AT Practical

Question 1

steps to conscious spinal assessment

Answer 1

1. introduce yourself
2. block head
3. AVPU
4. ABCs
5. ask for history
6. get someone else to hold head while you do visual and tactile scan of body
7. check for CSF, blood, fracture, soft tissue injury
8. ask for symptoms (pain, sensation and motor)
9. palpate c-spine (pain=emergency)
10. if unwilling to move activate EAP
11. log roll onto spinal board

Question 2

steps to unconscious spinal assessment

Answer 2

1. introduce yourself
2. block head
3. AVPU and ABC
4. activate EAP when notice unconscious
5. try to stimulate consciousness by pinching traps
6. monitor vitals, signs and symptoms until ambulance arrives

Question 3

steps to concussion assessment

Answer 3

1. introduce yourself
2. block head
3. UABC
4. ask history and MOI (whiplash, impact, rotation+impact)
5. rule out spinal fracture by asking for symptoms, checking sensory and motor responses and palpating c-spine)
6. check for CSF, blood, fractures and soft tissue injury
7. check cognitive signs (confusion, memory)
8. check symptoms (headache, balance, nausea)
9. check physical signs (poor coordination, personality change)
10. if ONE symptom NO RTP

Question 4

history for SCAT 6

Answer 4

1. have you had a concussion before? how many?
2. when was your last concussion
3. what symptoms did you have?
4. how long was concussion recovery?

Question 5

when do you not need to do a SCAT 6?

Answer 5

if they already had one symptom of concussion and bad MOI

Question 6

when do you receive medical attention for a concussion?

Answer 6

1. positive observable signs (motionless, gait/balance, confusion and disorientation, etc.)
2. Glascow coma scale of <15 (assess visual, verbal and motor response)
3. neck pain, tenderness or loss of ROM (spinal immobilization and collar)
4. coordination and ocular/motor screen (look side-to-side and up-and-down without double vision)
5. memory assessment/maddocks question score of <5 (where are we, which half is it)
6. vomiting more than twice

Question 7

steps for on-field SCAT 6

Answer 7

1. athlete history (past head injury and diagnosis)
2. rate symptome (1=mild, 6=severe)
3. do symptoms worsen with PA and MA
4. ask why they dont feel 100%

Question 8

steps for sideline SCAT 6

Answer 8

1. cognitive screening
2. coordination and balance
3. delayed recall
4. calculate total cognitive score
5. make decision

Question 9

cognitive screening for SCAT 6

Answer 9

1. orientation: where are you, what day is it
2. immediate memory: what words do you remember from this list of words (3 trials)
3. concentration: repeat these letters in reverse order and months in reverse order (30 secs is good)

Question 10

coordination and balance for SCAT 6

Answer 10

1. stand on one leg with eyes closed
2. walk heel-to-toe in a straight line as fast as possible
3. dual-cognitive task (walk heel-to-toe while counting backwards from 100 by 7)

Question 11

delayed recall for SCAT 6

Answer 11

how many words can you remember from the list earlier

Question 12

steps for splinting extremities

Answer 12

1. fracture testing (gentle palpation, tapping/vibration, compression)
2. if positive splint
3. check CMS
4. splint in position they’re found in unless they’re comfy to move then stabilize
5. splint joint above and below injury
6. tie with splint at joints above and below
7. check CMS again

Question 13

when do you not splint

Answer 13

1.. open wounds
2. loss of CMS
3. fractures to femur, upper tibia, upper humerus, spine, head
4. when athlete is going into shpock
5. when athlete refuses

Question 14

steps for log rolls

Answer 14

1. put on collar
2. one person on torso - 1 hand shoulder and 1 hand lateral hip
3. one person hips/legs - 1 hand lateral hip, 1 hand legs
4. charge person holds head and directs when to lift athlete
5. lift at same time and position athlete on center of board
6. if not centred there “V” or “W” slide on charge persons count
7. strap in knees, hips, and nips
8. sling ankles and knees to spinal board
9. put guards at head over charge persons hands
10. forehead and chin strap on and tightened equally
11. when secure charge person can remove hand
    ***If pain or resistance lay the athlete back donw and reassess

Question 15

what do you do if you have no collar or spinal board?

Answer 15

call 911

Question 16

steps for abdominal assessment on-field

Answer 16

1. introduce yourself
2. look at breathing
3. does breathing cause pain?
4. are they supporting their abdomen?
5. bruising, swelling, protrusion?
6. referral pain?
7. quadrant assessment
8. put athlete in comfy position
9. 911 if organ

Question 17

quadrant assessment

Answer 17

1. athlete in supine with knees bent to relax abdominal muscles
2. using flat fingers palpate in clockwise manner starting with upper right
3. guarding? rigidity? tenderness on palpation? rebound tenderness? referral pain with palpation?

Question 18

common referral patterns

Answer 18

1. liver= right shoulder
2. spleen= left shoulder and 1/3 down arm
3. kidney= low back into anterior hip and groin
4. appendix= LRQ, midway between bellybutton and ASIS
5. bladder= lower abdomen/upper thigh area

Question 19

on-field ankle assessment steps

Answer 19

1. what happened
2. what hurts (show me)
3. has anything like thsi happened before? past injury to this ankle?
4. palpate and tell me what hurts
5. look for swelling and bruising
6. actively dorsiflex, plantarflex, invert and evert
7. push against my and match my resistance in those motions
8. safely get athlete of the field

Question 20

sideline ankle assessment steps

Answer 20

1. fracture testing
2. ATFL test (anterior drawer, plantarflexion + inversion)
3. talar tilt (pull talus up and side-to-side)
4. PTFL test (neutral + inversion)
5. CFL test (dorsiflex +inversion)
6. high ankle sprain test (dorsiflex and eversion)
7. thompson test (achilles)
8. passive testing and overpressure

Question 21

on-field knee assessment steps

Answer 21

1. what happened
2. what hurts (show me)
3. has anything like thsi happened before? past injury to this knee?
4. palpate and tell me what hurts
5. look for swelling and bruising
6. actively extend and flex as much as possible
7. push against me and match my resistance in those motions
8. check knee cap
9. safely get athlete of the field

Question 22

sideline knee assessment steps

Answer 22

1. fracture testing
2. test knees passively with overpressure
3. valgus (MCL)
4. varus (LCL)
5. anterior drawer (ACL)
6. posterior drawer (PCL)
7. mcmurrays (meniscus)
   - IR for lateral meniscus
   - ER for medial meniscus
8. thessaly test (ACL)
9. lachmans (ACL)