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On-Field Emergencies and



Todd C. Malvey and Thomas D. Armsey

In This Chapter

Head and spinal cord injury Athletes with a helmet and face mask Lightning safety Preparedness

Preseason planning Emergency planning Game-day planning Medical bag

Sideline medical supplies

Emergencies at sporting events are usually caused by trauma, aggravation of a known medical problem, presentation of a previously unknown medical problem, or an environmental cause/catastrophe. The list of potential causes of on-field emergencies is numerous and still expanding (Table 3-1). Some of the potential causes of on-field emergencies are immediately life threatening (cardiac arrhythmia, airway compromise), while others may rapidly become life threatening if medical care is not administered quickly (cervical spine injury, traumatic brain injury). The team physician and other medical personnel should be able to acutely assess, manage, and triage both traumatic injuries and numerous medical conditions.

When reaching an athlete that is injured, a primary survey should be made using the ABCDE method (airway, breathing, circulation, disability/neurologic status, exposure). Cervical immobilization should be started immediately, especially if the athlete has neurologic deficits, pain, or altered mental status. Immobilization of the cervical spine should be maintained until spinal cord and brain injury is ruled out.

Evidence of airway compromise includes labored and/or unequal breath sounds. Noisy respirations may be an indication of a partial airway obstruction, and clearing the airway of the obstruction should be attempted by sweeping a gloved finger into the oropharynx and/or by suction. The athlete's circulatory status can be affirmed by palpation of a carotid artery pulse. Any bleeding should be identified and controlled by applying a pressure dressing.

If spontaneous respirations and/or a pulse are absent, then cardiopulmonary resuscitation should be started immediately. The athlete is artificially ventilated with either mouth-to-mouth, mouth-to-mask, bag-valve mask, or oropharyngeal airway (unconscious athletes only) respirations, cricothyrotomy, or endo-tracheal intubation. Chest compressions should be started, and an automated external defibrillator should be attached to the athlete as soon as possible. It has been shown that early defib-rillation helps to save lives by converting ventricular fibrillation, the most common lethal arrhythmia, to a normal rhythm.

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