KHP 340 Exam 1 Study Guide
KHP 340 Exam 1 Study Guide KHP 340
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This 17 page Study Guide was uploaded by Sharon Liang on Sunday September 11, 2016. The Study Guide belongs to KHP 340 at University of Kentucky taught by Caitlin Whale in Fall 2016. Since its upload, it has received 14 views. For similar materials see Athletic Training in Kinesiology&Health Promotion at University of Kentucky.
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Date Created: 09/11/16
KHP 340 Exam 1 Study Guide Injuries When injuries occur, though they’re normally not life-threatening, they require immediate care Emergencies are unexpected events that require prompt assistance and the time gap between the occurrence and the assistance plays a huge role in the result Errors in initial injury management can prolong the time required for rehabilitation or cause life-threatening situations to occur Approach to Injury Evaluation Prior to injury: policies, surroundings/environment, and resources Response to injury: assessment of athlete’s injury (primary and secondary) Reason for EAP Primary concern is maintaining cardiovascular and CNS functioning Key to emergency aid is the initial evaluation of injured athlete Members of sports medicine team must always act prudently and reasonably Must have prearranged game plan that can be implemented on a moment’s notice Emergency Action Plan (EAP) 1. Separate plans should be developed for different facilities Outline personnel and role Identify necessary equipment 2. Established equipment needs for sport/setting Emergency and sport equipment Helmet removal policies and procedures 3. Phone availability and most importantly, 911 4. Athletic trainers should be familiar with community based health care delivery plan Know communication, transportation, and treatment policies - Communication: individual calling medical personnel must relay the following information a. Type of emergency b. Suspected injury c. Present condition d. Current assistance e. Phone and emergency locations - Transportation Keys to gates/locks must be easily accessible Key facility and school administrators must know EAPs and specific roles - Treatment Individual should be assigned to accompany athlete in hospital Plans should also be in place for other game personnel (coaches, referees, etc.) Principles of On-the-Field Assessment Appropriate acute care can’t be provided without a systematic assessment occurring on the playing field first Assessment - Determine nature and severity of injury (primary survey) - Determine consequence of injury (secondary survey) - Provides information regarding direction of treatment Primary Survey Performed initially to establish life threatening conditions by evaluating airway, breathing, and consciousness (ABC’s) Life threatening symptoms - Respiratory emergency - Cardiovascular emergency - Severe bleeding Process: follow basic CPR - Establish unresponsiveness - Protective equipment issues - Establish breathing Be careful of airway - Establish circulation - Control bleeding Watch for shock ALWAYS call 911 before attempting to move: - Unconscious victim - Spinal injury With ANY loss of movement or sensation following head or spine injury Emergency CPR - Evaluate to determine need - Should be certified in American Heart Association, American Red Cross, or National Safety Council Possible Conditions Unconscious athlete - If athlete is breathing and unconscious, don’t move until consciousness is regained - If athlete is not breathing and unconscious, ABC’s need to be established If in prone position, roll athlete over If in supine, keep it that way External bleeding - Direct pressure: firm pressure (hand and sterile gauze) placed directly over site of injury against bone - Elevation: reduces hydrostatic pressure and facilitates venous and lymphatic drainage to slow bleeding - Indirect pressure: 11 points on either side of the body where pressure is applied to slow bleeding Internal Hemorrhage - Normally invisible unless manifested by body opening, x- ray, or any other diagnostic technique - Can occur beneath skin (bruise) or contusion, intramuscularly or in joint with little danger - Bleeding within body cavity can result in “life or death” situation - Hard to detect and hospitalization treatment - Can lead to shock if not treated properly Shock - Generally occurs with severe bleeding, fracture, or internal injuries - Result of decrease in blood available in circulatory system - Movement of blood cell slows, decreasing oxygen transport to the body - Signs Pulse: fast, feeble Skin: pale, cold, clammy Assessment (Secondary Survey) Life threatening situation ruled out Gather specifics about injury Assess vital signs while performing more detailed evaluation of conditions that don’t pose life threatening consequences - Pulse Direct extension of heart function Can identify if other complications exist o Shock, bleeding, diabetic coma, or heat exhaustion Normal adult: 60-80 bpm; normal child: 80-100 bpm - Respiration Normal adult: 12 breaths per minute Abnormalities o Shallow o Gasping o Irregular pattern o Frothy blood coughed up - Blood pressure Amount of pressure is the exerted on the arterial walls o Measured with sphygmomanometer Systolic blood pressure: pressure caused by heart pumping o Normal: 115-120 mmHg Diastolic blood pressure: residual pressure between contractions o Normal: 75-80 mmHg - Temperature Normal 98.6˚F Measured in mouth, under armpit, or against tympanic membrane. However, best method is to measure core temperature which is measured rectally. - Skin color Good indicator of health state 3 common colors o Red: elevated temperature, heat stroke, high blood pressure o White: insufficient circulation, shock, fright, hemorrhage, heat exhaustion, or insulin shock o Blue (cyanotic): airway obstruction or respiratory insufficiency Assessed by capillary refill - Pupils Sensitive to situations impacting nervous system Most pupils regular outline and shape o Important for AT to know of any unique pre-existing difference an athlete may have Normal is pupils are equal in dilation and reactive to light - Consciousness Must always be continually assessed o Alertness and awareness of environment o Response relative to vocal stimulation - Movement Inability to move indicates serious CNS deficit o Hemiplegia: inability to move one side o Bilateral tingling and numbness or sensory/motor deficit in the upper extremity may indicate cervical spine injury - Abnormal nerve response Response to adverse stimuli can provide important info o Numbness and tingling in limb w/o movement can indicate cold or nerve damage o Severe pain, lack of pulse, loss of sensation can indicate blocked blood vessel o Total loss of pain can indicate hysteria, shock, drug use, or spinal cord injury However, generalized or local pain specific to the injured area indicates an absence of spinal injury Principles of Off-the-Field Assessment Off Field - More complete exam - By a team in an acute setting HOPS (History, Observation, Palpation, Special Tests) History: most important piece of the puzzle - Questions Onset: What happened? Did you hear any sounds associated with the injury? Provocation: What makes it hurt? Quality: How bad does it hurt? Radiation: Is the pain localized or does it radiate? Severity: How bad is the injury? Time: When did this start? What time of day does it hurt the most? How long has this been going on? Observation: visual inspection - Inspect area for: Deformities: out of place? Mishappens? Discolored? Is there a visible wound? Swelling? How are they carrying themselves? How’s their gait? How do they position their own body? BILATERAL COMPARISON: ALWAYS COMPARE OTHER SIDE Palpation: putting hands on area - What do you feel? Feel the area Start way from the actual spot and work your way towards injury Search for important landmarks: Are they as they should be? Is there a certain structure that’s affected? Is the pain localized to the bone or soft tissue? Can you feel crepitus? Is there heat? How is the ROM? Limited? Excessive? Neuro-exam: strength, sensation, etc. Special Tests - Done by the athletic trainer, physical therapist, or physician. OTHERS SHOULD NOT ATTEMPT - There are numerous special tests created to assess damage to specific body structures Treatment Immediate treatment - Primary goal is to limit swelling and extent of hemorrhaging - Control with RICE (Rest, Ice, Compress, Elevate) Don’t Forget to Document SOAP Notes - Subjective: patient report such as history and symptoms - Objective: practitioners observations, visual signs - Assessment: Practitioners’ findings, special tests, ROM, MMT, etc. - Plan: how will you treat management, rehabilitation, short and long term goals Review and Some New Concepts Acute vs chronic mechanism - Trauma - Overuse - Disease Skin injury - Rashes/infections - Skin disruption Muscle injury - Strains - Tendon rupture - Tendinopathy - Cramps - Muscle soreness Joint injury - Subluxations/dislocations - Sprains - Arthritis - Cartilage injury Bone injury - Growth plate injury - Traumatic fractures - Stress fractures - Peristatic Other injuries - Nerve injury - Head injury - Heat illness Fractures 101 Young Athletes and Fractures Young athletes are at risk for physical injuries - Can often be missed by clinicians - Some cases can result in growth disturbances - It’s important for athletic trainers to know how to identify injuries and avoid future complications Outcomes Salter-Harris types I and II - Often resolve on their own - Poor outcomes have been reported - Nonunion, malalignment, and growth retardation Salter-Harris types III and IV - Higher rate of poor outcomes - Often require surgery to secure displaced fragments and proper alignment of growth plate - Timely identification can reduce risk of complications Mechanical Injury Trauma: physical injury or wound sustained in sport produced internally or externally Mechanical injury: force or mechanical energy applied to any part of the body resulting in harmful disturbance in structure and/or function Sport injuries can result from external forces directed on the body or can occur within the body internally Types of Mechanical Loads Shear: blister, abrasions Compressions: arthritis, contusions, fractures Tension: strains, sprains, avulsions Torsion: spiral fracture Bending: complete fracture Tissues Properties Load: external force(s) acting on internal force(s) Stiffness: ability of tissue to resist a load - Stress: internal resistance to an external load - Strain: extent of deformation of tissue under loading Deformation: change in shape of tissue Soft Tissue Trauma Soft tissue or non-bony tissue - Non-contractile tissues include ligaments, skin, cartilage, capsules, fascia, dura mater, and nerve roots - Contractile tissue involves muscles and its parts including tendons and bony insertions Skin Injuries Anatomical considerations - Skin represents largest organ of the body consisting of the epidermis and dermis - Soft pliable nature of skin makes it easy to injure Laceration: wound in which has been irregularly torn Skin avulsion: skin that’s torn by same mechanism as laceration to the extent that tissue is completely ripped from source Incision: wound in which skin has been sharply cut Puncture: penetration of skin by sharp object Wounds Friction blister - Continuous rubbing over skin surface causing a collection of fluid below or within epidermal layer Abrasion - Skin is scraped against rough surface resulting in capillary exposure due to skin removal Contusion - Compression or crush injury of skin surface that produces bleeding under the skin Acute Muscle Injuries Contusions - Result of sudden blow to body - Can be deep and/or superficial - Hematoma results from blood and lymph flow into surrounding tissue - Can penetrate to skeletal structures causing a bone bruise - Usually rated by the extent to which muscle is able to produce range of motion - Blow can be so severe that fascia surrounding muscle ruptures allowing muscle to protrude Strains - Stretch, tear, or rip to muscle or adjacent tissue - Cause is often obscure Abnormal muscle contraction result from o Failure in reciprocal coordination or agonist and antagonist o Electrolyte imbalance due to profuse sweating or strength imbalance - May range from minimum separation of connective tissue to complete tendinous avulsion or muscle rupture Skeletal Muscle Injuries Anatomical characteristics - 3 types of muscle 1) Cardiac 2) Smooth 3) Skeletal Strains 1) Grade I: some fibers have been stretched or actually torn resulting in tenderness and pain on active ROM; movement is painful but full range is present 2) Grade II: number of fibers have been torn and active contraction is painful, usually a depression or divot is palpable with some swelling and some discoloration 3) Grade III: complete rupture of muscle or musculotendinous junction, significant impairment, with initially a great deal of pain that diminishes due to nerve damage Other Muscle Problems Spasm: in response to upper motor neuron lesion in the brain Cramp: result of overloading of the muscle and depletion of electrolytes or an interruption of synergism with opposing muscles Guarding: splinting response to injury Tendon Injuries Breaking point occurs at 6-8% of increased length Tears generally occur in muscle and not tendon Repetitive stress on tendon will result in microtrauma and elongation - Repeated microtrauma may evolve into chronic muscle strain - Results in weakening tendon Chronic Musculoskeletal Injuries Progress slowly over a long period of time Repetitive acute injuries can lead to chronic condition Constant irritation due to poor mechanics and stress will cause injury to become chronic Chronic muscle injuries - Representative of low grade inflammatory process with possible scarring - Acute injury is improperly managed Chronic Conditions Tendonitis: acute inflammation of tendon Tenosynovitis: inflammation of the synovial sheath Tendinosis: degenerative changes in the tendon Ligamentous Injuries Connective tissue: bone to bone Comprised of collagen Classification scheme similar to that of muscular injuries - Grade I: “stretch” - Grade II: “partial tear” - Grade III: “complete” Skeletal Trauma Anatomical characteristics - Dense connective tissue matrix - Outer compact tissue - Inner porous cancellous bone While bones have viscoelastic properties, bone is fairly rigid and serves as a poor shock absorber Brittle nature increases under tension rather than compression Cylindrical nature of bones make them very strong (resistant to bending and twisting) Anatomical weak points - Stresses become concentrated in areas where changes in shape and direction occur - Gradual changes in shape are much more advantageous Nerve Trauma Most common injury mechanisms are compression or tension Neuritis can range from minor problems to total paralysis Lacerations of nerves along with compression of nerves resulting from fractures and dislocations can impact nerve function
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