SPTH3011 Sports Therapy in Action Notes PDF

SPTH3011 – SPORTS THERAPY IN ACTION Assessment Preparation  Defined as a “traumatically induced transient disturbance of brain function that involves a complex pathophysiological process” (Harmon et al, 2013) “Concussion is a subset of mild traumatic br...

SPTH3011 – SPORTS THERAPY IN ACTION Assessment Preparation  Defined as a “traumatically induced transient disturbance of brain function that involves a complex pathophysiological process” (Harmon et al, 2013) “Concussion is a subset of mild traumatic brain injury which is classified based on acute Concussion injury characteristics at the less severe end of the brain injury spectrum.” (Harmon et al, 2019) “Concussion is one of the most difficult athletic injuries to diagnose and manage” (Tamara et al, 2017)  Pathophysiology A cascade of events – cellular and molecular Mechanical forces of a concussive mechanism can stretch or strain brain tissue Damage to neurons Damage to axons Damage to blood vessels Disruption of ions i.e. potassium and calcium Imbalance of neurotransmitters Potential inflammatory response  How to recognise a concussion – Criteria 1 Typically observed at distance/video Typically identified on-field Confirmed loss of consciousness (LOC) Player not orientated in time, place, and person Suspected LOC Definite confusion Convulsion Definite behavioural change Tonic posturing Oculomotor signs e.g. nystagmus Balance disturbance/ataxia On-field identification of signs or symptoms of concussion Clearly dazed  Signs and symptoms LOC Ataxia Lying motionless for >5 seconds Unsteady on rising Falling with no protection Unsteady on feet Failure to protect themselves on the ground Unusual postural reaction Cervical hypertonia Unusual postural reaction Clearly Dazed Vacant or blank stare Tonic Posturing Rigid extension of upper limbs (fencing reaction)  How to recognise a concussion – Criteria 2 Head impact where diagnosis not immediately apparent OUCH Criteria OUCH criteria Possible behaviour change O - On the floor after other players have moved on Possible confusion U - Unsteadiness in any position Injury observed with potential to result in a concussive C - Composing themselves on knees before standing injury H - Holding head/face after impact Possible transient or sub-threshold criteria 1 signs e.g. possible LOC, possible balance disturbance etc. 5 Step Analysis GRTP Flowchart Be aware that you may have U19 players in your teams! Accelerated RTP – ONLY UNDER DR SUPERVISION DANGER DRABCDE & AVPU RESPONSE? (UNCONSCIOUS) ALERT AIRWAY VOICE BREATHING PAIN UNRESPONSIVE CIRCULATION UNCONSCIOUS DISABILITY ENVIRONMENT MILS KNEE MILS INSPECT AFTER AIRWAY RESPONSE JAW THRUST MEASURE ADJUNCT APPLY ADJUNCT BREATHING CHECKS (RVP) BR NORMAL (10-30) = NON-REBREATHE BR ABNORMAL (30) = BVM CIRCULATION SKIN TURGOR, AFTER CAP REFILL, PUPILS 4 MINUTE TIMER BREATHING FOR A 5 MINUTE CHECK SKIP MADDOCKS & NEXUS TOP TO TOE WHEN UNCONSCIOUS PATIENT ALWAYS TREAT BECOMES ALERT AS UNSTABLE RESTART VITALS  AIRWAY ANATOMY AND OBSTRUCTIONS Common Airway Obstructions Upper Larynx Lower Tongue Laryngospasm Bronchospasm Oedema Foreign Material Secretions Foreign Material Oedema Blood, Vomit, Teeth Blood Protective Trauma Equipment Aspiration AIRWAY NOISES Stridor: A harsh, high pitched noise occurring commonly on inspiration caused by turbulent flow in the upper airway is suggestive of an upper airway obstruction. https://www.youtube.com/watch?v=vDdJo0RPKa8 https://www.youtube.com/watch?v=JSdEK79J4dw Snoring: Occurs when the pharynx is partially obstructed by the soft palate or tongue. Gurgling: Occurs due to secretions or fluid (e.g. vomit) in the upper airway. Choking: Choking occurs when there is a mechanical obstruction to airflow such as a foreign body. Airway reflexes have to be present. Hoarseness: Hoarseness is an abnormal deep, harsh voice generally caused by irritation of, or injury to, the vocal cords. SUCTION Suction only under direct visualisation AIRWAY ADJUNCTS Oropharyngeal Airway (OPA) Nasopharyngeal Airway (NPA) OPA Sizing Insertion Inverted With Incisors to the Tongue angle of the Depressor mandible  THIS VIDEO PROVIDES SOME KEY INFO ON OPA USE – PLEASE NOTE THAT FOR A CERVICAL SPINE INJURY YOU NEED TO JAW THRUST INSTEAD OF A HEAD TILT CHIN LIFT, AS SHOWN IN THIS VIDEO NPA Sizing Insertion Tip of the nose to Lubrication, bevel against septum, nostril the tragus in which septum deviates from (usually right), rotate if resisted GOLD STANDARD – SUPRAGLOTTIC AIRWAY (I-GEL) AIRWAY ADJUNCT CONTRAINDICATIONS OPA NPA I-Gel Conscious or semi-conscious Basilar/base of skull # Conscious or semi-conscious patient patient Oral trauma or obstruction Nasal pathologies or obstructions Complete airway obstruction Severe trismus (lockjaw) Coagulopathy or anticoagulation High risk of aspiration therapy (warfarin etc.) Foreign body obstruction Severe nasal trauma Massive facial trauma or airway deformity Size too small – can obstruct Severe facial trauma Tracheal pathology airway BREATHING MASKS – NON-REBREATHER MASK  Most widely used device in prehospital setting: shock management  Creates a tight seal over the athlete’s nose and mouth  Reservoir mask attached to hold oxygen  Should always contain oxygen  Flutter valves allow exhaled air to escape mask  Set flowmeter at 10-15 L/min  Used for normal breathing rates BREATHING MASKS – BAG AND VALVE MASK (BVM)  External management of the airway and breathing  Patient DOES NOT have to be unconscious  Used for abnormal breathing 30  6 second respiration rate  Short and sharp use of the BVM will promote stomach inflation and sickness. MANAGEMENT OF MEDICAL David Hickman CONDITIONS ACUTE Diabetic Collapse MEDICAL EMERGENCIES Fainting Acute Cerebral Event Asthma Anaphylaxis Heat Illness DIABETIC COLLAPSE The body's inability to regulate its blood sugar levels. This can lead to dangerously high or dangerously low blood sugar levels. Hypoglycaemic (low blood sugar) normally defined as 33% of pts best Moderate Asthma: Acute Severe Asthma: predicted value  Peak expiratory flow rate  PEFR 33-50% of pts best  Severe breathlessness i.e. (PEFR) 50-75% of pts best predicted value cannot complete sentences predicted value in one breath  Cannot complete sentences  Normal speech  Tachypnoea  BR >25bpm  BR 110bpm  Collapse  HR