emergency sports medicine pitch and sideline injury management dr pl viviers university of...
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EMERGENCY SPORTS MEDICINE
PITCH AND SIDELINE INJURY MANAGEMENT
Dr PL ViviersUniversity of Stellenbosch
Dr L HoltzhausenUniversity of the Free
State
April 21, 2023
FAIL TO PREPARE =
PREPARE TO FAIL
INTRODUCTION
• Moment of injury until specialised care
• Recognition of severity
• Have guidelines
• Stressful experience - be prepared!
IMPORTANT GOALS ON THE PITCH
• Recognise severity
• Know what can and should be done
• Know what should NOT be done
ASSESSMENT OUTCOMES
• Red
– Urgent specialised care
• Amber
– Moderate – requires furhther medical assessment
• Green
– Minor – treat on field
STEP 1: WHAT SHOULD I CHECK FOR
• “SPORTS”
• Speak to the player
• Problem identification
• Observe
• Rule out serious injury
• Touch
• Skills assessment
STEP 2: WHAT SHOULD I DO
• “TREAT”
• Talk to the player
• Remove safely from the field
• Emergency transfer
• Avoid further injury
• Treatment
– Definitive treatment
– Interventions
ON-FIELD RETURN TO PLAY DECISION MAKING
• Is there a risk to worsen the injury?
• Is there a risk for another injury?
• Is there a risk for other players?
SPECIFIC INJURIES
HEAD INJURIES
• Concussion or not?
• Differential diagnosis
• SA Sports Concussion
• SA Rugby Boksmart guidelines
• IRB Concussion guidelines
• C-spine
• Other injuries!
FACIAL INJURIES
• Assess for associated injuries (head and spine)
• Palpate bony prominences
• Diplopia – can indicate orbital fracture
• ROM of mandible
• Eye movements
NOSE BLEED/EPISTAXIS
• Palpate for crepitus
• Check for septal haematoma
• Control bleeding
• Ice
• Rule out CSF leak
DENTAL INJURIES
• Fractured tooth
• Tooth luxation
• Avulsed tooth (missing tooth)
EYE INJURIES
• Identify severe injuries• Accurate history• Serious injury (signs and
symptoms– Deep, throbbing or
stabbing pain– Abnormal protrusion– Pupil shape/reaction– Lacerated globe– Loss of vision– Persistent blurred vision– Diplopic vision– Hyphema
• Visual acuity
• Documentation
• Test extra-ocular movements
• Severe injuries – immediate referral
CHEST
• Majority - blunt trauma• Consider all structures:
– Rib cage– Heart– Lung – Big vessels
• Aware of associated injuries– Upper ribs – brachial plexus– Middle ribs – lung issue– Lower ribs – hepatic, spleen,
renal– Sternal – cardiac/big vessels
ABDOMEN
• Rare – be aware
• Hepatic and splenic most common
• If suspicion – keep nil per mouth until referral
GENITO-URINARY
• Renal
– Direct blow to the back/flank
– Suspicion – lower rib fractures and Grey-Turner sign
– Emergency referral
• Scrotal
– Exclude testicular dislocation, torsion or rupture
SKIN
• Common
• Important to pay attention to deep structures
• Lacerations
– Control bleeding
– Proper cleaning
– Proper suturing
– Remember tetanus
MUSCULO- SKELETAL
• Fractures
• Dislocations
• Splinting
– Joints proximal and distal immobilised
– Improvise
GENERAL COMMENTS
• Collapsed player with associated trauma - treat as C-spine injury
• Collapsed players should be removed from the field and assessed by trained personnel
• Save life before limb
• If a player cannot perform basic skills there is increased risk for further injury and harm to others
