approach taught by ATLS (Committee on Trauma,
1997) and should occur where the athlete is found.
They should initially be left in that position unless
they are prone and unconscious or there is a problem
performing the “ABCs” (Luke and Micheli, 1999;
Blue and Pecci, 2002), in which case they should be
logrolled to a supine position.- The logroll should ideally be a four person tech-
nique in which the team leader is at the victim’s
head maintaining in-line immobilization of the
head and neck, while the other three members of
the team are controlling the torso, hips, and legs.
The athlete should be turned in the direction of the
three assistants according to the count of the leader
and then onto a spine board placed under the
athlete. - If an athlete is wearing an appropriately fitted helmet,
neither the helmet nor its chin strap should be
removed. Padding or sandbags should be placed
around the helmet and the shoulders; hips and legs
immobilized. The face-guard can easily be removed
by prying or cutting it off for access to the airway.
The helmet and shoulder pads should be considered a
single unit—the removal of either one necessitates
the removal of the other, as leaving only one of them
in place forces the neck out of a neutral position
(Haight and Shiple, 2001; Gastel et al, 1998). If the
athlete is not wearing a helmet, a rigid cervical collar
should be applied with in-line immobilization of the
spine. - After the primary survey is complete and the patient
stabilized, a more detailed secondary survey should
be performed either on the field or on the sideline,
depending on the status of the athlete and the envi-
ronmental conditions. - The factors to be considered while evaluating the
fallen athlete include whether or not the injury was
witnessed/unwitnessed and/or traumatic/atraumatic.
The age, general conditioning, and specific medical
conditions of the athlete should be considered, as
well as the general characteristics of the sport, such
as the amount of contact (i.e., collision, limited con-
tact, and noncontact), the degree of speed involved,
and the duration of the event. Finally, the environ-
mental conditions must be considered as both a
potential causative and/or exacerbating factor in the
injury.
•After the initial examination of the patient is com-
pleted, the FP should identify any problem areas and
categorize them as being of either an immediate or
potential life threatening/disabling nature and treat
accordingly. Frequent reevaluation of the injured ath-
lete is a must.
IMMEDIATE LIFE THREATENING
INJURIESRESPIRATORY COMPROMISEUPPERAIRWAYOBSTRUCTION- Although rare in organized sports, respiratory arrest
can result from upper airway obstruction(UAO).
Signs include respiratory distress with little or no air
movement, significant accessory muscle use, and
stridorous, wheezing, or snoring breath sounds. If the
athlete is unconscious, the airway should be opened
with a jaw-thrust maneuver to keep the tongue from
occluding the airway and an oral/nasal airway inserted
as necessary. In-line repositioning of the head/neck
may be necessary to establish airway patency if the
neck is significantly contorted. The oropharynx
should be inspected for foreign bodies and removed
if visualized; however, blind finger sweeps are not
recommended in either children or adults. Significant
facial/mandibular trauma with resultant loss of sup-
port of the tongue or with blood, secretions, and loose
teeth in the pharynx can produce UAO, particularly in
the unconscious athlete who has lost protective
airway reflexes. Other causes of UAO, such as airway
edema from anaphylaxis, inhalation burn injuries, or
an expanding neck or retropharyngeal hematoma
from neck trauma should be considered, with early
intubation a priority. Surgical airway capability is a
necessity as well.
LARYNGEALFRACTURE- This rare injury occurs after direct trauma to the ante-
rior neck. Signs include stridor, hoarseness, subcuta-
neous emphysema, and perhaps bony crepitus and a
palpable fracture. Although airway obstruction may
not be immediate, it can rapidly progress to this stage
because of resultant edema and as with other causes of
obstruction, early intubation is a priority; surgical
airway capability is again a necessity.
PNEUMOTHORAX
•A simple pneumothorax may be spontaneous (i.e.,
rupture of a bleb) or traumatic, with spontaneous
pneumothoraces occurring more often in sports that
involve changes in intrathoracic pressure (i.e., scuba
diving and weightlifting) (Partridge et al, 1997) and
traumatic pneumothoraces occurring secondary to rib
fractures. Symptoms may include unilateral chest
pain, dyspnea, and cough. Immediate treatment is
rarely needed unless the patient is severely dyspneic
or the pnuemothorax is open or under tension. Those
with a stable simple pneumothorax should be given12 SECTION 1 • GENERAL CONSIDERATIONS IN SPORTS MEDICINE