II. Causes: Head and Neck Injury
- Head Injury in Sports (including Concussion)
- C-Spine Trauma or Cervical Spine Fracture
- Brachial Plexus Burner
- Auricular Hematoma
- Nasal Fracture
- Dental Trauma (e.g. Tooth Avulsion)
- Eye Trauma (e.g. Hyphema, Corneal Abrasion, Eye Foreign Body)
-
Facial Fracture (e.g. Maxillary Fracture, MandibleFracture, Orbital Fracture, Zygomatic Arch Fracture)
- Evaluate for airway compromise
- Evaluate Extraocular Movements and ask about Diplopia
-
Epistaxis
- Start with nasal pressure and consider intranasal Decongestant (e.g. Phenylephrine, Oxymetazoline)
- Place nasal pack (or balloon such as Rhinorocket) if refractory
III. Causes: Chest or Thoracic Injury
IV. Causes: Abdominal or Lumbar Injury
V. Causes: Miscellaneous
VI. Causes: Sports Specific Injury
- Baseball
- Basketball
- Ankle Injury (e.g. Ankle Sprain)
- Finger Injury (e.g. Jammed Finger)
-
Bicycling
- See Bicycling
- Bowling
- Shoulder Injury (e.g. Rotator Cuff Tendinopathy)
- Elbow Injury (e.g. Medial Epicondylitis or Bowler's Elbow)
- Wrist Injury (e.g. wrist Tendonitis)
- Ulnar Neuropathy of the thumb (Bowler's Thumb)
- Low Back Pain
- Boxing or Mixed Martial Arts
- Closed Head Injury or Concussion
- Facial Lacerations
- Shoulder Injury (e.g. Shoulder Dislocation)
- Extensor Tendon Sagittal Band Tear (Boxer's Knuckle)
- Finger Fracture
- Knee Injury (e.g. Ligamentous Injury)
- Toe Fracture
- Cheerleading
- Closed Head Injury or Concussion
- Ankle Injury
- Low Back Pain (e.g. Spondylolysis)
-
Football
- Closed Head Injury or Concussion
- Knee Injury (e.g. Ligamentous Injury, Meniscal tear)
- Golf
- See Golf Injuries
- Hockey
- Closed Head Injury or Concussion
- Ankle Injury (e.g. Ankle Sprain)
- Shoulder Injury (e.g. AC Joint Separation)
- Hamstring Strain
- Knee Injury (e.g. MCL Strain)
- Inline Skating
- Lacrosse
- Closed Head Injury or Concussion
- Ankle Injury (e.g. Ankle Sprain)
- Knee Injury (e.g. Ligamentous Injury)
- Rib Fracture or Contusion
-
Running
- See Running Injury
- Scuba Diving
- Soccer
- Swimming
- Shoulder Injury (e.g. Rotator Cuff Tendinopathy)
- Knee Injury (MCL Strain or Swimmer's Knee)
- Skiing
-
Surfing
- See Surfing Injury
- Tennis
- Wrestling
VII. Management: Sideline Medical Provider
- Preparation
- Introduce yourself to the athletic trainer (typically first point of contact for injured athletes)
- Ask about an existing emergency action plan (EAP) - see prevention below
- Identify nearest hospitals and Trauma Centers
- Identify location of facility emergency equipment
- Automated External Defibrillator (AED)
- Spine Board
- Athletic trainer's bag
- Treatment or training room for more thorough off-the-field evaluation and management
- Bring emergency supplies if not available at facility or with trainer
- See First Aid Kit
- Personal Protection Equipment (gloves, Eye Protection, mouth-to-mouth mask)
- Cervical Collar
- Dressing supplies (e.g. ace wrap, gauze, Bacitracin)
- SAM splints
- Nasal pack
- Flash light
- Position yourself available to respond to injuries
- Clear view and quick access to the playing field
- Approach
- See ABC Management
- See Primary Survey
- See Secondary Survey
- Collapsed Athlete
- See Exercise Induced Syncope
- Emergent conditions in the collapsed Athlete (3H's)
- Heart (e.g. Cardiac Arrest spontaneous or Traumatic, serious Arrhythmia)
- Head (e.g. Traumatic Brain Injury, Seizure)
- Heat Stroke
- Assume Cervical Spine Injury if Altered Mental Status, bilateral extremity symptoms, midline cervical tenderness, paralysis, severe Neck Pain
- See Cervical Spine Injury
- See NEXUS Cervical Spine Decision Rule
- Apply Cervical Collar
- Log Roll Patient onto Spine Board
- Leave helmets and pads in place for EMS tansport unless interfering with patient management
- Use additional assistants to ensure Cervical Spine stabilization if equipment removal needed
- Head or Neck Injury indications for Emergency Department transfer
- Cervical Spine Injury
- Open Fracture
- Facial Fracture (e.g. Mandibular Fracture, Maxillary Fracture, Orbital Fracture)
- Significant Eye Injury (e.g. Acute Vision Loss, Hyphema)
- Other management
- Closed Head Injury
- See Head Injury in Sports
- See Closed Head Injury
- See Return to Play after Concussion
- Athletes suspected of Concussion shoule not return to play on the same day of injury
- Lacerations
- See Laceration Repair
- Control bleeding
- Evaluate for associated significant injury (e.g. open Fracture, Hemorrhage, deep space injury, neurovascular injury)
- Control bleeding and bandage more significant injuries and transfer to emergency department
- Irrigate wound
- Repairs using Suture (or staple of the scalp) may return to play on same day (if not otherwise contraindicated)
- Repairs using Tissue Adhesive should not return to play on same day (wound dehiscence risk)
- High risk Laceration Repairs (e.g. vermilion border, ear helix, Eyelid) are best in a clinical environment by skilled operator
- Closed Head Injury
VIII. Prevention
- See Football Helmet
- See Bike Helmet
- See Eye Protection in Sports
- See Preparticipation Physical Evaluation
- Emergency action plan (EAP)
- All-cause preparatory plan for sideline emergencies
- Prepare for cardiac emergencies (e.g. readily available AED, basic life support training for staff and players)
- Cardiac event survival is 79% in schools with EAP (44% in schools without an EAP)
- Prepare for serious injuries (e.g. Closed Head Injury, Cervical Spine Injury, serious torso injuries)
- Practice the emergency action plan (including AED, CPR) at least annually
- References
IX. References
- Amores (2021) Crit Dec Emerg Med 35(11): 19-24
- Dreis (2020) Crit Dec Emerg Med 34(7):3-21
- Reilly, Curry and Swaminanthan (2024) Collapsed Athlete, EM:Rap, 6/10/2024
- Ursman (2022) Am Fam Physician 106(5): 543-8 [PubMed]