chapter 25 Injury Prevention and Treatment Sue Carver

chapter 25 Injury Prevention and Treatment Sue Carver

Injury Prevention • Minimizing injury risk – – – Planning Equipment Education Monitoring and modification for special needs Guidelines for exercise progression • Proper handling of injuries • Knowledge of universal guidelines for handling blood and body fluids

Soft-Tissue Injuries • See table 25. 1 in the textbook. • Sprain versus strain – Sprain: overstretching or tearing of ligament – Strain: overstretching or tearing of muscle tendon • Contusion: impact force that results in bleeding in underlying tissues • Heel bruise: sudden abnormal force to heel that results in trauma to underlying tissue

Bone Injuries Fracture Disruption of bone with or without loss of continuity or external exposure (see table 25. 2) Periosteal irritation Low-grade inflammatory process causing proliferation of fibroblasts and generalized scarring of connective tissue (continued)

Bone Injuries (continued) Simple fracture Bone fracture without external exposure Compound fracture Bone fracture with external exposure

Treatment of Soft-Tissue Injuries Chronic versus acute injury – Chronic: prolonged or lingering; generally, symptoms last over 6 wk – Acute: sharp, intense pain or injury that rapidly reaches a crisis (continued)

Treatment of Soft-Tissue Injuries (continued) • Use of heat – – Increases circulation Reduces pain due to tight muscles Promotes muscle relaxation Used in later stages of recovery once chance for swelling has diminished • Use of cold – – Decreases swelling Reduces inflammation Reduces pain due to swelling Can trigger muscle activity

PRICE is used in the treatment of acute softtissue injuries: – – – Protect Rest Ice Compress Elevate

Types of Wounds and Skin Disorders • See tables 25. 3 and 25. 4 in the textbook. • Incision: cutting of skin resulting in an open wound with cleanly cut edges and exposure of underlying tissue • Laceration: tearing of skin resulting in an open wound with jagged edges and exposure of underlying tissue • Puncture: direct penetration of tissues by a pointed object (continued)

Types of Wounds and Skin Disorders (continued) • Abrasion: scraping of tissues resulting in removal of the outermost layers of skin and the exposure of numerous capillaries • Skin irritations: blister, callus, corn, ingrown toenail, intertrigo, plantar wart

Medical Problems Related to Wounds and Skin Disorders • Excessive bleeding: internal or external bleeding that results in massive loss of circulating blood volumes • Internal bleeding: bleeding within the deep structures of the body (chest, abdominal, or pelvic cavity) and bleeding of any of the organs contained within these cavities (continued)

Medical Problems Related to Wounds and Skin Disorders (continued) • Shock: massive physiological reaction to trauma, generally temporary and often resulting in a decrease in blood pressure and depression of other vital processes • Infection: contamination of tissue by a pathogenic organism

Environmental Concerns: Heat Illnesses • See table 25. 5 in the textbook. • Heat syncope: fainting or loss of strength because of excessive heat • Heat cramps: spasmodic muscular contractions caused by exertion in extreme heat (continued)

Environmental Concerns: Heat Illnesses (continued) • Heat exhaustion: collapse with or without loss of consciousness, suffered in conditions of heat and high humidity, resulting largely from the loss of fluid and salt by sweating • Heat stroke: final stage of heat exhaustion, in which thermoregulatory system shuts down to conserve depleted fluid levels

Signs of Heat Illness and Overexertion • • • Nausea Extreme breathlessness Dizziness Unusual fatigue Muscle cramping Headache

Factors Contributing to Heat Illness • • • Temperature and humidity Diet Medication Body weight Activity level

Environmental Concerns: Cold • See table 25. 6 in the textbook. • Deep frostbite: freezing of deep tissue, including muscle and bone • Frost nip: freezing of tips of extremities such as ears, nose, or fingers involving only the surface of the skin • Superficial frostbite: freezing of layers of skin and subcutaneous tissue • Hypothermia: core body temperature drops below 95 °F.

Factors Contributing to Cold-Related Injuries • Improperly dressing for conditions • Cold and rain combined; cold with high windchill factor • Exercising in cold water, particularly when air temperature is low

Diabetic Reactions • See table 25. 7 in the textbook. • Diabetic coma (hyperglycemia): loss of consciousness caused by too little insulin • Insulin shock (hypoglycemia): anxiety, excitement, perspiration, delirium, or coma caused by too much insulin or not enough carbohydrates to balance insulin intake

Common Cardiovascular Conditions • Tachycardia: heart rate greater than 100 bests · min– 1 at rest • Bradycardia: heart rate below 60 beats · min – 1 at rest • Hypotension: low blood pressure • Hypertension: high blood pressure

Common Pulmonary Complications • Apnea: temporary cessation of breathing • Dyspnea: difficult or labored breathing beyond what is expected for the intensity of the work • Tachypnea: excessively rapid breathing • Airway obstruction: blockage of the airway • Hyperventilation: imbalance in respiratory gases caused by breathing out too much carbon dioxide (continued)

Common Pulmonary Complications (continued) • Asthma: spasm of the smooth muscles of the bronchial tubes; edema and inflammation of the mucous lining are triggered • Respiratory shock: lungs unable to supply enough oxygen to the circulating blood

Treatment of Airway Obstruction 1. 2. 3. Heimlich maneuver Head tilt, chin lift Rescue breathing

Common Orthopedic Problems • See tables 25. 8 and 25. 9 in the textbook. • Inflammatory reactions (-itis): bursitis, capsulitis, epicondylitis, myositis, plantar fasciitis, tendinitis, tenosynovitis, synovitis • Stress fracture • Mechanical low-back pain • Shin splints

CPR and Emergency Procedures 1. Have an emergency plan. 2. Have equipment, supplies, and emergency forms easily available. 3. Remain calm. 4. Check scene for clues to determine injury history. 5. Check vital signs.

Vital Signs • Heart rate: normally 60 to 100 beats · min– 1 at rest • Skin color – Red: heat stroke, high blood pressure, carbon monoxide poisoning – Blue: airway obstruction, respiratory insufficiency, heart failure, poisoning – Ashen: fright, insufficient circulation, heat exhaustion, insulin shock, heart attack • Body temperature: normally 98. 6 °F (37 °C) (continued)

Vital Signs (continued) • Mobility: loss could indicate neurological involvement or spinal cord injury • Blood pressure: SBP/DBP – – High: damage or rupture of blood vessels Low: severe hemorrhage; heart attack Rise in SBP with stable or falling DBP: brain damage Fall in SBP with rise in DBP: heart ailment

Determining Course of Action 1. Check surroundings, ask questions, do systematic head-to-toe evaluation, and check for medical alert bracelet. 2. Check for consciousness. If victim is not breathing, begin rescue breathing. 3. Check quality of breathing: Check for fast versus slow, labored versus normal, sputum or blood, and abnormal smell. (continued)

Determining Course of Action (continued) 4. Control profuse bleeding by applying pressure over the wound, at pressure point, or, as last resort, with a tourniquet. 5. Look for signs of head injury such as unconsciousness, nausea, vomiting, clear or straw-colored fluid coming from the ears and nose, and deformity of skull. 6. Check to see if pupil response is dilated, constructed, uneven, or unresponsive to light. 7. Check for neck or back injury.

Response to Cardiac Arrest 1. Cardiopulmonary resuscitation (CPR) can keep oxygen flowing to brain but cannot restore a normal heart beat. 2. The automated electronic defibrillator (AED) allows individuals with limited experience to safely and effectively defibrillate a heart. Artificial respiration (AR) or rescue breathing (RB) can restore breathing. 3. Guidelines for CPR, RB, AR, and AED use should be consistent with local Red Cross or American Heart Association recommendations.