SHS.502.Lec-16-0.pptx Emergency procedure

Emergency care

1. Emergency Procedures and Primary Care in Physical Therapy

2. Thoracic Injuries

3. Objectives General management tips Trauma/emergency specific treatment Fracture and dislocation (Rib fracture, Sternum fracture, Sternoclavicular dislocation) Pneumothorax (Tension, open and hemopeumothorax ) Acute pulmonary embolism

4. General management tips Observe general appearance of athlete, determine level of consciousness, and check ABCs if necessary. Obtain a history if possible. Measure vital signs . Auscultate lungs for adventitious sounds Palpate chest wall Percuss chest wall Directly observe chest wall. Continue to monitor vital signs.

5. Fractures D irect or indirect force Fractures of ribs 10 through 12 may injure abdominal organs such as the liver or spleen, whereas upper rib fractures may injure the lungs.

6. Rib fracture Rib fractures present with localized pain that increases on compression of the rib cage. Crepitus at the fracture site may also be felt with deep inspiration. Respiratory effort is limited because of pain, which typically prevents the athlete from being able to take a full breath

7. Rib Fracture (treatment) Although fracture is painful , a single rib fracture with no internal injury does not constitute an emergency and can be treated with rest, ice, and medication for pain. X-rays are required for a definitive diagnosis

8. Fracture ( sternum) Fractures of the sternum require a significant amount of force and can be life threatening because the force may be transmitted to the heart, lungs, or great vessels of the chest. Severe dyspnea, point tenderness and sternal deformity

9. Sternoclavicular Dislocation Posterior dislocation of the sternoclavicular joint may cause respiratory distress from the clavicle, placing pressure on the trachea and surrounding structures . If the athlete is in respiratory distress , immediately treat with basic airway maneuvers and supplemental oxygen . If improvement is not noted quickly , then reduction of the dislocation should be attempted

10. Reduction of Sternoclavicular joint

11. Flail Chest Chest to move in a paradoxical(opp.) manner during respiration. Isolated flail chest injuries may be treated by placing the athlete on the affected side and transporting him or her to a trauma centre. The athlete’s own body weight on the affected side will act to splint and support the flail chest.

12. If C-spine precautions are necessary, then the use of manual pressure or placement of a large bulky dressing directly over the flail segment may be beneficial in acting as a splint. High-flow oxygen therapy, vital sign monitoring, and rapid transport are crucial . If dyspnoea increases, endotracheal intubation and positive pressure ventilations must be considered.

13. Tension Pneumothorax If breathing sounds are absent on the affected side and severe dyspnea and jugular vein distension are present, then a tension pneumothorax should be immediately suspected

14. If the athlete is able to breathe adequately, give supplemental high-flow oxygen and call EMS immediately. Monitor the athlete closely and watch for deterioration in his or her condition.

15. If the athlete is unconscious or unable to breathe adequately, then assist respirations with a bag-valve mask . If the symptoms still do not improve, needle decompression must be performed rapidly

16. Open pneumothorax An opening in the chest wall that allows air to enter the pleural space is an open pneumothorax. Treatment of an open pneumothorax involves creating a one-way valve with a dressing

17. Covering the opening with a sterile occlusive dressing sealed on three sides will allow air to leave the thorax on exhalation but will seal off the opening so that air does not enter the chest cavity on inhalation.

18. Open Pneumothorax

19. Hemothorax Blood in pleural cavity Effective treatment of a hemothorax includes oxygen supplementation and respiratory support .

20. Acute pulmonary embolism Symptoms of an acute pulmonary embolism include a sudden onset of Chest pain , dyspnea, tachycardia, and bloody sputum . Lung sounds may reveal wheezing, although normal lung sounds are common. Treatment includes Early recognition, oxygen administration, and rapid transport to the hospital