1. EMERGENCY SPORTS MEDICINE PITCH AND SIDELINE INJURY MANAGEMENT Dr PL Viviers University of Stellenbosch Dr L Holtzhausen University of the Free State September 23, 2015

2. FAIL TO PREPARE = PREPARE TO FAIL

3. INTRODUCTION Moment of injury until specialised care Recognition of severity Have guidelines Stressful experience - be prepared!

4. IMPORTANT GOALS ON THE PITCH Recognise severity Know what can and should be done Know what should NOT be done

5. ASSESSMENT OUTCOMES Red –Urgent specialised care Amber –Moderate – requires furhther medical assessment Green –Minor – treat on field

6. STEP 1: WHAT SHOULD I CHECK FOR “SPORTS” Speak to the player Problem identification Observe Rule out serious injury Touch Skills assessment

7. STEP 2: WHAT SHOULD I DO “TREAT” Talk to the player Remove safely from the field Emergency transfer Avoid further injury Treatment –Definitive treatment –Interventions

8. ON-FIELD RETURN TO PLAY DECISION MAKING Is there a risk to worsen the injury? Is there a risk for another injury? Is there a risk for other players?

9. SPECIFIC INJURIES

10. HEAD INJURIES Concussion or not? Differential diagnosis SA Sports Concussion SA Rugby Boksmart guidelines IRB Concussion guidelines C-spine Other injuries!

11. FACIAL INJURIES Assess for associated injuries (head and spine) Palpate bony prominences Diplopia – can indicate orbital fracture ROM of mandible Eye movements

12. NOSE BLEED/EPISTAXIS Palpate for crepitus Check for septal haematoma Control bleeding Ice Rule out CSF leak

13. DENTAL INJURIES Fractured tooth Tooth luxation Avulsed tooth (missing tooth)

14. EYE INJURIES Identify severe injuries Accurate history Serious injury (signs and symptoms –Deep, throbbing or stabbing pain –Abnormal protrusion –Pupil shape/reaction –Lacerated globe –Loss of vision –Persistent blurred vision –Diplopic vision –Hyphema Visual acuity Documentation Test extra-ocular movements Severe injuries – immediate referral

15. CHEST Majority - blunt trauma Consider all structures: –Rib cage –Heart –Lung –Big vessels Aware of associated injuries –Upper ribs – brachial plexus –Middle ribs – lung issue –Lower ribs – hepatic, spleen, renal –Sternal – cardiac/big vessels

16. ABDOMEN Rare – be aware Hepatic and splenic most common If suspicion – keep nil per mouth until referral

17. GENITO-URINARY Renal –Direct blow to the back/flank –Suspicion – lower rib fractures and Grey- Turner sign –Emergency referral Scrotal –Exclude testicular dislocation, torsion or rupture

18. SKIN Common Important to pay attention to deep structures Lacerations –Control bleeding –Proper cleaning –Proper suturing –Remember tetanus

19. MUSCULO- SKELETAL Fractures Dislocations Splinting –Joints proximal and distal immobilised –Improvise

20. GENERAL COMMENTS Collapsed player with associated trauma - treat as C- spine injury Collapsed players should be removed from the field and assessed by trained personnel Save life before limb If a player cannot perform basic skills there is increased risk for further injury and harm to others

21. THANK YOU Dr Pierre Viviers University of Stellenbosch plv@sun.ac.za