Sports Injury AssessmentProcedures

Primary and Secondary Surveys

• It is important to perform a Primary and Secondary survey.

• Primary Survey (make sure you are safe before you treat)– Detect and treat Life Threatening conditions– “Treat as you go”– ABCDE’s

“A” Airway “B” Breathing “C” Circulation “D” Disability “E” Expose

“A”IRWAY

• An  obstructed  airway  may  quickly lead to respiratory arrest and death.

• Assess   responsiveness   and,   if necessary, open the airway.

“B”REATHING

• Respiratory  arrest  will  quickly  lead to  cardiac  arrest.   

• Assess  breathing, and,   if   necessary,   provide   rescue breathing.

• Look   for   and   treat conditions   that   may   compromise breathing,   such   as   penetrating trauma to the chest.

“C”IRCULATION

• If  the  patient’s  heart  has  stopped, blood and oxygen are not being sent to  the  brain.

• Irreversible  changes will begin to occur in the brain in 4 to 6  minutes;  cell  death  will  usually occur  within  10  minutes.

• Assess circulation, and, if necessary, provide  cardiopulmonary resuscitation (CPR).  

•  Also check for profuse bleeding that can be controlled. • Assess and begin treatment for

severe  shock or the potential for severe shock.

“D”ISABILITY

• Serious central nervous system injuries can lead to death.  

• Assess the patient’s level of consciousness and, if you suspect a head or neck injury, apply a rigid neck collar.   

• Observe the neck before you cover it up.  • Also do   a   quick   assessment   of   the

patient’s   ability   to   move   all extremities.

“E”XPOSE

• You cannot treat conditions you have not  discovered.  •  Remove  clothing–

especially if the patient is not alert or communicating  with  you–to  see  if you   missed   any   life-threatening injuries.

• Protect   the   patient’s privacy,  and  keep  the  patient  warm with a blanket if necessary.

Primary Survey Continued

• As soon as the ABCDE process is completed, you will  need  to  make  what  is  referred  to  as  a status decision of the patient’s condition.

• A status decision is a judgment about the severity of the patient’s condition and whether the patient requires immediate transport to a medical facility without a secondary survey at the scene.  

• Ideally, the ABCDE steps, status, and transport decision  should  be  completed  within  10  minutes  of your arrival on the scene.

Secondary Survey

• The  object  of  a  secondary  survey  is  to  detect medical and injury-related problems that do not pose an  immediate  threat  to  survival  but  that,  if  left untreated, may do so.

• Usually the trauma assessment is about  20  percent  patient  interview  and  80  percent physical  exam.     On  the  other  hand,  the   medical assessment   is  80  percent  patient  interview  and  20 percent physical exam.   Both the physical exam and patient interview should always be done for all medical and trauma patients.

• H.O.P.S.

HOPS- History

• History: Attitude, mental condition, and perceived physical state.– Stated by the athlete.– Primary Complaint– Mechanism of Injury– Characteristics of the Symptoms– Limitations– Past History

HOPS - History

• Initial and most important step in the evaluation process.

• In many instances, the history alone describes the illness or injury. Physical exam only confirms it.

HOPS -HISTORY CONT.

1. Look at the athlete.• Anxious• Posture• Walk freely or limp• Guarding

2. Identify the chief complaint• Why is the athlete there to see you.

3. Review previous medical history• Acute or Chronic• Any previous injury or surgery

HOPS - History Cont.

4. Review Symptoms• Athlete’s interpretation of injury or illness• When asking about pain use the following

PQRST– Provocation

» What causes the pain.– Quality

» What type of pain» Sharp, aching, dull, burning, etc….

– Region/Radiating» Location of pain, Radiating pain

– Severity» Scale of 1 to 10

– Time» When does it hurt, how long, » What makes it better or worse

HOPS - History cont.

– At conclusion of History ask yourself was the history AMPLE?

• A = Allergies (Bee sting, Penicillin)• M = Medicine• P = Previous Illness or Injury• L = Last thing taken by mouth• E = Events leading up to injury or illness

HOPS- Observation and Inspection

• Observation: Measurable objective signs.– Appearance– Symmetry– General Motor Function– Posture and Gait– Deformity, swelling, discoloration, scars,

and general skin condition

HOPS- Palpation

Rule out FX (fracture) Skin temperature Swelling Point tenderness Crepitus Deformity Muscle spasm Cutaneous Sensation (nail bed refill) Pulse

HOPS- Special Tests

• Functional Tests– Active Range of Motion (AROM)– Passive Range of Motion (PROM)– Resisted Manual Muscle Testing (RROM)

• Stress Tests– Ligamentous Instability Tests– Special Tests

HOPS- Special Tests

• Neurologic Tests– Dermatomes– Myotomes– Reflexes– Peripheral Nerve Testing

• Sport-Specific Functional Testing– Proprioception and Motor Coordination

HOPS- Special Tests

• Sport-Specific Skill Performance– Throw the football, baseball, softball, javelin...– Kick the soccer ball, football, opponent…

S.O.A.P. Notes

• S=Subjective information gathered from the patient

• O=Objective • A=Assessment• P=Plan

SOAP- Subjective

• History: Attitude, mental condition, and perceived physical state.– Stated by the athlete.– Primary Complaint– Mechanism of Injury– Characteristics of the Symptoms– Limitations– Past History

SOAP- Objective:

• Observation: Measurable objective signs.– Appearance– Symmetry– General Motor Function– Posture and Gait– Deformity, swelling, discoloration, scars,

and general skin condition

SOAP- Objective

Rule out FX (fracture) Cutaneous Sens.Skin temperature PulseSwellingPoint tendernessCrepitusDeformityMuscle spasm

SOAP- Objective

• Functional Tests– Active Range of Motion (AROM)– Passive Range of Motion (PROM)– Resisted Manual Muscle Testing (RROM)

• Stress Tests– Ligamentous Instability Tests– Special Tests

SOAP- Objective

• Neurologic Tests– Dermatomes– Myotomes– Reflexes– Peripheral Nerve Testing

• Sport-Specific Functional Testing– Proprioception and Motor Coordination

SOAP- Objective

• Sport-Specific Skill Performance– Throw the football, baseball, softball,

javelin...– Kick the soccer ball, football, opponent…– Macarena, Cabbage Patch, Mash Potato

SOAP- Assessment

• Analyze and assess the individual’s status and prognosis

• Suspected injury Site• Damaged Structures Involved• Severity of Injury• Progress Notes

SOAP- Plan

1. Immediate treatment given2. Frequency and duration of treatments

and modalities and evaluation3. On-going patient education4. Criteria for discharge/return to play

On Field Assessment

On The Field Assessment

• History:– Location of Pain– Presence of abnormal neurological signs– Mechanism of Injury– Associated sounds (snap, crack, pop)

On The Field Assessment cont.

• Observation:– Check the surrounding area– Body positioning– Movement of the athlete– Level of responsiveness– Primary survey– Inspection for head or neck trauma– Inspection of the injured body part

On The Field Assessment cont.

• Palpation– Joints– Bones– Soft tissue– Skin temperature

On The Field Assessment cont.

• Functional Testing– Active Range of Motion (AROM)– Passive Range of Motion (PROM)– Resistive Range of Motion (RROM)– Weight Bearing

On The Field Assessment cont.

• Stress Testing– Ligamentous stability

• Neurological Testing– Cutaneous– Motor

On The Field Assessment cont.

• Vital Signs– Pulse– Respiratory Rate– Blood Pressure– Temperature– Skin Color– Pupils– Disposition

On The Field Assessment cont.

• Moving the Athlete– Ambulatory Assist– Manual Conveyance– Spine Board– Pool Extraction

Physician Ordered Tests

• Blood Test• Radiographs (X-Ray)• Computed Tomography (CT)• Magnetic Resonance Imaging (MRI)• Radionuclide Scintigraph (Bone Scan) • Ultrasonic Imaging • Electromyography (EMG)

Special Tests

X-ray MRI

Special Test cont.

CT scan Bone Scan

Special Tests cont.

Ultrasound Electromyography - EMG