Lecture 19 - Neck Injuries and On-field Assessment

Question 1

what 3 things should you be thinking when running on field?

Answer 1

1. is the athlete at risk (life/limb) –> activate EAP
2. is the area stable (safety and effectiveness) –> should the game continue
3. how do i get the athlete off the field –> walk, assist, non-weight bearing, boarded/immobilized

Question 2

what is the first thing you should do during an on-field assessment?

Answer 2

• ensure the c-spine is stabilized (if at risk of injury)
• check if athlete is conscious or unconscious
• then start primary care (active EAP after if necessary)

Question 3

what is the primary survey assessment?

Answer 3

• looking for potentially life-threatening situations
• UABC’s (unresponsiveness, airway, breathing and circulation)
• look for spinal injury
• also consider significant deformity (fracture), profuse bleeding or shock
• activate EAP if yes, if no, continue with a secondary assessment

Question 4

what are the 4 steps for caring for an athlete with a suspected neck injury?

Answer 4

1. stabilize the c-spine (and keep stabilized)
2. keep athlete still (tell them, if they try to move, hold down by chest)
3. get a brief history (body positioning, numbness and tingling, etc.)
4. palpation and assessment (pain, weakness, deformation, dermatomes and myotomes)

Question 5

what are the 8 questions of subjective spinal survey?

Answer 5

1. can you tell me what happened (MOI)
2. do you have pain in your head?
3. neck
4. back
5. do you have numbness in your arms or legs (get specific)
6. pain anywhere else?
7. can you wiggle your toes (or roll ankles if in boots/skates)
8. can you wiggle your fingers

Question 6

what is a stinger-burner injury?

Answer 6

• hit/disturb the brachial plexus
• 3 possible MOI’s (stretch, whack or pinch)
• unilateral pain (not in neck), motor changes to shoulder abduction, external rotation and elbow flexion
• heals quick/transient –> feeling may be back by the time they reach the sidelines

Question 7

what is the return-to-play protocol for a stinger-burner injury?

Answer 7

• can return if symptoms are gone within 5 minutes
• if they have full ROM and strength (need to be able to protect themselves)
• if they can complete sport-specific skills (on the sidelines, without symptoms)
• if they mentally feel ready

Question 8

what are the two usual types of C-spine injuries?

Answer 8

1. burst fracture (caused by axial load-vertical compression)
2. compression fracture (compression-flexion injury)

Question 9

how would you determine a c-spine injury?

Answer 9

• neck pain
• pain on central palpation
• bilateral findings
• myotomes and dermatomes
• upper and lower extremity findings (anything below site of injury)

Question 10

what key structures do you need to palpate with a suspected c-spine injury?

Answer 10

• upper back
• neck
• shoulder
• clavicle
• sternum

Question 11

how do you test for sensation?

Answer 11

• dermatomes
• pinprick for pain, cotton for pressure

Question 12

how do you test for innervation?

Answer 12

• myotomes
• reflexes and movements

Question 13

what is the canadian c-spine rule?

Answer 13

*stabilize the c-spine first then check…
send for radiography if…
- dangerous mechanism, or numbness/tingling in >1 extremity
- midline c-spine tenderness
- unable to rotate the neck
*if in doubt, get them checked out

Question 14

how/why would you perform a log roll on an athlete?

Answer 14

• if an airway is not present
• firm grip on stable helmet, cross arm technique to roll over athlete, using commands “prepare to roll” and “roll” all 4 people will roll athlete as one unit
• avoid twisting

Question 15

what position should the spine be immobilized in with a suspected c-spine injury?

Answer 15

• neutral
• so no compromise to the airway or spinal cord

Question 16

when should you not force the cervical spine into neutral?

Answer 16

1. movement causes/increases pain, neurological symptoms or muscle spasms compromise the airway
2. resistance to movement is encountered
3. patient expresses apprehension

Question 17

what should you do after the primary survey/evaluation?

Answer 17

• roll the patient if necessary
• reassess primary
• support the head (especially if wearing shoulder pads)
• secondary survey

Question 18

why must equipment be removed from an injured athlete?

Answer 18

• EMS will not transfer a person without airway access

Question 19

what removal tools should you have?

Answer 19

• cordless screwdriver
• cutting tool (as a backup if screws/nuts are stripped/rusted)
• depends on the sport and the equipment

Question 20

what does the term “don’t lose your head” imply?

Answer 20

• keep as much equipment on as possible as long as they are safe and secure
• ensure airway
• reduce movement as much as possible

Question 21

what does the term “all or nothing removal” imply?

Answer 21

• if equipment must be removed (airway, etc.) remove all equipment (helmet, shoulder pads, etc.) to reduce the movement of the c-spine

Question 22

what are the steps to removing a helmet and equipment?

Answer 22

1. remove mask (cut straps/unscrew) –> partner 1 keeps head still, partner 2 deals with the mask
2. remove cheekpads (cut/snap out) –> partner 1 keeps head still, partner 2 deals with cheek straps
3. remove helmet –> partner 1 removes helmet, partner 2 has vice grip/alligator grip to maintain cervical alignment
4. cut jersey, cut straps/laces on shoulder pads –> partner 1 keeps head still, partner 2 cuts
5. remove shoulder pads –> partner 1 removes pads, partner 2 has alligator grip
6. cervical collar –> partner 1 keeps head stable, partner 2 applied collar

Question 23

which method of transport to the spine board is better?

Answer 23

• vertical lift > log roll
• will have less movement
• log roll if patient is already on their stomach or if not enough people (only need 3-4)

Question 24

how do you perform the vertical lift?

Answer 24

• 8 people necessary
• 1 at head, 1 to move board and 6 on sides (shoulder, hip and knee)

Question 25

how do you secure someone to transport on the spine board?

Answer 25

1. secure athlete to the board with straps
2. start with the thorax (heaviest in case of vomiting)
3. then strap head
4. then strap lower body

Question 26

what are the steps of an on-field assessment if it obviously not a c-spine injury?

Answer 26

1. injury
2. conscious vs unconscious (only unconscious if in shock)
3. primary survey
4. secondary survey (vital signs, history, msk evaluation, treatment options and transportation) –> follow-up
   * may have to wait for ref to call you to field or for play to stop, depends on sport rules)
   *safety is the most important, speed and accuracy are essential

Question 27

how do you determine history in non-emergent cases?

Answer 27

• ask them about it (what happened, where does it hurt, did you hear anything, have you injured this or the other side before)

Question 28

what must you do in an on-field primary examination for non-emergent injuries?

Answer 28

• clear above and below (no weight bearing until cleared)
• palpate
• special tests for stability of bones and joints –> (grade 1 = stable, grade2/3 = unstable so don’t weight bear)

Question 29

what is the treatment/transportation for non-emergent cases?

Answer 29

• severity determines medical management
• take time to do a sideline assessment if not urgent (STTT, primary and secondary again)
• look at ROM, strength and function (if good can return after doing some sideline observation)
• remove from play = ice and immobilize, follow-up at dr/hospital
• follow-up with them the next day

Question 30

what should you tell the coaches after an injury?

Answer 30

• can they play
• are they 100% (/what % are they at)
• suspected time until they can play again (that game?)
• how they are/what they injured
• time off/when you will know (after the follow-up)

Question 31

what should you check for in the follow-up?

Answer 31

• ice
• immobilization
• treatment plan
• clinical assessment (if necessary)