Slide 1Sideline Emergencies
• No Disclosures
• Consider situations where immediate action may change outcome
• Understand your role in the medical team during an emergency
Goals
3
4
6
strike.
If a lightning emergency is declared: Seek shelter in a fully enclosed building or
enclosed metal top vehicle with the windows up Avoid open areas and stay away from isolated tall
trees, towers, utility poles. Stay away from objects that conduct electricity -
wire fences, power lines. Do not lie on concrete floors or lean on concrete
walls. Never lie flat on the ground. Never shelter under a tree. Stay in safe shelter for 30 minutes after last sound
of thunder.
Act fast if someone is struck by lightning. Lightning victims do not carry an electrical charge,
are safe to touch and need urgent medical attention.
Dial 911 If indicated, begin BLS and use AED. Reverse Triage
Weather Emergency: Lightning
• Your PRIMARY responsibility is the athlete • Case by case for others that need assistance • Discuss with your EMS crew in advance
Athletes, Coaches, Staff, Fans, Band, Cheer, Mascots……
8
• Be Efficient • Calm the athlete – reassure • Verbalize plan out loud
• Move to the sideline or transport? • Think twice act once
Primary Survey
– During ventricular repolarization – Just prior to peak of T wave
• Results in VF
Commotio Cordis
• Usually male (> 90%) and young (mean age of 14) • Sudden collapse or have brief (< 10 sec) period prior to
collapse • Tx w/ defibrillation
– Survival rate = 25% w/ early defibrillation (< 3 min) – 1% survival if > 3 min
Heat Illness: Types
Associated Signs
Heat Rash Normal Pruritic Rash Papulovesicular skin eruption – clothed areas
Heat Syncope Normal Dizziness and generalized weakness
Loss of postural control, rapid mental status recovery once supine
Heat Cramps Normal or elevated But < 104F
Painful muscle contractions
Heat Exhaustion 98.6 – 104 F Dizziness, malaise, fatigue, nausea, vomiting, headache
Flushed, profuse sweating, cold clammy skin, normal mental status
Heat Stroke > 104 F Possible hx of heat exhaustion before mental status change
Hot skin w/wo sweating, CNS disturbance
Heat Illness: Risk Factors
• Hot temperature • Dehydration – as little as 30 minutes • High intensity exercise • Heavy equipment or clothing • Obesity • Deconditioning • Medication/Drugs
– Stimulants (Adderall®) – Diuretics
– Fever (risk of myocarditis) – Body temperature already elevated
18
transport
19
Anaphylaxis
20
Anaphylaxis
21
• Calm and reassure the person
• Bee sting - scrape the stinger off – Do not use tweezers or squeeze the stinger (releases venom)
• Lie them flat and elevate lower extremities
• Cover with blanket
• Do NOT place a pillow under the person's head – can block airway
• Do NOT give the person anything by mouth if having trouble breathing
Anaphylaxis: Pharmacologic Treatment
> 30 kg (66 lbs)
sweating, nausea/vomiting, difficulty breathing, dizziness, weakness or shakiness, anxiety
Seizure
• Prevent injury by blocking/removing hazards • Do Not hold or tie the person down • Turn the person on the side to prevent aspiration/choking • Cushion head, remove glasses • Do not place anything in the person’s mouth (solid or liquid) • Do not try to force the teeth apart • Time and characterize the seizure • Stay with the person until the seizure ends
• On the field: Oxygen, AED, serial vitals, start IV, finger stick glucose – Status Epilepticus – Diazepam 10 mg
Hypoglycemia: IM Glucagon
25
• EMS answers to medical command • Will transport to nearest facility unless higher level of care
needed. • Do you need to consider helicopter? Trauma center?
Pediatric Center? • Who goes with athlete?
Transport
26
• Monitor vs Transport • Ambulance vs Car
Sideline or Secondary Survey
27
• Serial Exams – by the game clock • Take and hold the helmet • Notify coaching staff
• Evaluate at conclusion of event and have plan for follow up and also educate on triggers for more prompt care.
• Concern for any issue that progressively gets worse
Monitor
28
effected side • Jugular Venous Distension • Absent Breath Sounds
Tension Pneumothorax
32
Technique: • 14 gauge needle, 3 ¼ inch • Midclavicular 2nd ICS or Anterior Axillary Line 5th ICS • Push until flush with skin • Hold for 5-10 seconds • Withdrawal needle, leaving catheter
• Evolving Pain • Rigid Abdomen • Peritoneal Signs (hop) • Rebound or guarding • Back Pain – worse with lying
Abdominal Injury
33
• Consider: • Can they go on own power? • Can they access their vehicle? • What on the way could get or be made worse? • Will they go?
• What if this was your child/relative/friend?
Transport From Sideline
• Blow Out Orbital Fracture – Eye motion impaired – Muscle Entrapment
• Globe Rupture – Tear drop shaped pupil – Vitreous Humor Leakage – DO NOT PATCH
• Hyphema – Blood In anterior chamber
• Globe Luxation – Cover with Cup and transport
ENT Emergencies
• Tooth Extrusion – Can push back and splint
• Tooth Intrusion – DO NOT pull out
• Tooth Avulsion – Handle Crown not root – Put in save a tooth, saliva, milk
NEVER EVER TAP WATER – Can be packed back into socket
and stabilized
Dental Issues
36
• Sticky – Good Samaritan Law? • Communication with medical team • Consider age – consent – scope of practice
Liability
37
Take your pulse
Weather Emergency: Lightning
Take Control
Scouts Moto
Primary Survey
Anaphylaxis
Anaphylaxis