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Immobilization and shifting of injured athelete


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Immobilization and shifting of injured athelete

  1. 1. IMMOBILIZATION AND SHIFTINGIMMOBILIZATION AND SHIFTING OF INJURED ATHELETEOF INJURED ATHELETE Dr.RAJAT JANGIR Consultant Arthroscopy and Orthopedic Surgeon Saket Hospital, Mansarovar Assistant Professor Mahatma Gandhi Medical College, Jaipur Fellowship In Arthroscopy(South Korea) International Olympic Committee Diploma Sports Medicine(UK) Sports Physician RIO Olympic 2016
  2. 2. Basic life support (BLS) Advanced cardiac life support (ACLS)
  3. 3. What is the most dangerous sport? Cheerleading
  4. 4. OVERALL APPROACHOVERALL APPROACH Anticipate the worst Never make any assumptions History and Exam have to make sense Don’t take short cuts Document frequently TEAMWORK
  5. 5. INITIAL APPROACH INJUREDINITIAL APPROACH INJURED ATHELETEATHELETE Initial primary assessment Rapid resuscitation A more thorough secondary assessment Followed by diagnostic tests and disposition.
  6. 6. What will we see 1) Head and Spinal Trauma 2) Bony Injuries / Dislocations 3) Sprains and Strains 4) Soft Tissue Injuries 4Also, non traumatic problems including cardiac problems, dehydration, asthma exacerbations
  8. 8. PRIMARY SURVEYPRIMARY SURVEY Collapsed athlete Choking Seizures Motionless or moving patient - Grossly deformed limb Major bleed
  9. 9. On arrival – “Hello, are you OK” RESPONSIVE (awake, can move, opens eyes, moans, grunts, movement) or UNRESPONSIVE Breathing Normal or Breathing Abnormal
  10. 10. Unresponsive Breathing
  11. 11. Unresponsive not breathing
  12. 12. SECONDARY SURVEYSECONDARY SURVEY History Physical exam: head to toe “Tubes OR fingers in every orifice” Complete neurological exam Special diagnosis tests Re-evaluation
  13. 13. Glasgow Coma ScaleGlasgow Coma Scale  EyesEyes  ““Open your eyes”Open your eyes”  VerbalVerbal  ““What happened to you?”What happened to you?”  Add “T” to score if intubatedAdd “T” to score if intubated  MotorMotor  ““Hold up two fingers”Hold up two fingers”
  14. 14. Secondary surveySecondary survey History “AMPLE” A:Allergies M:Medication currently being taken P:Past illness and operations,pregnancy L:Last meal E:Event/Environment related to the injury
  15. 15. Secondary surveySecondary survey HEAD  Signs of skull base fracture  Pupillary size  Hemorrhages of conjunctiva/fundi  Visual acuity  Ocular movement  Posterior scalp laceration
  16. 16. Secondary surveySecondary survey NECK Cervical tenderness, subcutaneous emphysema Oesophageal injury Tracheal/laryngeal injury Carotid injury (penetrating/blunt)
  17. 17. Secondary surveySecondary survey CHEST  Inspect  Palpate  Percuss  Auscultate  Obtain x-rays
  18. 18. Secondary surveySecondary survey ABDOMEN  Inspect  Auscultate  Palpate  Percuss  Reevaluate  Special studies
  19. 19. Secondary surveySecondary survey Perineum:contusion,hematoma, laceration,urethral blood Rectum:sphincter tone,high riding prostate,pelvic fracture,rectal wall integrity,blood Vagina:blood,laceration
  20. 20. Secondary surveySecondary survey Musculoskeletal  Contusion, deformity  Pain  Perfusion  Peripheral neurovascular status  X-ray
  21. 21. Head Trauma/Concussions What is important for this patient? What should we be assessing very carefully?
  23. 23. ConcussionConcussion TRAUMATIC BRAIN INJURY Most patients will not have LOC No need for a head blow to develop a concussion
  24. 24. History: SymptomsHistory: Symptoms • Dizziness • “Stunned” • Confusion • Forgetfulness • Behavior or mood changes
  25. 25. Physical examPhysical exam Palpation – Head, neck and upper shoulders – No need to do exertion testing.  If in doubt, sit out
  26. 26. Mental statusMental status Orientation – Place, time, situation  Period, score, opponent – Concentration  Months of the year in reverse order  Name 3 objects
  27. 27. Neurologic examNeurologic exam Cranial nerves Reflexes Babinski Balance Error Scoring System (BESS) – Check balance in 2 legs, tandem and 1 leg  Flat surface and high density foam
  28. 28. History: SymptomsHistory: Symptoms Headache Nausea Double vision Sensitivity to light or sounds
  29. 29. SECONDARY SURVEYSECONDARY SURVEY The complete history and physical examination
  30. 30. Principles of TreatmentPrinciples of Treatment Protect spinal cord from secondary injury We have little or no effect on primary injury Focus on prevention of secondary injury
  31. 31. Head/Neck Trauma Treatment 1) Careful attention to ABCs 1) Full Trauma Assessment 1) Careful attention to LOC, GCS 1) Maintain C-Spine 2) Complete Spine board immobilization 3) Watch for changes in mental status and vital signs
  32. 32. C CollarsC Collars Philadelp hia Soft Miam i J Aspen
  33. 33. Spine boardsSpine boards
  34. 34. Immobilize Everyone!Immobilize Everyone! ATLS- Standard of care. Part of ABCDE ACS (Published new guideline in 2013) Prehospital Trauma Life Support (Until 2011) National Association of Emergency Medical Technicians
  35. 35. LogrollLogroll
  36. 36. LogrollLogroll
  37. 37. Good or bad?Good or bad? Patients still should get spinal immobilization because the benefits outweigh the risk …......… right?
  38. 38. C-Spine Immobilization
  39. 39. Definitive Care in the FieldDefinitive Care in the Field  PackagingPackaging  Spinal immobilization if indicatedSpinal immobilization if indicated  Splint musculoskeletal injuriesSplint musculoskeletal injuries  Dress woundsDress wounds
  40. 40. TransportationTransportation  ClosestClosest appropriateappropriate facilityfacility  to reach trauma centerto reach trauma center  Receiving facilities should be determined by localReceiving facilities should be determined by local protocolprotocol  ModeMode  GroundGround  AeromedicalAeromedical
  41. 41. Bony Injuries 1) Fractures/Breaks A) Open B) Closed 2) Dislocations
  42. 42. Fractures Treatment? Open and Closed Fractures
  43. 43. Fractures Treatment? 1)Cover an open wound with dressing, control bleeding and do not try to push the bone back in
  44. 44. Fractures Treatment? 2) Elevation for if appropriate for wound control
  45. 45. Fractures Treatment? 3) Immobilize the injury, checking for distal pulses, motor function, and sensation before and after splinting (DNVS)
  46. 46. Fractures Treatment? 4) Fractures should not be reduced in the field, but we can apply traction to one type of fracture.
  47. 47. Dislocation Treatment? 1) Assess DNVS 1) Immobilize affected in position of comfort 1) Reassess DNVS 1) Apply Ice 1) Do not try to reduce the dislocation
  48. 48. 1) Be Creative (not overly creative) 1) Immobilization in a position - comfortable for the patient, yet maintains stabilization and is safe for transport 1) Loss of any aspect of DNVS is a bad splint 1) Immobilize proximal and distal joints if possible 1) There is never just one “right” splint General Immobilisation Splinting Tips
  49. 49. Sprains and Strains Strains (pulled muscle): tearing of the muscle fiber from excessive stretch Sprains: a stretch of tear of a ligament Signs and Symptoms? Pain Swelling Redness Limited mobility
  50. 50. How bad can they be?
  51. 51. Treatment Sprains and Strains 1) Splinting affected area if necessary 2) Assess DNVS before and after splinting 3) Ice/elevation 4) Discontinue activity
  52. 52. Methods of immobilizationMethods of immobilization Splinting; wooden, commercial Brace or support Strap Slab immobilization  Cast immobilization  Traction  External fixation  Open reduction and internal fixation
  53. 53. Purpose of immobilizationPurpose of immobilization Temporary Definite
  54. 54. A. Taylor brace B. Chairback
  55. 55. C. Jewett hyperextension brace D. Lumbosacral support
  56. 56. Strap immobilizationStrap immobilization Figure of eight strap Gibney’s strap Velpeau’s strap A band or slip used in attaching parts to each others
  57. 57. GibneyGibney’’s straps strap Nondisplaced fracture of ankle Ankle Sprain
  58. 58. VelpeauVelpeau’’s straps strap Injury of shoulder region
  59. 59. Take Home MessageTake Home Message ABCDE Cervical Collar Application Logroll Shifting