That’s A Wrap: Week 2

6 Sep

The weekly blog of an athletic trainer covering high school sports, including injury recaps.  This is an insight into the daily life/profession of an athletic trainer.  All incidents are meant for educational purposes and names/teams may be changed in order to protect identification.  That’s A Wrap will post on Tuesday mornings as a recap of the previous week and any upcoming highlights.

Last Monday, after I had written the previous “That’s A Wrap” I was summoned to the local hospital for an injury of a player at an away game.  Naturally it was something I work on very hard, closed head injuries, a.k.a. concussion.  Apparently he lost consciousness after a hit and was not stable during the on field examination.  He was quickly evacuated to the hospital where I met him and the medics.  What was truly amazing was the rapid response from the staff AND the proper information given to the athlete and family about concussions.  Amazingly, the attending physician recognized me – my constant courses/meetings on concussions – and he conferred with me about the injury.  I would even say it went as far as a consult, which is satisfying to me because as he readily admitted concussions are a clinical diagnosis and after clearing all life threatening injuries it was time to get the right information and management for the patient.

It seemed as though our football team was going to be whittled down to about 4/5 of the starting numbers after the first week and lingering injuries.  However like anything else in life the team had to press on with what was available as I did what I do best, try to get them back safely and quickly.  By the time the freshman team played on Thursday we had resolved 3 of our 10 injuries on the board, getting us back to almost full strength.

On Friday the team played their first home game, in very high heat.  Thankfully the humidity was low, but game time temperature was 98 degrees after a week of low 80’s.  Of course I was worried about heat related illnesses, we had two pig troughs standing by with ice and water in case of emergency.  All week-long we were harping on hydration and proper nutrition to prevent as many cramps and issues as possible.  Once the sun went down the temps dropped rapidly but we were tearing through water, 32 gallons by half time for 38 total suited up players and coaches.  In the second half we went through about 20 gallons, for a staggering 52 gallons of water.  Granted not every drop gets ingested, it was a testament to the student athletic trainers and support staff to keep ‘em drinking.

All of the preparation paid off as we did not have ONE cramp all night.  There were some tired boys out there but no heat related issues and on top of that no injuries of significance.  I turned to my student after the game and told him that we did our job perfectly tonight, as we never hit the field and had no injuries.

The only injury I had to deal with all week was tonight, during a JV game.  A player from the opposing team went down with a knee injury, unknown MOI with previous history on the knee.  The unusual thing about the injury was that he could not straighten the knee out and he was reporting it was “locked”.  Come to find out after speaking to his parents, that his past medical history of that knee had returned, confirmed via a positive McMurray’s and Appley’s test.  With all the tricks I had in my bag I could not get it to “unlock” and he was carted off to go home and get in the hot tub, per doctors orders, to get the leg to relax and possibly “unlock”.

It will be a very intense week as the schedule stiffens a bit and the pressure rises.  Here is to hoping we stay injury free and get some more players back.

Concussion count – 1 (Schutt AiR Advantage)

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5 Responses to “That’s A Wrap: Week 2”

  1. Michael Hopper September 6, 2011 at 20:56 #

    Dustin, I’m glad you made it through last week pretty easily. I was actually surprised to not have too much Friday night as well. When we arrived at the field it was 99 degrees out. At game time, it had already dropped to 92 and at half it was 82! I had one DB cramp up, but he handled it on his own on the field in between plays and had one other player cramp up, but 15 seconds of stretching fixed him for the rest of the night.

    I thought I was going to have a cake-walk of a night.. didn’t go onto the field until 3:45 to go in the 4th quarter. Quickly went downhill from there— shoulder with possible labrum injury, few plays later knee injury with no determined damage done, and the very next play dislocated patella! The officials let the last 1:45 run out without making the kids leave the huddle once we got the ambulance off the field…

    We’re at 1 concussion and 1 diagnosed “mild” concussion. Doctor told the kid he might have had a “mild” concussion so he held him out for a week. Now I’m making him go through RTP protocol whether he actually had one or not.

    • Doc September 7, 2011 at 00:18 #

      Am curious Michael:

      What specific RTP protocal are you using?

      Who makes the final determination for RTP ?

      What type of assessment tools are used to assess and monitor the concussion symptoms fleading to RTP?

      What other disciplines are involved in the assessing and monitring of the concussion symptoms…?

      Thank you for your consideration. This is a learning experience for me.

      • Doc September 7, 2011 at 00:36 #

        PS…

        oops Michael..apologize for not noticing typos…if there is a way to edit after posting…please advise?

        Thus I will try again…editing / rewording 2 of the 4 questions found within my initial post

        Am curious Michael:

        1- What specific RTP protocol are you using?

        3- What assessment tools are used to assess and monitor the concussion symptoms and the subsequent determination of RTP? (reworded this question…)

        Thanks.

  2. Michael Hopper September 7, 2011 at 05:45 #

    Doc,

    1. Our RTP protocol is a pretty basic 5-day protocol increasing intensity of activity each day as long as the athlete is asymptomatic. In this particular case, we’re actually at longer than 5 days not because he has had problems, but because the schedule just falls that way.

    2. In my school, I do. I’m the Certified Athletic Trainer and I’m the healthcare provider onsite. If a physician clears an athlete and I disagree, I will hold him/her out.

    3. We use the SCAT 2 form that is commonly used for neuropyschological evaluation. We will typically utilize this form as a part of the sideline evaluation and then follow up 24 hours later. Then, we will re-evaluate 1-2 times normally. We are in the process of possibly adding ImPACT as another assessment tool for us to use.

    4. If I determine that an athlete has suffered a concussion, then he/she is sent to a physician. If I have an athlete suffer multiple concussions, then they will get sent to a sports medicine physician who was additional background in concussion management.

  3. Doc September 7, 2011 at 11:40 #

    Many thanks , Michael, for the quick response.

    As part of the screening/assessment – do you look for emotional concerns? if so, how do you gather this info ?

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