Patellar tendonitis/jumper's knee - Initial treatment is conservative with rest, ice, NSAIDs, patellar taping, strengthening exercises. - If conservative treatment fails after 6-8 weeks, consider corticosteroid injection. - Surgery is rarely required and usually only considered after failed conservative treatment for more than 3-6 months.

1. EMERGENCY PLAN AND
INITIAL INJURY EVALUATION

2. Emergency Plan
 Proper planning is essential to ensure appropriate initial
first aid management of an injury.
 Anything done ahead of time to improve athletes’ health
should be a priority.
 Failure to have an emergency plan is grounds for
negligence.

3. Emergency Plan Components
The emergency plan:
• Identifies personnel directly involved in carrying out the
plan.
• Specifies necessary equipment.
• Establishes a mechanism for communication.
• Is derived from overall emergency planning policies.
• Incorporates local emergency care facilities.
• Specifies documentation needed to support plan
implementation and evaluation.
• Is reviewed and rehearsed at least annually, and the
results of these efforts are documented.
• Is reviewed by the administration and legal counsel of the
sponsoring organization or institution.

4. The Emergency Team
Members of the emergency team are personnel
directly involved in interscholastic sports
programming (high school level), including:
Coaches
Administrators
Team physician
Athletic trainer
Local EMS staff

5. Functions of Emergency
Team Members
Members of the emergency care team are
responsible for:
Immediate care of athlete.
Emergency equipment retrieval.
Activation of EMS, if necessary.
Directing EMS to injury scene.

6. Emergency Plan
Plan should be comprehensive and include:
 Procedures for both home and away events.
 Steps for dealing with emergency situations affecting
athletes, fans, and sideline participants.
 Locations of phones (school personnel should have cell
phones).
 Emergency phone numbers.
 Directions to the site for EMS.
 Access points for EMS.

7. First Aid Training
 All personnel should be trained in
basic first aid, CPR, AED use.
 Training should be conducted by
nationally recognized organizations,
e.g., the American Heart Association.
 Personnel should upgrade training at
least every 3 years.
 Personnel should have periodic “mock”
emergency drills to rehearse the plan.
© Phototdisc

8. Injury-Evaluation Procedures
Coach’s responsibility is the immediate care of acute
injury—this is critical.
 Coaches will be seen as “first responders” and should
focus on providing care to the extent of their training.
 Coaches should avoid going beyond their level of
training.
 By law, coaches are most often held accountable for
proper care when no physician or athletic trainer is
present.

9. Injury-Evaluation Procedures
Coaching personnel should have BLS (basic life support)
training that focuses on life-threatening situations.
Primary BLS skills are:
 Airway assessment and opening techniques.
 Rescue breathing.
 CPR.
 AED protocol.
Coaches must distinguish minor from major injuries.

10. Initial Check
 The initial check must include assessments of:
 Responsiveness
 Airway
 Breathing
 Severe Bleeding

11. Initial Check: Nervous System
Is the athlete responsive?
AVPU Scale
• Alert and aware
• Verbal stimulus response
• Painful stimulus response
• Unresponsive to any stimulus
 If athlete fails to show any response, he or she is “unresponsive to any
stimulus.”
If spinal or head injury is suspected, immobilize head and neck immediately.

12. Initial Check: Airway Assessment
Ask athlete a simple question.
 A response indicates at that time the
airway is open and circulation is
adequate.
 If athlete is unresponsive and has no
apparent serious head or spinal
injuries:
 Use head-tilt/chin lift method (do not
remove helmet or face mask).

13. Initial Check: Airway Assessment
If the person is not breathing and
spinal or head injury is suspected:
o Use jaw-thrust technique and
finger sweep (shown at left).
Breathing Assessment
•Conscious athlete is breathing but
must be monitored.
•Unconscious athlete can be assessed
quickly, ONCE airway is opened.
•Look, listen, and feel for air flow.

14. Initial Survey: Circulation
Assessment
 Responsive athlete who is breathing will have
signs of circulation.
 If athlete is unresponsive, breathing, coughing,
and movement in response to rescue breaths are
signs of circulation.
 If there are no signs of circulation, begin CPR.

15. Initial Survey: Hemorrhage Assessment
Most external bleeding is obvious.
Control with direct pressure, elevation, pressure points,
and/or pressure bandage.
-- Take precautions against bloodborne pathogens.
Internal hemorrhage is difficult to detect.
An early sign of internal hemorrhage is hypovolemic (blood & fluid
loss causes the heart to improperly work) shock. Signs include:
 Rapid weak pulse.
 Rapid shallow breathing.
 Moist clammy-feeling skin.
 Blue skin inside lips and under nail beds.
**Shock is a true medical emergency.

16. Physical Exam
Observation
• Continually monitor for signs of breathing and circulation.
• Note athlete’s body position and behavior.
• Note signs and symptoms relating to the injury.
• Perform D-O-T-S assessment – Deformities, Open Injuries, Tenderness,
Swelling

17. Shock
Signs and symptoms include:
• Profuse sweating
• Cool, clammy-feeling skin
• Dilated pupils
• Elevated pulse and respiration
• Irritable behavior
• Extreme thirst
• Nausea and/or vomiting

18. Treating Shock
 Have athlete lie down (supine) with legs elevated about 8
to 12 inches.
 Cover the athlete with a blanket (if environment is such
that loss of body heat is possible).
 Monitor vital signs.
 If spinal injury is suspected, do not move the athlete.

19. Taking Medical History
 Keep questions simple and brief— “yes” or “no” answers.
 Use easy-to-understand terms; avoid questions leading to
a preferred answer.
 Coaches should maintain composure.
 Ask athlete what happened. Ask if there were any strange
sounds when injury occurred. If athlete is in pain, ask
where it hurts.
 Inquire about previous injuries to involved area.
 Present history to medical personnel.

20. Palpation
Palpation:
 If practiced, is a useful skill to find deformity, spasm,
swelling, etc.
 A learned skill that requires physical contact with the
athlete.
 Should be performed carefully to avoid aggravating
existing injuries.
 Begin by palpating away from areas of injury.
 Begin with the uninjured limb, if the injury is to an
extremity.

21. Removal from Field or Court
 If athlete is conscious and has no injuries that preclude
walking, he or she may leave field under own power but
with assistance.
 If lower-extremity injury is present, use passive transport
system.
 If athlete is unconscious or may have neck injury:
 Stay with athlete
 Monitor vital signs
 Treat for shock
 Summon EMS
 Unless athlete is likely to be injured further, do not move
prior to EMS arrival.

22. Return to Play?
 Athletes with neurologic injury should not be allowed to
return until evaluated by trained medical personnel.
 Athletes suffering from heat-related problems should be
removed from participation and cleared for return only
by a medical professional.

23. The Coach’s Limitations
 Coaches must take special care NOT to overstep the
bounds of their training and expertise when managing
an injury.
 Coaches should only provide first aid care and should
avoid performing any procedure that is clearly the
domain of allied health personnel.

24. Assessing Minor Injuries
 S.O.A.P. Notes
 S – Subjective: Patient’s side of the story – onset
of the injury, pain level, type of pain, what
causes the pain (movement), other symptoms
 O – Objective: Vital signs, document observations
(bruising, swelling, deformity, etc), lab results,
measurements (height, weight, joint angles)
 A – Assessment: Physician’s diagnosis
 P – Plan: prescribed medication, further medical
tests, referral to another physician

25. Common SOAP Notes Acronyms
 Pt – Patient
 w/o – without
 f/u – follow up
 ROM – range of motion
 MOI – method of injury
 BP – blood pressure
 HR – heart rate
 - Left
 - Right
L
R

26. SOAP Note Practice
 Acronym Practice
 Soap Note Example
 Write a Soap Note for this accident

27. Scenario
A 17 year old girl comes to see you c/o pain in her lower legs.
She has been in the school athletics team for 4 years and has
recently started training for the london marathon. She says she
has pain in her lower legs and points to the middle 1/3 of her
tibias. It comes on if she runs any more than 4 or 5 miles and can
last for days after the run
You note she is tender on the medial border of her tibias in the
mid/upper 1/3
What advice would you give and what is your management
plan?

28. Shin Splints
• Medial Tibial Stress Syndrome/Shin Splints
• Not Specific Diagnosis - Refers to pain along the
course of the tibia
• Cause is thought to be related to overloading
muscles of the lower limb and biomechanical
irregularities
• Encompasses 3 main entities:
1. Medial Tibial Stress Syndrome
2. Chronic compartment syndrome
3. Tibial stress fracture

29. Case 1
 A 23 year old footballer has had a
twisting injury to the knee which has
now locked and become swollen. He
can weight-bare with pain. You see
him a week after the injury.
 What do you want to know?
 What treatments are available?
 Are the treatment different if he were
60?

30. Meniscus Injuries
 Are there mechanical symptoms
 Fragility tear or not
 Referral Options:
 Haemarthrosis
 Arthroscopy without imaging
 Imaging

31. Case 2
 An 13 year old boy has persistent pain
in his knee following a minor trauma
two weeks ago. You can find no
locking, effusion, instability. He can
walk with minor discomfort. Would
you:
 A. Wait and see
 B. Refer to physio
 C. X-ray

33. Case 3
 25 year old man with anterior knee
pain. When you examine him he can
straight leg raise, has no effusion or
locking or crepitus but has point
tenderness on the distal pole of the
patella.
 What is wrong?
 How do we treat this?