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Questions and Answers
Which of the following is considered a sign of a concussion?
Which of the following is considered a sign of a concussion?
What does the acronym LOC stand for in the context of concussion assessment?
What does the acronym LOC stand for in the context of concussion assessment?
What is tonic posturing, as it relates to potential concussion symptoms?
What is tonic posturing, as it relates to potential concussion symptoms?
According to the OUCH criteria, what does 'U' stand for?
According to the OUCH criteria, what does 'U' stand for?
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In the context of potential signs of a concussion, what does 'clearly dazed' typically involve?
In the context of potential signs of a concussion, what does 'clearly dazed' typically involve?
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Which of the following should be assessed as part of the 'DRABCDE' primary survey of a potentially concussed athlete?
Which of the following should be assessed as part of the 'DRABCDE' primary survey of a potentially concussed athlete?
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What immediate action is suggested if an athlete is lying motionless for more than 5 seconds after a head impact?
What immediate action is suggested if an athlete is lying motionless for more than 5 seconds after a head impact?
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What is the significance of 'cervical hypertonia' as it relates to concussion?
What is the significance of 'cervical hypertonia' as it relates to concussion?
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When is an accelerated return-to-play (RTP) protocol permissible following concussion?
When is an accelerated return-to-play (RTP) protocol permissible following concussion?
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What 'D' stand for in the DRABCDE primary survey of injured athlete?
What 'D' stand for in the DRABCDE primary survey of injured athlete?
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According to the definitions provided, which statement best characterizes the relationship between concussion and mild traumatic brain injury (mTBI)?
According to the definitions provided, which statement best characterizes the relationship between concussion and mild traumatic brain injury (mTBI)?
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Why is concussion considered one of the most difficult athletic injuries to diagnose and manage?
Why is concussion considered one of the most difficult athletic injuries to diagnose and manage?
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Which of the following is NOT considered a primary mechanism in the pathophysiology of a concussion?
Which of the following is NOT considered a primary mechanism in the pathophysiology of a concussion?
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During a concussion, mechanical forces stretch or strain brain tissue, potentially causing damage to which of the following structures?
During a concussion, mechanical forces stretch or strain brain tissue, potentially causing damage to which of the following structures?
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Which of the following is a criterion typically identified on-field when recognizing a concussion?
Which of the following is a criterion typically identified on-field when recognizing a concussion?
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What cascade of events contribute to the pathophysiology of a concussion?
What cascade of events contribute to the pathophysiology of a concussion?
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A player on the field is described as having a definite behavioural change and oculomotor signs. According to the content, where is this typically identified?
A player on the field is described as having a definite behavioural change and oculomotor signs. According to the content, where is this typically identified?
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Which of the following is most likely observed at distance/video when trying to recognise a concussion?
Which of the following is most likely observed at distance/video when trying to recognise a concussion?
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What is the first criteria listed when trying to recognise a concussion at distance/video?
What is the first criteria listed when trying to recognise a concussion at distance/video?
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Which of the following is LEAST likely to be directly caused by the mechanical forces of a concussive mechanism?
Which of the following is LEAST likely to be directly caused by the mechanical forces of a concussive mechanism?
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Which of the following is the MOST important consideration when using suction in airway management?
Which of the following is the MOST important consideration when using suction in airway management?
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When inserting an oropharyngeal airway (OPA), what is the purpose of initially inserting it upside down?
When inserting an oropharyngeal airway (OPA), what is the purpose of initially inserting it upside down?
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In what situation would an NPA be the MOST appropriate choice?
In what situation would an NPA be the MOST appropriate choice?
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What is the recommended flow rate for oxygen delivery when using a non-rebreather mask?
What is the recommended flow rate for oxygen delivery when using a non-rebreather mask?
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What is the MOST immediate risk associated with providing short and sharp ventilations with a Bag Valve Mask (BVM)?
What is the MOST immediate risk associated with providing short and sharp ventilations with a Bag Valve Mask (BVM)?
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Which device has the greatest risk of causing airway obstruction if the incorrect size is used?
Which device has the greatest risk of causing airway obstruction if the incorrect size is used?
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What distinguishing characteristic is associated with hoarseness?
What distinguishing characteristic is associated with hoarseness?
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For a patient with suspected cervical spine injury, which maneuver is recommended to open the airway instead of the head-tilt chin-lift?
For a patient with suspected cervical spine injury, which maneuver is recommended to open the airway instead of the head-tilt chin-lift?
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In which scenario is the i-Gel supraglottic airway contraindicated?
In which scenario is the i-Gel supraglottic airway contraindicated?
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When inserting a nasopharyngeal airway (NPA), which anatomical landmark should you measure from to determine the appropriate size?
When inserting a nasopharyngeal airway (NPA), which anatomical landmark should you measure from to determine the appropriate size?
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In an unconscious patient, which of the following is the correct initial sequence of assessment?
In an unconscious patient, which of the following is the correct initial sequence of assessment?
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What is the significance of 'RVP' in the context of breathing checks?
What is the significance of 'RVP' in the context of breathing checks?
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When assessing an unconscious patient, under what circumstances would skipping the 'Maddocks & Nexus' criteria be appropriate?
When assessing an unconscious patient, under what circumstances would skipping the 'Maddocks & Nexus' criteria be appropriate?
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Which of the following airway noises is most indicative of a lower airway obstruction?
Which of the following airway noises is most indicative of a lower airway obstruction?
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What intervention is MOST appropriate for a patient with $BR$ (breathing rate) of 35?
What intervention is MOST appropriate for a patient with $BR$ (breathing rate) of 35?
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Which of the following is NOT typically assessed within the 'Circulation' component of the primary survey?
Which of the following is NOT typically assessed within the 'Circulation' component of the primary survey?
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Which of the following is more likely to be indicated by upper airway obstruction?
Which of the following is more likely to be indicated by upper airway obstruction?
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After initial stabilization, when should vital signs be reassessed in a patient who was initially unconscious but becomes alert?
After initial stabilization, when should vital signs be reassessed in a patient who was initially unconscious but becomes alert?
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Which of the following is the most immediate risk associated with gurgling sounds in a patient's airway?
Which of the following is the most immediate risk associated with gurgling sounds in a patient's airway?
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What potential complication could arise from improper use of the jaw-thrust technique?
What potential complication could arise from improper use of the jaw-thrust technique?
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Flashcards
AIRWAY
AIRWAY
The passage through which air enters the lungs; vital to breathing.
RESPIRATORY RATE (BR)
RESPIRATORY RATE (BR)
The number of breaths taken per minute; normal is 10-30 breaths.
RESPONSE CHECK
RESPONSE CHECK
Assessment to determine if a patient is alert or unresponsive.
CIRCULATION CHECK
CIRCULATION CHECK
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STRIDOR
STRIDOR
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SNORING
SNORING
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GURGLING
GURGLING
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JAW THRUST
JAW THRUST
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UNCONSCIOUS PATIENT
UNCONSCIOUS PATIENT
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COMMON AIRWAY OBSTRUCTIONS
COMMON AIRWAY OBSTRUCTIONS
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Concussion
Concussion
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Pathophysiology
Pathophysiology
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Loss of consciousness (LOC)
Loss of consciousness (LOC)
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Oculomotor signs
Oculomotor signs
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Neurological damage
Neurological damage
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Neurotransmitter imbalance
Neurotransmitter imbalance
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Inflammatory response
Inflammatory response
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Tonic posturing
Tonic posturing
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Behavioral change
Behavioral change
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Convulsion
Convulsion
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Nystagmus
Nystagmus
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Ataxia
Ataxia
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Clearly Dazed
Clearly Dazed
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LOC
LOC
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OUCH Criteria
OUCH Criteria
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Unsteady on Rising
Unsteady on Rising
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Cervical Hypertonia
Cervical Hypertonia
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Head Impact
Head Impact
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DRABCDE & AVPU
DRABCDE & AVPU
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Choking
Choking
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Hoarseness
Hoarseness
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Oropharyngeal Airway (OPA)
Oropharyngeal Airway (OPA)
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Nasopharyngeal Airway (NPA)
Nasopharyngeal Airway (NPA)
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Supraglottic Airway
Supraglottic Airway
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OPA Contraindications
OPA Contraindications
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NPA Contraindications
NPA Contraindications
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Non-Rebreather Mask
Non-Rebreather Mask
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Bag-Valve Mask (BVM)
Bag-Valve Mask (BVM)
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Airway Management Devices
Airway Management Devices
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Study Notes
Concussion
- Defined as a "traumatically induced transient disturbance of brain function that involves a complex pathophysiological process" (Harmon et al, 2013).
- Often a subset of mild traumatic brain injury, at the less severe end of the brain injury spectrum (Harmon et al, 2019).
- One of the most difficult athletic injuries to diagnose and manage (Tamara et al, 2017).
- Caused when the force from a blow to the head, sudden deceleration, or other impact to the body travels to the head. The force causes the brain to move around inside the skull.
Pathophysiology
- Cascade of cellular and molecular events.
- Mechanical forces can stretch or strain brain tissue.
- Damage to neurons, axons, and blood vessels.
- Disruption of ions (e.g., potassium and calcium).
- Imbalance of neurotransmitters.
- Potential inflammatory response.
Cognitive Symptoms
- Feeling mentally foggy
- Difficulty concentrating
- Difficulty remembering
- Repeating questions
- Feeling mentally slowed down
- Forgetful of recent information
- Confused about recent events
- Answering questions slowly
Physical Symptoms
- Headache
- Nausea/vomiting
- Balance problems
- Numbness/tingling
- Sensitivity to light/noise
- Visual problems
- Dizziness
- Dazed or stunned
Emotional Symptoms
- Irritability
- Sadness
- More emotional
- Nervousness
Sleep Symptoms
- Drowsiness
- Sleeping less than usual
- Sleeping more than usual
- Trouble falling asleep
How to Recognize a Concussion - Criteria 1
- Confirmed loss of consciousness (LOC)
- Suspected LOC
- Convulsion
- Tonic posturing
- Balance disturbance/ataxia
- Clearly dazed
How to Recognize a Concussion - Criteria 2
- Head impact where diagnosis not immediately apparent
- Possible behavior change
- Possible confusion
- Injury observed with potential for concussion
- Possible transient or sub-threshold criteria 1 signs (e.g., possible LOC, possible balance disturbance)
5-Step Analysis
- Head impact (Time 0)
- Immediate response (0-2 seconds)
- Delayed response (3-7 seconds+)
- Returning to feet
- Return to play
GRTP Flowchart
- Clearance by healthcare professional (HCP) or doctor recommended
- Routine return to play pathway for adults & U19
- Different timeframes for return to play (RTP) based on age group/stage
- Follow specific guidelines/flowchart as directed by physician
Airway Anatomy and Obstruction
- Common Obstructions: Tongue, Oedema (swelling), Foreign material, Blood, Vomit, Teeth, Protective Equipment
- Upper Airway: Nasal cavity, Pharynx, Larynx
- Lower Airway: Trachea, Primary bronchi, Lungs
- Additional: Bronchospasm, Secretions, Oedema, trauma
Airway Noises
- Stridor: Harsh, high-pitched noise during inspiration, often suggestive of upper airway obstruction.
- Snoring: Partial obstruction of the pharynx by the soft palate or tongue.
- Gurgling: Secretions or fluids in the upper airway.
- Choking: Mechanical obstruction to airflow, often a foreign body.
- Hoarseness: Abnormal voice due to vocal cord irritation or injury.
Suction
- Suction only under direct visualization.
Airway Adjuncts
- Oropharyngeal Airway (OPA): Device inserted into the mouth to maintain an open airway.
- Sizing: Use incisors to appropriately size the airway.
- Insertion: Inverted & With Tongue Depressor
- Nasopharyngeal Airway (NPA): Device inserted through the nose.
- Sizing: Determine size by measuring from the tip of the nose to the tragus of the ear.
- Insertion: Lubricate & bevel against the septum (and if resisted, rotate)
- Gold Standard - Supraglottic Airway (I-Gel): Advanced airway device.
Airway Adjunct Contraindications
- OPA: Conscious or semi-conscious patient with oral trauma or obstruction, severe trismus (lockjaw), foreign body obstruction, size too small to be effective.
- NPA: Conscious or semi-conscious patient with nasal pathologies or obstructions, coagulopathy, severe nasal trauma or severe facial trauma.
- I-Gel: Conscious or semi-conscious patient with complete airway obstruction, high risk for aspiration, massive facial trauma or airway deformity , or tracheal pathology
Breathing Masks
- Non-rebreather mask: Used for emergencies or shock management. Creates a seal and has a reservoir to hold and deliver oxygen. Flutter valves allow exhaled air to escape.
- Bag-valve mask (BVM) External management of the airway and breathing for patients who are not unconscious. Used for abnormal breathing rates (<10 or > 30).
Acute Medical Emergencies
- Diabetic Collapse
- Fainting
- Acute Cerebral Event
- Asthma
- Anaphylaxis
- Heat illness
Diabetic Collapse
- Body's inability to regulate blood sugar levels (high or low).
- Hypoglycaemic (low blood sugar) <3.0 mmol.
- Signs and symptoms include: Shaking, trembling, sweating, headache, difficulty concentrating, slurring of speech, aggression/confusion, fitting/seizures, unconsciousness.
- Treatment: Confirm diagnosis by blood glucose measurement. Co-operative patients get oral glucose. More severe cases, apply sugary substance to buccal area.
Fainting
- Inadequate cerebral perfusion.
- Commonly occurs with low blood pressure (BP).
- Someone might have a history of repeated faints.
- Signs and symptoms: The patient feels faint/ lightheaded/dizzy, slow pulse rate, low BP, Pallor and sweating, Nausea and vomiting, Loss of consciousness.
- Treatment: Lay flat, raise legs, loosen clothing, O2 at 15 L/min. If unresponsive, monitor for signs of life.
Asthma
- Common respiratory illness affecting ~5% of the population.
- Issue is bronchospasm, constriction of surrounding muscles, causes narrowing of the lower airways.
- Airway inflammation causes swelling and further narrowing.
- Signs and symptoms include wheezing, coughing, tight chest, breathlessness, cyanosis, tripod position, accessory muscle breathing.
- Categories of asthma: Moderate, Acute severe, Life-threatening.
- Treatment: Based on the category.
Anaphylaxis
- Severe, potential life-threatening reaction to a trigger (e.g., allergies).
- Body overreacts to a substance causing symptoms (S&S).
- Signs and symptoms: Sudden collapse, dizziness, cold and clammy skin, confusion, sense of impending doom, loss of consciousness, swelling of tongue/throat, difficulty swallowing/speaking, horse voice, noisy breathing..
- Treatment: Confirm condition as anaphylaxis, support airway, give epinephrine (EpiPen), remove trigger, lay flat (unless breathing/conscious problems), elevate legs, and potentially subsequent epinephrine injection.
Chest Injuries
- Potentially Fatal Chest Trauma: Airway obstruction (A), Tension Pneumothorax (T), Open Pneumothorax (O), Massive Hemorrhagic Thorax (M), Flail Chest (F), Cardiac Tamponade (C).
- Airway Obstruction: Laryngeal trauma, hoarseness, subcutaneous emphysema.
- Tension Pneumothorax: Air in the pleural cavity, increasing pressure, causing collapse of the lung and shifting of the mediastinum.
- Open Pneumothorax: A sucking chest wound, a puncture wound allowing air to enter the pleural space.
- Massive Hemorrhagic Thorax: Significant blood loss in the chest cavity.
- Flail Chest: Multiple rib fractures causing a segment of the rib cage to detach, causing paradoxical breathing.
- Cardiac Tamponade: Excess fluid/blood accumulation in the pericardial sac, hindering heart function.
- How Breathing Works: Describes the role of the parietal pleura, visceral pleura, pleural space, and lubricating fluid.
Spinal Injuries
- Although rare in sport, spinal injuries, especially those connected with cord damage need attention.
- Typically low velocity.
- Secondary pathology from hypoxia is often the cause of permanent damage.
- Effective management is critical to prevent lasting issues.
Shock
- What is Shock?: Body's response to inadequate blood flow. Hypoperfusion (decreased flow) causes decreased blood flow and oxygenation to the brain. Recognition includes tachycardia, vasoconstriction, decreased cardiac output, decreased conscious state, and decreased arterial pressure.
- Types of Shock: Hypovolemic (fluid loss), Hemorrhagic (blood loss), Anaphylactic (allergy), Septic (infection), Neurogenic (autonomic nervous system dysfunction), Cardiogenic (heart dysfunction), Hypoglycemic (low blood sugar), Psychogenic (response to stress)
Possible Pupil Checks
- Pupils: Equal and responsive/reactive to light is typical.
- Possible Conditions Affecting Pupils: Holmes-Adie syndrome, Argyll Robertson pupil, Horner's syndrome, Midbrain compression, Pontine stroke.
Monday Seminar
- Mock online exam.
- Approximately 20 minutes long.
- Sample exam questions.
- Idea of content and phrasing.
- Electronic devices for the exam.
- PowerPoint with answers afterwards.
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Description
Test your knowledge on the signs and assessment criteria for concussions. This quiz covers vital concepts related to concussion symptoms, procedures for evaluation, and management protocols. Understand important terms and their implications in sports-related injuries.
