ATTR 322
Krzyzanowicz- Spring ‘13
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Understand the differences between on-thefield examination and clinical assessment
Identify conditions that warrant termination
of the exam
Understand how to implement an Emergency
Action Plan
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Purpose of on the field exam is to determine
the next course in evaluation or management
◦ Immediate emergency care
 Heart attack, femur fracture
◦ Transport to hospital/physicians office for care
 Sutures, x-ray to r/o fx (non-emergency)
◦ Move to sidelines for further evaluation
 Perform a more thorough evaluation
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Ask yourself “Does this situation require
emergency management to save patient’s life
or extremity”
◦ Immediate examination must rule out
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Lack of ABC’s
Life-threatening trauma to head or spinal column
Profuse bleeding
Fractures
Joint dislocation (to a point)
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Emergency Action Plan (EAP)
◦ Personnel
 Physician, EMS
◦ Equipment
 Splints, AED
◦ Communication
 Cell phone, radio
◦ Standard procedures
 Catastrophic event
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Good to review EAP at least once a year
◦ Get together with local EMS as well
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Each sport has specific rules about on-fieldevaluations
◦ Wrestling-3 minutes injury evaluation time
◦ Football- unlimited
◦ Soccer- must be waved onto field by official
 Find out from your coach/league, etc
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Conditions warranting termination of the
evaluation
◦ Always err on the side of caution if uncertain
◦ Activate the EAP
◦ Begin injury management
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What conditions can we think of?
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Are they moving?
◦ Conscious
 Apena? or dyspnea?
 Activate EMS (if needed)
◦ Unconsciouscervical spine trauma
 Stabilize head and neck
 Activate EAP & EMS
 Check ABC’s
◦ SeizingCNS trauma
 Activate EAP & EMS
 Check ABC’s
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Identify other serious conditions that require
immediate management
◦ Bleeding
◦ Gross deformity
◦ Other signs of trauma
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Rule out head/spinal trauma
Calm athlete
Rule out injury other body parts
Manage the condition
Treat for shock (if indicated)
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Determine (ask while observing/palpating)
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Location of pain
Peripheral symptoms
Mechanism of injury
Associated signs and symptoms
History of injury
**If athlete is unconscious or disoriented seek
information from witnesses.
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Bony alignment
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◦ Gross deformity
◦ Tender to palpation (TTP)
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Crepitus
Joint alignment
◦ Palpate along joint line to
determine alignment
Swelling
◦ Disruption to tissue
◦ Bursa
◦ Tissues with a rich blood
supply (eg, face)
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Painful Areas
◦ Tender to palpation
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Deficit in the muscles
or tendons
◦ Palpable defect
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AROM
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Strength assessment
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PROM
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Weight-bearing status (LE injuries)
◦ Assesses their willingness to move the limb
◦ A break test examines the muscle’s ability to sustain
contracting (I don’t really do very often on field)
◦ Often delayed until clinical evaluation
◦ DON’T do if the athlete cannot perform AROM
◦ If a fracture has been ruled out and ROM tests have been
completed, the athlete may walk off the field with
assistance.
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Purpose
◦ Immediately tests the ligaments and capsule
involved before swelling and guarding begin
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Select the best tests for that pathology
◦ Suspected ACL injury DO NOT perform all 7 special
tests
 Those with the best sensitivity and specificity
 Lachman’s, Pivot Shift (difficult), Ant. Drawer
 Wait until off the field to perform all tests you may want
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Cranial nerve tests
Cervical nerve tests (upper quarter screen)
◦ Perform on suspected concussions as well as
cervical spine injuries (NO strength testing!)
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Assess motor function distal to injury
◦ Don’t move injured bone or joint
 Eg, Ask an athlete with an anterior GH dislocation to
wiggle his or her fingers
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Dislocation or fracture can compromise
vascular structures
Vascular tests
◦ Check distal pulses
◦ Capillary refill testing
◦ Edema formation distal to injury
 Blockage of venous return
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“Normal” injury (i.e. sprained ankle)
◦ Do this in off-field clinical assessment
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Determine best ambulation
◦ Walking, 2 man carry, etc
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Take all pieces of your puzzle
◦ Determine what needs to be done on sidelines
 If able to r/o injury or further injury
 Determine if RTP is allowed
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Consult a physician if necessary
Younger athletes vs. older athletes
◦ Conservative vs. aggressive management
Risk of reinjury?
Assessment of function
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Strength and ROM
Pain
Proprioception
Functional activity progression
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Practice
◦ Everytime you go onto the field with your ACIwatch them-what do they do? What do you want in
your bag of tricks.
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Sport
◦ Some sports you need to be quick (football,
wrestling)
 Coach needs to know if the patient can get back in or
not
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Patience
◦ Don’t rush a medical emergency
 Take every precaution not to cause more harm