1. Management of Acute Pathologies
ATTR 322
Krzyzanowicz- Spring ‘13

2. Objectives
Understand the differences between on-the- field examination and clinical assessment
Identify conditions that warrant termination of the exam
Understand how to implement an Emergency Action Plan

3. Purpose
Purpose of on the field exam is to determine the next course in evaluation or management
Immediate emergency care
Heart attack, femur fracture
Transport to hospital/physicians office for care
Sutures, x-ray to r/o fx (non-emergency)
Move to sidelines for further evaluation
Perform a more thorough evaluation

4. Immediate Management
Ask yourself “Does this situation require emergency management to save patient’s life or extremity”
Immediate examination must rule out
Lack of ABC’s
Life-threatening trauma to head or spinal column
Profuse bleeding
Fractures
Joint dislocation (to a point)

5. Emergency Planning Emergency Action Plan (EAP)
Personnel
Physician, EMS
Equipment
Splints, AED
Communication
Cell phone, radio
Standard procedures
Catastrophic event
Good to review EAP at least once a year
Get together with local EMS as well

6. Sport Specific Rules
Each sport has specific rules about on-field- evaluations
Wrestling-3 minutes injury evaluation time
Football- unlimited
Soccer- must be waved onto field by official
Find out from your coach/league, etc

7. Critical Findings Conditions warranting termination of the evaluation
Always err on the side of caution if uncertain
Activate the EAP
Begin injury management
What conditions can we think of?

9. Primary Survey Are they moving? Conscious
Apena? or dyspnea?
Activate EMS (if needed)
Unconsciouscervical spine trauma
Stabilize head and neck
Activate EAP & EMS
Check ABC’s
SeizingCNS trauma

11. Secondary Survey
Identify other serious conditions that require immediate management
Bleeding
Gross deformity
Other signs of trauma
Rule out head/spinal trauma
Calm athlete
Rule out injury other body parts
Manage the condition
Treat for shock (if indicated)

12. On-Field History Determine (ask while observing/palpating)
Location of pain
Peripheral symptoms
Mechanism of injury
Associated signs and symptoms
History of injury
**If athlete is unconscious or disoriented seek information from witnesses.

13. On-Field Inspection

14. On-Field Palpation Bony alignment Crepitus Joint alignment Swelling
Gross deformity
Tender to palpation (TTP)
Crepitus
Joint alignment
Palpate along joint line to determine alignment
Swelling
Disruption to tissue
Bursa
Tissues with a rich blood supply (eg, face)
Painful Areas
Tender to palpation
Deficit in the muscles or tendons
Palpable defect

15. Joint/Muscle Function
AROM
Assesses their willingness to move the limb
Strength assessment
A break test examines the muscle’s ability to sustain contracting (I don’t really do very often on field)
PROM
Often delayed until clinical evaluation
DON’T do if the athlete cannot perform AROM
Weight-bearing status (LE injuries)
If a fracture has been ruled out and ROM tests have been completed, the athlete may walk off the field with assistance.

16. Joint Stability Tests Purpose Select the best tests for that pathology
Immediately tests the ligaments and capsule involved before swelling and guarding begin
Select the best tests for that pathology
Suspected ACL injury DO NOT perform all 7 special tests
Those with the best sensitivity and specificity
Lachman’s, Pivot Shift (difficult), Ant. Drawer
Wait until off the field to perform all tests you may want

17. Neurological Testing Cranial nerve tests
Cervical nerve tests (upper quarter screen)
Perform on suspected concussions as well as cervical spine injuries (NO strength testing!)
Assess motor function distal to injury
Don’t move injured bone or joint
Eg, Ask an athlete with an anterior GH dislocation to wiggle his or her fingers

18. Vascular Exam
Dislocation or fracture can compromise vascular structures
Vascular tests
Check distal pulses
Capillary refill testing
Edema formation distal to injury
Blockage of venous return
“Normal” injury (i.e. sprained ankle)
Do this in off-field clinical assessment

19. Getting off the field Determine best ambulation
Walking, 2 man carry, etc
Take all pieces of your puzzle
Determine what needs to be done on sidelines
If able to r/o injury or further injury
Determine if RTP is allowed

20. Return to Play Consult a physician if necessary
Younger athletes vs. older athletes
Conservative vs. aggressive management
Risk of reinjury?
Assessment of function
Strength and ROM
Pain
Proprioception
Functional activity progression

21. Review Practice Sport Patience
Everytime you go onto the field with your ACI- watch them-what do they do? What do you want in your bag of tricks.
Sport
Some sports you need to be quick (football, wrestling)
Coach needs to know if the patient can get back in or not
Patience
Don’t rush a medical emergency
Take every precaution not to cause more harm