Sports Medicine: Just the Facts

CHAPTER 4 • FIELD-SIDE EMERGENCIES 13

oxygen and transported to a medical facility for fur-

ther evaluation and management.

OPENPNEUMOTHORAX

• This is defined as a pneumothorax accompanied by an
  open wound to the chest (sucking chest wound).
  Treatment consists of placing an occlusive dressing
  over the open wound and taping it down on three sides
  to create a one-way valve that allows air to exit with-
  out reentering till a definitive thoracostomy tube can
  be placed.

TENSIONPNEUMOTHORAX

• This occurs when a pneumothorax is accompanied by
  progressive accumulation of air in the pleural space
  with the resultant increase in intrathoracic pressure
  causing a shift of mediastinal structures away from
  the pneumothorax as well as a decrease in venous
  return and cardiac output. In addition to the previ-
  ously listed symptoms, these athletes may have tra-
  cheal deviation away from the affected side with
  jugular venous distention and hypotension. This is a
  true medical emergency that requires immediate treat-
  ment by needle decompression of the chest with a
  large (14–16 gauge) needle or catheter inserted in the
  anterior chest wall in the second intercostal space at
  the midclavicular line, followed by placement of a
  thoracostomy tube.

CARDIAC ARREST

•Although devastating when it occurs in a young athlete,
a traumatic sudden death is extremely rare with inci-
dence varying depending on the age of the athlete and
the sporting event (O’Connor et al, 1998). The most
common cause of sudden cardiac death in young ath-
letes is congenital cardiovascular structural abnormali-
ties with hypertrophic cardiomyopathy leading the list,
followed by coronary artery anomalies and myocarditis
(McCaffrey et al, 1991). The most common cause in
older athletes (age >30–35) is atherosclerotic heart dis-
ease causing acute ischemic events.

• The field-side treatment of any cause of cardiac arrest
  should follow advanced cardiac life support (ACLS)
  guidelines with attention to early cardiopulmonary
  resuscitation (CPR) and defibrillation as indicated. An
  equally important task for the FP is to identify those
  athletes who are having warning signs of cardiac dis-
  ease and dysrhythmias, such as sudden unexplained
  syncope or collapse, exertional syncope, early fatigue,
  or anginal chest pain during or immediately following
  exertion (O’Connor et al, 1998). Strong consideration

should be given to withholding these athletes from

further competition until a thorough evaluation is per-

formed.

ANAPHYLAXIS

•Anaphylactic reactions are acute systemic hypersensi-

tivity reactions that can be idiopathic, exercise-

induced, or allergen-induced, and although rare, they

can progress very rapidly and prove fatal if unrecog-

nized. Insect stings (esp. hymenoptera) may be a

cause of sports related anaphylaxis.

• The symptoms of anaphylaxis may include urticaria/
  angioedema, upper airway edema, dyspnea, wheezing,
  flushing of skin, dizziness/hypotension/syncope, gas-
  trointestinal symptoms, rhinitis, and headache
  (Winbery and Lieberman, 1995). Symptom onset is
  typically rapid (within 5–30 min of exposure), and in
  its most severe form can progress to severe bron-
  chospasm, airway edema, and fatal cardiovascular col-
  lapse.
  •Treatment consists of prompt attention to the ABCs,
  followed by treatment with 100% oxygen, epineph-
  rine (1:1000) 0.3–0.5 mL in adults or 0.01 mg/kg in
  children given subcutaneously or intramuscularly and
  repeated every 10–15 minutes as needed, IV (intra-
  venous) fluids if hypotensive, beta-agonists by nebu-
  lizer if bronchospasm is present, antihistamines (H1
  and H2 blockers), and glucocorticoids if available.
  The athlete must be rapidly transported to a medical
  facility as continued observation will be required.

SEVERE HEMORRHAGE

• Hemorrhage in the athlete may be the result of lacera-
  tions, fractures, vascular disruptions, or visceral organ
  or muscle disruptions. It can manifest as either mas-
  sive external bleeding or insidious and occult internal
  bleeding. Control of external bleeding should follow
  the basic principles of hemostasis, which include
  steady direct pressure over the bleeding site and over
  larger arteries proximal to the site of injury, as well as
  elevation of the affected body part. Blind clamping of
  bleeding vessels and tourniquet application (with the
  possible exception of a traumatic amputation) are not
  recommended.


• Scalp lacerations can cause significant hemorrhage
  and often go unnoticed if the athlete is lying on his
  back or is strapped to a spine board.


• Occult bleeding may produce delayed signs and symp-
  toms, and what may at first appear to be an atraumatic