Immobilization and shifting of injured athelete I Dr.RAJAT JANGIR JAIPUR

IMMOBILIZATION AND SHIFTINGIMMOBILIZATION AND SHIFTING
OF INJURED ATHELETEOF INJURED ATHELETE
Dr.RAJAT JANGIR
Consultant Arthroscopy and Orthopedic Surgeon
Saket Hospital, Mansarovar
Assistant Professor
Mahatma Gandhi Medical College, Jaipur
Fellowship In Arthroscopy(South Korea)
International Olympic Committee Diploma Sports Medicine(UK)
Sports Physician RIO Olympic 2016

Basic life support (BLS)
Advanced cardiac life support (ACLS)

What is the most dangerous sport?
Cheerleading

OVERALL APPROACHOVERALL APPROACH
Anticipate the worst
Never make any assumptions
History and Exam have to make
sense
Don’t take short cuts
Document frequently
TEAMWORK

INITIAL APPROACH INJUREDINITIAL APPROACH INJURED
ATHELETEATHELETE
Initial primary assessment
Rapid resuscitation
A more thorough secondary assessment
Followed by diagnostic tests and
disposition.

What will we see
1) Head and Spinal Trauma
2) Bony Injuries / Dislocations
3) Sprains and Strains
4) Soft Tissue Injuries
4Also, non traumatic problems including cardiac
problems, dehydration, asthma exacerbations

PRIMARY SURVEYPRIMARY SURVEY
Collapsed athlete
Choking
Seizures
Motionless or moving patient - Grossly
deformed limb
Major bleed

On arrival – “Hello, are you OK”
RESPONSIVE (awake, can move, opens
eyes, moans, grunts, movement) or
UNRESPONSIVE
Breathing Normal or Breathing Abnormal

SECONDARY SURVEYSECONDARY SURVEY
History
Physical exam: head to toe
“Tubes OR fingers in every orifice”
Complete neurological exam
Special diagnosis tests
Re-evaluation

Glasgow Coma ScaleGlasgow Coma Scale
 EyesEyes
 ““Open your eyes”Open your eyes”
 VerbalVerbal
 ““What happened to you?”What happened to you?”
 Add “T” to score if intubatedAdd “T” to score if intubated
 MotorMotor
 ““Hold up two fingers”Hold up two fingers”

Secondary surveySecondary survey
History
“AMPLE”
A:Allergies
M:Medication currently being taken
P:Past illness and operations,pregnancy
L:Last meal
E:Event/Environment related to the injury

HEAD
 Signs of skull base
fracture
 Pupillary size
 Hemorrhages of
conjunctiva/fundi
 Visual acuity
 Ocular movement
 Posterior scalp
laceration

NECK
Cervical tenderness, subcutaneous
emphysema
Oesophageal injury
Tracheal/laryngeal injury
Carotid injury (penetrating/blunt)

CHEST
 Inspect
 Palpate
 Percuss
 Auscultate
 Obtain x-rays

ABDOMEN
 Inspect
 Auscultate
 Palpate
 Percuss
 Reevaluate
 Special studies

Perineum:contusion,hematoma, laceration,urethral
blood
Rectum:sphincter tone,high riding prostate,pelvic
fracture,rectal wall integrity,blood
Vagina:blood,laceration

Musculoskeletal
 Contusion, deformity
 Pain
 Perfusion
 Peripheral
neurovascular status
 X-ray

Head Trauma/Concussions
What is important for this patient?
What should we be assessing very carefully?

ConcussionConcussion
TRAUMATIC BRAIN INJURY
Most patients will not have LOC
No need for a head blow
to develop a concussion

History: SymptomsHistory: Symptoms
• Dizziness
• “Stunned”
• Confusion
• Forgetfulness
• Behavior or
mood changes

Physical examPhysical exam
Palpation
– Head, neck and upper
shoulders
– No need to do exertion
testing.
 If in doubt, sit out

Mental statusMental status
Orientation
– Place, time, situation
 Period, score, opponent
– Concentration
 Months of the year in reverse order
 Name 3 objects

Neurologic examNeurologic exam
Cranial nerves
Reflexes
Babinski
Balance Error Scoring System (BESS)
– Check balance in 2 legs, tandem and 1 leg
 Flat surface and high density foam

History: SymptomsHistory: Symptoms
Headache
Nausea
Double vision
Sensitivity to light or sounds

SECONDARY SURVEYSECONDARY SURVEY
The complete
history and
physical
examination

Principles of TreatmentPrinciples of Treatment
Protect spinal cord from secondary injury
We have little or no effect on primary
injury
Focus on prevention of secondary injury

Head/Neck Trauma Treatment
1) Careful attention to ABCs
1) Full Trauma Assessment
1) Careful attention to LOC, GCS
1) Maintain C-Spine
2) Complete Spine board immobilization
3) Watch for changes in mental status and vital signs

C CollarsC Collars
Philadelp
hia
Soft
Miam
i J
Aspen

Immobilize Everyone!Immobilize Everyone!
ATLS- Standard of care. Part of ABCDE
ACS (Published new guideline in 2013)
Prehospital Trauma Life Support (Until
2011)
National Association of Emergency
Medical Technicians

Good or bad?Good or bad?
Patients still should get spinal immobilization
because the benefits outweigh the risk
…......… right?

Definitive Care in the FieldDefinitive Care in the Field
 PackagingPackaging
 Spinal immobilization if indicatedSpinal immobilization if indicated
 Splint musculoskeletal injuriesSplint musculoskeletal injuries
 Dress woundsDress wounds

TransportationTransportation
 ClosestClosest appropriateappropriate facilityfacility
 to reach trauma centerto reach trauma center
 Receiving facilities should be determined by localReceiving facilities should be determined by local
protocolprotocol
 ModeMode
 GroundGround
 AeromedicalAeromedical

Bony Injuries
1) Fractures/Breaks
A) Open
B) Closed
2) Dislocations

Fractures Treatment?
Open and Closed Fractures

1)Cover an open wound with dressing,
control bleeding and
do not try to push the bone back in

2) Elevation for if appropriate for wound
control

3) Immobilize the injury, checking for
distal pulses, motor function, and
sensation before and after splinting
(DNVS)

4) Fractures should not be reduced in the
field, but we can apply traction to one
type of fracture.

Dislocation Treatment?
1) Assess DNVS
1) Immobilize affected in position of comfort
1) Reassess DNVS
1) Apply Ice
1) Do not try to reduce the dislocation

1) Be Creative (not overly creative)
1) Immobilization in a position - comfortable for the
patient, yet maintains stabilization and is safe for
transport
1) Loss of any aspect of DNVS is a bad splint
1) Immobilize proximal and distal joints if possible
1) There is never just one “right” splint
General Immobilisation Splinting Tips

Sprains and Strains
Strains (pulled muscle): tearing of the muscle fiber
from excessive stretch
Sprains: a stretch of tear of a ligament
Signs and Symptoms?
Pain
Swelling
Redness
Limited mobility

Treatment Sprains and Strains
1) Splinting affected area if necessary
2) Assess DNVS before and after
splinting
3) Ice/elevation
4) Discontinue activity

Methods of immobilizationMethods of immobilization
Splinting; wooden, commercial
Brace or support
Strap
Slab immobilization
 Cast immobilization
 Traction
 External fixation
 Open reduction and internal fixation

Purpose of immobilizationPurpose of immobilization
Temporary
Definite

C. Jewett hyperextension brace
D. Lumbosacral support

Strap immobilizationStrap immobilization
Figure of eight strap
Gibney’s strap
Velpeau’s strap
A band or slip used in attaching parts to each others

GibneyGibney’’s straps strap
Nondisplaced fracture of ankle
Ankle Sprain

VelpeauVelpeau’’s straps strap
Injury of
shoulder
region

Take Home MessageTake Home Message
ABCDE
Cervical Collar Application
Logroll Shifting

Immobilization and shifting of injured athelete I Dr.RAJAT JANGIR JAIPUR

Immobilization and shifting of injured athelete I Dr.RAJAT JANGIR JAIPUR

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Immobilization and shifting of injured athelete I Dr.RAJAT JANGIR JAIPUR