SPORTS MEDICINE

Susan Niles, MSE, ATC, LATLead Athletic Trainer

NURSING MANAGEMENT OF SPRAINS, STRAINS AND PLAYGROUND INJURIES

41st Annual Belle Blackwell School Nurse Conference Provided by Texas Children’s Hospital Provider #18-267764-A

7.24.2019 | Cypress, TX | 7a – 5:30p

CONTINUING NURSING EDUCATIONTexas Children's Hospital is an approved provider with commendation of continuing nursing education by the Texas Nurses Association - Approver, anaccredited approver with distinction, by the American Nurses Credentialing Center’s Commission on Accreditation.

REQUIREMENTS FOR SUCCESSFUL COMPLETIONTo receive contact hours for this continuing education activity, the participant must: • Sign in to the activity• Attend the entire activity• Complete a participant evaluation online

Once successful completion has been verified, a “Certificate of Successful Completion” will be awarded for 6.0 contact hour(s). For web link issues, email cne@texaschildrens.org

LEARNING OUTCOMEAt the conclusion of this continuing nursing education activity, the participant will be able to improve nursing management, care coordination and resources for school age children.

CONFLICTS OF INTERESTExplanation: A conflict of interest occurs when an individual has an opportunity to affect or impact educational content with which he or she may have a commercial interest or a potentially biasing relationship of a financial nature. All planners and presenters/authors/content reviewers must disclose the presence or absence of a conflict of interest relative to this activity. All potential conflicts are resolved prior to the planning, implementation, or evaluation of the continuing nursing education activity. All activity planning committee members and presenters/authors/content reviewers have submitted Conflict of Interest Disclosure forms.

The activity’s Nurse Planner has determined that no one who has the ability to control the content of this CNE activity – planning committee members and presenters/authors/content reviewers – has a conflict of interest.

COMMERCIAL SUPPORTThis CNE activity has not received commercial support.

JOINT PROVIDER STATEMENTThis CME/CNE activity has been jointly provided by Texas Children’s Hospital collaboratively with Texas School Nurses Organization Region IV.

SPORTS MEDICINE

• Understand the basic principles of splinting

• Differentiate wrapping and taping

• Review splinting and wrapping techniques for common playground injuries

OBJECTIVES

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• About 75% of nonfatal injuries involving playground equipment occur on public playgrounds • Fractures

• Dislocations

• Sprains

• Strains

PLAYGROUND INJURIES

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• Indication: suspected fracture

• Contraindication: further harm, circulation concerns

SPLINTING

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PRINCIPLES OF SPLINTING• Pre/Post evaluation – circulation, color,

sensation, etc.• Splint above and below the fracture site• Splint as they are found

• Anatomical

• Pain

• Do I need to splint?

SPORTS MEDICINE

TYPES OF SPLINTS

• Vacuum splint

• Air splint

• Anatomical splint

• SAM splint

• Cardboard splint• Anything available…

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• Indications (RICE)• Swelling

• Support• Minimal – awaiting further evaluation

• Pain

• Contraindications• Circulation concerns

WRAPPING

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WRAPPING TECHNIQUES

• Supplies: ACE wrap, powerflex/coban• Distal to proximal• Snug, not tight• Maintain circulation, color, movement

• Considerations: swelling may increase causing the wrap to tighten. Re-wrap if pain increases or circulation decreases.

SPORTS MEDICINE

TAPING• Taping

• Support to participate while recovering from injury

• Prophylactic

• Athletic Trainer

SPORTS MEDICINE

• Wrapping: Sprains, swelling

• Splinting: Fracture

• Taping: defer to AT

WHAT/WHEN

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• Mechanism

• Pain

• Swelling

• Bruising

• Crepitus• Deformity

FRACTURE SPRAIN• Mechanism

• Pain

• Swelling

• Bruising

• Crepitus• Deformity

SPORTS MEDICINE

• Toe – Anatomical splint -buddy tape

• Foot – Cardboard, SAM, other

TOES AND FEET

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• Mechanism• Weight bearing – 4 steps?• Wrap v splint

• Sprain - compression

• Fracture – splint: SAM, cardboard, vacuum splint

• Dislocation = 911

• Crutches if limping

ANKLE – SPRAIN V FRACTURE

SPORTS MEDICINE

• Patellar dislocation• Will reduce on it’s own

• Wrap v splint

• Fracture: SAM splint, cardboard splint, knee immobilizer

• Sprains: knee immobilizer, crutches, wrap for swelling

KNEE

SPORTS MEDICINE

• Hip avulsion fractures• Sudden, forceful muscle contraction

• No splint - crutches

• Femur: Anatomical, rigid splint. Call 911

• Pelvis: Maintain position. Call 911

• Tib/fib: SAM, vacuum, pillows

HIP, PELVIS, LEG

SPORTS MEDICINE

• Height on crutches not usually accurate

• 2 finger widths from armpit• Elbows slightly bent• Handle should be at the bend of the wrist

when arms are relaxed

Limping = crutches

CRUTCH FITTING

SPORTS MEDICINE

• Shoulder dislocation: sling

• Clavicle fracture: sling

• Humerus fracture: sling

• Elbow• Dislocation: maintain position call 911.

• Fracture: splinting long arm, sling, cardboard, SAM

UPPER ARM/SHOULDER

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• Fall on an outstretched Hand (FOOSH)• Forearm – consider elbow

• Wrist – consider hand

• Cardboard, SAM, magazines

WRIST/FOREARM

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• Hand: extended wrist splint

• Fingers: anatomical and/or rigid splint• tongue depressor and tape.

HAND AND FINGERS

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911

• Pelvis, spine, neck, femur

• Open fracture

• Elbow, ankle, knee dislocations

• Circulation concerns

• Pain

• Other

SPORTS MEDICINE

• Suspected fracture - splint above and below the site in the position it is found

• If wrapping is indicated, wrap distal to proximal

• Maintain circulation for any splitting or wrapping

• Most splinting can be done with minimal supplies

TAKE HOME POINTS

SPORTS MEDICINE

• Beam, Joel W. (2017) Orthopedic taping, wrapping, bracing and padding. Philadelphia, PA. F.A. Davis Company

• Prentice, William E (2017) Principles of Athletic Training: A guide to evidence based clinical practice, 7th

Edition. New York, NY. McGraw-Hill Education

• https://www.cdc.gov/HomeandRecreationalSafety/Playground-Injuries/playgroundinjuries-factsheet.htm

• www.redcross.org/images/MEDIA_customProductCatalog/m5540601_FA-CPR-AED-Part-Manual.pdf

REFERENCES

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COMMENTS/QUESTIONS?