to call ambulance
position of player, do they need moving-if prone may need to be moved into supine but if can mx as are then leave
shout for help and equipment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

how is response assessed?

A

take MILS first
speak loud
squeeze earlobe
NEVER SHAKE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is assessed in airway?

A

look inside players mouth: gum shield, blood, teeth, mud, tongue-jaw thrust
remove obvious obstructions with magills forceps
excess secretions may require suction
if airway cant be maaintained consider adjuncts
if cant be assessed may need to move

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

how is breathing assessed?

A

look listen and feel for 10s
not breating->CPR
normal breathing >10/min
record RR and trend
palpate chest wall high and wide for expansion
expose chest and neck-distended neck veins=surgical emphysema
tracheal position
auscultation and percussion-may need to wait until medical room (apices, mid and bases)
may need 100% O2 and pulse oximetry at this point

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what pneumonic hekps with detailed assessment of breathing/

A 
R=RR
I=inspection
P=palpation
P=percussion
A=auscultation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what soudnds may be heard on auscultation/
normal wheezes: airway narrowing e.g. asthma crackles: fluid or infection stridor: laryngeal injury or airway blockage diminished breath sounds: fracture, haematoma no breath sounds: not breathing, tension penumothorax
26
what sounds may be heard on percussion?
normal=resonant hyporesonant/dull=fluid hyperresonant=air
27
what is included in the circulation assessment?
``` life threatening heamorrhage carotid pulse radial pulse and vol-often absent in severe trauma/bleed absence of radial pulse=IV fluids CRT<2s on nail or sternum distended neck veins colour oxygen at 15L/min if not already consider external haemorrhage internal haemorrhage: "on the floor and 5 more": chest, abdo, retro-peritoneal, pelvis, long bones ```
28
how is internal haemorrhage assessed for?
chest: usually identified in B abdo: palpate four quadrants-firm/pain=blood pelvis: position of legs and palpate retroperitoneal=palpate long bones=femur
29
what is assessed in dysfunction?
AVPU: alert=cognitively alert (stimulating convo not just answering qs) GCS pupil response to light blood glucose
30
what is assessed in expose/examine/
``` remove clothing to see injury distal pulses medical hx# dont restrain a combating player convulsive player: approach, MILS, airway ```
31
what is ATOM FC for?
conditions that will immediately kill
32
what is the ATOM FC pneumoni?
``` airway obstruction tension pneumothorax open pneumothorax massive haemothroax flail chest cardiac tamponade (+/-pulmonary contusion/pulmonary oedema) ```
33
what is dealt with as first priority in the assessment?
ABC any problems at each dstage address once A-E done consider distracting injuries and extrication
34
what additional tools might be used in a complete survey/
BP | ECG
35
what are the reversible causes diability?
4 Hs: hypothermia, hypovolaemia, hypoxia, hypo/hyperkalaemia | 4Ts@ tension pneuomothorax, tamponade, toxins, thrombosis
36
summarise the approach to the airway.
is the mouth clear? yes-> is it open->yes->sounds. no->jaw thrust if mouth isnt clear: suction or forceps
37
what is the sumary for appraoich to breahting?
are they breathing normally? no->CPR yes->rate, depth, equal expansion, oxygen
38
what is the summary for circulation?
is there a pulse? yes->blood on floor and 5 more no->CPR
39
what is the summary for dysfunction?
AVPU | pupils equal and reacting to light
40
what is the summary for expose and examine?
check other injiries | extricate to medical room for secondary survey or ambulance
41
what should be included for the head in the secondary survey?
CSF leakage from ear or nose bruising pupillary reaction open or depressed skull fracture
42
what should be included in the neck for secondary survey?
maintained in neutral position fracture dislcoation immobilised
43
what should be included for shoulders in secondary survey/
fractures | dislocation
44
what should be included in the chest for secndary survey?
``` reassess-expose and examine penetrating injury subcut emphysema deformities/fractures of ribs auscultation percussion ```
45
what is included in the abdomen for the secondary survey?
guarding distension brusing liver and spleen: high R and L
46
what is included in the spine for the secondary survey?
difficult to assess once immobilised, cehck in log roll: fracture/dislocation, sensation, pain
47
what is included in the pelvis for secondary survey?
fracture/dislcoation: do not spring the pelvis-gentle pressure
48
what is included in genital/rectal for secondary survey/
bleeding | incontinence
49
what is included in the legs and arms for the secondary survey?
``` fracture/dislocation sensation pain presence or absence of distal pulses capillary refill distal to injury colour ```
50
what is the GCS scoring system
``` lowest score 3 eye opening 4=spontaneous 3=opening to speech-shout 2=opening to pain-pressure on nail bed 1=no eye opening motor 6=obeys commands e.g. lift arm 5=localises pain 4=withdraws from pain 3=abnormal flexion-pain at fingertips bends arm at elbow 2=extensor response-pain at fingertips elbow straigtens 1=no response to pain verbal response 5=orientated-who and where they are, uear 4=confused conversation 3=inappropriate words-usualy only 1 or 2 words 2=incomprehensible sounds 1=no verbal response ```
51
what GCS score will an unconscious player usually have?
<8
52
what are the basic air way manoevres?
most can be carreid out in all positions jaw thrust: brings mandible forward and pulls tongue forward: with index and middle finger steady upward and forward oressure at angles of mandible head tilt chin lift: no cx spine concerns. 1 hand on forhead and tilt back, 2 fingers under chin and lift
53
what is the look, listen and feel for breathing skill order?
1. look for max 10s, look to see if chest is rising and falling equally and bilaterally. check RR 2. not breathing begin CPR. normal breathing is >10/min 3. palpate chest wall high and wide for expansion, expose chest and neck for distended neck veins and emphysema, trachea position 4. listen for added sounds. auscultationapices, middle and lower lobes 5. percussion 6. if breathing normall continue, 100% oxyge might be indicated 7. pulse oximetry reading recorded
54
describe the steps in assessing circulatory response.
check carotid pulse (between adams apple and SCM) as gain cx spine control for 10s radial pulse (palamr, lateral to FCR tendon) allligns to circulating vol-may be absent need to note and monitor radial pulse carotid and radiaul pulse simultaneously if someone else to support neck absence of radial pulse-> IV fluids CRT: fingernails or sternum: press for 5s should be <2s. consider cold weather distended neck veins colour: pale/cyanosed 15L/min oxygen in depth assessment circulation: vol, external haemorrhage, internal bleeding internal bleeding: chest, abdo, pelvis, retroperitnoeal, long bones-femur
55
what should be checked before commencing secondary survey?
ABC
56
what can cause airway obstruction?
tongue-often accompanied by snoring sound teeth, blood vomit swelling of tissues due to allergic reaction or trauma life threatening: faceial fracture, laryngeal fratcure, tongue, posteriorly dislocated clavicle, choking
57
what additional techniques are used to open airways?
airway adjuncts suction advanced airways
58
what are the sizes of OP airways?
``` 00=baby 0=infant 1=children 2=small adults 3=adults 4=arge adults 5=very large adults ```
59
how are OP airways measured
recommended: incisors to angle of jaw | tragus of ear to corner of mouth
60
how are OP airways inserted?
recommended: use pen torch and tongue depressor to deirectly insert=decreased trauma to roof of mouth without=turn upside down, insert halfway, then rotate clear outh before insert if show signs of rejecting then remove apply oxygen
61
what GCS is suually needed for OP airway/
<8 or will have gag reflex
62
when are NP airways used?
jaw or facial injuries, convulsing, high erconscipusness
63
what are the CI to NP airway
``` acute nasal injury suspected fracture to base of skull nasal polyps or recurrent nose bleeds <12 hypothermic ```
64
how are NP airways inserted?
size smaller than nostril: 6-7mm+F, 7-8mm+m lubricate NP tilt nostril back and insert into R or bigges t nostril with bevelled edge towards the septum if cant insert try in L and point bevel to L septum and rotate on resistance
65
what are the sizes of i gel?
3=small adults 30-60kg 4=medium adults 50-90kg 5=large adults 90+kg
66
when is the i gel used/
SCA an dneeds more definitive airway
67
how is igel inserted/
``` lubricate press chin down insert teeth should be on bite block tape down from maxilla to maxilla can attach BVM directly ot via catheter mount ```
68
when is suction used/
regurgitation in unconscious player excessive sputum blood from maxillofacial injury, head ijury, epistaxis
69
how should suction be used?
only insert as far as can see and suction on way out suction 5-10s and max 20s dont damage soft tissue
70
is oxygen prescription only?
yes
71
what should the oxygen kit have?
``` oxygen cylinder BVM non rebreathe mask OP and NP igels pulse oximetry stethoscope magills spare oxygen tubing pen torch tongue depressor syringe ```
72
when should oxugen be used?
``` risk hypoxia difficulty breathing or obstructed airway stroke, head injury, heart attack, sca unconscious or in shock spinal injury chest injury suspected internal haemorrhage open or close fractyre with possible interbal haemorrhage multiple injuries ```
73
what else is needed with oxygen therapy?
pulse oximetry
74
what is a non rebreathor mask?
requires player to breathe unassisted can deliver high concentration soxygen covers nose and mouth and is attached to reservoir bag that is attached to cylinder reservoir bag filled to 2/3 before placed on player
75
what is a pocket mask used for
resuscitation | can directly connect to oxygen
76
when are BVM used/
if player isnt breathing adequately
77
how is the BVM administered/
2 person: 1 jaw thrust and sealing mask onto face | second to squeeze bag: 1s squeeze=500ml (required)
78
what should oxygen be given at in the emergency environment/
15L/min aiming for sats 94-98%
79
how can airways be classified/
maintained: capable of maintaining without need for intervention maintainable: simple manoevres or adjunct unmaintainable: definitive airway needed
80
what are the indication sfor surgical airways?
severe maxillofacial trauma without access to airway foreign body in upper airway oedema of throat tissues preventing visualisation of the cords severe orophpharynegeal heaorrhage intubation is not possible
81
what are CI to surgical airway?
availability of less invasive means od securing the airway laryngeal fractire pre-existing or acute laryngeal pathology anatomical landmarks obscured by gross haemorrhage/surgical emphyseama tracheal transecrtion wit retraction of trachea into the mediastium athetes under 12
82
how is direct tracheal access obtained?
through cricothyroid membrane of anterior neck
83
what is the definitive surgical airway?
surgical insertion of a large bore cuffed tracheostomy tube | usually inappropriate in pre osptial setting
84
what surgical airway technique will by time for 30 mins?
jet insulfation via needle cricothyroidotomy
85
is needle cricothyroidotomy often successful/
no | must be very competent to attempt
86
when should you pleace a player in the recovery posiiton?
alone and player is breathing but cant adequately maintain airway alone and need to leave them to summon help alone and player begins to regurgitate
87
what are common features of laryngeal injury/
hoarse voice, stridor on inspiration | loalised pain, swelling, tachypnoea, dyspnoea, step in the larynx and surgical emphysema
88
how are laryngeal injuries managed?
``` airway manoevres or adjuncts may not help hosptial asap calm player call ambulance sit up of possible 100% oxogen may not tolerate cervical collar ```
89
why is a posteriorly dislcoated clavicle dangerous/
may damage trachea, oesophagus, jugyular vein, subclavian artery and veun, caroitd artery
90
how can a posteriorly discloated clavucle be managed/
if choking or dyspnoea need mx asap | pull forward-this would require surgucal towel clip
91
what are common features of choking/
``` sudden obstruction difficulty breathing and speaking coughing cyanosis unconscious ```
92
how is choking mx?
encourage to cough if becomes exhausted or cyanosed: 5 back blows (between scapula), 5 abdo thrusts (arms rund, cench fist and pull up) and repeat if unconscious: remove foreign bidy with magills, chest compressions if a child 5 rescue breaths before compressions
93
what are some life threatening injuries that will affect breathing?
pneumothorax tension pneumothorax open pneuomothorax haemothorax
94
who is spontaneous pneumothorax common in?
tall, thin males 20-40 | smoking, substance abuse
95
what commonly causes spontaneous pneumothorax?
rupture of ub pleural blebs or bullae
96
what causes traumatic pneumothroax/
often fractured ribs driven inwards
97
how does pneumothorax often present?
pleuritic chest pain, tachypnoea, resp distress | signs may be subtle and only apparante hors later
98
how is a simple pneumothorax mx?
oxygen hospital monitor O2 sats, RR, HR, CRT, BP penthrox
99
what is an open pneumothorax
air is sucked into lung and pleural cavity through an open chest wound, air may bubble out as exhale, medical emergency
100
how are open pneumothorax mx?
cover wound and hospital asap
101
what is a haemothorax?
bleeeding into pleural cavity
102
what are the features of a haemothorax?
unequal expansion, brusing, rib fracture, dull percussion, reduced breath sounds, tachycardia, tachypnoea, low sats
103
how is haemothorax mx?
high flow O2 | IV access and fluids
104
what is a tension pneumothorax?
air enters but can not escaoe-flap of tissue acts as one way valve intrathoracic pressure increases with every breath
105
what are the features of a tension pneumothorax?
``` resp distress and icnreased RR absent breath sounds hyperresonant percussion severe pain neck vein distended subcut emphysema anxiety hypotension traheal devvitaion away cardiac arrest ```
106
how is tension pneumothorax mx?
needle throacocentesis: wude bore cannula 14 gauge (orange) onto 2nd IC upper border 3rd rib mid clavicular, will hear hiss of air, this is only temporary and wull need a defnitibe chest drain and high flow oxygen
107
what will an NP and OP airway do?
enable breathing to continue if spontaneosult breathing | keep airway open if require assisted venitlation-although could use igel
108
how should a pocket mask be used?q
``` place over players mouth between lower lip/chin and over nose sealed tight placing thumbs against mask and fingers under jaw can jaw thrust at the same time blow into mask until thorax lifts fir 1s remove mask and allow player to expire repeat whole process for 2 breaths should take 4s recheck airway is open recheck players mouth for obstruction ```
109
how is a non rebreath mask used/
covers nose and mouth and elastic cord around head attached reservoir bag (1.5L) and tank providing 15lpm before mask on reservoir bag inflated to greater than 2/3 full to preinflate used a gloved finer over the valve approx 1/3 air depleted as player inhales allows administration high conc oxygen-60-90% 2 valves: tiop valve on then dial to 15 pulse oximetry
110
what are the clinical signs for needle thoracocentesis?
``` increaed RR abesent breath sounds distended neck veins hyperresonant percussion tracheal deviation away (late sign) ```
111
how is needle thoracocentesis carried out?
once tension pneumothorax confirmed high flow oxygen and pulse oximeter 14g cannula at 90 degrees into thoracic cavity: 2nd IC space uper border of 3rd rib mid clavicular line. if unsuccessful 5th IC space upper border 6th rib mid axilary libe advance 1-2 inches while advancing wihtdraw the needle once needle enders pleural space there will be a pop/give-remove needle and hiss of air, secure canula dispose needle procedure may be repeated
112
how is a needle cricothyroidotomy performed?
player supine palpate cricothyroid membrane: expands from anteroinferior border of larynx and anterosuperior border cricoid cartilage swab skin stabilise trachea with thumb and forefinger puncture with needle and syringe 16 gauge canula caudally at 45 degrees through membrane attached to a 10ml syringe and aspirate as needle advanced aspiration of air confirms presence tracheal lumen remove syringe and attach oxugen tubng and secure with tape high flow oxygen cover hole for 1s with dinfer and release it for 4s-contonue with intermittent ventilation this is termed jet insufflation and can be maintained for 30 mins auscultate to check for air entry
113
how is the 2 person bougie surgical technique performed?
player in supine and neck neutral locate cricothyroid cartilage 1 person stabilises thyroid cartilage and uses scalpel to make transverse incision over cricothyroid membrane. if not notmal anatomy need a verticle incision to dissect membrane thena transverse incision once transvers eincision made turn the scalpel90 degrees to opn person 1 introduces a bougie through open aiway-dont remove scalpel before inserting person 2 inserts a cuffed size 6 endotracheal tube distaly over the top of the bougue into the cricothyroid membrane incusion person 2 then inflates cuff endotracheal tube as person 1 removes boughie person 1 attaches BVM person 2 observres for chest movement person 2 secures ET tue
114
give some complications of surgical airways?
``` aspiration of blood haematoma formation oesophagueal laceration mediastinal emphysema perforating posterior tracheal wall-bougue negates blood obscuring view ```
115
describe the sequence for the collapsed player in football/
1. personal safety 2. response 3. shout for help 4. painful stimuli 5. ABC if the player responds: A-E, oxygen, AED close if doesnt respond: check mouth, open airway-usualy jaw thrust airway: should feel 2 breaths in 10s and at least 10 heart beats pulse: A_E, oxygen no pulse: CPR and AED
116
what is the technique for CPR?
``` kneel nect to chest centre of chest heel of one hand on chest, fingers interlocking, shoulders over chest and arms straight allow adequate recoil 5-cm compressionin adults 100-120 compressions/min 30:2 ratio ```
117
what is the technique for ventilations/rescue breathing in SCA?
jaw thrust pocket mask may be supplemented with oxyge althouh BVM preferred oral airway inserted asap inspiratory time 1s watch chest rise then fall, give 2 breaths max 4s total when >1 person present 2 person CPR: 1 chest compressions 1 ventiltions ideally ventilation required with 2 person BVM techniquw
118
what is the resuscitation cycle/
30:2 5-6 rounds in the 2 min AED reassessment window change every 1 or 2 mins to avoid fatigue dont stop to recheck unless show signs of regaining consciousness
119
how is an AED used/
appliaed asap ideally on side of pitch restart compression simmediately after automatically reassess rhythm every 2 mins
120
what do you do if the player is not breathin gbut has a pulse?
in resp arrest BVM 10-12/min regular pulse checks when can breathe independently switch to non rebreather mask
121
what is the resus sequence in a child?
5 initial rescue breaths | CPR: 15:2 100-120/min depth 4-5cm
122
when should resus be stopped?
obvious signs normal circulation: pulse, opens eyes, coughing, moving, breathing help arrivs decisions to stop should not be taken pitchside
123
what is asynchroous CPR?
in the presence of a definitive airway igel counts, as does intubation once igel inserted requires 1-2 rounds for seal to form so continue 30:2 then continuous CPR as helps in maintaining perfusion pressure (which drops during rescue breaths and takes 4 rounds to get back to where it was) oxygen does not have to be used for shock with i gel as it is a sealed unit-catheter preferable
124
what is the priority if there isnt a pulse?
CPR and AED
125
what is the sinoatrial node?
in RA near opening SVC | pacemaker-initiates impulses most raoidly
126
what is the atrovetricular node?
in wall of atrial seotum | normall stimulated by impulses from SAN but can inititate own impulses but at a slower rate
127
what is the atrioventricular bundle?
originate in AV node, runs through septu then divides into L anr R bundle branches in ventricular myocardium break off into purkinje fibres
128
what is the commonest type of arrhythmia in SCA?
ventricular fibrillation=1/3
129
what are the shoclable rhythms/
ventricular fibrillation, vebtricular tachycardia
130
what is ventricular fibrillation/
chaotic electrical activity within the myocardium thousands of cells fire ipulses stimulating contraction at different times defib only tx
131
what is ventricular tachycardia/
impulse from within ventricle HR from normal-300bpm defib only tx
132
what safety rules need to be observed before each shock?
no one touches player stand clear shout ensure players chest isnt wet check not in an explosive atmosphere-oxygen should be at least 1m away player not on a metal surface-metal stretcher is fine as long as no one else touching the metal and pads arent on metal ensure pads 1 pads width aware from pacemakers remove any jewelerry and underwire bra if has ICS but hasnt fired then still use AED remove GTN or nicotine patches
133
where are AED pads positioned
sternum and apex (R uoer and L lower) can try anterior posterior if shcoks not effective
134
what are the main non shockable rhythms/
asystole and pulseless electrical activity
135
what is asystole?
lack of any electrical activity | always fatal absent QRS and baseline wander of flat line
136
what is pulseless electrical activity?
non-shockable rhythm electrical activity normal but mechanical function doesnt occur may appear as normal sinus rhythm on monior
137
what is the chain of survival?
early acces to player/prompt recognition of cardiac arrest/urgent call for help, 999 and defibrillator early administration CPR early use of defibrillator early advanced cardiac life supprot/administration of drugs/prompt transfer to definitive care
138
what is an unwitnessed collapse?
cardaic arrest until proven other wise
139
when should you move a player before CPR?
usualy never if have to do in 2 min re analysis windor for max 10s aim for min 2 cycles on scene and organise extrication as agreed priority is to maintain CPR dont move from pitch to room to ambulance
140
what should happe in ROSC
``` monitor ABC high flow oxygen: BVM until RR>10 leave AED pads on keep warm ensure amebulance contacted ```
141
summarise BLS in SCA?
safe approach player response help and AED if unresponsive ABC: look, listen and feel 10s for breathing and oulse chest compressioins and AED pads 999 30:2 adults, 15:2 children 5-6cm adults, 4-5cm children 100-120 bpm each ventilation 1sd high quality CPR and minimal interruptions safe shock return to CPR immediatelt after shock dont stop to reassess unless show signs of life or more help arrives cx spine considerations relaxed in cardiac arrest
142
what drugs are used in a shockable cardiac arrest?
adrenaline, amiodarone
143
how much adrenaline is given in shockable cardiac arrest?
``` 1mg bolus (paeds=0.01mg/kg) 1:10,000 prolonged arrest: after 3rd shock, flush with 20ml saline then every 3-5 min ```
144
how much amiodarone is given in shockable cardiac arrest?
300mg IV blous after 3rd shock 20ml flush 150mg after 5th shock paeds:5mg/kg after 3rd shock
145
what drugs are used in non shockable cardiac arrest?
adrenaline: 1mg 1:10,000 asap, then every 3-5 min
146
what are the reversible causes of cardiac arrest?
4Hs:hypoxia, hypovolaemia, hypothermia, hypokalaemia/hyperkalaemia 4 Ts: tension pneumothorax, tamponade, toxins, thrombosis
147
what is hypothermia?
body temp under 35 degres celcius
148
what is normal body temp?
36.9 degrees celsius
149
what ECG changes are seen in hypokalaemia?
slat T, prominent U, wide QRS | long QT syndrome
150
what ECH changes are seen in hyperkalaemia
tall peaked T degenerateing into sine wVE
151
what is cardaic tamponade/
blood or other gfluid accumulate in pericardium and puts pressure on heart so it cant pump effectively
152
what are the features of cardiac tamponade
hard palpating pulse, jugular vein distension, muffled heart sounds, drop in BP and narrowing pulse pressure, narrow QRS, rapid HR becks triad: distended neck veins, muffled heart sounds, hypotension, kussmauls sign (increased JVP), pulss paradoxus (decrease systolic BP>10mmHg during inspiration)
153
how is cardiac tamponade tx?
oxygen, semi recumbent position, rapid transport to hospital | pericardiocentesis
154
what is the gold standard tx for MI?
primary angioplasty | acute mx: morphine, oxygen , nitrates, aspirin
155
what are the features of MI?
``` severe central chest pain that may readiate to one or both sides of the chest and into the neck, jaw arms or back pain crushing in nature sweatin, faint, giddy, nausea, vomiting sense of impending doom shallow breathing irregular pulse ```
156
what are the clinical signs of a cardiac arrest?
sudden unconsciousness, absence of a major pulse (carotid) | breathing becomes absent and pupils will become dilated and unreative
157
who is death from SCA most common in?
male black 40% <18
158
what are the common initial signs of SCA?
agonal breathing seizure sudden collapse
159
give some e.g.of screening qs for risk SCA?
has anyone suddenly died in your family at a young age have you ever suffered from unexplained faitning episodes or dizziness do you suffer any sob during exercise that is not normal for you do you suffer from any palpitations during exercise that are not normal for you
160
what are common features of the athletes heart?
LV wall thickness increased LV looks like hypertrophic cardiomyopathy
161
what is hypertrophic cardiomyopathy/
familial, hterogenous expression hypertrophied LV, usually most prominant at V septum may narrow outflow tract->mitral regurg may effect muscle contraction leading to AF
162
what are some fearures of hypertrophic cardiomyopathy?
``` chest tightness on exertion palpitations dizziness/fainting sob disproprtionate with exercise heart murmur familial hx sudden death ```
163
what is wolff parkinson white syndrome?
accessory conduction tissue bypasses normal AV node and his-purkinje system ECG: short PR, wide QRS, delta wave before QRS, secnondary ST-T changes
164
what are some sx WPW?
tachycardia, dizzy, palpitations, cardiac arrest, fainting | increased risk ventricular arrhythmia
165
long QT syndrome?
hereditary | disorder of electrical rhythm
166
what are the features of long QT?
susceptible to torsade des pointes: less blood pumed starving the brain QT may prolong during exercise, emotion dont have all the time fainting
167
how is long QT mx?
beta blockers surgery implantable defib
168
what is marfans syndrome?
connective tissue dosrder characterised by skeletal, occular and cardiac abnormalities gene on chromosome 15 for glycoprotein fibrillin
169
what are tje features of marfans syndrome?
tall, chest wall abnormalities, kyphoscoliosis, arachnodactyly, high arched palpate, lens dislcoation, mitral valve prolapse +/- mitral regurg aortic root dilatation->aortic dissection or rupture
170
what is commotio cordis?
no RF-may be more common <16 as less muscle | direct blow causes ventricular fibrillation (usually, can be other arrhythmia)-apex 10-30ms before T wave peak
171
what is viral myocarditiis?
inflammation of myocardium coxsackie virus, enteroviruses can be aggravated by vigorous exercise
172
can you use an AED on a damp pitch or in the rain?
yes | use an umbrella
173
how are spinal injuries classified?
catastrophic: disruption of the ligamentous structures, bony anatomy and injury to spinal cord or adjacent nerve roots. usually results in permanent diability primary cord injury: immediate physical trauma to the cord secondary injury: deleterious effects of the trauma on injure neurones. hypoxia, haemorrhage, oedema
174
what are the types of spinal cord injiry/
complete: no motor or sensory function below the neurologica level inomplete injiry: retention of some sensation or movement. can contract anal spincter voluntarily no neurological deficit:
175
what are the common MOI for spinal cord injury?
``` axial loading (compression) hyper extension hyperflexion hyperrotation excessive lateral flexion unconscious signifnicant distraction injury: pain>7/10, upper thoracic injury ```
176
which MOI in football should have a high index of suspicion for spinal cord injury?
neck/head injury from direct blut trauma e.g. knee to face neck/head injury from indirect trauma through transfer of energy e.g. collision head injuries resulting in altered AVPU or decreased GCS by 1 point fall from twice players height axial spear onto non absorbant surface unconscious significant distraction injury
177
what are common sx in conscious players with spinal cord injury/
``` midline neck pain referred distally from the point of injury painful cervical ROM or reduced ROM disorientation/confusuon paraesthesia or paralysis difficulty breathing loss of bladder/bowel control ```
178
what are featurs of spinal cord injiry in an unconscious player?
``` spinal injury until proven otherwise resp difficulty/diaphragmatic breathing/accessory muscle use spinal colum deformity or haematoma flaccid limbs absent pain response neurogenic shock-dry warm extremities with flushed appearance priapism loss of bladder and bowelr control ```
179
what are on field red flags of spinal cord injury?
midline neck pain painful neck movement restricted/blocked neck movement
180
when should a log roll be avoided?
unstable pelvic fracture/injury multiple rib fractures on one side multiple lower leg fractures
181
what is the priority in a suspected spinal cord injiry?
MILS-also provides a red flag for the medical team
182
what is the MILS position?
thumbs to eyes dont cover ears can be done in any position align players nose with sternum
183
when can MILS be stopped?
secure immobilisation is in place: triple immobilised | ruled out using CCSPinES
184
when is the anterior hold technique used
1st contct takes up this position: 1 hand on forehead the other on sternum cupping chin or around zygomatic arch (pistol) and then the next person who arrives takes on MILS only in supine useful when applying blocks or straps
185
where are HCP positioned in the supine log roll?
1: head-MILS and direct manoevre 2: chest-shoulder and greater trochanter 3: pelvis-hip and upper thigh 4:knee-above knee and lower leg 5: eextrication device 3 hands over and 3 under
186
what communication is important in log rolling?
team leader coordinates | instead of 1 2 3: prepare to roll.... and roll
187
when is the prone log roll carried out?
move if unconscious and prone | consider any injuries when choosing which side to roll
188
what should you do if neutral allignment of the spine cant be achieved/
dont attempt to activelt move into a neutral position | may be because: pain/increasing, mechanical block, crepitus, muscle spasm, neurological sx develop
189
How can MILS be handed over?
using pistol grip: person 1 in MILS, 2 comes parallel and uses pincer grip onto zygoma, states i have control, first person releases MILS and take sup pincer grip on mandible and states i have control, 2 releases and takes up MILS using MILS: next to person in MILS, hans on top, slowly removes 1 hand at a time
190
does ABC have priority over a spina injury?
yes
191
how should he airway be opened in a player with a spinal injury?
jaw thrust if this doest work: modeified jaw thrust-10 degree tilt, any more and cervical spine may be compromised caution with airway adjuncts/suction as may lead to hypotension bradycardia, or cardiac arrest. however airway is the priority so use if necessary
192
what muscles are involved in breathing and their innervation?
diaphragm: phrenic nerve C3-5 intercostal and accessory muscles-multi-level abdo/trunk muscles-segmentaal level innervation
193
why can their be decreased ventilation from spinal cord injiry?
injury to lower C/T: intercostal muscles paralysed therefore dependent on diaphragm, will need oxygen and maybe assisted ventilation C region: diaphragm paralysed and wont be able to breathe-BVM if exercising will likely tbe using all therefore injury will build up lactate therefore need oxygen asap
194
how does spinal cord injury affect the circulation?
neurogenic shock: damage to autonomic nerve supply below level of lesion, resulting in a loss of sympathetic supply and vasomotor tone which leads to vasodilation and blood pooling in peripheral ns
195
what are the features of neurogenic shock?
hypotension, bradycardia, warm and perfued periphery, limbs warm and vasodilated may be the only sign SCI in unconscious player
196
how is neurogenic shock mx?
high flow oxygen and IV fluids if radial pulse lost | manage in supine-careful not to tilt feet down as may exacerbate pooling
197
what is assessed in disability in players with a spinal cord injiry?
AVPU sesation: paraesthesia, dermatomes motor: myotomes
198
do cervical collars replace MILS?
no | only provide 30% support
199
how are collars applied?
must be corrrect size-check brand for sizing info dont use in isolation must be in contact with sternum, clavicles, reapezius muscles and upper posterior thoracic spine head must be midline with chin over central fastener remove hoodie, football shirt fine can be applied before or after placed on spinal board must maintain MILS while applying until blocks and straps are in place
200
when are cervical collars not used?
if neutral allignment cant be achieved use MILS/blocks, padding and tape fracture to jaw, surgical emphsema, fractured larynx-maintain MILS instead
201
when may a collar be loosened?
airway compromise | discomfort
202
what are some complication sof using a collar?
raised ICP->aspiration/vomit->resp compromise->affects airway mx
203
what manoevre is ised to place a player centrally on a LBB?
V-manoevre: slides player down and back up board
204
which straps are applied first when a player is on a board?
body straps before head blocks and straps otherwise if has a seizure the pivot point will be in the neck or if vomits will strain as roll
205
where should the body straps be on LBB?
``` min 4 mid chest pelvis upper thighs lower legs ```
206
what is the LBB used for?
now recommedned as lifting/extrication device only as complications when remain on for a long period of time use a padded board or transfer to a vacuum mattress if going to be over 45 mins transfer time-however this unnecessary movement therefore use scoop stretcher instead
207
what is the advantage of a scoop stretcher/split devce
only need to tilt 15 degrees to be placed on , not 90 like LBB very useful when pelvic injury more comfortable dont need to log roll into bed, can just unclip
208
what are the disadvanatges of the split device?
may not accomodate players who are long (max 2.01m) or broad (max 43cm)-can place inside a basket stretcher to overcome less central spinal column support metal scoop is not recommended for use in football as is a lifting device only should remain on for more than 45 min
209
what is the gold standard spinal immobilisation device?
vacuum mattress | however cant be used a as a sretcher alone, must be on a LBB or SS
210
what are the advantages of a vacuum mattress?
inividually moulded cervical spine support LSA contact so greater comfort reduced risk soft tissue ischaemia
211
what are the disadvantages of a vacuum mattress?
puncture would make useles-caution on grassroot pitches immobilisation takes longer more expensive
212
what is triple immobilisation?
standard by which a cervical spine injry is said to be secure semi rigid collar foam blocks to head straps: forehead and chin improvised triple immobibisation is not acceptabe in preffessional football
213
what is a basket stretcher used for?
often used for limb injuries | when used alone does not provide enough support for spinal immobilidation alone-must be used with LBB or SS
214
when is a seated take down carried out for SCI?
if already semi-recumbent
215
how is a seated take down carried out
supported into supine from seated using modified MILS and place board against back while lowering onto the board at the same time if player is losing consciousness or deteriorating and needs intervention lower straight to ground need 4 people 2 and 3 in mils and extend hands under axilla to grip sinal board handle, 4th holds board from top dont move head more than 10 degrees past neutral-head must stay in contact with board
216
how are vomitingg managed in SCI?
either roll immobilisation device or log roll to prevent airway compromisse
217
how are seizures mx in spinal cord injury?
release manual restraint but continue modified mils ensure airway open if seizure is persistant use IV or rectal diazepam if no RR or HR palpated
218
how do you mx a combative player with a SCI?
dont attempt to restrain or mannually stabilise may need to let go as risk of causing more harm reassure and oxygen
219
how are children with SCI immpbilised/
no specific guides be more conservative and err on side of caution need paediatric collar
220
how is a player on a spinal device extricated?
``` recommends 5 people, 7 for larger player reasses ABC before start team lead at head shortest root feet first ``` motorised buggy
221
how can a spinal injury be ruled our?
ED: NEXUS or canadian c spine rules | in sport; CCSPinES
222
what are the canadian c spine rules?
for alert and stable trauma patients high RF which mandates radiography: >65, dangerous mechanism (fall from elevation-3ft, axial load to head, mvc high speed, motorised recreatiojal vehicle, bicycle collision), parenthesis in extremities low RF: simple rearend MVC (pushed into oncoming traffic, hit by bus, roll over, hit by high speed vehicle), seated or ambulatory, delayed onset neck pain, absence of midline C spien tenderness if low RF can safely allows ROM: rotate neck 45 degrees L and R if yes no radiogrphy
223
what are the NEXUS criteria for c spine injury?
``` no posterior midline cervical spine tenderness no evidence intoxication normal level of alertness no focal neurological defecit no painful distracting injuries if meets all no radiography ```
224
what are the clearing the c spine in sports and events criteria?
1. any high RF orsigns or sx that mandates immbobiisation: MOI (fall from twice height, axial load collision, significant distracting injury, unconscious on field of play, thoracic injury with pain >7/10) sx (paralysis, parasthesis, ataxia, seizures, GCS<15) if yes then immobilise, if no asses for low risks low risks: ambulatory, absence midline spine tenderness, no immediate neck pain if meets all ccan test ROM: rotate 45 degrees L and R
225
what is the JRCALC spinal injury suspicion?
unconsciousness is unwitnessed midline cervical/thoracic/lumbar spine pain or tenderness head injury abnormal focal gross neurological signs or sx/paraesthesia/anaesthesia/weakness/paralysis blunt trauma above clavicles intoxication with alcohol or drugs suspicious MOI painful distracting injury decreased response lack of full head control/painful active neck ROM
226
how do you manage the walking spinal injured player/
standint take down: upright against spinal board, supine, immobilised adapted MILS: 1 person either side of player walk from play to medical room and try algorithm to rule out, if cant then immobilise
227
how do you resuscitate someien with a SCI?
try and move gently but dont waste time
228
give the summary of mx a conscious player with a SCI/
``` dont move unless in immediate danger A-E with MILS dont release MILS until on board and triple immobiilised open airway: jaw thrust 100% oxygen if stable consider exrtication if in doubt immobilise and secure movement only by fully trained people ```
229
how is a player with a SCI that is unconscious mx?
dont move unless in immediate danger MILS check inside mouth and jaw thrust-airway is priority, if cant be maintained in position player is in will have to move keep the player still and warm
230
what is the key dimension when sizing a cervical collar?
trapezius at base of neck and a line that would transect the chin
231
how are head blocks applied?
``` player is central on device body strapped c spine control with MILS person 2 prepares blocks and puts straight edge to players head and placed on velcro over person ones hands, once both block sin MILS on outside of blocks, person 2 attaches chin and forehead straps OR ``` can be done by transferring to pincer grip then putting in place for the SS angled edge next to head straps preattached ina H format but in same position
232
how si the player secured to a vaccuum mattress?
mannualy smooth out beads first place the player in the split device on the vacuum mattress and then remove thes split device attach restraint strap: brings sides around player push beads away from above players head. shape around head and full voids by shoulders and base of neck secure head with blocks ans straps
233
how is the walking player with a SCI mx?
``` person 1 takes up MILS facing player 2 and 3 place 1 hand in MILS and the other linking the players arm person one removes MILS take to predertimed location assist to supine and immobilise ```
234
what are the main causes of unresponsiveness on the field of play?
``` SCA head injury syncope asphyxia heat exhaustion epileptic seizure hypoglycaemia hypovolaemia ```
235
what are some features of scalp wounds/
usually from direct trauma player may be dazed or confused, may have concusion often bleeds a lot
236
where may skull fractures occur
fracrured vault of skull: if scalp wound generally assume fracture depressed fracture: direct blow, may be adent, caredufl handling as underlying structures may be damaged base of skull: indireect force e.g blow to jaw. may be aleak of CSF from ear or nose
237
wht is the lucid interval?
after a brain injury plaer appears conscious and talking untilpressure due to clot increases and has effects
238
what is coning?
effects vital centres resulting in life threatening CVa nd resp abnormalities first sign is player becoming confused and disorientated
239
what can cause dilated pupils?
fright, brain deprived of oxygen, drugs (atropine)
240
what can cause constricted pupils?
narcotics OD disorders affecting CNS bright light
241
what can cause unequal pupils?
head injury stroke (dilate on afected area) congenital
242
what are some common features of an acute concussion?
headache, feeling in afog, emotional liability loss of consciousness, poor coordination/balance, seizure, slow to answer qs or follow directions, easilty distracted, N+V, vacant stare, slurred speech, double vision, slowed reaction time personality changes, inappropriate behaviour, irritabilty, inannproproate emotions
243
what are the signs of concussion the same as?
a mild, moderate or early severe brain injiry
244
can someone with concussion sx play on?
no
245
what is concussion/
an injiry to the brain resulting in a disturbance of brain function
246
how does concussion affect those under 18?
more susceptibel to brain injiry take longer to recover have more significant memory and mental processin gissues more susceptible to complications including death by a single or second impact
247
does a concussion increase the risk of further concussion?
yes
248
what proportion of players with concussion lose consciousness?
less than 10%
249
what qs can be asked to assess for concussion/
what venue are we at which half/what time who scored the last goal/how did you get here whic team did you play last/where were you this time last week did your team win the last game/what were you doing this time last week
250
which sx of concussion suggest the need the urgent medical care?
severe neck pain, deteriorating consciousness, increasing confusion, severe or increasing headache, repeated vomiting, unusualy behaviour change, seizures, doubles vision, weakness/tingling/burning
251
what should someone with a concussion not do?
be left alone in first 24 hrs consume alcohol for 24 hrs drive until given clearance/no sx
252
how long does each RTP stage take?
adults: stage 1=14d, others 24, min 19d child: 1=14d, min 48 for others, min 23d
253
how many stages of retuen to play are there?
6
254
what happens at stage one in concussion RTP?
initial rest | after 24 hrs can reintroduce activities of daily living but if cause sx shouls rest
255
what happens in stage 2 of RTP?
walking, jogging, swimming, no sport or resistnce trainingn, weightlifting HR<70% under 15 mins aims to increase HR
256
what happens at stage 3 of the return to play?
simple movement such as running drills under 80% HR under 45 mins aims to add movement
257
what happens at stage 4 RTP?
complex training e.g. shooting, small sided games. resistance training, no head impact under 90% max HR under 60 mins aims: exercise, coordination an dskills
258
what happens in stage 5 return to play?
normal training | aims to restore confidence and assess functional skills
259
what happens in stage 6 return to plaey?
fully rehabed
260
when can a player progress to the next stage in the return to play?
if no sx and min time reached | should only leave datge 1 if no medication and doing normal work/school
261
what should a player do if they get sx while going through return to play?
rest for 24 hrs (48 if u19) and return to previous stage
262
which stages is it recommended to have clearance from a HCP?
before enters stage 5
263
how are recurrent concussions managed?
2nd concussion within 12 months, hx multiple concussions, unusual presentations or prolonged recovery should be managed by HCP with experience in sports concussion and MDT
264
what are the min criteria for an enhanced care setting (faster RTP following concussion)
Dr with experience in mx of concussion available to supervise player and clear prior to RTP baseline SCAT5 before injury clinical serial multimodal assessment post concussion to guide protocol formalised GRTP with regular SCAT5 recored in notes access to MDT inc neuropsycology/neurology/neurosurgery documented concussion education programme for all coaches and players in the team involved
265
what is the min return to play after concussion in the enhanced care setting?
adults: d6 children: d12
266
how long is each stage in the enhanced care setting RTP following concussion?
adult: all 24 hr | <19: stage 1=7d, others 24 hr
267
when is clearance by a dr needed in the enhanced RTP setting following concussin?
after stage 1 and 4
268
which head injury sx need urgent referral to hospital?
``` fractured skull penetrating skull trauma deterioration consciousness focal neuro sx confusion/impariment consciousness >30 mins LOC >1 min persistent vomiting or icnreasing headache convulsios more than 1 episode concussion in match/training (should never happen) assessment difficulty e.g. aggressive all <18 high risk e.g. haemophilia inadequate post injury supervision high risk MOI e.g. high velocity impact ```
269
which parts of the face are fixed?
upper: frontal bone mid: orbital, nasal, mxaillar,a dnzygomatic bones
270
which parts of the face arent fixed?
lower face: mandible-articulates with skull through TMJ
271
where is the paranasal sinus?
mid face
272
how should facial injuries be initially assessed?
A-E often bloody injury delt with in E if blnt trauma apply MILS unti can rule out, also consider concussion
273
what facial injuries are likely to cause airway ciompromise
mid face fracture | haemorrhage into oral cavity as a result of a fracture, soft tissue or internal mucosa trauma
274
how should the airway be managed in facial injuries?
traditional airway ladder early suction and use of magils forceps to remove excess saliva, blood or teeth CI to adjuncts: NPA in base of skull fracture
275
should conscious playeys with a facial fracture and hameorrhage sit up/
yes-upright with head forward to allow postural drainage | however need to rule out c-spine
276
what is a methodocial order for a facual examination?
frontal area, orbits, eyes, nose, maxilla, zygoma, TMJ, ears, mandible, mouth
277
how should the face be examined?
directly in front look for asymetry avoid aggresive palpation
278
how are orbital fractures often caused?
inferior wall often fratured when direct blow to eye rather than a ruptture of the globe. this is a protective mechanism
279
what suggests tethering of the inferior rectus muscle?
limitation of upward gaze
280
what suggests infra-orbital nerve injury?
numbness of face below the eyes or upper gums
281
what are some sx of an orbital fractre?
``` orbital ecchymosis diplopia reduced eye movements/limitation of upward gaze enopthalmus surgical emphysema epistaxis infra-orbital/upper gum numnbess may only become apparent when blow nose and force gas through fracture-therefore ask to not blow nose ```
282
what are some features of a nasal fracture?
``` deformity epistaxis bruising/swelling impaired breating out of nostrils dorsal tenderness mobililty/ crepitus septal deviation/septal haematoma ```
283
how are nasal fractures managed?
check septul with nasal speculum if cant breathe due to septal disclocation try and relocate using finger if septal haematoma urgent ENT referral usually inappropriate to relocate on field of play-ice pack for 10 mins and ED
284
what are some sx of maxillary fracture?
``` swelling elongation of facial skeleton malocclusion diplopia telecanthus bilateral subconjunctival haemorrhage bilateral periorbital ecchymosis dystopia CSF rhinorrhoea altered sensation of lateral nasal and infraorbital skin altered sensation of maxillary teeth ```
285
how are maxilary fractures mx?
may cause bony instability and airway compromise | if cant maintain airway may need to draw an unstable segment forward to open
286
what is the typical MOI of a zygomatic fracture/
direct blow to lateral face
287
what are some features of zygomatic fracture/
``` focal pain palpable step deformity ecchmosis laceration cant open and close moth difficulty swallowing ```
288
how are maxillary fractures classified?
le fort classification I, II, III increasing area invovled
289
how is a zygomatic dislocation mx?
if TMJ dislocated and no crepitus/evidence of fracture may relocate if experienced-thumbs in mouth and fingers on mandible and move inferoposterior
290
what commonly causes mandibular fracture?
blow to chin | usually doesnt occur in isolation
291
what are some features of a mandibular fracture/
``` focal pain restriction of jaw movements/trismus malocclusion intra-oral contusion/swelling visible step deformity/teeth mal-allignment bleeding from gingiva mobile or avulsed teeth sub lingual haematoma paraesthesia of lowerl lip/chin bleeding in external auditory canal ```
292
what is hyphema?
bleeding from iris vessels | may suggest deeper injury and can raise pressure in the eye
293
what is exophthalmos?
globe is more prominant | such as hamatoma behind the eye
294
what is enophthalmus?
globe sunken | e.g. due to eye ball dropping through fracture
295
what is retrobulbar haemorrhage?
rare, sight-threatening complication orbital and zygomatic fractures due to bleeding within confined space of orbital peiosteal envelope-increases pressure on central artery of retina
296
what are some features of retrobulbar haemorrhage?
``` diminishing visual acuity loss of pupil reaction ophthalmoplegia increasing globe pain proptosis ```
297
what equipment might you need to treat eye injuries on the field of play?
``` pen torch/ophthalmoscope saline irrigation cotton buds fluorescein eye drops eye pad and tape broad spectrum abx drops topical anaesthetic drops 1L saline bag and giving set ```
298
how should an eye assessment be carried out?
hx and sx inspection: conjunctival haemorrhage, changes in contour of globe, hyphaemia, iris or pupil irregularity acuity visual fields: guadrants movement: H pupillary response: direct and consensual fundoscopy fluorescein staining and subtarsal foreign body searc adjacent structure assesment if any present reomove from field and send for assessment
299
what eye injuries need follow up?
all except mild corneal abrasions if no dr present need to go to ED if can apply abx drops and eye pad may have assessment next day
300
what is the common MOI of epistaxis?
direct blunt blow to nose e.g. eblow
301
what are some features of epistaxis?
bleeding from one or both nostrils localised pain/tenderness at point of impact nasal deformity/swelling difficulty breathing ghrough one or both nostrils
302
how is epistaxis mx?
A-E +/- MILS suitable posiiton and reassure lean head forward and breathe through mouth gauze swab and external digital oressure by pinching cartilage for min 10 mins if controlled insert cotton dental roll-may allow to continue plating if bleeding cant be stopped remove from game and nasal tampon dont blow nose or snifff for 10 mins rest and avoid exertion over next few hours
303
how can profuse epistaxis be mx?
nasal plug nasal packing: if no skull fracture. is an intranasal device hospitl
304
how is contusion managed?
if no significant underlying injury | compression with ice to reduce swellin, bruising and tenderness
305
which teeth are most commonly injured?
maxillary incisors
306
how should fracture through tooth into dental pulp be mx>
often painful | dressing over exposed pulp
307
should a subluxed tooth be realligned?
yes | ask to lightly bite down on gauze swab
308
how should a fully avulsed tooth be mx?
dont touch rooot if can re-implant: not in children, bite down on gauze until reach dentist if cant reimplant then store in hanks balanced salt solution, milk, players saliva, held in buccal sulcus (not children) and reimpant asap (usually successful within 4 hrs)
309
where is the carotid pulse and systolic pressure?
lateral to thyroid cartilage and deep to SCM | 60-70mmHg
310
where is the femoral pulse and systolic pressure?
1cm below mif inguinal point | 80mmHg
311
where is the radial pulse and systolic pressure?
lateral to flexor carpi radialis on volar aspect of wrist | 90 mmHg
312
what is blood pressure?
pressure circulating fluid exerts on a blood vessel
313
what is capillary refill a marker for
volume status- in hypovolaemia blood distributed centrally
314
how is CRT determined?
pressure on sternum (best) or distal finger for 5s, colour should come back in 2s
315
how may external bleeding appear at source?
arterial: spurts to pulse rate venous: constant flow capillary: oozes to wound surface
316
when does catastrophic bleeding occur?
damage to major vessel | would bleed to death in minutes
317
where is blood often lost?
``` on the floor kit wound dressings thoracic cavity: haemothorax abdo cavity: spleen, liver pelvis closed fracture sof long bones-femurs retro-perioneal-kideneys ```
318
what are some other signs of bleeding?
``` faint nausea thirst agitaed dizzy cold/shiverng blurred vision ```
319
how much blood is often lost in fractures?
<500mls: tibia, fibula, ankles, wrist, arm. due to tight fascial compartments 1-2L: femur
320
how can blood loss from fractures be reduced?
longitudinal realignment and splinting
321
how is external bleeding mx?
open airway oxygen therapy check for foreign bodies clean dressing and pressure sitting or lying to slow HR immobilising and elevativ injured area indirect pressure if foreign body but not tourniquet check pulses regularly-distal if foreign body leave in and dress around if continues to bleed apply indirect pressure (femoral or brachial) for 10 mins, release to allow colour back and repeat if necessary
322
what types of shock are commonly seen in football?
hypovolaemic anaphylactic cardiogenic
323
what causes cardiogenic shock?
poorly functioning heart
324
what causes hypovolaemic shock?
too little fluid in circulation
325
what causes neurogenic shock?
inefficientnervous control of blood vessels
326
what causes anaphylactic shock?
reaction to injection/sting that reduces preipheral resistance and venous return
327
what causes toxic shock?
peritonitis | meningococcal meningitis
328
what can cause shock?
internal/external bleeding->hypovolaemia illness allergic rxn
329
what are some features in hypovolaemic shock?
blood loss increasing RR reducinig or absend radial pulse
330
how much blood can be lost without a physiological consequence?
500ml
331
how much blood is in an adult?
5L
332
how many stages of hypovolaemic shock are there/
4 | only apply to >12
333
what occurs in the first stage of hypovolaemic shock?
up to 15% blood loss: pallor, CRT<2s, HR up to 100bpm, no change in BP systolic BP being maintained through compensatory mechanisms mediated through thte autonomic NS
334
what occurs in the second stage of hypovolaemic shock?
15-30% blood loss pallid, cool, clammy skin, CRT>2s, HR>100bpm, normal systolic BP but increased diastolic body is at limit of compensation
335
what occurs in stage 3 of hypovolaemic shock?
30-40% blood loss | anxiety, restlessness, agitation, increased RR, HR>120bpm, systolic BP<100/loss radial pulse
336
what happens in stage 4 of hypovolaemic shock
>40% blood loss moribund appearance, central cyanosis, altereed consciousnes, tachycardia and weak pulse, resp distress, systolic BP<70 and absnet radial pulse
337
how is shock mx?
``` open airway high conc oxygen immobilise fractyresm control bleeding IV access keep at normal temp raise legs for blood flow to organs if possible avoid unnecessary movement reassurance check pulse, breathing, consciousness NBM ```
338
how many attempts at cannu;ation should be made outside the hospital?
3
339
what is prophylactic cannulation/
if a player may deteriorate | strict guideaance pre-hospital due to infection risk
340
what is proactive cannulation?
if need immediate drug therapy pain relief, arrhythmias, cardiac arrest fluids: trauma, dehydratiom, fractures, shock
341
which size cannula should be used>
smallest possible | in emergeny: short and thick does the trick
342
what are the different sizes of cannula?
``` orange: 14G 3.5 mins to infuse grey=16G 6 mins green=18G 10 mins pink=20G 15 mins blue=22G 22 mins ```
343
what equipment is needed for cannulation?
cannula, tourniquet, alcohol swab, gloves, sharps bin, gaueze, tape, saline flush
344
describe the cannulation protocol?
``` explain procuedure tourniquet and clench fist sterile swab area skin tight pierce skin-flashback lower parallel and advance 5mmm and withdraw sttlette as insert=2nd flashback release tourniquet cap on cannula secure with dressing flus with 5ml saline ```
345
which fluid is normally administered?
normal saline (0.9% NaCl)
346
what are crystalloids?
e.g. saline | safe and versatile but rapidly distributed through whole body
347
what are colloids?
larger molecules, stay in circulation longer, more direct effect on vascular vol but less on a cellular level
348
what fluid bolus should be given and when?
if radial pulse absnet | 250ml crystalloid
349
how should fluid be administered?
fluid elevated and seal removed from giving port close flow regulator on giving set pump chambers on givign set until half full release flow regulator and allow fluid to fill tubing to luer lock release luer lock and get rid of air bubbles attach fluid to cannulae
350
why may an inusion fail to run/
``` blood clot in canula giving set tube kinked tourniquet on obstructed cannula against vein wall or valve flow regulator closed canula not in vein ```
351
when may IV fluids make bleeding worse?
damage d liver bleeding slightly due to haematoma | fluid disrupts haematoma making bleeding worse
352
which type of shock may IV fluids not help?
neurogenic: loss of peripheral vascular tone so circultion has greater space to accomodate added fluid
353
which route shouls be used for immediate vascular access
IV | if cant get then intraosseous
354
how much saline is needed for effective wound cleaning?
250-500mls
355
where are common sites for internal bleeding?
``` thoracic cavity abdo cavity retroperitoneal cavity pelvic cavity closed fractures of long bones-femur ```
356
what should indirect pressure be applied with?
fingers or thumbs-whichever can exert the most pressure
357
what is a closed fracture?
clean break and usually no complications
358
what is an open fracture?
skin broken by bone | high risk infection
359
what is a complicated frature?
complications e.g. neurovascular compromise
360
what is a greenstick fracture?
often in children bone is split but not totally severed if dont notice could lead to permanent eformity
361
what is a stress fracture?
caused by repetitive stress over time | often tibia or navicular
362
what are common places for discloations?
patella, shoulder, jaw, thumb, finger
363
what is a fracture dislocation?
simultaneous fracture and partially/fully dislodged joint
364
what are some features of fractures/
``` pain at site of injury loss of movement and power deformity, swelling, asymmetry shortening of limb tender to touch crepitus inability to wt bear associated paraesthesia ```
365
how should fractures be mx?
DRABCDE and MILS MOI, signs and sx aware of distracting injuties assume fracture if in doubt reassure dont move until fulll assessment-need to expose area if upper limb and player is mobile may need to support limb and assist into medical room consider entonox/penthrox oxygen therapy-promotes recovery check allignment and tenderness neurovascular statys: distal pulse, sensatin, temp, CRT spport and immobilise dress open fractures if deformed but circualtion and neurology intact can splint in situ if unstable: held firmly above and below and splinted, may need reallignment keep warm
366
how should you manage a fracture with a compromised circulation or neurology?
neutral alignment | check distal pulse
367
what should you do if neurovascular status has decreased after splinting?
if was prsent before then slowly move back until pulse felt and splint there unless pelviv fracture: leave brace in place and note time ulse lost
368
how are pelvic fracture mx?
``` suport with brace/straps/bandage at level of greater trochanters secure tightly check NV status before and after 100% oxygen if legs splayed tie together aid under knees and seesaw up IV access do not roll player ```
369
what does the deep peroneal nerve supply?
anterior compartment sensation: dorsal 1st web space test muscle: extensor digitorum longus-lift toes
370
what does tibial nerve supply/
deep posteriro compartment sensation: sole of foot action to test: curl toes
371
how can nerve supply to superficial psoterior compartment be tested?
gastroc and soleus-push down foot
372
what does superficial peroneal nervre supply?
peroneal compartment | sensation: dorsum of foot
373
what does saphenous nerve supply?
sensation: medial border of foot
374
what does the sural nerve supply?
sensation: lateral border of foot
375
how should neurovascular assessment be done?
``` stability: hold above and below injury exposure vascular assessment: colour, CRT, pulses (foot=dorsalis pedis and tibialis posterior) sensation motor: curl toes, squeeze hand ```
376
when should the limb be realligned?
1 attwmot in the medical room | if inexperienced and intactNV hen splint in vacuum splint and hospital asap
377
what does increased pain with reallignment suggest?
high probabiliy fracture therefore splint
378
what type of shoulder dislocation can be done pre-hospital?
anterior
379
how are anterior shoulder dislocations relaoctaed?
spaso technique | hold arm at wrist and forearm, verticle traction until 90 degrees then externall rotated
380
when can players return after dislcoation/
never shoulders or elbow | can after PIPJ/DIPJ
381
describe the stimson technique for shoulder relocation?
lie prone with arm hanging down from plinth | traction down to wrist or hold a small weight
382
where is acute compartment syndrome common?
lower limb and foreearm
383
what are the features and causes of acute compartment syndrome/
bleeding into fascial space with little room for swelling pain out of proportion with injury skin pale, mottled,, shiny movement causes pain late signs: paraesthesia, paralysis, pulselessness
384
how is acute compartment syndrome mx?
needs emergency surgey | traction splint e.g kendrick
385
what signs are common with chest injuries?
``` difficulty breathing haemoptysis increased RR unequal chest movements pain at site of injury ```
386
how should altered RR be managed?
increasing: >30=urnet transfer | <10=assisted ventilation, be ready for resus
387
how should penetrating chest wounds be covered?
russel or asherman seal | NOT 3 sided dressings
388
what is the purpose of a splint?
``` immobilise limb reduce pain prevent further damage reduce bleeding from moving fragments minimise progress of shock ```
389
what must a splint be to be useful?
long enough to immobilis the joint abive and below the fracture wide enough for full support well padded strong enough to prevent movement
390
what fractures are arm slings used for?
``` upper arm collar bone shoulder ribs, sternum, scapula wrist hand forearm ```
391
which type of sling is best for shoulder injuries?
broad-supports beneath elbow
392
what type of sling do hand and wrist injuries need?
elevation sling to minimise swelling
393
what type of support do long bone injuries in the arm and forearm ned?
malleable splint, crepe bandage, broad sling
394
how are broad slings applied/
``` arm at right angle, slightly inclined sling between arm and body point underneat and beyond elbow lower end of bandage up over arm tied above collarbone at same side as injured arm tips of finger svisible ```
395
how are triangular slings applied/
injured arm diagonally across chest with fingertips on collar bone base of bandage parallel to body on uninjured side sling under affected arm, elbow, wrist and hand tied above collar bone on uninjured side
396
should you insist on placing arm in a sling?
no should be allowed to support own limb if alrady doing so improvised sling: pulling shirt over elbow
397
what is entonox and its CI/
inhaled nitrous oxide | allergy, head, facial or chest injury
398
what is penthrox and CI
the green whistle | CI: head injury
399
what are the componenst of the kendrick splint?
``` ankle hitch upper thigh system traction pole knee elastic straps thigh elastic strap ankle elastic strap ```
400
how is the kendrick splint applied?
ankle hitch slightly ablve ankle bone tighten stirrrup by pullign green tapped strap until snug under heel upper thigh strap close to inguinal region, seesaw into place and engage the strap in place in the crouch region snap out tractio pole from folded lie it outside of leg so it extendsjust below heel a few inches, if too long bend it over to adjust place pole in outer loops, outer thigh and beneath ankle secure elastic strap around knee apply traction by pulling loop into ankle at desired tension strap the ankle and hip straps in place splint is applied recheck NV status
401
how is a box splint applied?
slide under slightly elevated leg, wrap around ensuring foot in neutral, lower leg recheck NV before fastening secure straps recheck NV
402
how is a vacuum splint aplied?
when neutral allignment cant be obtained once supported wrap the splint around the limb, valve attached to a pump deflates the splint removing air so it is moulded around limb recheck NV
403
how long does it take penthrox to be effective?
6-10 inhalations
404
what is the max dose of penthox as analgesia/
6ml 15ml in a week consecuive days of use not recommended
405
how is penthrox prepared?
activated carbon chamber inserted into dilutor hole on top of inhaler (deactivates agent on expirations and prevents staff inhaling) remove cap from vial and inhaler inhaler to 45 degrees and tip vial into base while rotating the green whistle loop over wrist, inhale through mouthpiece and exhale into inhaler inhale intermittently and will last 1 hr
406
what are the features of anaphylaxid?
``` due to histamine itching flushing nausea vomiting diarrhoea urticaria angiodema conjunctivits rhinitis bronchial asthma bronchospasm laryngeal spasm stridor breathlessness, cyanosis central vasodilation hypotension anaphlactic shock ```
407
how is anaphylaxis mx?
lie down open airway oxygen 15L/min non rebreathe mask adrenaline 0.5mls 1:1000 in adults IM (may have epipen) into middle 1/3 vastus lateralis monitor airway, breathing, BP and pulse pressure no improvement after 5 mins: 2nd dose hospital
408
what are the features and mx of a mild allerguc rxn?
urticarial rash chlorpheniramine 10mg IV 2nd line: hydrocortisone 200mg IV
409
what is are the features and mx of a moderate allergic rxn?
urticarial rash and minor lip/tongue swelling | chlorpheniramine 10mg IV and hydrocortisone 200mg IV
410
how is a moderate allergic rxn with breathlessness mx?
chlorphenarmine 10mg IV hydrocortisone 200mg IV salbutamol nebuliser 5mg
411
what are the features and mx of a severe allergic rxn?
immediate and preogresive lip tongue sweklling and stridor chlorphenarmine 10mg IV hydrocortisone 200mg IV salbutamol nebuliser 5mg IM adrenaline 500mcg 1:1000 every 5 mins if needed IV fluids 0.9% saline
412
when does exercise induced asthma occur?
typically 15 mins after starting exercise | but ca be sooner in cold dry conditions
413
how can exercsie induced asthma be prevented?
prophylactic beta2 agonists or sodium cromoglycate inhalers or oral leukotreine antagonists before exercisse tight overall control
414
what percentage of those with asthma have exercise induced sx?
upt to 90%
415
what are some features of an asthma attack?
``` coughing wheezing anxiety/distress difficulty speaking breathless tachnpnoeic >25 tachycardic >110 tight chest exhaustion LOC ```
416
how are asthma attachs mx pitchsside
reassure sit in a comfy position and lean forward and loosen tight clothing help administer ow n salbutamol idealy throigh a spacer if RR high slow steady breaths dont leave unattended no improvement take 2 puffs every 2 mins up to a max 10 puffs nebulised salbuatmol as alternative: 5mg flow rate 5-8L/min oxygen-can repeat dose (dose 2.5mg children) hospital
417
why can life threatening attack cause pneumothorax?
severe bronchonsriction and gas trapping high airway pressures to achieve ventilation
418
when can aplayer return to play after an asthma attack?
if no sx | if sx continue should cease activity for the day
419
what causes type 1 diabetes?
failure to produce insulin
420
what causes type 2 diabetes?
body doesnt produce enough insulin or use it properly
421
what causes hypoglycaemi\?
imabalnce between training and nutrition heat, altitude more rapid onset in diabetics
422
what are the early features of hypoglycaemia?
``` poor decision making reduced skills as decreased coordination fatigue yawning confusion can occur hours after exercise as increased insulin sensitivity ```
423
how is hypoglycaemia mx/
conscious: 20-20mg glucose every 10-15 min: 3tsp sugar, hypostop gel, 200ml full fat milk, 90mls coke unconscious: 1mg IM glucagon, 50ml 20% glucose IV or hypostop gel/jam into buccal mucosa
424
how dies exercsie effect elipely?
may decrease freq seizures not excluded from sports need medciationa nd safety
425
how are epileptic fits mx?
mostly self limiting just ensure airway, RR, HR | if prolonged: oxygen, diazepam IV 0.1mg/Kg or PR, or lorazepam
426
what are the most common causes of seizure in football?
HI, hypoxia
427
how are seizures mx?
``` A-E + MILS airway-jaw thrust oxygen B and C i concussion will be self limiting if hypoxia: airway and oxygen if HI: manage what see if epilepsy: dont fixate ```
428
what is the effect of exercise on URTI?
regular moderate decreases rates high intensity inceases risk recurrent infections sign of overtraining
429
how can athletes decrease infections?
``` minimise exposure: contacts hand washing monitor training control diet: aa reduce environental stress flu jab ```
430
can athletes train if unwell?
only if sx abve neck: nasal congestion, runny eyes
431
what is level 1 PPE/
surgical mask
432
what is level 2 PPE/
surgical mask, gloves, apron +/_ eye protection if risk of splashes
433
what is level 3 PPE?
gloves, filtering face piece respirator, eye protection, long sleeve fluid repellant gown
434
what PPE level is usually used in football/
2
435
what self screening qs for covid can be done before training?
``` high temp >37.8 degrees new continuous cough sob sore throat loss or change in normal taste or smell feeling generally unwell persistantly tired close contact/living with a confirmed or suspected case of covid 19 in past 2 weeks ```
436
how do you manage an acutelt ill suspect covid case at training?
separate from group | ensure safe: do they need a and e or can they go home
437
what are the changes in CPR during covid?
level 2 ppe dont check mouth for breathing cover nose and mouth with a towel before CPR no rescue breaths in adult if not wearing PPE stand abck still 5 breaths at start and rescue breaths for children
438
what needs a higher level of PPE than 2?
LOC, compromsied airway, facial bleeding, rescue breathing for adults
439
what players are on the low risk covid pathway/
bubbles, screening for sx, testing twice weekly
440
what are the PPE changes if on alow risk covi pathway
only need level 2 for AGP in a separate room
441
what order do you don PPE/
``` hand wash iner glove cover all mask goggles gloves ```
442
what order do you doff PPE/
``` gloves gown shoe cover goggles mask inner glove ```
443
what care is required post resus?
AB: oxygen sats 94-98%, advanced airway waveform capnography, ventilate lungs to normocapnia C: 12 lead ECG, IV, SBP>100, crystalloid fluid, intra arterial BP monitpring, consider vasopressor/inotrope to maintain SBP temp 32-36 degrees-avoid fever cardiac casue: if ST elevation coronary angiography +/- PCI consider CT brain
444
what is the AED checklist for clubs?
``` do you have AED storage: inside, outside, locked, code who has keys/code heated cabinet outside where is nearest AED and whol colects register with local ambulance nominated person to care and service how often battery checks and record ```
445
when is a pharmacologically assisted laryngeal mask insertion done?
all else failed cant deliver RSI patient hypoxic
446
how can a pelvic major haemorrhage be managed on pitch?
pelvic binder

trauma (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions