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Learn about facial injury red flags, CSF identification, EAP essentials, and return-to-play guidelines for athletes from Dr. Rehal Bhojani.
Q: What are the red flags for hematomas?
A: Protocols from SCAT6 and other guidelines for hematomas or hemorrhages emphasize watching for loss of consciousness (LOC), altered mental status, and vomiting. Quickly identify these signs to avoid missing late concussions or other critical issues. Ensure the mechanism of injury (MOI) aligns with the trauma; diagnosis is challenging if it doesn't.
Q: How can CSF be identified, and what is the “halo sign” red flag?
A: The halo sign, also known as the ring sign, remains the best indicator for identifying cerebrospinal fluid (CSF). CSF is distinct: it has a clear-to-mucous color, is super thin, lighter than water, and does not mix with other fluids. For instance, a soccer player initially diagnosed with a concussion showed a bloody nose and consistent halo sign post-game, necessitating immediate emergency room referral.
Q: What essential elements should be added to an Emergency Action Plan (EAP)?
A: EAPs are becoming more comprehensive, focusing on three key areas. First, ensure resource accessibility by including contacts for ENTs, dentists, and eye doctors. Second, review the EAP regularly, two to three times a year, rather than just annually, using past injury knowledge to proactively improve it. Third, if using AI to draft EAPs, meticulously verify all listed resources.
Q: What items should be included in kits for eye and tooth injuries?
A: For eye and tooth injuries, kits should include 4×4 gauzes, an otoscope, a “Save a Tooth” system, eyedrops, nasal tampons, and Afrin. Physician-approved medications should also be added, along with an ENT kit, which is available online.
Q: What are the risks and benefits of athletic trainers performing sutures on the field?
A: On-field suturing depends on the location and type of laceration, with the cause (e.g., metal object) being crucial due to potential tetanus considerations. Athletes often return to play the same day with sutures. For facial lacerations, specific types and sizes of sutures are used, but caution is advised near the eye. Eyebrows and the skull are generally suitable for suturing if no underlying fracture exists. Control bleeding and inform athletes of the risks associated with playing with sutures; safety is paramount.
Q: When can athletes return to play after tooth injuries?
A: For primary (baby) teeth, if no secondary tooth injury is suspected, return to play (RTP) is generally straightforward. However, secondary tooth injuries involving complex factors can lead to lasting effects. It is important to document whether the injury involves primary versus permanent teeth. For younger children, involve parents to understand the mechanism of injury and the potential for future crown and root fractures.
Q: What current sports medicine trends should recent graduates be aware of or learn in the classroom?
A: Sports medicine is constantly evolving, with increased pressure for accurate decision-making. Recent graduates need to be proficient in current literature and comfortable with shared decision-making and escalating care. As athletic trainers often serve as primary sports medicine providers, they require broad skills across various domains.
Q: How can these emerging sports medicine competencies be effectively taught?
A: Teaching these competencies is challenging due to the need for comprehensive exposure. Educational methods vary by setting, and the field has expanded significantly. Training provides a broad scope, so it's important not to be narrow-minded. Past experiences remain relevant, and post-training, continuous reading and skill refinement are crucial. In a controlled educational environment, students should learn as much as possible, as quickly as possible, to prepare for real-world practice.
Q: What topics are covered in today's breakout session?
A: Today's breakout session focuses on facial injuries, incorporating practical eye, ear, and nasal examinations. The session emphasizes that history-taking accounts for 80% of a diagnosis, with the physical examination comprising the remaining 20%.
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