Injury Report

1. Injury Report

2. HOPS • History • Observation • Palpations • Special Tests

3. History • Basic Information • Name of athlete • Date of birth & gender • Sport, position, year & season • Activity & group • Location, weather, & type of surface

4. History • Injury History • Date & time of injury • Onset • Acute, chronic, or re-injury • Body part & side • Mechanism & how did it occur • Was there an existing injury and if yes, what & when • Pain • Location, type, any sounds • General condition of the athlete

5. History Present history • What is the problem? • How did it occur? • When did it occur? • Did you fall? • How did you land? • Which direction did your joint move? • Did you feel or hear something when it occurred? • If so, what?

6. History Present history Injury Location: • Toes, Lower Leg, Hip, Lumbar, Shoulder, Forearm, Cervical, Foot, Knee, Pelvis, Thorax, Upper Arm, Wrist, Head, Ankle, Thigh, Abdomen, Thoracic, Elbow, Fingers, Face, Medical

7. History Present history With one finger, point to the exact location of the injury: • Proximal, Distal, Superior, Inferior, Medial, Lateral, Anterior, Posterior, RUQ, RLQ, LUQ, LLQ, Midline

8. History Present history Pain Type: • Nerve • Sharp, bright, burning • Muscle • Dull, aching, referred to another area • Bone • Localized and piercing • Vascular • Poorly localized, aching, referred from another area

9. History Present history Pain Location: • Deep • more difficult to match the pain with the site of trauma, may cause treatment to be performed at the wrong site • Superficial • better elicited pain corresponding with the site of pain stimulation

10. History Present history Does the pain change at different times? • Chronic inflammation • indicated by pain that usually subsides during activity • Edema • pain that increases in a joint throughout the day

11. History Present history Does the athlete feel a sensation other than pain? • Pressure on nerve roots can produce pain or a sensation of “pins and needles” (paresthesia)

12. History Present history If the injury is related to a joint: • Is there stability? • Does it feel if it will give way? • Does it lock and unlock? • Positive responses may indicate the joint has a loose body catching or inhibiting the normal musculature support in the area

13. History Present history How long has the athlete had the injury? • Acute • immediate • Chronic • over an extended period of time

14. Observations

15. Observations • Usually taken during the history • What do you see? • Swelling • Redness • Ecchymosis • Scars, blisters, calluses • Limp or abnormal movement • Asymmetry, protrusions, malalignments, deformities • Guarding, facial expressions, etc

16. How does the athlete move? Limp Facial expression Asynchronous Movement No movement Guarding Slow movement Swelling Redness Deformity Inflammation Ecchymosis Asymmetries Abnormal Sound Atrophy Observation

17. Elbow Observations • Cubitus Recurvatus • Hyperextension

18. Toe Observations • Morton’s Toe • Abnormally short 1st metatarsal makes the second toe appear longer and putting more weight bearing on the 2nd metatarsal • Bunions (Hallux Valgus) or Bunionettes (Tailor’s Bunions) • In all bunions, both the flexor and extensor tendons are malaligned, creating more angular stress on the joint. • Corns • Hammer Toes or Clawed Toes • Malalignment of the metatarsophalangeal joint and PIP joints • Toe Overlap • Ingrown Nail • Subungual Hematoma

19. Foot Observations • Pes Planus • Flat feet • Pes Cavus • High arch

20. Knee Observations • Genu Varum • Bowed Legs • Genu Valgum • Knock Knees • Genu Recurvatum • Hyperextension

21. Lumbar Observations • Scoliosis • Lateral curvature of the spine • Kyphosis • Increased thoracic curvature • Lordosis • Increased lumbar curvature • Forward head posture • Head protrudes forward caused by kyphosis • Flatback posture • Flat posture caused by a decreased lumbar curvature • Swayback posture • Anterior shifting of the entire pelvis resulting in hip extension

22. Postural Malalignments • Kyphosis • Forward head • Flatback • Swayback • Lordosis • Scoliosis

23. Palpations • Bony & muscular • Point tenderness (pain) • Differences compared to the able side • Temperature (hot or cold) • Crepitus • Pulse • Dermatomes • Spasms or cramps

24. Special Tests • Active range of motion (AROM) • Passive range of motion (PROM) • Resistive range of motion (RROM) • Aka active resistive range of motion (ARROM) • Muscle grade (done with active range of motion) • Ligament tests • Special tests • Functional tests • Sports specific tests • Neurological tests • Reflexes and glascow coma scale • Vital signs

25. Suspected Injury • Write all suspected injuries • Severity • Immediate care • Service & initial treatment • Status & restrictions • Instructions to the athlete • Athlete & evaluator must sign the document

26. The unconscious athlete must always be considered to have a life-threatening injury, which requires an immediate primary survey.

27. THE PRIMARY SURVEY • The athletic trainer should immediately note the body position and determine the level of consciousness and unresponsiveness. • Airway, breathing, and circulation should be established immediately. • Injury to the neck and spine should always be considered as a possibility in the unconscious athlete. • If the athlete is wearing a helmet, it should never be removed until neck and spine have been clearly ruled out. However, the face mask must be cut away and removed to allow for CPR. • If the athlete is supine and not breathing, airway, breathing, and circulation should be established immediately.

28. THE PRIMARY SURVEY • If the athlete is supine and breathing, nothing should be done until consciousness returns. • If the athlete is prone and not breathing, he or she should be log-rolled carefully to the supine position and ABCs should be established immediately. • If the athlete is prone and breathing, nothing should be done until consciousness returns, then the athlete should be carefully log rolled onto a spine board because CPR could be necessary at any time. • Life support for the unconscious athlete should be monitored and maintained until emergency medical personnel arrive. • Once the athlete is stabilized, the athletic trainer should begin a secondary survey.

29. Controlling Bleeding • Direct pressure • Elevation • Pressure points • Tourniquets (only for special circumstances)

30. Shock:Signs and Symptoms • Blood pressure is low • Systolic pressure is usually below 90 mmHg • Pulse is rapid and weak • Rapid Breathing • Athlete may be drowsy and appear sluggish • Altered level of consciousness • Respiration is shallow and extremely rapid • Skin is pale, cool, and clammy • Restlessness or irritability • Nausea and vomiting • A blue tinge to lips and nail beds

31. Shock:Treatment • Make sure that 9-1-1 or the workplace emergency number has been called • Continue to monitor the victim’s airway, breathing, and circulation (ABCs) • Control any external bleeding • Keep the victim from getting chilled or overheated • Help the victim rest comfortably. If the victim is not having trouble breathing or if it is not expected that the victim has a head, neck, or back injury or broken bones in the hips or legs, elevate the legs about 12 inches • Comfort and reassure the victim until advanced medical personnel arrive and take over • Do not give food or drink to the victim

32. THE SECONDARY SURVEY: Vital Signs • Pulse, respiration, blood pressure, temperature, skin temperature, skin moisture, skin color, pupils , level of consciousness, ability to move, reaction to pain, abnormal nerve response, and breath sounds

33. THE SECONDARY SURVEY:Pulse • Adults range between 60 and 80 beats per minute • Children range between 80 and 100 beats per minute • Infants range between 120 to 160 beats per minute • Trained athletes may be slower • Heart rate can be taken at the radial or carotid artery for 30 seconds then multiply by two

34. THE SECONDARY SURVEY:Pulse • Fast & weak • Shock, heat exhaustion, diabetic coma • Fast & strong • Fright, stress, Fever, HTN, heat stroke, stimulant drugs • Slow & weak • Drug overdose, impending death • Slow & strong • Stroke, head injury

35. THE SECONDARY SURVEY:Respiration • Adult breathing rate is 12 breaths per minute • Children breathing rate is 20 to 25 breaths per minute • Infant breathing rate is 24 to 50 breaths per minute • Watch the chest rise and fall for 30 seconds then multiply by two

36. THE SECONDARY SURVEY:Respiration • Rapid & shallow • Airway obstruction (partial), heart failure, chest or abdominal injury or pain • Rapid & deep • Diabetic coma, head injury, stress • Slow & shallow • Drug overdose, impending death • Labored • Airway obstruction

37. THE SECONDARY SURVEY:Blood Pressure • Normal range 90/60 mmHg - 120/80 mmHg • Borderline HTN 139/89 mmHg • Hypertension is 140/90 mmHg or higher • Top number represents the systolic pressure • Bottom number represents the diastolic pressure

38. THE SECONDARY SURVEY:Blood Pressure • High or rising • Fright, stress, head injury, CNS problems, poisoning • Low or falling • Shock, internal bleeding

39. THE SECONDARY SURVEY:Temperature • Oral = 98.6º ± 1º • Axillary = 97.6º • Rectal = 99.6º • Core temperature • Very High • Heat stroke, infection, fever • Elevated • Heat exhaustion, infection, fever • Low • Hypothermia

40. THE SECONDARY SURVEY:Skin Temperature • Warm is normal • Hot • Hyperthermia • Cold • Hypothermia

41. THE SECONDARY SURVEY:Skin Moisture • Dry is normal • Damp • Shock, fright, stress • Very sweaty • Heart attack, insulin shock, shock

42. THE SECONDARY SURVEY:Skin Color • Pink on thenar prominence • Normal capillary refill is less than 2 sec • Capillary refill longer than 2 sec is circulatory compromise

43. THE SECONDARY SURVEY:Skin Color • Red (Flushed) – Excessive Circulation to the skin • Fever, diabetic coma, heat stroke, hypertension (HTN) • White (Pallor/Pale): circulatory insufficiency • Stress, shock, hypoglycemia, heat exhaustion, heart attack • Blue (Cyanosis): respiratory insufficiency • Airway obstruction, respiratory insufficiency, pump failure, shock, traumatic asphyxia • Yellow (Jaundice) – Liver Function • liver failure, hepatitis, chronic alcoholism • Gray (Ashen): circulatory insufficiency • heart attack • Blotchy (Mottled): circulatory insufficiency • shock, poor perfusion

44. THE SECONDARY SURVEY:Pupils • Should be equal and reactive to light • Constricted • Bright light, opiates/heroin overdose, some poisonings • Mid-point • Dead (pupils are fixed and dilated) • Dilated • Stress, fright, coma, amphetamine/stimulant overdose, CNS injury, • early stage of death • One pupil dilated • Head injury

45. THE SECONDARY SURVEY:Level of Consciousness Alert and oriented to • Time What day is it? • Place Where are you? • Person What is your coaches name? • Purpose What are you doing today?

46. THE SECONDARY SURVEY:Level of Consciousness Glascow Coma Scale • Normal Score is 15 • Eye opening is 4 maximum • Motor response is 6 maximum • Verbal response is 5 maximum • Under 15 is considered altered • Under 7 is considered a coma

47. THE SECONDARY SURVEY:Level of Consciousness Eye opening • 4 – Spontaneous • 3 – Verbal • 2 – Pain • 1 – None

48. THE SECONDARY SURVEY:Level of Consciousness Motor response • 6 – Obeys • 5 – Localizes to pain • 4 – Withdraws to pain • 3 – Flexion (decorticate) • Flexion of arms • Hyperextension legs • 2 – Extension (decerebrate) • Arms and legs extended • Internally rotated • 1 – None

49. THE SECONDARY SURVEY:Level of Consciousness Verbal response • 5 – Oriented • 4 – Confused • 3 - Inappropriate words • 2 – Incomprehensible sounds • 1 – No verbal response

50. THE SECONDARY SURVEY:Ability to Move • Normal is a full range of motion (ROM) • Apparent inability • Guarding due to trauma, fracture, or pain • True inability • Paralysis • One sided – head injury • Below – spinal injury