FEEL: Pulse: Neck pulse is strongest; feel here if unconscious or possible shock;

Radial pulse for arms: (at wrist below thumb)

Dorsalis Pedis pulse for legs: (mid top of foot just below ankle) - OR -

Tibialis Posterior pulse for legs: (just below & behind the "bump" that forms the inside part of the ankle)

A fast weak pulse (more that 100 - 120) means shock: activate EMS

Skin: generally cool & "clammy": think shock

Nerve Test: (Lightly touch the area to be checked & compare with opposite limb)

"Can you feel this?" "Does it feel different than over here (opposite limb)?"

Check "ability to feel" in:

Any absence or difference in the ability to feel means a nerve injury; if there is any neck pain, then the player may have a spinal cord injury:

IF ANYTHING SERIOUS IS FOUND UP TO THIS POINT: ACTIVATE EMERGENCY MEDICAL SYSTEM; KEEP PLAYER WARM, QUIET & STILL UNTIL HELP ARRIVES.

FIRST AID FOR SERIOUS PROBLEMS:

No Breathing; No pulse:

Þ CPR (Get certified!)

Pulse rapid, weak; skin cool, clammy, pale; player dizzy: Shock

Þ Cover with coat or blanket to keep warm (except in heat exhaustion)

Þ lift legs (increases blood return to the heart)

Severe Bleeding:

Þ Put firm pressure on the area with the cleanest "dressing" you have available. Although you may not be able to stop the bleeding, you will definitely slow it down.

Wear latex gloves for your protection.

*******************************************************************************************

IF EVERYTHING IS OK TO THIS POINT: NO SHOCK, MENTALLY OK, NO NECK PAIN AT ALL, NO SERIOUS HEAD, CHEST OR ABDOMEN PAIN, then continue:

ASK:

1. Player to move each of these areas:

2. Player to "push against you" in each of these areas (to check strength)

IF THERE IS WEAKNESS OR INABILITY TO MOVE IN A BODY PART WITHOUT AN INJURY TO THAT AREA, A NERVE OR SPINAL CORD INJURY MAY BE PRESENT.

HAVE SOMEONE CALL EMS SYSTEM. KEEP PLAYER STILL & QUIET.

THEN, IF NO NECK PAIN: ask player to move neck

If OK, then: No serious problems have been found

Proceed to Extremity Injury Evaluation:

II.  EXTREMITY INJURY EVALUATION                                         top

CHECKING THE ARMS AND LEGS:

"alfa": Ask / Look / Feel / Ask Player to Move

A weak pulse (without shock) indicates damage or significant pressure on the artery from injury

Capillary Refill: The pinkish color under our fingernails and toenails.

Press on the nail and the color should go whiter; let go and it should 'pop' back to pinkish in 2 seconds. ("1 Mississippi - 2 Mississippi").

Capillary refill is abnormal if:

Þ Color is pale or bluish at all

Þ Color doesn't 'pop' back to more pink within 2 seconds

FEEL  Skin: for swelling or deformity or grating bones

For Point Tenderness: Feel for a point of tenderness that is much greater in pain than the surrounding area that hurts from the injury. Example: It may hurt a lot generally around the ankle but if there is one spot that is much worse to the touch then there is Point tenderness

Point tenderness = fracture or severe sprain. Have the player get medical help.

Nerve Test: RECHECK FOR THE INJURED LIMB:

(Lightly touch the area to be checked & compare with opposite limb)

"Can you feel this?" "Does it feel different than over here (opposite limb)?"

Check "ability to feel" in the injured & opposite limb:

	Þ thumb pulp
	Þ little finger pulp
	Þ front / back of forearm
	Þ front / back of arm
	Þ Big toe pulp
	Þ top of foot beyond ankle
	Þ front / back of lower leg
	Þ front / back of thigh

Any absence or difference in the ability to feel means a nerve injury.

ASK:

1. Player to move each of the areas involved in the arm or leg injury:

2. Player to "push against you" in the affected areas (to check strength)

 

	Þ fingers
	Þ hand / wrist
	Þ forearm / elbow
	Þ arm / shoulder
	Þ toes
	Þ foot / ankle
	Þ leg / knee
	Þ thigh / hip

 

IS THE INJURY SERIOUS? Three "D's"

1. DEFORMITY: is a fracture until proven otherwise.
2. DISCOLORATION: is bruising. Rapid bruising is internal bleeding from either a broken bone or torn ligament (severe sprain).
3. DISABILITY: The immediate or rapid development of the inability to move, use or put weight on the injured part correlates with the seriousness of the injury. Diminished ability to feel (numbness) is part of this consideration.

	If no serious injuries have been found, have the player sit and do a recheck of the injury.
	If the player is able to sit and appears stable then help him / her to stand and assist over to the sideline.
	Sit or lay the athlete down and repeat the injury evaluation.

 

FIRST AID FOR LIMB INJURIES:                               top

Bleeding:

Þ Put firm pressure on the area with the cleanest "dressing" you have available. Although you may not be able to stop the bleeding, you will definitely slow it down.

Wear latex gloves for your protection. Put a Band-Aid or dressing on all wounds or abraisions (scrapes.)

Limb Injury:

Þ Splint the limb:

Þ Splinting technique: for elbow through fingers and knee through toes.

1. Remove the clothing from injured area if possible.
2. Check pulse & capillary refill and check sensation (ability to feel - see above).
3. Pad the splint with something soft.
4. Splint should be big enough to span from a joint above to a joint below the injury.
5. Fix the splint to the injured area firmly but not too tight.
6. Recheck the pulse, capillary refill and sensation. If any of these has worsened then the splint may be too tight. Loosen the splint and recheck. If pulse, capillary refill or sensation is still diminished then the player needs to see a doctor immediately.

 

Þ Splinting technique: for shoulder / upper arm:

Use a sling then wrap an Ace or similar bandage around the "slinged" arm and chest to improve the immobilization.

Repeat entire assessment on the sideline to determine if the injury is becoming significantly worse.

Please call Chesapeake Orthopedics and Sports Medicine Center at 410-768-5555 for any questions or to arrange for a more detailed instruction session for your organization.  

Link to AAOS Patient Info [ Home ] [ Up ] Copyright: 2002 - 2008  Chesapeake Orthopaedics & Sports Medicine Chesapeake Orthopedic & Sports Medicine Center 200 Hospital Drive Glen Burnie, MD 21061 410-768-5555; www.chesortho.com; www.orthopedicdoc.net