On-Field Evaluation of Head and Neck Injuries

1. On-Field Evaluation of Head and Neck Injuries Orthopedic Assessment III – Head, Spine, and Trunk with Lab PET 5609C

2. Equipment Considerations: Suspected spinal injury → helmet should NOT be removed Airway is accessible (facemask removal) Cervical collar can be applied with helmet and shoulder pads on Athlete’s head can be secured to spine board Helmet removal without removing the shoulder pads → cervical spine extension On-Field Evaluation

3. Facemask Removal: Facemask is attached to the helmet by thick plastic fasteners Can be cut off or unscrewed Most helmets have four fasteners Can cut all four or cut the bottom two and retract the mask On-Field Evaluation

4. Facemask Removal: Common tools for helmet removal: Hand held screwdriver Anvil Pruner Trainer’s Angels FM Extractor On-Field Evaluation

5. Chest Exposure: Shoulder pads and jersey should be left in place along with the helmet To access the chest for CPR, cut the jersey, shoulder pad stings and straps, and spread the pads apart so the chest is exposed On-Field Evaluation

6. Initial Inspection: Encumbering circumstances: Diver still in the water Football player lying on a pile Movement: Note any athlete movement Position of athlete: Alignment of arms, legs, cervical spine relative to trunk Splayed extremities must be aligned prior to spine-boarding or log-rolling the athlete Lesion of cervical or thoracic spinal cord Priapism On-Field Evaluation

7. Initial Action: Cervical Spine Stabilization Primary goal: Maintain the head and neck in alignment with the long axis of the body Kept from time of initial assessment, through transportation, and to the hospital Assign one person whose only responsibility is to secure and position the head and neck Usually the person with the most training and experience In-control – directs others On-Field Evaluation

8. On-Field Evaluation • Initial Action: Primary Survey / LOC • Determine level of consciousness: • “Can you hear me” • Response to painful stimulus • Determine ABCs: • Clear the airway and assess breathing • Remove mouthpiece • Check Circulation • Inspect ears and nose: • CSF • Secondary Survey: • Signs of trauma (fracture, dislocations, bleeding)

9. On-Field Evaluation • Management of Unconscious Athlete: • Airway: • Permanent brain damage – within 4 minutes after oxygen deprivation • Assess airway: • Look, listen, feel for breathing • Emergency Roll: • No pulse / not breathing and not in supine position • Maintain in-line stabilization • Expose chest • Remove facemask • Jaw thrust to open airway • 2 quick breaths • Circulation: • Carotid pulse • Not breathing with pulse – Rescue breathing • No pulse – CPR

10. Modified Jaw Thrust: Grasp each side of the mandible at the angle and pull upwards Must be careful not to disturb the c-spine May not always open the airway Should be done by a professional rescuer or athletic trainer Essentially dislocating the jaw On-Field Evaluation

11. Management of Unconscious but Breathing Athlete: C1 Lesion → Altered brain stem function and cardiac arrest C2 – C4 → phrenic nerve interruption: Respiratory distress On-Field Evaluation

12. On-Field Evaluation • Management of Unconscious but Breathing Athlete: • Cervical spine evaluation: • Palpate for gross bony deformity • Blood pressure: • Palpation of pulse and minimum Systolic BP: • Carotid artery – 60 mmHg • Femoral artery – 70 mmHg • Radial artery – 90 mmHg • Pupil responsiveness: • Open athlete’s eyelids: • Open eyelids – pupil constriction • Absence – brain not receiving oxygen / brain damage • Continue monitoring: • Every 5 minutes

13. On-Field Evaluation • Management of Conscious Athlete: History • Loss of consciousness: • Does athlete describe “blacking out” or “seeing stars” • Mechanism of injury • 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

14. On-Field Evaluation • Management of Conscious Athlete: • Inspection: • Cervical vertebrae: • Alignment • Cervical musculature: • Presence of spasm • Palpation: • Cervical spine: • Spinous and transverse processes: • Alignment, crepitus, tenderness • Cervical musculature: • Spasm in upper trapezius, levator scapulae, SCM • Unilateral spasm – cervical vertebral dislocation when skull is rotated and tilted to opposite side

15. On-Field Evaluation • Management of Conscious Athlete: • Neurological Testing: • Sensory testing • Motor Testing • Active motion: • Wiggle toes and fingers • Movement of ankles, wrists, knees, elbows, hips, and shoulders

16. Removing the Athlete from the Field: Walking athlete off the field: Lying → standing: ↓ BP (risk of fainting / unsteadiness) Allow athlete to adjust to position changes On-Field Evaluation

17. On-Field Evaluation • Removing the Athlete from the Field: • Using a Spine Board: Supine Athlete • Place the extremities in axial alignment • Arm on side toward which athlete rolled abducted to 1800 (if not wearing shoulder pads) • Place the spine board close to the side of the patient • Other responders position along the side of the athlete, according to the captain’s (person at the head) directions • Ideal to have 4 or 5 additional helpers, depending on the size of the patient • Each person is responsible for one body segment: trunk, hips, thighs, lower legs

18. On-Field Evaluation • Removing the Athlete from the Field: • Using a Spine Board: Supine Athlete • No matter how distorted it may appear, the neck MUST be stabilized in the position it is found • Put the spine board close to the patients side • Roll together on the captains signal • Ask if anyone has questions before proceeding • Example: “we’ll roll on 3. ready 1,2,3”

19. On-Field Evaluation

20. On-Field Evaluation

21. Removing the Athlete from the Field: Using a Spine Board: Supine athlete Continue to stabilize head and neck throughout the roll and on the spine board Use chin straps and foam blocks to secure the head on the board Secure the limbs with straps Distribute help personnel and lift together On-Field Evaluation

22. On-Field Evaluation • Removing the Athlete from the Field: • Using a Spine Board: Prone athlete • One person takes charge and immobilizes the head • Hands should be placed so that the head and neck can maintain their position as the body moves • Assistants kneel and reach across patient’s body • Each person is in charge of a different part, such as the trunk, hips, and legs • Their arms should cross each other for stability and synchronization • Limbs are placed at athlete’s sides • On the captain’s call, the body is turned in unison onto the board