Nursing Management of Sprains, Strains and Playground Injuries

NURSING MANAGEMENT OF SPRAINS, STRAINS AND PLAYGROUND INJURIES

Susan Niles, MSE, ATC, LAT Lead Athletic Trainer 41st Annual Belle Blackwell School Nurse Conference Provided by Texas Children’s Hospital Provider #18-267764-A 7.24.2019 | Cypress, TX | 7a – 5:30p

CONTINUING NURSING EDUCATION Texas Children's Hospital is an approved provider with commendation of continuing nursing education by the Texas Nurses Association - Approver, an accredited approver with distinction, by the American Nurses Credentialing Center’s Commission on Accreditation.

REQUIREMENTS FOR SUCCESSFUL COMPLETION To receive contact hours for this continuing education activity, the participant must: • Sign in to the activity • Attend the entire activity • Complete a participant evaluation online

Once successful completion has been verified, a “Certificate of Successful Completion” will be awarded for 6.0 contact hour(s). For web link issues, email [email protected]

LEARNING OUTCOME At the conclusion of this continuing nursing education activity, the participant will be able to improve nursing management, care coordination and resources for school age children.

CONFLICTS OF INTEREST Explanation: A conflict of interest occurs when an individual has an opportunity to affect or impact educational content with which he or she may have a commercial interest or a potentially biasing relationship of a financial nature. All planners and presenters/authors/content reviewers must disclose the presence or absence of a conflict of interest relative to this activity. All potential conflicts are resolved prior to the planning, implementation, or evaluation of the continuing nursing education activity. All activity planning committee members and presenters/authors/content reviewers have submitted Conflict of Interest Disclosure forms.

The activity’s Nurse Planner has determined that no one who has the ability to control the content of this CNE activity – planning committee members and presenters/authors/content reviewers – has a conflict of interest.

COMMERCIAL SUPPORT This CNE activity has not received commercial support.

JOINT PROVIDER STATEMENT This CME/CNE activity has been jointly provided by Texas Children’s Hospital collaboratively with Texas School Nurses Organization Region IV. SPORTS MEDICINE OBJECTIVES

• Understand the basic principles of splinting • Differentiate wrapping and taping • Review splinting and wrapping techniques for common playground injuries SPORTS MEDICINE PLAYGROUND INJURIES • About 75% of nonfatal injuries involving playground equipment occur on public playgrounds • Fractures • Dislocations • Sprains • Strains SPORTS MEDICINE SPLINTING

• Indication: suspected fracture • Contraindication: further harm, circulation concerns SPORTS MEDICINE PRINCIPLES OF SPLINTING • Pre/Post evaluation – circulation, color, sensation, etc. • Splint above and below the fracture site • Splint as they are found • Anatomical • Pain • Do I need to splint? SPORTS MEDICINE TYPES OF SPLINTS

• Vacuum splint • Air splint • Anatomical splint • SAM splint • Cardboard splint • Anything available… SPORTS MEDICINE WRAPPING

• Indications (RICE) • Swelling • Support • Minimal – awaiting further evaluation • Pain • Contraindications • Circulation concerns SPORTS MEDICINE WRAPPING TECHNIQUES

• Supplies: ACE wrap, powerflex/coban • Distal to proximal • Snug, not tight • Maintain circulation, color, movement

• Considerations: swelling may increase causing the wrap to tighten. Re-wrap if pain increases or circulation decreases. SPORTS MEDICINE TAPING • Taping • Support to participate while recovering from injury • Prophylactic • Athletic Trainer SPORTS MEDICINE WHAT/WHEN

• Wrapping: Sprains, swelling

• Splinting: Fracture

• Taping: defer to AT SPORTS MEDICINE FRACTURE SPRAIN • Mechanism • Mechanism • Pain • Pain • Swelling • Swelling • Bruising • Bruising • Crepitus • Crepitus • Deformity • Deformity SPORTS MEDICINE TOES AND FEET

• Toe – Anatomical splint -buddy tape

• Foot – Cardboard, SAM, other SPORTS MEDICINE ANKLE – SPRAIN V FRACTURE

• Mechanism • Weight bearing – 4 steps? • Wrap v splint • Sprain - compression • Fracture – splint: SAM, cardboard, vacuum splint • Dislocation = 911 • Crutches if limping SPORTS MEDICINE KNEE • Patellar dislocation • Will reduce on it’s own • Wrap v splint • Fracture: SAM splint, cardboard splint, knee immobilizer • Sprains: knee immobilizer, crutches, wrap for swelling SPORTS MEDICINE HIP, PELVIS, LEG

• Hip avulsion fractures • Sudden, forceful muscle contraction • No splint - crutches • Femur: Anatomical, rigid splint. Call 911 • Pelvis: Maintain position. Call 911 • Tib/fib: SAM, vacuum, pillows SPORTS MEDICINE CRUTCH FITTING

• Height on crutches not usually accurate

• 2 finger widths from armpit • Elbows slightly bent • Handle should be at the bend of the wrist when arms are relaxed

Limping = crutches SPORTS MEDICINE UPPER ARM/SHOULDER

• Shoulder dislocation: sling • Clavicle fracture: sling • Humerus fracture: sling • Elbow • Dislocation: maintain position call 911. • Fracture: splinting long arm, sling, cardboard, SAM SPORTS MEDICINE WRIST/FOREARM

• Fall on an outstretched Hand (FOOSH) • Forearm – consider elbow • Wrist – consider hand • Cardboard, SAM, magazines SPORTS MEDICINE HAND AND FINGERS

• Hand: extended wrist splint

• Fingers: anatomical and/or rigid splint • tongue depressor and tape. SPORTS MEDICINE 911

• Pelvis, spine, neck, femur • Open fracture • Elbow, ankle, knee dislocations • Circulation concerns • Pain • Other SPORTS MEDICINE TAKE HOME POINTS

• Suspected fracture - splint above and below the site in the position it is found • If wrapping is indicated, wrap distal to proximal • Maintain circulation for any splitting or wrapping • Most splinting can be done with minimal supplies SPORTS MEDICINE REFERENCES

• Beam, Joel W. (2017) Orthopedic taping, wrapping, bracing and padding. Philadelphia, PA. F.A. Davis Company

• Prentice, William E (2017) Principles of Athletic Training: A guide to evidence based clinical practice, 7th Edition. New York, NY. McGraw-Hill Education

• https://www.cdc.gov/HomeandRecreationalSafety/Playground-Injuries/playgroundinjuries-factsheet.htm

• www.redcross.org/images/MEDIA_customProductCatalog/m5540601_FA-CPR-AED-Part-Manual.pdf SPORTS MEDICINE

COMMENTS/QUESTIONS?