Sideline Emergencies Jeanne Doperak, DO UPMC Sports Medicine July 2021 Disclosures • No Disclosures 2 Goals • Outline strategies/approach for handling sideline emergencies • Consider situations where immediate action may change outcome • Understand your role in the medical team during an emergency 3 My Experience 16 years on a sideline 4 Take your pulse 5 Survey the Scene – Is it safe? Anything can happen! 6 Weather Emergency: Lightning Lightning NOAA - http://www.lightningsafety.noaa.gov/ If you hear thunder, lightning is close enough to strike. If a lightning emergency is declared: Seek shelter in a fully enclosed building or Act fast if someone is struck by lightning. enclosed metal top vehicle with the windows up Lightning victims do not carry an electrical charge, Avoid open areas and stay away from isolated tall are safe to touch and need urgent medical trees, towers, utility poles. attention. Stay away from objects that conduct electricity - Dial 911 wire fences, power lines. If indicated, begin BLS and use AED. Do not lie on concrete floors or lean on concrete Reverse Triage walls. Never lie flat on the ground. Never shelter under a tree. Stay in safe shelter for 30 minutes after last sound of thunder. 7 Athletes, Coaches, Staff, Fans, Band, Cheer, Mascots…… • Your PRIMARY responsibility is the athlete • Case by case for others that need assistance • Discuss with your EMS crew in advance 8 Take Control 9 Scouts Moto Equipment AED? Personal Emergency Action Plan (EAP) PRACTICE 10 Primary Survey • CAB • What hurts? Brief Exam • Be Efficient • Calm the athlete – reassure • Verbalize plan out loud • Move to the sideline or transport? • Think twice act once 11 Collapsed Athlete: Possible Etiologies BLS/AED 13 Commotio Cordis • Direct non-penetrating blow (blunt trauma) • Timed perfectly – During ventricular repolarization – Just prior to peak of T wave • Results in VF Commotio Cordis • Usually male (> 90%) and young (mean age of 14) • Sudden collapse or have brief (< 10 sec) period prior to collapse • Tx w/ defibrillation – Survival rate = 25% w/ early defibrillation (< 3 min) – 1% survival if > 3 min Heat Illness: Types Condition Core Temp F Associated Associated Signs Symptoms Heat Edema Normal None Mild edema in dependent areas Heat Rash Normal Pruritic Rash Papulovesicular skin eruption – clothed areas Heat Syncope Normal Dizziness and Loss of postural generalized weakness control, rapid mental status recovery once supine Heat Cramps Normal or elevated Painful muscle Affected muscles firm But < 104F contractions to palpation Heat Exhaustion 98.6 – 104 F Dizziness, malaise, Flushed, profuse fatigue, nausea, sweating, cold clammy vomiting, headache skin, normal mental status Heat Stroke > 104 F Possible hx of heat Hot skin w/wo exhaustion before sweating, CNS mental status change disturbance Heat Illness: Risk Factors • Hot temperature • Dehydration – as little as 30 minutes • High intensity exercise • Heavy equipment or clothing • Obesity • Deconditioning • Medication/Drugs – Stimulants (Adderall®) – Diuretics • Alcohol • Acute or chronic illness – Fever (risk of myocarditis) – Body temperature already elevated Heat Illness: Treatment Algorithm Goals: - 1 degree/3 minutes - 102oF before transport 18 Heat Illness: Ice Bath Immersion 19 Anaphylaxis 20 Anaphylaxis 21 Anaphylaxis: Non-pharmacologic Treatment • Calm and reassure the person • Bee sting - scrape the stinger off – Do not use tweezers or squeeze the stinger (releases venom) • Lie them flat and elevate lower extremities • Cover with blanket • Do NOT place a pillow under the person's head – can block airway • Do NOT give the person anything by mouth if having trouble breathing Anaphylaxis: Pharmacologic Treatment • Epinephrine (EpiPen®) • Auto-injector • Upper outer thigh • Appropriate for individuals > 30 kg (66 lbs) • Common side effects: – Tachycardia, palpitations, sweating, nausea/vomiting, difficulty breathing, dizziness, weakness or shakiness, anxiety Seizure • Prevent injury by blocking/removing hazards • Do Not hold or tie the person down • Turn the person on the side to prevent aspiration/choking • Cushion head, remove glasses • Do not place anything in the person’s mouth (solid or liquid) • Do not try to force the teeth apart • Time and characterize the seizure • Stay with the person until the seizure ends • On the field: Oxygen, AED, serial vitals, start IV, finger stick glucose – Status Epilepticus – Diazepam 10 mg Hypoglycemia: IM Glucagon 25 Transport • EMS answers to medical command • Will transport to nearest facility unless higher level of care needed. • Do you need to consider helicopter? Trauma center? Pediatric Center? • Who goes with athlete? 26 Sideline or Secondary Survey • Take your time • Get out of the action • Monitor vs Transport • Ambulance vs Car 27 Monitor • Serial Exams – by the game clock • Take and hold the helmet • Notify coaching staff • Evaluate at conclusion of event and have plan for follow up and also educate on triggers for more prompt care. • Concern for any issue that progressively gets worse 28 Lung Injury 29 Lung Injury: Pneumothorax Tension Pneumothorax • SOB • Tachycardic • Trachea Deviates Away from effected side • Jugular Venous Distension • Absent Breath Sounds 31 Lung Injury: Needle Decompression Technique: • 14 gauge needle, 3 ¼ inch • Midclavicular 2nd ICS or Anterior Axillary Line 5th ICS • Push until flush with skin • Hold for 5-10 seconds • Withdrawal needle, leaving catheter 32 Abdominal Injury • Evolving Pain • Rigid Abdomen • Peritoneal Signs (hop) • Rebound or guarding • Back Pain – worse with lying 33 Transport From Sideline • Consider: • Can they go on own power? • Can they access their vehicle? • What on the way could get or be made worse? • Will they go? • What if this was your child/relative/friend? 34 ENT Emergencies • Blow Out Orbital Fracture – Eye motion impaired – Muscle Entrapment • Globe Rupture – Tear drop shaped pupil – Vitreous Humor Leakage – DO NOT PATCH • Hyphema – Blood In anterior chamber • Globe Luxation – Cover with Cup and transport 35 Dental Issues • Tooth Fracture – Save pieces – not emergent • Tooth Extrusion – Can push back and splint • Tooth Intrusion – DO NOT pull out • Tooth Avulsion – Handle Crown not root – Put in save a tooth, saliva, milk NEVER EVER TAP WATER – Can be packed back into socket and stabilized 36 Liability • Sticky – Good Samaritan Law? • Communication with medical team • Consider age – consent – scope of practice 37 Thank you – Questions? 38.