Scene 1

On-field emergencies- A Sports Physiotherapist’s Perspective

Dr.  Neeraj  Kumar PT BPT, MSPT Professor & Vice Principal, Dr.APJ Abdul  Kalam  College of  Physiotherapy Pravara  Institute of Medical Sciences (Deemed to be University) Loni , Dist.-  Ahmednagar , Maharashtra, www.pravara.com

Scene 2

Dr. A.P.J. Abdul  Kalam  College of Physiotherapy

'A.'.u.AML ULU cage
-_iiii $üiii iii iiiiiii iiiiü

Pravara  Institute of Medical Sciences  (Deemed to be University)

( Estd .- 1976 as Dept of Physiotherapy to provide patient care)

Dept of Orthopaedics PT Dept of  Neuro  PT Dept of  Cardiorespiratory  PT Dept of Community PT Dept of Paediatrics PT Smt.  Sindhutai  E.  Vikhe   Patil  Spinal Cord      Injury Rehabilitation  Center Prosthetic and Orthotic Lab Kinesiotherapy  lab Electrotherapy &  Electrodiagnosis  Lab

We impart: BPT  (from 1997) MPT  (from 2004) - in all above 5  depts PhD  (from 2010) - in all above 5  depts

www.pravara.com , 02422-271489,  contact@pmtpims.org ,  principal.cpt@pmtpims.org

Scene 3

Preparation for emergencies Classification  Assessment of Life threatening situation Procedure for unconscious athletes Assessment of serious injuries Minor injuries and their management Triage  Criteria for return to play Medical bag to cater emergencies

Scene 4

1. 	 Appropriate personnel , equipment for transport and stabilization. 2.	 Ensure appropriate communications  – network on  place prior to emergency.  3.	 Rehearse emergency responses  to ensure system in  place.

Scene 5

4.	 Cardiovascular  – Basic life support qualified personnel.  5.	 Have a prepared emergency plan .  6.	 Neurological  – Initial assessment – motor, sensory-immediate 			transport – treat as neck injury.  7.	 Anaphylaxis  – Asthma, Bee sting.

Scene 6

8.   Gastro _ intestinal  – rupture Spleen , Bowel. 9.     Genito -Urinary   –  Haematuria , then  remove from field.  10.   Hypoglycaemia . 11.   Hyperthermia   and  Hypothermia.  Dislocation s  – Knee, Elbow, Ankle, Foot, Hip -   		 neurovascular  complications.

Scene 7

CLASSIFICATION  of the  INJURED ATHLETE  on the  FIELD

Life threatening injuries which requires emergency management Injuries that prevent further participation Injuries that permit continuation of play after treatment

Scene 8

‘ Inju ries or Conditions that impair, or have the potential to impair vital function, of the CNS and Cardio-Respiratory system are considered Emergency  situations’

Scene 9

ASSESSMENT of  LIFE  THREATENING INJURIES  – 4  phases.

Rapid primary evaluation– establish scene  safety  Emergency or immediate treatment after primary  examination  Detailed secondary  evaluation  Institution of definitive care based on secondary  assessment

NB.	  There are 02 assessment phases and 02 treatment phases.

Scene 10

RESPONSIVENESS AIRWAY BREATHING CIRCULATION

Scene 11

Cardio Pulmonary emergency.  Unconscious athlete.  Hemorrhages.  Fractures.  Shock.  Hyperthermia  – Heat stress.  Hypothermia  –  Cold stress.

Other Emergency  Situations  in  the  Field  -

Scene 12

Primary EVALUATION  –  of Life Threatening Injuries.

The Protocol is:- Airway maintenance. Breathing.  C-spine control. D. Disability and Neurological status. E. Expose complete (undress) patient.

Scene 13

Ensure patent down to level of larynx  –   clear  foreign bodies,  teeth. Possible co-existence of C-spine   fracture -     hyperextension should never occur , immobilize  head  and 	neck.  Assume C-spine injury in any injury above Clavicle - 	Maintain Airway.

Scene 14

Chest injuries that can prevent breathing- Tension Pneumothorax.  Open Pneumothorax.  Flail Chest.

Scene 15

External bleeding – Direct pressure. Elevation. Pressure points. Internal Hemorrhage – shock.

Scene 16

Assess Unresponsiveness C-Spine control Proceed  to  ABC Open Airway . Head  tilt/chin lift method - if no neck or head  injury Jaw  thrust  method  Heimlich  maneuver or  	 Abdominal thrust Finger  sweep

Scene 17

Establish  Breathing Assess by  look, listen, feel  principle Establish  Circulation Carotid pulse  Circulation maintained through  	chest compression  CPR (15:2, with two rescuer)

Scene 18

Degree of Severity –  on CANTU scale (Mild, moderate, severe). Monitor – suspected concussion.  Guidelines for season. 	 *  First   concussion –     return to play if asymptomatic 							after 1 week. 	*  Second concussion – out one month. 	* Third concussion –   out for season.

Scene 19

SERIOUS  INJURIES   INJURIES  that  PREVENT  further PARTICIPATION

Scene 20

PRINCIPLES OF ASSESSMENT OF SEVERE INJURIES

1. Follow correct sequence of  priorities

Scene 21

Fingers  –   Assess, field side reduction, temporary return to play – 							 must be individualized .	  Elbow – Shoulder Ankle or Foot   –   Field side reduction  depends  		on experience of Team 	Physician then Emergency Transport.

Scene 22

Knee   	-  may reduce field side, depends on experience, rule out 		                     vascular complications, immediate emergency transport.

Hip              –  Immediate transport.

Patella         –   Reduce field side depends on experience – rule out ACL 								   injury.

Scene 23

INJURIES  that  PERMIT  PLAY   after  TREATMENT.

Scene 24

Musculoskeletal injuries Strain Sprain  Abrasion Teeth or mouth injuries Minor external eyes injuries Anterior chamber injuries Photophobia  Nose injuries Fractures- Ear injuries External trauma

Scene 25

Scene 26

Anterior chamber injuries. Photophobia. Evaluation of visual activity – ROM.

Stop bleeding before returning to play. Fracture –continue play in non contact sport.

External trauma – suture, strapping. Loss of hearing – evaluate.

Saline or milk  preservation Transport to appropriate facility Evaluation of additional trauma – fracture mandible, mastoid.

Scene 27

Sport Related Injuries  are  Assessed   using the -

HOPS FORMAT . History of injury.  Observation and Inspection. Palpation. Special Tests . ( Hops Format uses both – Subjective and Objective information)

Scene 28

TRIAGE – Steps Assessment of injured persons quickly. Returning to most seriously injured and assess again. Immediate treatment to that person.

TRIAGE  - Assessment of all injured persons to  determine priority of care.

Scene 29

Check surrounding area for objects or      	structures that can contribute to injury.      Scan the body and note body       	positions or deformity.     Unconscious patients summon medical assistance.      Decerebrate  rigidity-extension in all 4 extremities .      Decorticate rigidity-extension of legs,       	flexion  of elbows.

Scene 30

Scene 31

No potential threat to life or limbs. Minimal potential for further injury. Painless weight  bearing . Informed consent – with respect to potential for further 			injury where there is no threat to life or limb.

Scene 32

Scene 33

Medical Bag and Supplies to Cater for Emergencies.

Circulation supplies . 	 * IV catheters. * IV fluids. * Tourniquet. * Defibrillator device .

Transport supplies . 	 *  Spineboard  with head support.  * Stretcher.

Airway & Ventilation . * Heavy  Scissors or bolt cutters. * Oral  Airways, Nasal Airways. * Cervical  collar – rigid. * Ventilation  masks – pocket type & ventilation bag. *  Endotracheal   tubes, Laryngoscope. *  Portable Suction unit & Oxygen.

“MURPHY’S LAW – if anything can go wrong, it will go wrong.!”

Scene 34

On-field emergencies- A Sports Physiotherapist's Perspective

 www.pravara.com , 02422-271489,  contact@pmtpims.org ,  principal.cpt@pmtpims.org  

On-field emergencies- A Sports Physiotherapist's Perspective

Scene 1 (0s)

Scene 2 (1m 29s)

Scene 3 (3m 54s)

Scene 4 (4m 23s)

Scene 5 (8m 47s)

Scene 6 (10m 17s)

Scene 7 (11m 49s)

Scene 8 (14m 21s)

Scene 9 (15m 10s)

Scene 10 (19m 14s)

Scene 11 (19m 27s)

Scene 12 (19m 40s)

Scene 13 (23m 4s)

Scene 14 (24m 11s)

Scene 15 (24m 39s)

Scene 16 (25m 27s)

Scene 17 (26m 52s)

Scene 18 (29m 17s)

Scene 19 (31m 17s)

Scene 20 (31m 37s)

Scene 21 (33m 9s)

Scene 22 (35m 54s)

Scene 23 (36m 40s)

Scene 24 (37m 13s)

Scene 25 (38m 36s)

Scene 26 (39m 53s)

Scene 27 (41m 30s)

Scene 28 (41m 57s)

Scene 29 (44m 6s)

Scene 30 (46m 17s)

Scene 31 (47m 21s)

Scene 32 (48m 5s)

Scene 33 (48m 12s)

Scene 34 (50m 57s)