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Clinical Evaluation of Head Injuries-On-the-Field Evaluation

The initial on-the-field evaluation is directed toward assessing the levels of consciousness and of associated injuries, particularly cervical spine trauma. The medical personnel must first assess the patient’s airway, breathing, and circulation (i.e., ABCs).

If the patient is unconscious, the initial respondent must assume that an associated cervical spine injury has occurred, and the neck […]

Head Injuries and Concussion

Key Points

Traumatic events can lead to both primary injuries [e.g., scalp lacerations, intracranial bleeds, skull fractures, concussion, and diffuse axonal injury, (DAI)] and later, secondary injuries (e.g., herniation syndromes, diffuse edema, and hypoxic/ischemic injuries). Initial evaluation and treatment should progress through the ABCs (airway, breathing, and circulation) of trauma resuscitation. Glasgow Coma Scale is […]

Decision Making and Classification

The primary decision that a sports physician must make when confronted with a thoracolumbar condition is whether the athlete has a significant mechanical and/or neurological instability requiring urgent or emergent stabilization.

The spinal problem can be categorized initially as a high-energy injury, a low-energy injury, or even a no-injury situation. In turn, high-energy injuries to […]

Clinical Evaluation-History

The sports physician may be required to assess for a spinal problem in situations varying from an unconscious athlete in a difficult environmental presentation, such as on a steep ski slope or in a crumpled racecar, to a preparticipation examination in a sports medicine clinic.

The history may be the most important aspect of a […]

The Thoracolumbar Spine

Key Points

The majority of thoracolumbar spine injuries arising from low-velocity sports usually are less catastrophic than some of the athletic injuries involving the more vulnerable cervical spine. The thoracic spinal cord is protected by the relatively larger and less mobile thoracic vertebra and rib cage. The sports physician may be required to assess for […]

Management of Cervical Spine Injuries-Scenario 2: Altered Mental Status without Cardiorespiratory Compromise

Care of the cervical spine in the collision athlete with altered mental status presents a challenging problem for the sports medicine physician. After a rapid primary survey, a brief neurological assessment is performed to determine the athlete’s level of consciousness.

Important aspects of the on-field neurological examination include assessment of mental status (i.e., Glasgow Coma […]

Management of Cervical Spine Injuries-Scenario 1: Cardiorespiratory Compromise

Life-threatening alteration of cardiopulmonary function is a rare event in the collision sport athlete. Respiratory distress from obstruction of the airway can result by a foreign body, facial fractures, or direct injury to the trachea or larynx. The ability to maintain airway patency also can be lost secondary to a depressed level of consciousness.

In […]

Management of Cervical Spine Injuries-Primary Survey

On reaching the injured player, the primary objectives are to assess for immediately life-threatening conditions and to prevent further injury. The initial evaluation follows the ABCDE sequence of trauma care:

A, airway maintenance with cervical spine protection;

B, breathing and ventilation;

C, circulation;

D, disability (i.e., neurological status); and

E, exposure of the athlete.

During […]