The IOC Manual of Emergency Sports Medicine
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Trim Size: 216 mm X 279 mm fm.indd 03:4:4:PM 02/09/2015 Page ii Trim Size: 216 mm X 279 mm fm.indd 03:4:4:PM 02/09/2015 Page i THE IOC MANUAL OF EMERGENCY SPORTS MEDICINE Trim Size: 216 mm X 279 mm fm.indd 03:4:4:PM 02/09/2015 Page ii Trim Size: 216 mm X 279 mm fm.indd 03:4:4:PM 02/09/2015 Page iii THE IOC MANUAL OF EMERGENCY SPORTS MEDICINE EDITED BY DAVID McDonagh and DAVID ZIDEMAN Trim Size: 216 mm X 279 mm fm.indd 03:4:4:PM 02/09/2015 Page iv This edition first published 2015 © 2015 by the International Olympic Committee Wiley-Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley’s global Scientific, Technical and Medical business with Blackwell Publishing. Registered office: John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial offices: 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 111 River Street, Hoboken, NJ 07030-5774, USA For details of our global editorial offices, for customer services and for information about how to apply for permis- sion to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher. 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The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom. Library of Congress Cataloging-in-Publication Data The IOC Manual of Emergency Sports Medicine / edited by David McDonagh and David Zideman. p. ; cm. International Olympic Committee manual of emergency medical care in sports Includes bibliographical references and index. ISBN 978-1-118-91368-0 (pbk.) I. McDonagh, David O’Sullivan, editor. II. Zideman, David A., editor. III. International Olympic Committee, issuing body. IV. Title: The International Olympic Committee manual of emergency sports medicine. [DNLM: 1. Olympic Games. 2. Athletic Injuries--therapy. 3. Emergency Treatment. QT 261] RD97 617.1’027--dc23 2014041849 A catalogue record for this book is available from the British Library. Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be avail- able in electronic books. Cover images: © International Olympic Committee Typeset in 9.5/12pt Plantin Std by Laserwords Private Limited, Chennai, India 1 2015 Trim Size: 216 mm X 279 mm fm.indd 03:4:4:PM 02/09/2015 Page v The editors would like to thank Lesley Zideman for her efforts and the many hours she has contributed to this project. Trim Size: 216 mm X 279 mm fm.indd 03:4:4:PM 02/09/2015 Page vi Trim Size: 216 mm X 279 mm fm.indd 10:38:54:AM 02/13/2015 Page vii Contents List of contributors, xiii 4 Cardiopulmonary Resuscitation on the Field of Play 33 Foreword, xvii Ruth Löllgen, Herbert Löllgen, and David Zideman Preface, xix Sudden Cardiac Arrest on the Field of Play 34 About the Authors, xxi Recognition of Cardiac Arrest 34 Field of Play Airway 36 1 Emergency Care at the Olympic Games 1 Foreign Body Airway Obstruction Richard Budgett (FBAO or Choking) 37 Introduction 1 Field of Play Breathing 38 Early Preparations 1 Recovery Position 38 Final Preparations 2 Field of Play Circulation 38 Team and IF Doctors 4 FoP: Combining Compressions and Summary 4 Ventilations 39 2 Injury and Illness During the 2008 Summer and Expired Air Ventilation 39 the 2010 Winter Olympic Games 6 Bag-Valve-Mask Ventilation (Two Rescuer Kathrin Steffen, Torbjørn Soligard and Lars Technique) 39 Engebretsen FoP Removal 40 Vancouver Winter Games 2010 7 Rhythm Analysis 40 Beijing Summer Olympic Games 9 Shockable Rhythms 41 Bibliography 10 Nonshockable Rhythms 42 3 The Medical Team Response 12 Reversible Causes (The 4H’s and 4T’s) 42 David McDonagh and David Zideman Advanced Life Support 42 ABC on the Field of Play 14 Advanced Airway 44 Primary Survey 20 Simple Airway Adjuncts 44 Primary Survey 22 Inserting an Oropharyngeal Airway (OPA) 44 Primary Survey 24 Inserting a Nasopharyngeal Airway (NPA) 44 Transferring the Athlete from the FOP to the Advanced Airway Adjunct 45 Fieldside 27 Venous Access 45 Fieldside Assessment 27 Intraosseous Access 45 Pupils – Pathological Findings 28 Drugs 45 Blood Sugar 28 Implantable Cardiac Defibrillators (ICDs) 46 Blood Pressure 29 Postresuscitation 46 Athlete Medical Room Treatment 30 Bibliography 46 Transportation to Hospital 31 5 Cardiac Emergencies on the Field of Play 47 Discharge 31 Ruth Löllgen, Herbert Löllgen and David Zideman Teamwork 31 Sudden Cardiac Death (SCD) 47 Bibliography 32 FoP Management Non-traumatic Sudden Collapse 48 vii Trim Size: 216 mm X 279 mm fm.indd 10:38:54:AM 02/13/2015 Page viii Contents Clinical Findings/Management ACS (Fig 5.1) 50 Clinical Findings/Management Convulsing Clinical Findings/Management AA or AD 52 Athlete 79 FoP Management of Myocarditis 52 Referral or Discharge? 80 Clinical Findings/Management Hypertensive Differential Diagnoses of Seizures 80 Crisis 53 Bibliography 81 Clinical Findings/Management Bradycardia 54 10 Head Injuries 82 Clinical Findings/Management Tachycardia 57 David McDonagh and Mike Loosemore Bibliography 57 Sideline Observation 83 6 Control of Hemorrhage and Infusion FoP Management of a Convulsing Athlete 83 Management 58 Primary Survey – Convulsing Patient 84 Kenneth Wing Cheung Wu and Hiu Fai Ho FoP Management of a Nonconvulsing Athlete Introduction 58 with a Head Injury 85 FoP Management 59 Primary Survey on the FoP 85 External Bleeding Wounds 59 FoP Management of Head Injury with New Trends in Hemorrhage Control 60 a Low GCS 85 Internal Bleeding 60 Management of Head Injury with a GCS 12–14 on the FoP 85 Infusion Management 61 Fieldside Evaluation 86 Conclusion 62 Secondary Survey at the Fieldside 86 Bibliography 62 Management of Patients with Head Injuries 86 7 Anaphylaxis 63 Andy Smith and Jerry Nolan Pupil Examination 87 Glasgow Coma Scale 88 Introduction 63 Binocular Hematomas – Raccoon Eyes 90 Signs and Symptoms 64 Battles Sign 90 Management of Anaphylaxis 64 A Focused Medical History 90 Bibliography 67 Transfer to the Hospital 91 8 Asthma and Respiratory Emergencies 68 Joseph Cummiskey When Should the ED Request a Cranial CT? 91 Scalp Lacerations and Bleeding 92 Observation – From Outside the FoP and While Smelling Salts 92 Approaching the Patient 68 Bibliography 92 FoP Management of a Suspected Chest Medical Event 68 11 Concussion – Onfield and Sideline Evaluation 93 Paul McCrory and Michael Turner Primary Survey 68 Fieldside Management of Chest Medical Introduction 93 Conditions 69 Epidemiology 93 Pulmonary Embolism 70 Definition of Concussion 93 Bronchial Asthma and Exercise-Induced Symptoms and Signs of Acute Concussion 94 Bronchospasm (EIB) 70 Fieldside Recognition of Concussion 94 The Effect of Environmental Conditions and Concussion Injury Severity and Recovery 94 Pollutants in Sport Activity 73 Concussion Management 100 Bibliography 76 Concussion in Child and Adolescent Athletes 103 9 Seizures and Epileptic Emergencies 77 Geraint Fuller Prevention of Concussion 103 Other Specific Issues 104 Preparation 77 Conclusion 105 Fieldside Observation 77 Bibliography 105 Observations on Approaching the Athlete 78 viii Trim Size: 216 mm X 279 mm fm.indd 10:38:54:AM 02/13/2015 Page ix Contents 12 Throat Injuries 106 Fieldside Management Eye Injury 126 Jonathan Hanson, Padraig B.