The IOC Manual of Emergency Sports Medicine

Description

The Manual focuses on the fieldside diagnosis and treatment of severe injuries and illnesses that can present at a sports event. It concentrates on basic diagnostic skills and treatment modalities as the sports physician has often limited diagnostic and treatment facilities available. Each chapter concentrates on an illness or anatomical injury and offers a structured diagnostic and therapeutic approach in this difficult pre-hospital environment. The chapters explain what problems are to be expected with specific conditions as well as which treatment plan should be implemented and how to evaluate and reassess those plans.

Table of Contents

List of contributors
Foreword
Preface
About the Authors

1 Emergency Care at the Olympic Games 1
Richard Budgett

• Introduction 1
• Early Preparations 1
• Final Preparations 2
• Team and IF Doctors 4
• Summary 4

2 Injury and Illness During the 2008 Summer and the 2010 Winter Olympic Games 6
Kathrin Steffen, Torbjørn Soligard and Lars Engebretsen

• Vancouver Winter Games 2010 7
• Beijing Summer Olympic Games 9
• Bibliography 10

3 The Medical Team Response 12
David McDonagh and David Zideman

• ABC on the Field of Play 14
• Primary Survey 20
• Primary Survey 22
• Primary Survey 24
• Transferring the Athlete from the FOP to the
• Fieldside 27
• Fieldside Assessment 27
• Pupils – Pathological Findings 28
• Blood Sugar 28
• Blood Pressure 29
• Athlete Medical Room Treatment 30
• Transportation to Hospital 31
• Discharge 31
• Teamwork 31
• Bibliography 32

4 Cardiopulmonary Resuscitation on the Field of Play 33
Ruth Löllgen, Herbert Löllgen, and David Zideman

• Sudden Cardiac Arrest on the Field of Play 34
• Recognition of Cardiac Arrest 34
• Field of Play Airway 36
• Foreign Body Airway Obstruction (FBAO or Choking) 37
• Field of Play Breathing 38
• Recovery Position 38
• Field of Play Circulation 38
• FoP: Combining Compressions and Ventilations 39
• Expired Air Ventilation 39
• Bag-Valve-Mask Ventilation (Two Rescuer Technique) 39
• FoP Removal 40
• Rhythm Analysis 40
• Shockable Rhythms 41
• Nonshockable Rhythms 42
• Reversible Causes (The 4H’s and 4T’s) 42
• Advanced Life Support 42
• Advanced Airway 44
• Simple Airway Adjuncts 44
• Inserting an Oropharyngeal Airway (OPA) 44
• Inserting a Nasopharyngeal Airway (NPA) 44
• Advanced Airway Adjunct 45
• Venous Access 45
• Intraosseous Access 45
• Drugs 45
• Implantable Cardiac Defibrillators (ICDs) 46
• Postresuscitation 46
• Bibliography 46

5 Cardiac Emergencies on the Field of Play 47
Ruth Löllgen, Herbert Löllgen and David Zideman

• Sudden Cardiac Death (SCD) 47
• FoP Management Non-traumatic Sudden
• Collapse 48
• Clinical Findings/Management ACS (Fig 5.1) 50
• Clinical Findings/Management AA or AD 52
• FoP Management of Myocarditis 52
• Clinical Findings/Management Hypertensive Crisis 53
• Clinical Findings/Management Bradycardia 54
• Clinical Findings/Management Tachycardia 57
• Bibliography 57

6 Control of Hemorrhage and Infusion Management 58
Kenneth Wing Cheung Wu and Hiu Fai Ho

• Introduction 58
• FoP Management 59
• External Bleeding Wounds 59
• New Trends in Hemorrhage Control 60
• Internal Bleeding 60
• Infusion Management 61
• Conclusion 62
• Bibliography 62

7 Anaphylaxis 63
Andy Smith and Jerry Nolan

• Introduction 63
• Signs and Symptoms 64
• Management of Anaphylaxis 64
• Bibliography 67

8 Asthma and Respiratory Emergencies 68
Joseph Cummiskey

• Observation – From Outside the FoP and While Approaching the Patient 68
• FoP Management of a Suspected Chest Medical Event 68
• Primary Survey 68
• Fieldside Management of Chest Medical Conditions 69
• Pulmonary Embolism 70
• Bronchial Asthma and Exercise-Induced Bronchospasm (EIB) 70
• The Effect of Environmental Conditions and Pollutants in Sport Activity 73
• Bibliography 76

9 Seizures and Epileptic Emergencies 77
Geraint Fuller

• Preparation 77
• Fieldside Observation 77
• Observations on Approaching the Athlete 78
• Clinical Findings/Management Convulsing Athlete 79
• Referral or Discharge? 80
• Differential Diagnoses of Seizures 80
• Bibliography 81

10 Head Injuries 82
David McDonagh and Mike Loosemore

• Sideline Observation 83
• FoP Management of a Convulsing Athlete 83
• Primary Survey – Convulsing Patient 84
• FoP Management of a Nonconvulsing Athlete with a Head Injury 85
• Primary Survey on the FoP 85
• FoP Management of Head Injury with a Low GCS 85
• Management of Head Injury with a GCS 12–14
• on the FoP 85
• Fieldside Evaluation 86
• Secondary Survey at the Fieldside 86
• Management of Patients with Head Injuries 86
• Pupil Examination 87
• Glasgow Coma Scale 88
• Binocular Hematomas – Raccoon Eyes 90
• Battles Sign 90
• A Focused Medical History 90
• Transfer to the Hospital 91
• When Should the ED Request a Cranial CT? 91
• Scalp Lacerations and Bleeding 92
• Smelling Salts 92
• Bibliography 92

11 Concussion – Onfield and Sideline Evaluation 93
Paul McCrory and Michael Turner

• Introduction 93
• Epidemiology 93
• Definition of Concussion 93
• Symptoms and Signs of Acute Concussion 94
• Fieldside Recognition of Concussion 94
• Concussion Injury Severity and Recovery 94
• Concussion Management 100
• Concussion in Child and Adolescent Athletes 103
• Prevention of Concussion 103
• Other Specific Issues 104
• Conclusion 105
• Bibliography 105

12 Throat Injuries 106

• Jonathan Hanson, Padraig B. Sheeran, Brian Carlin and David Zideman
• Penetrating Trauma 107
• Clinical Findings/Management Penetrating Neck Wound 108
• Blunt Trauma 108
• Clinical Findings/Management Blunt Neck Trauma 108
• Clinical Findings/Management Laryngeal Contusion 109
• Clinical Findings/Management Laryngeal Fracture 110
• Needle Cricothyrotomy 110
• Surgical Cricothyrotomy 111
• VASCULAR INJURY - Clinical Findings Acute Vascular Neck Injury 112
• Clinical Findings Delayed Presentation Vascular Neck Injury 112
• Management Aerodigestive Track Injury 113
• Bibliography 113

13 Facial Injuries 114
David McDonagh and Mike Loosemore

• FoP Management Serious Facial Injuries 114
• Facial Injury - Clinical Findings/Management Serious Facial Injury 115
• Fieldside Management Serious Facial Injury 115
• Clinical Findings/Management Serious Facial Injury 116
• Clinical Findings/Management LeFort Fracture 117
• Clinical Findings/Management Mandibular Fracture 118
• Clinical Findings/Management Orbital Fracture 118
• Clinical Findings/Management Zygomatic Fracture 119
• Clinical Findings with a Nasal Fracture 121
• Clinical Findings/Management NOE Fracture 122
• Clinical Findings/Management Septal Hematoma 122
• Clinical Findings/Management Epistaxis 123
• Bibliography 124

14 Eye Injuries and Other Ocular Emergencies 125
Sibel Kocabeyoglu, Uður Erdener and David McDonagh

• Fieldside Observation and Observations on Approaching the Athlete 126
• Fieldside Management Eye Injury 126
• Eye – Blunt Trauma 127
• Clinical Findings/Management Hyphema 128
• Clinical Findings/Management Lens Subluxation 128
• Posterior Chamber Hemorrhage 129
• Clinical Findings/Management Retinal Detachment 130
• Clinical Findings/Management Blowout Fracture 130
• Clinical Findings/Management Orbital Fracture 131
• Clinical Findings/Management Rupture of the Globe 131
• Clinical Findings/Management Retrobulbar Hemorrhage 132
• Clinical Findings/Management Periocular Ecchymosis 132
• Clinical Findings/Management Subconjunctival Hemorrhage 133
• Eye – Penetrating Injuries 134
• Treatment 134
• Non-traumatic Ocular Emergencies 135
• Bibliography 136

15 Dental Injuries 137
Paul Piccinini and Anthony Clough

• Types of Injuries 137
• Management of Dental and Orofacial Injuries 138
• Fractured Teeth 138
• Dental Luxation 138
• Intrusions 139
• Avulsions 139
• Trauma to the Alveolus 139
• TMJ Trauma 140
• Soft Tissue Trauma 140
• Injury Prevention 141

16 Thoracic Injuries 142
David McDonagh and David Zideman

• Fieldside Observation and Observations on Approaching the Athlete 142
• FoP Management Chest Injury 143
• Clinical Findings/Management Chest Injury 143
• Fieldside Management Chest Injury 144
• Clinical Findings Traumatic Pneumothorax 145
• Clinical Findings Major Traumatic Pneumothorax 146
• Clinical Findings Tension Pneumothorax 146
• Pneumothorax Treatment 147
• Tension Pneumothorax – Immediate Treatment 147
• Needle Thoracostomy of Tension Pneumothorax 148
• Clinical Findings/Management Hemothorax 149
• Clinical Findings/Management Flail Chest 150
• Clinical Findings/Management Pulmonary Contusion 151
• Clinical Findings/Management Sternal Fracture 152
• Needle Pericardiocentesis 153
• Primary Management of Penetrating Thoracic Injuries 155
• Bibliography 156

17 Abdominal Injuries 157
David McDonagh and Dara Lundon

• FoP Management of an Abdominal Injury 158
• Clinical Findings/Management Abdominal Injury 158
• Clinical Findings/Management Penetrating Abdominal Wound 160
• Clinical Findings/Management Blunt Abdominal Injury 161
• Clinical Findings Splenic Injury 162
• Clinical Findings Liver Injury 163
• Clinical Findings Kidney Injury 164
• Clinical Findings/Management Scrotal Trauma 165
• Clinical Findings/Management Testicle Torsion 166
• Bibliography 167

18 Pelvic Injuries 168
Andy Smith and João Grangeiro Neto

• FoP Management Pelvic Injuries 169
• Clinical Findings/Management Pelvic Injury 169
• Fieldside Management Pelvic Injury 171
• Clinical Findings Pelvic Injury at the Fieldside 171
• Summary 175
• Bibliography 175

19 Spinal Injuries 176
Éanna Falvey and Craig Roberts

• Preparation for Onfield Management 177
• FoP Management Potential Spinal Injury 177
• Primary Survey Potential Spinal Injury 177
• FoP Management of a Patient with Findings Indicative of a Spinal Cord Injury 178
• Transfer of the Patient onto the Spinal Board/Lifting Device 179
• Transfer from the FoP to the Fieldside 179
• Fieldside Management Potential Spinal Injury 179
• Clinical Findings with a Potential Spinal Injury 180
• Return to Play After a Fieldside Evaluation of a Neck Injury 180
• Clinical Findings with a Potential Cervical Spinal Fracture 181
• Clinical Findings/Management Facet Joint
• Injuries 182
• Clinical Findings/Management Stinger Injury 183
• Clinical Findings/Management Acute Prolapsed Disc 184
• Clinical Findings Spondylolysis and Spondylolisthesis 185
• Bibliography 185

20 Extremity Injuries 186
Michael R Carmont and David McDonagh

• Fieldside Observation and Observations on Approaching the Athlete 186
• FoP Management - Limb Injury 187
• Clinical Findings Limb Injury 187
• Onfield Management Limb Injury 188
• Realignment of Fracture/Dislocations 188
• Transfer from the FoP 189
• Fieldside Management Limb Injury 189
• Splint Selection and Application (See Chapter 30) 190
• Analgesia 193
• Ski Boot Removal 194
• Paralympic Sport 195
• Documentation 195
• Bibliography 195

21 Aquatic Athlete Injuries and Emergencies 196
Margo Mountjoy and Saul Marks

• Introduction 196
• Swimming 196
• Synchronized Swimming 198
• Diving and High Diving 199
• Water Polo 201
• Open Water Swimming 202
• Conclusion 204
• Bibliography 204

22 Emergency Care of the Adolescent Athlete 205
Lisa M. Vopat and Lyle J. Micheli

• Introduction 205
• Primary Survey and Stabilization (See Chapter 3) 206
• Differences in Injury Pattern 208
• Emergency Planning and Fieldside Preparedness 211
• Conclusion 211
• Bibliography 211

23 Emergency Medical Care in Paralympic Sports 212
Peter Van de Vliet and Mike Wilkinson

• The Paralympic Athlete 212
• Injury and Illness in Paralympic Athletes 214
• Impairment-Specific Considerations of Medical Care 216
• Specific Paralympic Medical Concerns 218
• Autonomic Dysreflexia 218
• Conclusion 219
• Bibliography 219

24 Cold Injuries 220
Ken Zafren, Gordon Giesbrecht and David McDonagh

• The Collapsed Cold Athlete 221
• Primary Survey in a Cold Athlete 221
• Prehospital Treatment for a Cold But
• Nonhypothermic Patient or for a Mildly Hypothermic Patient 222
• Prehospital Treatment of a Patient With Moderate or Severe Hypothermia 222
• CPR and Severely Hypothermic Patients 223
• Frostbite 223
• Clinical Findings/Management Frostbite 224
• Nonfreezing Cold Injuries (NFCI) 226
• Bibliography 227

25 Severe Dehydration and Exertional Heat Illness 228
Eunice M. Singletary

• Introduction 228
• Fieldside Observation and Observations on Approaching the Athlete 228
• Primary Survey Severe Dehydration or Heat Illness 229
• Blood Pressure and Pulse 230
• FoP Management Dehydration, Exercise-Associated Hyponatremia and Heat-Related Illness 230
• Specific Conditions 231
• Bibliography 235

26 Hypo- and Hyperglycemia 236
Kathryn E. Ackerman and David McDonagh

• Hypoglycemia 236
• Clinical Findings Severe Hypoglycemia 237
• Clinical Findings Mild Hypoglycemia 237
• Hyperglycemia 238
• Clinical Findings Hyperglycemia 238
• Bibliography 240

27 Wound Care 241
David McDonagh and Sally Whitmore

• FoP or Fieldside Management 241
• Wound Location 242
• Reassessment of Wounds and Dressing Changes 243
• Tetanus Vaccines 245
• Burns, Abrasions, and Blisters 245
• Bibliography 247

28 The Role of the Paramedic on the Field of Play 248
Mike Nolan and David Whitmore

• Planning and Logistics 248
• Clinical Practice 249
• Additional Information 251

29 The Role of the Physiotherapist on the Field of Play 253
Mark Brown, Michael Kenihan and Marie-Elaine Grant

• Introduction 253
• An Emergency Situation When Traveling with a Team of Athletes Either Nationally or Internationally 254
• An Emergency Situation Either Nationally or Internationally Where the Physiotherapist is Covering the Event Alone and There is No Doctor or Paramedic Available 256
• Onfield Assessment and Management 257
• Bibliography 260

30 Emergency Medications and Equipment at the Fieldside 261
Mark Faulkner, Fionna P. Moore and David Zideman

• The Bag 262
• Immobilization and Carrying 263
• Stretcher or Trolley Bed 263
• The Spinal Board 263
• The Scoop Stretcher 263
• The Basket Stretcher 263
• Carry Sheet 264
• Semi-Rigid Cervical Collars 264
• Head Blocks 264
• Body Straps 264
• Vacuum Mattresses 264
• Limb Splints (See Chapter 20) 264
• Pelvic Splints (See Chapter 18) 265
• Resuscitation (See Chapter 4) 265
• Dressings and Hemorrhage Control 266
• Drug Administration and Intravenous Access 267
• Medications 267
• Intravenous Fluids 271
• Bibliography 272

31 Emergency Medications and the WADA Prohibited List 272
Alan Vernec and Eduardo de Rose

• Therapeutic Use Exemption 275
• Strict Liability 276
• Supplements 276
• Possession of Prohibited Medication and Physician Responsibility 277
• Summary 277

32 Retrieval and Repatriation of Injured and Ill Athletes 279
Mark Brown and Glenn Brown

• Introduction 279
• Preplanning 279
• Team Medical Staff Skills 280
• Equipment Requirements 280
• Medical Transport Options 281
• Specialist Medical Evacuation and Repatriation Services 281
• Insurance/Repatriation Processes 282
• Other Procedural Considerations 282
• Bibliography 283

Appendix 1 International Olympic Committee Executive Board 284

• PREAMBLE 284
• Olympic Charter, July 2007 284
• Chapter I: Relationships Between Athletes and Health Care Providers 285
• Chapter II: Protection and Promotion of the Athlete’s Health during Training and Competition 288
• Chapter III: Adoption, Compliance and Monitoring 289
• Chapter IV: Scope, Entry into Force and Amendments 290

Appendix 2 Sport-Specific Injury Profile and Equipment Guide 292

• Winter Olympics Federations 292
• Summer Olympics Federations 295

Appendix 3 Healthcare Professional Skillbase 304

• Field of Play (FoP) 304

Appendix 4 Treatment Algorithms at a Glance 306

Index 315