# Its football time



## Topher38 (Feb 19, 2008)

You are working a local football game when you get a call for a downed player. The coaches say it was a head to head hit, one player walked away a little dazed and the other lays concious on the ground.


The patient is a 16 year old male.
He is laying prone on the ground with arms and legs out stretched. 
He is alert to verbal stimuli, AOx4
He is complaining that he is really tired and he feels like he is made of sand. 
He has pulse, motor, and sensory in all 4 extremties.

Airway is patent, says hes having a little difficulty breathing
Breathing is patent, no abnormal sounds, mild difficulty breathing
No obvious bleeding, cap refill is normal, pulse is present, strong

Pulse 79
B/p   112/87
Pupils PEARL/Equal and reactive to light
B/R   13
Skin  Pink/moist

The boys father is standing close to you guys, video taping the whole thing h34r:


Now continue your assessment and treatment..............


----------



## seanm028 (Feb 19, 2008)

Vitals seem pretty normal for a 16 y/o male who's been playing football.

I would have my partner EMT hold C-spine while I checked with the trainer - most team trainers have those "Trainer's Angel" things which cut away the face guard, allowing access to the airway without removing the helmet and compromising C-spine.  With the face guard gone, I would start the Pt on O2 via NRB and do a motor/sensory evaluation on the extremities (Can you feel me squeezing your toes?  Can you wiggle them?).  I'd perform a quick trauma assessment, checking for any DCAP-BTLS while being careful not to move the Pt.

Then I'd do a full spinal immobilization using a long board.  The helmet could be tricky, and I'm assuming a collar wouldn't fit around it.  I would use a head block and just tape the helmet to it; as long as the player is wearing shoulder pads, the helmet will keep his head and neck stable.  Repeat motor/sensory eval.

Load him up and transport.  Obtain more vitals and possibly more motor/sensory en route.


----------



## firetender (Feb 20, 2008)

Seeing as you're now doing more than assessing, you're being filmed, you may as well play to the camera. What else could one assume but that the Father finds it more important to document the care his Son is receiving then really being there with him?

In that case, it's a matter of CYA by speaking loudly enough to make sure it's recorded that you're doing everything you're supposed to do in a sequential manner.

The Father's attention is the disturbing part of the whole thing. How better to assure your kid does NOT get the care he deserves than by putting the emergency caregiver under inordinate pressure?


----------



## Capt.Hook (Feb 20, 2008)

Sean, 

Pretty much my plan of action.  Actually fairly important to at least get the pt loaded and away from the camera.  As firetender spoke, also important to play to the camera, especially since "serious life threats" were minimal, as of now.

I'd also ask about previous concussion experience and or troubles while active, sports related or not.  The trainer may be of help, although my HS was really small, the "trainer" was either the coach or a teammates nurse mom.  Small town America!

Prone causes added time and work to board and load.  Assessments show no issues with outstretched extremities, fold them in, board, and load.


----------



## Jolt (Feb 20, 2008)

One part of the vital signs I would have liked to see is whether the respirations were irregular.  That way you could monitor the player for signs of increased intracranial pressure (always a possibility with a hard hit to the head).  A major part of SAMPLE in this case would be events leading to emergency.  He probably lost conciousness and it's possible that he doesn't remember being hit at all, that would be an important piece of assessment.

I don't feel like going through the whole thing, I just wanted to make a few points.


----------



## EMTryan (Feb 20, 2008)

The kid is probably fine but because of the mechanism it is good to suspect the worse (especially with a video camera rolling). I think one of the first things I would do is ask him if his head hurts and have him rate the pain (0-10). Since the mechanism suggests the possibilty of head injury I would inititate C-Spine stabilization and backboard him especially if he is complaining of any head/neck/back pain. I would follow Sean's plan but O2 via NRM may be a bit overkill so I might use the nasal cannula if I could get it on him.


----------

