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Ballpark Triage and First Aid

Learn about common injuries and illnesses encountered in sports, and gain basic triage and first aid knowledge. Topics covered include spine injuries, head injuries, facial injuries, extremity injuries, and more.

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Ballpark Triage and First Aid

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  1. Ballpark Triage and First Aid C. Michael Remoll, MD FACEP Associate Chief, Emergency Dept. Anne Arundel Medical Center

  2. Objectives: • To present medical scenarios most likely to be encountered in role as BBSC manager/coach • To provide terminology and definitions associated with some common “ballpark” injuries and illnesses • To provide basic triage and first aid principles for such injuries and illnesses

  3. VS

  4. Specific Topics • Spine injuries • Closed Head Injuries • Facial Injuries • Extremity Injuries • Blunt Force Internal Injuries • Heat-Related Illnesses • Allergic Reactions • Lightning Injuries

  5. Spine Injuries • High potential for significant disability • Most commonly result from collision, fall • Immediate recognition and initial treatment most important • When suspected, immediately seek medical attention: 911

  6. Spine Injuries • Spinal cord extends from the base of the skull to the mid-back • Spinal Cord is protected by the spinal vertebral bones (neck and back bones), ligaments, muscles • Injury to vertebral bones, ligaments (fractures, dislocations) may lead to injury of the spinal cord • Level of spinal cord injury determines severity of disability • Neck injuries can lead to quadroplegia; back injuries can lead to paraplegia

  7. Spine Injuries: Signs/Symptoms • Neck and/or back pain • Abnormal Sensation: numbness, tingling • Inability to move extremities • Shock: pale, sweaty, mental status change

  8. Spine Injuries: First Aid • Call 911 immediately • Immobilization: If patient is on the ground, keep him/her perfectly still • If patient is standing, gently help him/her to ground, lying on back • Place objects around patient to ensure immobilization • Leave batting helmet on • Place blanket/jacket over patient for warmth

  9. Head Injuries • May be open or closed • Beware of associated spine injury • Most often are minor, but can be serious and life-threatening

  10. Head Injury: Definitions • Concussion: a type of traumatic brain injury (TBI), caused by a bump, blow, or jolt to the head, that can change the way your brain normally works • Epidural/Subdural Hematoma: “blood clot on the brain”

  11. Concussion: Statistics • each year, U.S. emergency departments (EDs) treat an estimated 173,285 sports- and recreation-related TBIs • during the last decade, ED visits for sports- and recreation-related TBIs, including concussions, among children and adolescents increased by 60%. • 6.5% of all ED visits for TBI are sports related • of all baseball-related injuries that are seen in the ED, 8% are from TBI • source: CDC website (cdc.gov)

  12. Concussion: CT findings

  13. Concussion • From blunt head trauma: fall, collision, direct blow (pitched ball, baseball bat) • Most do not involve loss of consciousness • Signs/Symptoms: • Four categories: Physical, Cognitive, Emotional, Sleep • The victim may not experience symptoms until hours or days after the injury • If any of these symptoms present following a head injury, the player should NOT return to play until he/she has been evaluated by a health care provider • a repeat concussion that occurs before the brain recovers from the first—usually within a short period of time (hours, days, or weeks)—can slow recovery or increase the likelihood of having long-term problems source: CDC website (cdc.gov)

  14. Epidural/Subdural Hematoma • Usually occurs with more significant trauma • Direct blow causes bleeding from a vein or artery inside the skull; exerts pressure on brain • May be impossible to distinguish from concussion initially • Rapid deterioration is suggestive of Epidural Hematoma • Require immediate medical attention: 911 • Consider associated spine injury

  15. Facial Injuries • Nasal Injuries • Eye Injuries • Dental Injuries • Usually from direct blow or collision • Consider associated spine/closed head injury

  16. Nasal Injuries • Signs/Symptoms: bleeding, swelling, deformity, pain • Treatment: Control bleeding • Have patient sit leaning slightly forward • Apply direct pressure • Seek medical attention

  17. Eye Injuries • Usually from thrown ball • Most often the eye is protected by the boney orbit • If there is any associated eye pain or problems with vision, must seek immediate medical attention • Foreign body (sand, grass, bug) in eye: irrigate with water; if symptoms persist, may have a corneal abrasion (seek medical attention )

  18. Dental Injuries • Fractured tooth: Contact dentist ASAP • Avulsed tooth: Tooth dislodges from the jaw • Important to reimplant tooth ASAP • Transport tooth in milk or saliva • Dental/Medical attention ASAP for re-implantation (50% success when within 50 minutes)

  19. Extremity Injuries • May be contusion, abrasion, sprain, strain, dislocation, fracture • Most commonly involve wrist, ankle, hand, leg, arm

  20. Definitions • Contusion: bruise; occurs when blood vessels are damaged as a result of a direct blow • Abrasion: scrape; injury that rubs off the surface of the skin • Laceration: a cut or tear of body tissue; may be superficial or deep

  21. Definitions • Sprain: injury of a ligament (tough fibrous tissue connecting bone to bone) • Strain: injury of either muscle or tendon (attaches muscle to bone) • Tendons, muscles, and ligaments may be torn-more significant injury

  22. Definitions • Fracture: a break in a bone; may be partial or complete • Dislocation: displacement of a bone (or bones) in a joint

  23. Extremity Injuries: Bone • May result from collision, fall, direct blow • Wrist, ankle, hand, fingers, arm, leg • Signs/Symptoms include hearing a “snap” or “pop”, deformity, swelling, discoloration, pain, inability to move the extremity • If there is significant swelling, discoloration, pain, or if any deformity seek immediate medical attention • Immobilize extremity, control any bleeding, apply ice • If practical (hand, wrist, ankle, foot), elevate extremity

  24. Extremity Injuries: Soft Tissue • May result from collision, fall, direct blow • Abrasions should be gently cleaned with warm water and soap • Contusions should be treated with ice • Lacerations: apply pressure, dressing; elevate if possible; seek medical attention • Consider underlying boney injury

  25. Blunt Force Internal Injuries • Usually result from collision, direct blow, fall • Organs at risk: liver (right), spleen (left), kidney (flanks) • Signs/Symptoms: pain which usually persists, then signs of blood loss • If organ injury suspected, seek medical attention immediately: 911

  26. Signs of Blood Loss • Increased heart rate • Dizziness • Pallor • Sweating • Confusion • Syncope (passing out)

  27. SHOCK

  28. Heat-related Illnesses • Heat Exhaustion • Heatstroke • Heat Cramps

  29. Heat Exhaustion • From exposure to high temperature and dehydration • Symptoms/Signs: Weakness, malaise, headache, dizziness, nausea, vomiting, muscle aches, sweating, flushed skin, high heart rate, fast breathing • Treatment: Remove from heat, hydrate (avoid caffeine), rest, fanning

  30. Heatstroke • Progression from Heat Exhaustion • Diagnosis: No sweating (usually), confusion (or seizures, unconsciousness), body temperature > 104 degrees • Requires immediate medical attention: 911 • Extreme cooling measures: ice packs, wet sheet

  31. Heat Cramps • Painful, involuntary contractions of muscles in those who have been sweating and not replacing electrolytes • Occur during or (more commonly) during rest period after activity • Usually involve calves, thighs, shoulders • Treatment/Prevention: fluids, electrolytes (sports drinks)

  32. Insect Stings • Bees, wasps, yellow jackets, hornets • Cause 500 deaths/year in U.S. • Localized Reaction: pain, redness, swelling; treat will cool compress, elevation • Systemic Reaction (Anaphylaxis): • Serious and may be life-threatening • Hives, “throat closing”, shortness of breath, lightheadedness, passing out • Requires immediate medical attention: 911 • Benadryl, Epi-pen

  33. Lightning • 2,000 deaths worldwide per year (100 in U.S.) • From direct strike or “Splash Injury” • May cause variety of injuries • Anyone with symptomatic lightning injury requires immediate medical attention: 911 • Prevention: • If you hear thunder, you are in range • Avoid open spaces, high elevations, tall objects • Don’t stand in groups (stay 15 feet apart) • Don’t carry or hold tall metal objects • Catcher’s stance • Car provides good shelter

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