1. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 6 Injury Management

2. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Expectations for the Coach Coach is expected to: –Evaluate the situation –Assess the severity of injury –Recognize life-threatening conditions –Provide immediate care –Initiate procedures to ensure proper referral for on-going management

3. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Determination of Findings Determine whether the situation can be handled on-site or if referral to a physician is warranted Acute care options available to the coach: –Standard acute care (i.e., cold, compression, elevation, protected rest, as appropriate) with no physician referral –Standard acute care with physician referral –Standard acute care with immediate physician referral (i.e., emergency care facility) –Summon EMS

4. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The Emergency/Accident Plan Well-developed, written process that defines the policies and procedures to be used in the management of an acute injury –Should not be limited to emergency conditions –Comprehensive, yet flexible –No single plan can satisfy the needs of every organization

5. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Developing the Emergency Plan Input from: –Personnel at the facility –Higher authorities to which the institution reports –Medical personnel –Legal personnel

6. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Developing the Emergency Plan (cont’d) Areas to address: –Population being served –Potential injuries/conditions –Personnel –Availability of medical/first aid equipment –Facility access –Communication –Documentation

7. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementing the Emergency Plan Rehearse plan Personnel other than just those involved in implementing the plan should evaluate the plan

8. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Bloodborne Pathogens Microorganisms present in blood and other body fluids of infected individuals Best practice – treat the blood of any individual as if infected Management: –Open wound – follow Universal Precautions (refer to Box 6.2)

9. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Bloodborne Pathogens (cont’d) Management (cont’d): –Treatment setting Clean work surfaces immediately following treatment with a biohazard product or a bleach and water solution (mixed at a ratio of 1:10) Clean floor spills Dispose of biohazard materials appropriately Maintain recordkeeping and documentation

10. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Soft Tissue Wound Management Open wounds –Follow universal precautions & infection control standards –Steps: Control the bleeding Direct pressure & elevation If not effective, use indirect pressure

11. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Soft Tissue Wound Management (cont’d) Open wounds (cont’d) –Steps: (cont’d) Clean the wound Determine whether emergency care is required (conditions – refer to Box 6.3) Dress the wound

12. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Soft Tissue Wound Management (cont’d) Closed wound –Goal: reduce inflammation, pain, and secondary hypoxia –Treatment: PRICE principles Protected rest, ice, compression, and elevation

13. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Soft Tissue Wound Management (cont’d) Application of cold –Physiological effects Vasoconstriction at the cellular level Analgesic

14. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Soft Tissue Wound Management (cont’d) Application of cold (cont’d) –Physiological effects (cont’d) Decreased Tissue metabolism (i.e., decreases the need for oxygen), which reduces secondary hypoxia Capillary permeability Pain Muscle spasm

15. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Soft Tissue Wound Management (cont’d) Application of cold –Indications & contraindications (refer to Box 6.4) –Techniques: Cold pack Ice massage; cold whirlpool – not for immediate management

16. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Soft Tissue Wound Management (cont’d) Application of cold –Length of application time ASAP following injury 15 – 30 minutes on; 1-2 hours off –Stages of cold sensation: cold, burning, aching, and analgesia

17. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Soft Tissue Wound Management (cont’d) Application of compression –Physiological effects Decreases hemorrhage Reduces the space available for fluid seepage Encourages fluid absorption –Technique: elastic wrap Apply distal to proximal Sufficient tension to compress but not constrict

18. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Soft Tissue Wound Management (cont’d) Application of compression (cont’d) –Length of application time: constant –Option: cold wet compression wrap to secure cold pack –Do not use compression if additional pressure compounds trauma

19. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Soft Tissue Wound Management (cont’d) Elevation of injured site –Physiological effects Reduces bleeding in the area Encourages venous return Prevents pooling of blood in the extremities –Technique: 6-10 inches above heart

20. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Soft Tissue Wound Management (cont’d) Protected rest –Continued unrestricted activity could result in increased bleeding, increased pain, and delayed healing –Technique: Lower extremity – use of crutches Upper extremity – splint or brace (e.g., sling) –Length of time – varies (does not mean cessation of activity … means relative rest)

21. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Soft Tissue Wound Management (cont’d) Protected rest (cont’d) –Immobilization can prolong the repair and regeneration of damaged tissues –Early controlled mobilization can optimize the healing process following Wolff’s law

22. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Soft Tissue Wound Management (cont’d) Immobilization –Loss of strength –Weakness –Joint adhesions Mobilization –Muscle regeneration –Stiffer, stronger ligament –Joint lubrication & nourishment –Promotes healthy joint mechanics

23. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The Role of Movement in the Healing process of Soft Tissue Advantages of movement in the inflammatory phase –Encourages venous return –Encourages fluid resorption –Encourages phagocytosis –Prevents contracture and loss of range of motion

24. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The Role of Movement in the Healing Process of Soft Tissue (cont’d) Movement can be initiated when bleeding has stopped Movement type – gentle and controlled motions that progress to routine activities of daily living (ADLs)

25. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Bone Injury Management For suspected fracture: –Splint joint above and below fracture site, in the position found –Utilize cold application and elevation –Refer to physician

26. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Bone Injury Management (cont’d) Suspected fracture associated with a major trauma or injury – treat as a medical emergency –Waiting for EMS Control any bleeding (e.g., application of gentle pressure) Immobilize the injured area in the position in which it was found Apply cold to the area If shock is suspected, provide treatment for shock