1. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 7 Injury Assessment

2. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury Evaluation Sign –Objective, measurable physical finding –What the evaluator hears, feels, sees, or smells Symptom –Information provided by the injured individual regarding their perception of the problem

3. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury Evaluation (cont’d) Acute injury –Results from a single episode; sudden onset of symptoms Chronic injury Slow, insidious onset of symptoms

4. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins A coach should be prepared to perform an onsite evaluation of acute injuries sufficient to determine the nature and severity of the condition and, subsequently, the immediate management of the condition!

5. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The HOPS Format History –Primary complaint The injured individual’s perception of the current injury Evaluator asks questions that provide responses that describe the current nature, location, and onset of the condition

6. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The HOPS Format (cont’d) History (cont’d) –Mechanism of injury Physical cause or circumstance under which the injury occurred Knowing MOI helps identify involved structures and guides the ongoing assessment

7. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The HOPS Format (cont’d) History (cont’d) –Characteristics of the symptoms The location, onset, severity, frequency, duration, and limitations caused by the pain or disability

8. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The HOPS Format (cont’d) History (cont’d) –Characteristics of the symptoms (cont’d) Questions pertaining to: Pain Unusual sensations Sounds (e.g. “pop”) Feelings (e.g., tearing sensation; cracking sensation)

9. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The HOPS Format (cont’d) History (cont’d) –Related medical history Information regarding other conditions may help in assessment of current injury

10. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The HOPS Format (cont’d) Observation –Begins the moment the injured person is seen and continues throughout evaluation –Focus State of consciousness and body language General posture, willingness and ability to move, ease in motion, and general overall attitude Local injury site: deformity, swelling, or discoloration

11. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The HOPS Format (cont’d) Observation (cont’d) –Additional: general motor function, posture, and gait Bilateral comparison

12. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The HOPS Format (cont’d) Palpation –Physically touching and feeling –Gentle, circular pressure followed by gradual, deeper pressure

13. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The HOPS Format (cont’d) Palpation (cont’d) –Findings Temperature Swelling Point tenderness Crepitus Deformity Muscle spasm Cutaneous sensation Pulse

14. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The HOPS Format (cont’d) Testing –Functional tests AROM PROM RROM

15. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The HOPS Format (cont’d) Testing (cont’d) –Stress tests Joint function and integrity of joint structures, primarily noncontractile tissues Used to assess laxity of ligaments; the amount of “give”; graded on a 3-degree scale Joint instability

16. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The HOPS Format (cont’d) Testing (cont’d) –Special tests Techniques for detecting injury to a specific body part or area

17. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The HOPS Format (cont’d) Testing (cont’d) –Neurologic testing Components: motor; sensation; reflex Assessed using manual muscle testing and noting cutaneous sensory changes in peripheral nerve patterns Only necessary in orthopedic injuries if: Numbness, tingling, or a burning sensation is present Unexplained muscular weakness is present

18. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The HOPS Format (cont’d) Testing (cont’d) –Activity-specific functional testing Performance of active movements typical of the movements executed during sport or activity Assess strength, agility, flexibility, joint stability, endurance, coordination, balance, and activity-specific skill performance

19. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury Assessment and the Coach Primary survey –Identify and initiate management of any life- threatening conditions –Determines level of responsiveness and assesses airway, breathing, and circulation (ABC’s) –Approaching the individual observe body language and any talking –If unresponsive: attempt to arouse by gentle shake or pinch (without moving head/neck) and by shout

20. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury Assessment and the Coach (cont’d) Primary survey (cont’d) –Assessment of ABCs Airway: listen for abnormal sounds or absence of sounds; maintain open airway Breathing: look, listen, and feel Circulation: assess pulse

21. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury Assessment and the Coach (cont’d) If at any time during the assessment, conditions exist that are an immediate threat to life, or “red flags” are noted, the assessment process should be terminated and the emergency medical plan activated.

22. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury Assessment and the Coach (cont’d) Secondary survey –Identify the type and extent of any injury, the immediate disposition of the condition, on-site management

23. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury Assessment and the Coach (cont’d) Vital signs –Pulse Rate – reflects the rapidity of the heart contractions Normal adult 60-80; child 80-100 Volume – describes the sensation of the contraction Strong, weak

24. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury Assessment and the Coach (cont’d) Vital signs (cont’d) –Pulse (cont’d) Site: carotid artery Difficulty in assessing pulse, assess capillary refill Refer to Box 7.2

25. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury Assessment and the Coach (cont’d) Vital signs (cont’d) –Respiration Normal rate: adult 10 to 25 breaths per minute; child 20 to 25 Character: normal – without pain or effort; no abnormalities Refer to Box 7.2

26. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury Assessment and the Coach (cont’d) Vital signs (cont’d) –Temperature Normal body temp: 98.6 o F Skin is largely responsible for regulating temp Changes in body temp can be reflected in the skin Refer to Box 7.2

27. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury Assessment and the Coach (cont’d) Vital signs (cont’d) –Skin color Can indicate abnormal blood flow and low blood oxygen concentration in a particular body part or area Red; white or ashen; blue (refer to Box 7.2)

28. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury Assessment and the Coach (cont’d) Vital signs (cont’d) –Pupils Extremely sensitive to situations affecting the CNS Constricted/dilated Pupillary light reflex Check reaction to light – ordinarily constrict (protective)

29. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury Assessment and the Coach (cont’d) Vital signs (cont’d) –Pupils (cont’d) Eye movement Presence of diplopia Tracking ability Depth perception

30. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury Assessment and the Coach (cont’d) Vital signs (cont’d) –Blood pressure Pressure or tension of the blood within the systemic arteries Systolic – pressure when heart is beating (pumping blood); adult: 110-120mm Hg; child: 125-140mm Hg

31. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury Assessment and the Coach (cont’d) Vital signs (cont’d) –Blood pressure (cont’d) Diastolic – residual pressure in the arteries when the heart is between beats; adult: 70- 80mm Hg; child: 80-90mm Hg Reflects effectiveness of circulatory system Hypertension: 140/90 or higher Low blood pressure

32. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury Assessment and the Coach (cont’d) On-site history –What is wrong? What hurts? (establish the primary complaint) –How did it happen? What were you doing? (identify mechanism of injury) –Where is your pain? Is there one spot where it hurts the most? Can you describe the pain? Can you rate the pain on a scale of 1-10?

33. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury Assessment and the Coach (cont’d) On-site history (cont’d) –Do you have pain in any other areas? (identifying potential for more than one injury and/or referred pain) –Did you hear anything at the time of the injury? –Did you feel anything? (e.g., tearing sensation; snapping sensation; unusual movement of a joint)

34. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury Assessment and the Coach (cont’d) On-site history (cont’d) –Are you experiencing any unusual sensations in your arms or legs? –Has this ever happened to you before? (identify any pre-existing conditions that may have exacerbated the current injury or complicate the injury assessment)

35. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury Assessment and the Coach (cont’d) On-site observation –Approaching individual State of consciousness, body language, willingness & ability to move, general body posture, and overall attitude –Having reached the individual Site of the actual injury for any deformity, swelling, or discoloration

36. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury Assessment and the Coach (cont’d) On-site palpation –In the absence of understanding or being knowledgeable about the structures being palpated, the value of a coach performing palpation is questionable –Should consider the potential finding detected with palpation and determine if palpation is appropriate or necessary

37. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury Assessment and the Coach (cont’d) On-site palpation (cont’d) –Need to decide whether or not any palpation can contribute to determining the nature and severity of the injury –Informed consent – necessary prior to making physical contact

38. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury Assessment and the Coach (cont’d) On-site testing –If not contraindicated, identify the individual’s willingness to move the injured body part –AROM: note quantity and quality of movement –PROM: should not be assessed by coach

39. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury Assessment and the Coach (cont’d) On-site testing –RROM: If AROM is normal, coach may consider performing RROM to assess muscle strength Decision to perform RROM should be carefully considered –Weight bearing Successful AROM – attempt to walk

40. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury Assessment and the Coach (cont’d) On-site testing (cont’d) –Coach should not perform stress or special tests –Activity-specific functional testing If the findings to this point suggest the absence of injury, activity-specific functional testing can be used to confirm or refute those findings

41. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury Assessment and the Coach (cont’d) On-site testing (cont’d) –Equipment considerations Do not automatically remove equipment Guidelines for determining conditions for equipment removal should be defined in emergency medical plan

42. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Disposition Analyze information gained during assessment to determine management –Can be handled on site –Requires physician referral: immediate or prior to return to activity –Requires activation of EMS Must be able to identify any life threatening conditions