On-Field On-Field Evaluation of Head Evaluation of Head and Neck Injuriesand Neck Injuries
Orthopedic Assessment III Orthopedic Assessment III – Head, Spine, and Trunk – Head, Spine, and Trunk
with Labwith Lab
PET 5609CPET 5609C
On-Field EvaluationOn-Field Evaluation Equipment Equipment
Considerations:Considerations: Suspected spinal injury Suspected spinal injury
→ helmet should → helmet should NOTNOT be be removedremoved
Airway is accessible Airway is accessible (facemask removal)(facemask removal)
Cervical collar can be Cervical collar can be applied with helmet and applied with helmet and shoulder pads onshoulder pads on
Athlete’s head can be Athlete’s head can be secured to spine boardsecured to spine board
Helmet removal without Helmet removal without removing the shoulder removing the shoulder pads → cervical spine pads → cervical spine extensionextension
On-Field EvaluationOn-Field Evaluation
Facemask Removal:Facemask Removal: Facemask is Facemask is
attached to the attached to the helmet by thick helmet by thick plastic fastenersplastic fasteners
Can be cut off or Can be cut off or unscrewedunscrewed
Most helmets have Most helmets have four fastenersfour fasteners
Can cut all four or Can cut all four or cut the bottom two cut the bottom two and retract the and retract the maskmask
On-Field EvaluationOn-Field Evaluation
Facemask Facemask Removal:Removal: Common tools for Common tools for
helmet removal:helmet removal: Hand held Hand held
screwdriverscrewdriver Anvil PrunerAnvil Pruner Trainer’s AngelsTrainer’s Angels FM ExtractorFM Extractor
On-Field EvaluationOn-Field Evaluation
Chest Exposure:Chest Exposure: Shoulder pads and Shoulder pads and
jersey should be left jersey should be left in place along with in place along with the helmet the helmet
To access the chest To access the chest for CPR, cut the for CPR, cut the jersey, shoulder pad jersey, shoulder pad stings and straps, stings and straps, and spread the pads and spread the pads apart so the chest is apart so the chest is exposedexposed
On-Field EvaluationOn-Field Evaluation Initial Inspection:Initial Inspection:
Encumbering Encumbering circumstances:circumstances:
Diver still in the waterDiver still in the water Football player lying on a Football player lying on a
pilepile Movement:Movement:
Note any athlete movementNote any athlete movement Position of athlete:Position of athlete:
Alignment of arms, legs, Alignment of arms, legs, cervical spine relative to cervical spine relative to trunktrunk
Splayed extremities must be Splayed extremities must be aligned prior to spine-aligned prior to spine-boarding or log-rolling the boarding or log-rolling the athleteathlete
Lesion of cervical or thoracic Lesion of cervical or thoracic spinal cordspinal cord
PriapismPriapism
On-Field EvaluationOn-Field Evaluation Initial Action: Cervical Initial Action: Cervical
Spine StabilizationSpine Stabilization Primary goal: Maintain the Primary goal: Maintain the
head and neck in alignment head and neck in alignment with the long axis of the with the long axis of the bodybody
Kept from time of initial Kept from time of initial assessment, through assessment, through transportation, and to the transportation, and to the hospitalhospital
Assign one person whose Assign one person whose only responsibility is to only responsibility is to secure and position the secure and position the head and neckhead and neck
Usually the person with the Usually the person with the most training and experiencemost training and experience
In-control – directs othersIn-control – directs others
On-Field EvaluationOn-Field Evaluation
Initial Action: Primary Survey / LOCInitial Action: Primary Survey / LOC Determine level of consciousness:Determine level of consciousness:
““Can you hear me”Can you hear me” Response to painful stimulusResponse to painful stimulus
Determine ABCs:Determine ABCs: Clear the airway and assess breathingClear the airway and assess breathing
Remove mouthpieceRemove mouthpiece Check CirculationCheck Circulation
Inspect ears and nose:Inspect ears and nose: CSFCSF
Secondary Survey:Secondary Survey: Signs of trauma (fracture, dislocations, bleeding)Signs of trauma (fracture, dislocations, bleeding)
On-Field EvaluationOn-Field Evaluation Management of Unconscious Athlete:Management of Unconscious Athlete:
Airway:Airway: Permanent brain damage – within 4 minutes after Permanent brain damage – within 4 minutes after
oxygen deprivationoxygen deprivation Assess airway:Assess airway:
Look, listen, feel for breathingLook, listen, feel for breathing Emergency Roll:Emergency Roll:
No pulse / not breathing and not in supine positionNo pulse / not breathing and not in supine position Maintain in-line stabilizationMaintain in-line stabilization
Expose chestExpose chest Remove facemaskRemove facemask Jaw thrust to open airwayJaw thrust to open airway
2 quick breaths2 quick breaths Circulation:Circulation:
Carotid pulseCarotid pulse Not breathing with pulse – Rescue breathingNot breathing with pulse – Rescue breathing No pulse – CPRNo pulse – CPR
On-Field EvaluationOn-Field Evaluation Modified Jaw Thrust:Modified Jaw Thrust:
Grasp each side of the Grasp each side of the mandible at the angle mandible at the angle and pull upwardsand pull upwards
Must be careful not to Must be careful not to disturb the c-spinedisturb the c-spine
May not always open May not always open the airwaythe airway
Should be done by a Should be done by a professional rescuer professional rescuer or athletic traineror athletic trainer
Essentially dislocating Essentially dislocating the jawthe jaw
On-Field EvaluationOn-Field Evaluation
Management of Management of Unconscious but Unconscious but Breathing Athlete:Breathing Athlete: C1 Lesion → Altered C1 Lesion → Altered
brain stem function brain stem function and cardiac arrestand cardiac arrest
C2 – C4 → phrenic C2 – C4 → phrenic nerve interruption:nerve interruption:
Respiratory Respiratory distressdistress
On-Field EvaluationOn-Field Evaluation Management of Unconscious but Management of Unconscious but
Breathing Athlete:Breathing Athlete: Cervical spine evaluation:Cervical spine evaluation:
Palpate for gross bony deformityPalpate for gross bony deformity Blood pressure:Blood pressure:
Palpation of pulse and minimum Systolic BP:Palpation of pulse and minimum Systolic BP: Carotid artery – 60 mmHgCarotid artery – 60 mmHg Femoral artery – 70 mmHgFemoral artery – 70 mmHg Radial artery – 90 mmHgRadial artery – 90 mmHg
Pupil responsiveness:Pupil responsiveness: Open athlete’s eyelids:Open athlete’s eyelids:
Open eyelids – pupil constrictionOpen eyelids – pupil constriction Absence – brain not receiving oxygen / brain Absence – brain not receiving oxygen / brain
damagedamage Continue monitoring:Continue monitoring:
Every 5 minutesEvery 5 minutes
On-Field EvaluationOn-Field Evaluation
Management of Conscious Athlete: Management of Conscious Athlete: HistoryHistory Loss of consciousness:Loss of consciousness:
Does athlete describe “blacking out” or “seeing Does athlete describe “blacking out” or “seeing stars”stars”
Mechanism of injuryMechanism of injury Symptoms:Symptoms:
Pain in cervical spine Numbness, tingling, burning pain radiating
through upper or lower extremities Sensation of weakness in cervical spine, upper
and/or lower extremities Burning or aching in the chest secondary to
cardiac inhibition
On-Field EvaluationOn-Field Evaluation Management of Conscious Athlete: Management of Conscious Athlete:
Inspection:Inspection: Cervical vertebrae:Cervical vertebrae:
AlignmentAlignment Cervical musculature:Cervical musculature:
Presence of spasmPresence of spasm Palpation:Palpation:
Cervical spine:Cervical spine: Spinous and transverse processes:Spinous and transverse processes:
Alignment, crepitus, tendernessAlignment, crepitus, tenderness Cervical musculature:Cervical musculature:
Spasm in upper trapezius, levator scapulae, SCMSpasm in upper trapezius, levator scapulae, SCM Unilateral spasm – cervical vertebral Unilateral spasm – cervical vertebral
dislocation when skull is rotated and tilted to dislocation when skull is rotated and tilted to opposite sideopposite side
On-Field EvaluationOn-Field Evaluation
Management of Conscious Management of Conscious Athlete:Athlete: Neurological Testing:Neurological Testing:
Sensory testingSensory testing Motor TestingMotor Testing Active motion:Active motion:
Wiggle toes and fingersWiggle toes and fingers Movement of ankles, wrists, knees, elbows, Movement of ankles, wrists, knees, elbows,
hips, and shoulderships, and shoulders
On-Field EvaluationOn-Field Evaluation
Removing the Removing the Athlete from the Athlete from the Field:Field: Walking athlete off Walking athlete off
the field:the field: Lying → standing: Lying → standing:
↓ BP (risk of ↓ BP (risk of fainting / fainting / unsteadiness)unsteadiness)
Allow athlete to Allow athlete to adjust to position adjust to position changeschanges
On-Field EvaluationOn-Field Evaluation Removing the Athlete from the Removing the Athlete from the
Field:Field: Using a Spine Board: Supine AthleteUsing a Spine Board: Supine Athlete
Place the extremities in axial alignmentPlace the extremities in axial alignment Arm on side toward which athlete rolled abducted Arm on side toward which athlete rolled abducted
to 180to 18000 (if not wearing shoulder pads) (if not wearing shoulder pads) Place the spine board close to the side of Place the spine board close to the side of
the patientthe patient Other responders position along the side of Other responders position along the side of
the athlete, according to the captain’s the athlete, according to the captain’s (person at the head) directions(person at the head) directions
Ideal to have 4 or 5 additional helpers, depending Ideal to have 4 or 5 additional helpers, depending on the size of the patienton the size of the patient
Each person is responsible for one body segment: Each person is responsible for one body segment: trunk, hips, thighs, lower legstrunk, hips, thighs, lower legs
On-Field EvaluationOn-Field Evaluation
Removing the Athlete from the Field:Removing the Athlete from the Field: Using a Spine Board: Supine AthleteUsing a Spine Board: Supine Athlete
No matter how distorted it may appear, the No matter how distorted it may appear, the neck MUST be stabilized in the position it is neck MUST be stabilized in the position it is foundfound
Put the spine board close to the patients sidePut the spine board close to the patients side Roll together on the captains signalRoll together on the captains signal
Ask if anyone has questions before proceedingAsk if anyone has questions before proceeding Example: “we’ll roll on 3. ready 1,2,3”Example: “we’ll roll on 3. ready 1,2,3”
On-Field EvaluationOn-Field Evaluation
On-Field EvaluationOn-Field Evaluation
On-Field EvaluationOn-Field Evaluation
Removing the Athlete Removing the Athlete from the Field:from the Field: Using a Spine Board: Using a Spine Board:
Supine athleteSupine athlete Continue to stabilize head Continue to stabilize head
and neck throughout the and neck throughout the roll and on the spine boardroll and on the spine board
Use chin straps and foam Use chin straps and foam blocks to secure the head blocks to secure the head on the boardon the board
Secure the limbs with Secure the limbs with strapsstraps
Distribute help personnel Distribute help personnel and lift togetherand lift together
On-Field EvaluationOn-Field Evaluation Removing the Athlete from the Field:Removing the Athlete from the Field:
Using a Spine Board: Prone athleteUsing a Spine Board: Prone athlete One person takes charge and immobilizes the One person takes charge and immobilizes the
headhead Hands should be placed so that the head and neck Hands should be placed so that the head and neck
can maintain their position as the body movescan maintain their position as the body moves Assistants kneel and reach across patient’s Assistants kneel and reach across patient’s
bodybody Each person is in charge of a different part, such Each person is in charge of a different part, such
as the trunk, hips, and legsas the trunk, hips, and legs Their arms should cross each other for stability Their arms should cross each other for stability
and synchronizationand synchronization Limbs are placed at athlete’s sidesLimbs are placed at athlete’s sides On the captain’s call, the body is turned in On the captain’s call, the body is turned in
unison onto the boardunison onto the board