Ballpark Triage and First Aid

1. Ballpark Triage and First Aid C. Michael Remoll, MD FACEP Safety and Insurance Coordinator Broadneck Baseball and Softball Club

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

8. 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

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

12. 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

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

16. Head Injury: Definitions • Concussion: Head injury associated with no injury identifiable on CT scan • Epidural/Subdural Hematoma: “blood clot on the brain”

17. Greenwich High School, Salt Lake City, UT All-State Baseball Player Captain of High School Baseball Team

19. Concussion • From blunt head trauma: fall, collision, direct blow (pitched ball, baseball bat) • Signs/Symptoms: may have brief loss of consciousness, headache, dizziness, confusion, amnesia, nausea • If any of these symptoms present, victim should receive medical attention

20. 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

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

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

25. 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)

28. Jaw Injuries • Usually from direct blow or collision • Signs/symptoms: pain, tenderness, swelling, distortion of bite (malocclusion), bleeding of gums, loose teeth • Require medical attention

29. 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 reimplantation (50% success when within 50 minutes)

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

31. 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

32. 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

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

34. 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

35. 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

36. 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

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

40. SHOCK

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

42. 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

44. 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

46. 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)

47. Insect Stings • Bees, wasps, yellow jackets, hornets • Cause 500 deaths/year in U.S. • Localized Reaction: pain, redness, swelling; treat will cool compress, elevation • System 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

49. Lightning • 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 • Don’t stand in groups • Don’t carry or hold tall metal objects • Catcher’s stance • Car provides good shelter

50. Thank You Questions?