How to evaluate an injured athlete

Evaluation of the injured athlete

Evaluation of the injured or ill athlete consists of conducting a physical examination and obtaining a complete set of vital signs. Physical examination can be either a focused body systems approach or a global head-to-toe approach.

A physical examination has four components: inspection, palpation, percussion, and auscultation.

Inspection involves a close examination of the injured area looking for deformity, contusions, abrasions, swelling, and bleeding. Palpation involves touching the injured area to note abnormal findings such as deformity or crepitus.

Percussion consists of tapping the injured area to elicit tympanic sounds. Percussion is used for thoracic and

abdominal injuries and is difficult to perform in the athletic arena. Auscultation refers to listening to lung sounds

with a stethoscope and, although difficult in a noisy environment, it is a crucial skill for any seriously injured athlete, especially when the athlete is short of breath.

Evaluation of the injured athlete

The golden hour is the time between onset of injury and definitive surgical treatment. This universally accepted concept for the management of trauma patients means that paramedics concentrate on a rapid assessment and packaging of the patient to keep their on-scene time to less than 10 minutes. If the response time was 10 minutes and the transport time is also 10 minutes, you can readily see that half of the golden hour is gone before the patient even arrives at a hospital, preferably a trauma center. Therefore, it is important that no time is lost by the athletic trainer in deciding to summon EMS after the injury occurs. Although not all athletic injury emergencies are related to trauma, it is reasonable to extend the trauma managment concept to medical patients to avoid delays in getting the athlete to definitive care.

Parts of the Primary Survey

A: Stabilize cervical spine and check the airway.

B: Check for breathing.

C: Check for circulation.

D: Check for neurological disability (or apply defibrillator).

E: Check level of exposure

Secondary Survey

After the primary survey is complete and life-threatening conditions are managed, a secondary survey is performed.

This consists of a complete head-to-toe examination to rule out other injuries that may not be apparent on the primary examination. All components of the primary survey are continuously monitored so that any deterioration in the athlete’s condition is immediately recognized and corrected. Findings will need to be clearly communicated to EMS personnel once they arrive on the scene.

Secondary Survey Examination

Starting at the head use a look, listen, and palpate approach. Look for contusions, abrasions, lacerations, and deformity. Listen to breath sounds in the chest. Palpate body parts for crepitus, pain, and rigidity or masses. Listen for abnormal sounds while palpating.

Head-to-Toe Examination

Look at the pupils while examining the head. Pupils should be midline, equal, and round, and they should react to light and accommodation; the acronym PERRLA is frequently used

Pupil Examination: PERRLA

P Pupils

E Equal

R Round

R Reactive

L Light

A Accommodation (The pupils move in conjunction with each other and in the proper direction based on stimulation—for instance: “Follow my finger as it moves in different directions.”The pupils should move simultaneously and smoothly as they follow the finger.)

Vital Signs

Vital signs are appropriately named—they provide crucial information necessary to manage a seriously injured athlete. There are six easily measured vital signs: pulse, blood pressure, respiratory rate, temperature, pulse oximetry, and pain assessment. Vital signs should be repeated as often as the patient’s condition warrants. The athlete who is critically ill or injured should have vital signs measured at least every 3 minutes, whereas the less seriously injured may have vital sign intervals of 5 to 15 minutes.

The Six Vital Signs

■ Pulse

■ Blood pressure

■ Respiratory rate

■ Temperature

■ Pulse oximetry

Pain assessment

Normal Vital Signs

Adult Child

Pulse 60-100 _20

Blood pressure 120/80 70 _ 2 _ age

Respiratory rate 10–20 _20

Temperature 98.6°F 98.6°F

(37.0°C) (37.0°C)

Pulse oximetry _95% _95%

Pain 0 0

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