Chapter 12 - On-the-Field Acute Care and Emergency Procedures Flashcards Preview

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Flashcards in Chapter 12 - On-the-Field Acute Care and Emergency Procedures Deck (93):
1

Parts of an EAP

personnel and corresponding roles

available emergency equipment

procedures involving removal of equipment

phone numbers

keys should be accessible

inform members of the EAP

assign roles

carry contact info

EAP should include procedures for spectator injury

good relationship with local EMT's

obtain consent form minor's paretns

2

emergency call information given:

type of emergency situtation

type of suspected injury

present condition of athlete

current tx being applied

location of telephone being used

exact location of emergency

3

primary survey

assesses life-threatening injuries (CAB)

check, call, care

4

administering supplemental oxygen

bag-valve mask, pressurized cylinder of oxygen (10-15 L/min)

5

Venous hemorrhage

deep red with continuous flow

6

capillary hemorrhage

reddish, exudes from tissue

7

arterial hemorrhage

bright red, spurting

8

signs of shock

low blood pressure (systolic

9

secondary survey

pulse, respiration, blood pressure, temp, skin color, pupils, level of consciousness, movement, abnormal nerve response

10

pulse

(80-100 bpm)
rapid/weak may mean shock
bleeding
heat exhaustion
rapid/strong - heatstroke or fear

11

respiration

(12-20 breaths per minute)

12

blood pressure

(120/80 mm Hg) - high is 140/90

13

temperature

98.6 degrees
hot, dry (disease, infection, overexposure to heat); cool, clammy (trauma, shock, heat exhaustion)

14

skin color

flushed/red (heat stroke, sunburn, allergic reaction),

pale/ashen/white (insufficient circulation, fear, shock, hemorrhage, heat exhaustion, or insulin shock);

bluish/cyanotic (airway obstruction or respiratory insufficiency);

yellow/jaundice (liver disease or dysfunction)

15

pupils

one/both dilated (head injury, shock, heatstroke, hemorrhage);

unequal response to light (brain injury, alcohol/drug poisoning)

16

level of consciousness

alert, confused, drowsy, unresponsive

17

movement

bilateral deficits in UE (cervical injury) or lower extremity (injury below spine)

18

abnormal nerve response

numbness/tingling (nerve or cold damage)

blocking of main artery (severe pain, loss of sensation, lack of pulse in a limb)

complete lack of pain/awareness (shock, hysteria, drug usage, spinal cord injury)

19

crutch fitting

place tip 6 in anteriorly, 2 in laterally

2-3 finger widths under arm

arm flexion of 30 deg

place crutch 12-15 inch ahead and swing through

one crutch: hold truth on uninjured side and move crutch simultaneously with injured leg

20

Rules of every EAP (4)

1. every org that sponsors athletic events should have a written, structured EAP

2.) coordinate it with local EMS,s school public safety officials, onsite first responders, medical staff, school administrators

3.) specific to each venue

4.) px annually with all those involved

21

EAP should focus on these guidelines (3)

1.) instruction, preparation, expectations of all involved

2.) health care profs who will provide med care during px and games and supervise the execution of the EAP with respect to med care

3.) precise prevention, recognition, and tx and RTP policies for the common causes of sudden death in ahtletes

22

common causes of sudden death in athletes

Asthma
Catastrophic brain injury
cervical spine injury
diabetes
exertional heat stroke
exertional hypothermia
exertional sickling
head down contact in football
lighting
sudden cardiac arrest

23

Prevention and screening of ashtma

-thorough med history and exam

-structured warmup protocols

educate athlete about use of asthma meds, spirometry devices, triggers, s/sx, compliance

24

recognition of asthma

confusion, sweating, drowsy, forced expiratory volume in the first second of less than 40%, low o2 saturation, use of accessory muscles for breathing, wheezing, cyanosis, coughing, hypotension, bradycardia or tachycardia, mental status change, LOC, cannot lie supine, cannot speak properly

25

tx for acute asthma exacerbation

short-acting B2-agonist to relieve Sx

offer supplemental oxygen if available

severe cases (rapid sequential administrations may be needed)

26

for acute asthma, 3 administrations of short acting B2 agonist did not help, what should you do

refer to appropriate health care facility

27

Prophylactic asthma control tx

inhaled corticosteroids, and leukotriene inhibitors can be used

or long acting B2-agonist can be combined with other meds to control

28

after an asthma attack, when may an athlete return to play?

monitor lungs with peak flow meter,
values should be compared with baseline lung volume values and should be 80% of predicted values before the athlete may participate in activiteis

29

Prevention of catastrophic brain injuries

1.) AT coordinate informational meeting with athletes and coaches

2.) AT should enforce the use of standard certified helmets, and make all aware helmets do not prevent cerebral concussions

30

normal breathing rate

12 breaths per minute

31

normal end tidal carbon dioxide partial pressure

35-45 mm Hg

32

cerebral herniation care/tx

prepare for transport, elevate head to 30 degrees, IV may be needed if trained professional is available

33

Prevention of cervical spine injuries

1.) AT's familiar with sport specific MOI

2.) educate coaches and athletes

3.) corrosion-resistant hardware should be used in helmets. helmets should be regularly maintained throughout a season. should be recertified.

4.) emergency personnel should be up to date on techniques of transport to minimize motion

34

what s/sx require the initiation of the spine injury management protocol:

unconsciousness, altered level of consciousness, bilateral neurologic findings or complaints, significant midline spine pain with or without palpation, obvious spinal column deformity

35

tx and management of cervical spine injury

neutral position, manual stabilization applied immediately

do not apply traction

expose the airway

one who has the most training and experience should establish the airway and begin giving rescue breaths

convert stabilization to external device, but continue manual stabilization

immobilized with long spine board or other full body immobilization device

36

contraindications to re-alignment of the cervical spine

pain caused by movement, neurologic symptoms, muscle spasm, airway compromise, physical difficulty repositioning the spine, encountered resistance, apprehension expressed by the pt.

37

according to the position statement for the equipment laden athlete, should equipment be removed?

no, defer unless the helmet is not providing stabilization, equipment prevents neutral alignment, or prevents airway or chest access.

38

when should the face mask be removed?

once the decision has been made to immobilize and transport

39

Prevention of Diabetes

blood glucose monitoring, carb supplementation, guidelines for hyper/hypo-glycemia, insulin adjustments, urine testing for ketone bodies,

40

Hypoglycemia recognition

tachycardia, sweating, palpitations, hunger, nervousness, headache, trembling or dizziness; LOC or death can occur

41

hyperglycemia recognition

w/ or w/out ketosis.

if w/out ketosis look for: nausea, dehydration, reduced cognitive performance, feelings of sluggishness, and fatigue

42

hyperglycemia recognition with ketoacidosis

nausea, dehydration, reduced cognitive performance, feelings of sluggishness, and fatigue, Kussmaul breathing, fruity odor of breath, unusual fatigue, sleepiness, loss of appetite, increased thirst, frequent urination

43

Kussmaul breathing

abnormally deep, ver rapid sighing respirations, characteristic of diabetic ketoacidosis

44

tx of mild hypoglycemia

athlete should be conscious and able to follow directions

administer 10-15 g of carbs (4-8 glucose tablets or 2 tbsp of honey), assess blood glucose levels every 10-15 min

(activate EMS after 2 doses of carb and waiting 10-15 min)

if blood glucose levels return, provide substantial snack

45

tx of severe hypoglycemia

athlete is unconscious or unable to swallow or follow directions

medical emergency, activate EMS, administer glucagon if trained

46

RTP of athlete following mild hyper/hypo-glycemia

physician should determine a safe blood glucose range

47

when is blood glucose too low

below 70 mg/dL or (3.9 mmol/L)

48

Exertional heat stroke prevention

look for history of heat illness

7-14 days to acclimatize to heat

free access to water at all times

consistently replace water during px and games

sports med staff should educate coaches about heat illness

49

exertional heat stroke recognition

core body temp of greater than 104-105 taken via rectal thermometer after collapse

CNS dysfunction (disorientation, confusion, dizziness, vomiting, diarrhea, loss of balance, staggering, irritable, irrational, unusual behavior, LOC, delirium, hysteria, coma,

generally athlete will have hot sweaty skin, hypotension, or hyperventilation

50

tx of heat stroke

reduce core body temp to 102 ASAP.

cold water immersion (best option) (35-59 degrees F)

cool first then transport

51

Exertional hyponatremia prevention

-individualized hydration protocols

-consume adequate dietary sodium

-post exercise rehydration should aim to correct fluid loss accumulated during activity

-body weight changes, urine color, and thirst offer cues to the need for rehydration

-generally happens in athletes who drink too much water

-

52

exertional hyponatremia prevention recognition

- AT should recognize EH s/sx during and after exercise: over drinking, nausea, vomiting, dizziness, muscular twitching, peripheral tingling or swelling, headache, disorientation, altered mental status, physical exhaustion, pulmonary edema, seizures, and a decreased level of consciousness

include EH in DiffDx until proven otherwise

53

Tx and Management of exertional hyponatremia (severe)

IV hypertonic saline (3-5%) is indicated

transport to an advanced medical facility during or after tx

54

Tx and Management of exertional hyponatremia (mild)

restrict fluids and consume salty foods or a small volume of oral hypertonic solution

55

normal blood sodium levels

135-145 mEq/L

56

Exertional sickling prevention

- educate

-educate those with SCT and create tailored precautions for them

-those with SCT should be given longer periods of rest and recovery, be excluded from participation in performance tests (mile runs, springs, work-rest cycles in heat), emphasize hydration, control any asthma, have supplemental oxygen available when new to a high-altitude environment

57

Exertional sickling recognition

screen for SCT in PPE, testing for SCT to confirm

58

s/sx of exertional sickling

muscle cramping, pain, swelling, weakness, and tenderness; inability to catch one's breath; and fatigue, and be able to differentiate exertional sickling from other causes of collapse

know usual settings and app terns of exertional sickling

59

Exertional sickling tx

immediate withdrawal from activity

high-flow oxygen at 15 L/min w/ a non-breather face mask

monitor vitals, prepare to activate EAP if vitals decline

treat as a medical emergency

AT has duty to notify physicians of the presence of SCT and make sure they are prepared to treat the metabolic complications of explosive rhabdomyolysis

60

HEAD DOWN contact in football prevention

-head down contact is the only technique that causes axial loading

61

spearing

intentional use of head down contact technique.

62

do football helmets cause or prevent axial loading?

no

63

safest technique to avoid head down?

make contact with shoulder or chest while keeping head up. must be learned, practiced in px

64

lightning safety prevention

hear it, see it, flea it. remain indoors when lighting is close.

Establish EAP or policy specific to lighting

identify unsafe "shelters" - dugouts, picnic shelters, tents, storage sheds etc.

buses and cars that are fully enclosed can be safe

30 min should pass after the last lighting or sound of thunder

65

lightning tx

victims are safe to touch, must ensure one's own safety first

triage first lightning victims appear to be dead

apply AED, perform CPR

treat for concussive injuries, fractures, dislocations, and shock

66

Sudden Cardiac Arrest prevention

access to early d-frib is essential. (3-5 min after initial collapse)

PPE - include thorough history and complete record of exertional syncope or pre syncope, chest pain, personal or family history of sudden cardiac arrest, or family history of sudden death

67

Sudden cardiac arrest recognition

myoclonic jerking or seizure like activity after collapse. agonal gasping. sudden collapse. unconscious.

68

lightning watch

issued when the risk of a hazardous weather even is significantly increased but it's presence, location, or timing is unclear

69

lighting warning

issued when hazardous weather is occurring and is imminent, or has very high probability of occurring

70

Grand Mal seizure

generalized tonic clonic

71

s/sx grand mal seizure

sudden cry or moan
fainting
rigidity
muscle jerks
frothy saliva
shallow breathing
bluish skin
lasts 2-5 min

72

phases of grand mal seizure

aura
tonic phase
hypertonic
tonic clonic
autonomic discharge
post-seizure phase
postictal phase

73

aura

peculiar warning sensation

74

tonic phase

one continuous muscular contraction, victim stops breathing

75

hypertonic phase

extreme muscular rigidity

76

tonic clonic phase

rigidity and relaxation alternate rapidly, frothy saliva, may lose bladder/bowel control

77

autonomic discharge

hyperventilation, salivation, rapid heartbeat, victim may lose bladder or bowel control

78

post-seizure phase

victim lapses into a coma

79

postictal phase

recovery phase, all muscles relax, victim slowly becomes responsive, remains exhausted

80

petit mal s/sx

blank stare, rapid blinking, chewing movements, lasts only a few seconds

81

simple partial seizure s/sx

jerking in fingers and toes, victim stays awake, jerking may progress up hand, arm, then to whole body and becomes a convulsive seizure

82

perfusion

circulation of oxygen rich blood to the cells

83

hypovolemic shock

loss of blood (trauma, burns, diarrhea, vomiting, etc)

84

cariogenic shock

heart does not pump enough to circulate throughout the body (injury, heart attack, heart disease)

85

distributive shock

extreme blood vessel dilation - due to loss of nervous control associated with spinal cord injury or release of chemicals

86

obstructive shock

blockage of the forward movement of blood through the arteries in the body (associated with large clot in the vessel in the lung, trapped air in one side of chest, compression of the heart)

87

Hemorrhagic shock

loss of fluids/blood

88

Anaphylactic shock

severe allergic reaction, medical emergency

89

septic shock

widespread infection that causes organ failure

90

flushed/red skin color means:


(heat stroke, sunburn, allergic reaction),

91

pale/ashen/white skin color means:

(insufficient circulation, fear, shock, hemorrhage, heat exhaustion, or insulin shock);

92


bluish/cyanotic skin color means:

(airway obstruction or respiratory insufficiency);

93


yellow/jaundice skin color means:

(liver disease or dysfunction)