Prevention & Care of Athletic Injuries ATHT 3580 Fall 2016 Review Sheet for Test #1 ∙ Know Don't forget about the age old question of Meno: What is Virtue?
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the definition of ‘athletic training’ and be able to identify the domains of athletic training Athletic training is the prevention, recognition, evaluation, treatment, rehabilitation & health care administration of athletic injuries. Domains: Prevention Evaluation/clinical education & diagnosis Immediate care Treatment, rehab & reconditioning Organization & health care administration Professional development & responsibility ∙ Understand how someone becomes an athletic trainer and what ATC and NATA stand for Someone can become an athletic trainer by completing an accredited entry-level athletic training education program at a college or university. Program must be accredited by the Commission on Accreditation of Athletic Training Education (CAATE) Most athletic training curriculums are 2-3 ears of courses, which are blocked out in order for each semester Upon completion of accredited curriculum program, student must successfully pass a comprehensive, computerized exam administered by the NATA Once an ATC, athletic trainer may choose to pursue graduate degree, additional certifications, or simply obtain a job as a certified athletic trainer. NATA certification is universal. ∙ Know the difference between an athletic trainer and other types of “trainers” ∙ List settings in which athletic trainers work; understand administrative duties of athletic trainers Colleges & universities, secondary schools/school districts, professional sports, amateur sports settings (Olympics etc.), sports medicine clinics, hospitals & doctors’ offices, corporate or industrial setting and community recreation centers. ∙ Identify members of the sports medicine team and their roles Members of the sports medicine team include: Team physician, NATABOC certified athletic trainer, athletic training students, athletes, parents, coaches, athletic directors, conditioning coaches.∙ Describe what is involved with conducting primary and secondary surveys; ABC’s To conduct a primary survey, approach athlete in calm & reassuring manner; check that the scene is safe first. Need to prepare to clear & maintain airways; be prepared to provide CPR & activate emergency medical system. Remember to check & monitor vital signs. A written protocol for handling both life-threatening & non-life-threatening injuries should be drafted for each institution & approved by the team physician. Primary survey assesses the following: A: airway B: breathing C: circulation Secondary survey is conducted once primary survey is completed & it is determined to be non-life-threatening injury. It consists of: History Physical examination ∙ Identify and describe vital signs, normal ranges and what abnormal readings indicate Pulse- usually taken at radial artery in wrist or carotid artery in the neck (Adult: 60- 80 bpm, Kids: 80-100 bpm) Rapid: weak pulse- shock, bleeding; diabetic coma; heat exhaustion Rapid: strong pulse- heats stroke; fear/ severe fright Slow: strong pulse- skull fracture; stroke Blood pressure- indicates the amount of pressure exerted against the arterial walls Systolic pressure is determined as the heart contracts Diastolic pressure is determined as the heart rate relaxes between beats “Normal” blood pressure is 120/80 Respiration- measure by watching the chest rise & fall Normal respiration rates: Adult- 12-20 breaths/min, Kids- 20-25 breaths/min Shallow breathing usually indicates, Irregular/ gasping breathing could indicate a cardiac problem, blood from the mouth with breathing may indicate a fracture in the ribs Temperature- body temp is maintained by water evaporation & heat radiation Normal temp: 98.6 degrees F Temp can also be measured rectally (most accurate 99.6 degrees F) or in axillary (97.6 degrees F) (Oral ears, forehead) Hot, dry skin usually indicates disease, infection or overexposure to heat Cool, clammy skin usually indicates trauma, shock, or heat exhaustion Cool, dry skin usually indicates overexposure to cold Skin color- good indicator of state health, particularly in light-skinned individuals Pupils- extremely sensitive to situations affecting he nervous system (PEARL- pupils equal and reactive to light is important) State of Consciousness-in normal situations, athlete is alert, aware of environment & respond quickly to verbal cues Movement- can be classified by active, passive, assistive & resistive Abnormal nerve stimulation- always check motor (movement) & sensory (feeling) of the involved area to determine if there is nerve damage ∙ Explain what HOPRS, SOAP stand for and involve; identify questions to ask when taking the medical history during an evaluation HOPRS History- asking questions to determine chief complaint (location of pain, type of pain, pain level, type & location of other symptoms) Observation- of the athlete & injury site; occurs with the eyes only (swelling, deformities, discoloration, bleeding, scars, movement/gait, and other signs of trauma) always compare bilaterally Palpations- we begin our hands-on examination of the injury, palpate anatomical structures around the affected area, we will palpate all related bony & soft tissue structures, palpating for point tenderness/pain, swelling, temperature, crepitus, muscle spasms, skin temp, pulses, neurological sensation, etc. Range of Motion- the extent to which a body part can move through all of its plane movement Active ROM- refers to joint motion that occurs because of muscle contraction (the athlete performs on their own) Passive ROM- refers to movement completely performed by the examiner (examiner moves the body part, athlete does not) Resisted ROM/strength testing- isometric contraction performed at midpoint of range to eval contractile tissue. ROM can be measured with a Goniometer Special Tests- exist for nearly everybody region & are used to detect specific pathologies (used to determine ligament stability, joint stability, pain, impingement signs, muscle imbalances, other discrepancies) SOAP Subjective- history, what the athlete tells you about the injury Objective- evaluation; observations, palpations, ROM, special tests, etc. Assessment- identifies clinical impression or suspected injury Plan- outlines immediate treatment, action & referral, goals for treatment & rehab, & criteria for return to activity ∙ Describe what is involved in the remainder of an evaluation in regards to observations, palpations, ROM, MMT, and other testing MMT- graded on a scale from 0-5, with 5 being full strength ∙ Understand the PRICES concept and how it applies to treatment of injuries PRICES-one basic approach to immediate treatment of the injury Protection- prevent further injury Rest- rest the injury Ice- apply cold to decrease pain & swelling Compression- apply to minimize swelling Elevation- elevate injured area above to heart Support- apply wrap, tape, splint, sling, crutches ∙ Describe the different effects of ice and heat; how do we know when to incorporate them in treatment? What other types of modalities do we use to treat injuries? Ice vs Heat Effects of ice Decrease pain- “analgesic effect” Decrease swelling & inflammation Decrease blood flow = Vasoconstriction Effects of Heat Relaxation of muscles & tissues = pain relief Decreased muscle stiffness Increased blood flow = vasodilation Always use ice for at least first 48-72 hours after acute injury occurs This helps with completing the inflammatory process & allowing the healing process to begin Use of cold modalities reduces pain & swelling, reduces tissue temp, & removes heat from the body Cold modalities Ice bag/cold pack Cold whirlpool/ slush bucket Ice massage Cold spray Game ready Hot modalities- after first 48-72 hours after acute injury, we can re-assess signs & symptoms to determine if cold modality or hot modality to determine: if swelling, redness, or significant pain still persists, continue ice, if these symptoms are not present, heat therapy may be warranted Moist heat pack Warm whirlpool Ultrasound Massage Heat applications being in the subacute or chronic phases of injuries; very rarely use heat in acute phases May reverse healing process if you begin heat too soon. ∙ Be able to describe the events occurring in the inflammatory process and the healing process; name the 5 signs of inflammation or trauma ∙ Explain the importance of therapeutic exercise in treatment of injuries; identify the phases of rehab and the goals of a rehab program∙ List the mechanisms of injury for tissue damage and know what types of injuries result from each Tension- force that pulls or stretches tissue (Strain) Stretching- beyond yield point leads to rupturing of soft tissue or fracture of bone (fracture) Compression- a force that crushes tissue; injury occurs when force can no longer be absorbed (fracture, bruising) Shearing- force that moves across parallel organization of tissue and causes injury when force has exceeded strength of the tissue (turf burns, blisters) Bending- force on horizontal beam that creates stress within structure, causing bend or strain () ∙ Know definitions for general musculoskeletal injuries, including different types of fractures that we discussed in class Contusion- a “bruise;” an injury caused by a blow to the area in which the skin is not broken Sprain- a stretching or tearing of ligaments & joint capsule structures Strain- a stretching or tearing of muscles & tendons Dislocation- displacement of one or more bones or a joint from the original position Subluxation- a partial or incomplete dislocation Tendinitis- inflammation of tendon Tenosynovitis- inflammation of tendon sheath Synovitis- inflammation of the synovial membrane Myositis- inflammation of muscle tissue Myositis ossificans- inflammation of muscle with formation of bone Epicondylitis- inflammation of the epicondyle & tissue adjoining epicondyle to humerus (elbow) Fasciitis – inflammation of fascia Bursitis- inflammation of bursa sac Arthritis-inflammation of a joint ∙ List the five different types of open wounds and the management for each; describe general care for open wounds; identify the signs of infection in a wound Abrasion- outer layer of skin (dermis & epidermis) are damaged from being scraped on hard surface, bleeding is usually limited due to rupture of capillaries (typical scrape) Cleanse, antibiotic cream, dressing or band-aid Laceration- jagged, irregular tear of soft tissues. Cleanse, apply direct pressure with sterile gauze & elevate affected extremity Incision- skin has been sharply cut, as if by glass or metal, wound has smooth edges & sides. Same as above Avulsion- forcible separation or tearing of tissue from body, resulting in immediate bleeding, torn with same mechanism as laceration to the extent that tissue is completely ripped from its source. Apply direct pressure with sterile gauze & elevate affected extremity Puncture- small hole in tissues produced by an object piercing the skin layers, external bleeding is usually limited, but potential for internal damage is possible, potential for tetanus or other infection is possible. Cleanse around the area being careful not to push more debris into wound; if object is still impaled in body part, do not remove Always monitor open wounds for signs of infection Usually appear 2-7 days after injury Redness, swelling, hot & tender around wound Swollen & painful lymph glands near area of the infection Mild fever &/or headache Change dressings regularly ∙ Define and identify blood borne pathogens; understand universal precautions and OSHA Blood borne pathogens- pathogenic microorganisms that can potentially cause disease & are present in human blood & other body fluids BBP of most concern are HIV & Hepatitis B (Hepatitis C & D and Syphilis) Regulations concerning exposure to blood borne pathogens were established by the Occupational Safety and Health Administration (OSHA) in 1992 Universal precautions include: Prior to practice or competition, all of an athlete’s open wounds must be covered with fixed dressing that will not allow transmission Any athlete that is actively bleeding must be removed from the activity until bleeding is controlled and wounds are covered Proper containers with biohazard labels to dispose of soiled items need to be available as well as sharps containers for needles, syringes, & scalpels Biohazard labels should be red or orange ∙ Identify the purpose of taping and wrapping injuries; describe preparation of the body for taping and wrapping Primary purpose for tape application is to provide additional support, stability, or compression to the affected body part. Tape can also be applied to secure pads or bandages. The primary purpose or the application of elastic wraps is for support & compression Preparation Removal of hair: areas to taped should be shaved if possible Clean the area: skin should be clean & free of dirt, lotions, etc. Special considerations: observe for open wounds or blisters that may need covered; be aware of any allergies the athlete may have to tape, spray, or other products Position the athlete: athlete &/or extremity to be taped needs to be placed in the proper position Spray adherent: apply to the skin to assist in adhering tape to skin Skin lubricants: heal & lace pads used to reduce friction Pre-wrap/underwrap: applied to protect the skin during taping; not used with wraps ∙ Understand basic guidelines and procedures for taping and wrapping Prepare body part & person to be taped or wrapped as described previously Always apply wraps in the distal to proximal manner…why? You want to work with the way you want the blood to flow. Tape/wrap athlete from a stationary position Allow the tape/wrap to go with the natural angles of the body; don’t pull it where it does not want to go! Always be sure to secure loose ends & check capillary bed refill (CBR) to the area when completing a tape or wrap