Stephanie Norman

V00482420

EPHE 344
March 28, 2014

Care and Prevention of Athletic Injuries

Team Therapist Log Book

1. Table of Contents.................................................................................................1
2. Daily Log Practices..... 2
3. Personal Reflection of Training Experience...............27
4. Coachs Evaluation....................32
5. Further Analysis of One Injury................33
6. References...........................................................................................................38
7. Appendix A SCAT3...................39

Stephanie Norman
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EPHE 344
March 28, 2014

2. Daily Log Practices

January 30, 2014 Ebb Tide: 2 hours

Arrive to field at 5:00 pm, filled team water bottles, set up medical kit and informed rec
centre staff to turn on field lights.
Weather/Field conditions: Cold with light rain. Field was wet and had some pools of
water.
Informed team to complete medical form if anyone had not filled one out in September,
of if any major injuries/concussions/medical concerns had occurred since last September,
or if any medications had changed.
Practice ceased at 6:35 pm; left at 7 pm.

Taping:

MaH: Chief complaint Weak right thumb. Wishes to have thumb taped to provide extra
support and help prevent re-injury.
Subjective:
History of present injury: MaH says his right thumb gets jammed during practice
frequently, and likes to have it taped for practices and games. This jamming has been
going on for years and re-injures the thumb about once every 1-2 months, when he falls
on it awkwardly. No surgeries to the thumb. Currently in no (0/10) pain).
Previously taped? Yes
Allergies to tape? None reported
Objective:
MaH appears energetic and in no pain or distress.
Thumb does not appear to be bruised or swollen. No deformities or guarding.
Full active and passive ROM of thumb and equal capillary refill on both thumbs. Mild
(1/10) pain in passive ROM when in full extension of thumb.
Analysis:
Grade 1 strain, with weak tissues due to scar tissue and re-injuring area.
Plan:
Katie and I consulted the taping manual and decided the best way to tape it. Katie taped
thumb to provide support and help prevent re-injury & re-assessed ROM
Informed to come back if tape begins to fall off, or if tape causes irritation, or if thumb reinjured.

AaC: Chief complaint Weak left ankle. Wishes to have ankle taped for added support
and mental comfort while playing.
Subjective:

Stephanie Norman
V00482420

EPHE 344
March 28, 2014

History of present injury: Old inversion injury of left ankle that occurred about a year
ago. Currently in no (0/10) pain.
Previously taped? Yes
Allergies to tape? None reported
Objective:
AaC appears energetic and in no pain or distress.
Ankle does not appear to be bruised or swollen; no guarding or limping.
Full active, passive, and resisted ROM of ankle when compared to uninjured side. No
pain while performing ROMs.
Analysis:
Old injury to anterior talofibular ligament and perhaps other ankle ligaments that are
weak due to scar tissue and not strengthening the area with specific exercises.
Plan:
Ankle taped to provide support and help prevent re-injury & re-assessed ROM and
checked cap refill in toes.
Informed to come back if tape begins to fall off, or if tape causes irritation, or if ankle reinjured.

MuT: Chief complaint Wrists are weak and hurt when he falls on them. Likes the
comfort of the tape for a little extra support when he falls to prevent re-activation of old
injuries.
Subjective:
History of present injury: Sprained both wrists in the past (>1 year ago) and feels that
wrists are constantly weak and prone to re-injury. Always tapes wrists before practice and
games. Currently in no pain (0/10).
Previously taped? Yes
Allergies to tape? None reported
Objective:
MuT appears energetic and in no pain or distress.
Wrists are not bruised or swollen; no deformities and no guarding.
Full active and passive ROM of wrists and equal capillary refill on both index fingers.
Analysis:
Old hyperextension injuries damaging contractile tissues of wrist flexors resulting in scar
tissue build-up and decreased integrity of the contractile tissues.
Plan:
Wrists taped to provide support and help prevent re-injury & re-assessed ROM and cap
refill.
Informed to come back if tape begins to fall off, if tape causes irritation, or if wrists reinjured.

Stephanie Norman
V00482420

EPHE 344
March 28, 2014

February 13, 2014 Ebb Tide: 2 hours

Arrive to field at 5:00 pm, filled team water bottles, set up medical kit and informed
recreation centre staff to turn on field lights.
Weather/Field conditions: Cold but clear. The upper field was wet but the lower field was
slightly more dry. This is where ~half of practice occurred.
Received more medical forms from players who had not completed their last semester.
Got the President of Ebb Tide to sign athletic trainer contract.
Practice ceased at 6:45 pm; left at 7 pm.

Taping:

Katie taped wrists of MuT (frequently receives wrist tape; see above).

BaW: Chief complaint Hyperextended R thumb a few days ago. Wishes to have thumb
taped to provide extra support and help prevent re-injury.
Subjective:
History of present injury: reports hyperextension of R thumb last Sunday while playing
rugby. Says that it was swollen and sore the day it occurred, but the swelling went down
by the next day and currently feels only mild (1/10) pain.
Previously taped? Yes
Allergies to tape? None reported
Objective:
BaW appears energetic and in no pain or distress.
Thumb does not appear to be bruised or swollen.
Full active and passive ROM of thumb and equal capillary refill on both thumbs. Pt
appears to move thumb cautiously and slowly when performing active ROM.
Analysis:
Grade 1 strain damage to thumb flexors.
Plan:
Thumb taped to provide support and help prevent re-injury & re-assessed ROM
Informed to come back if tape begins to fall off, or if tape causes irritation, or if thumb reinjured. Will follow up with BaW next time I see him.

Other care:
MuT: Chief complaint Wishes to have Atomic Balm applied to both knees.
Subjective:
History of present injury: Knees are stiff due to age (>60) and old injuries that happened
in his youth. Had knee surgery on his left knee over 10 years ago. Currently in no (0/10)
pain. Always applies his own atomic balm to knees to warm them up before practices and
games, but forgot his today.
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March 28, 2014

Previously had atomic balm? yes

Allergies to balm? None reported
Objective:
MuT appears energetic and in no pain or distress.
Knees are not swollen, bruised or deformed.
Full active and passive ROM of knees. No limping or favouring one side over the other.
Analysis:
Stiff muscles and joints, plus force of habit.
Plan:
Advised to perform a thorough warm-up before joining practice to warm up the knees.
MuT refused and just requested the atomic balm. Therefore, we applied the atomic balm.
Informed to come back if knees stiffen further or become painful, or if re-injury occurs.
Notes and Personal Reflection: I felt more confident in taping thumbs now that we covered it in
the lab. BaW seemed more satisfied in the tape job that I did, which was a nice ego-boost.
However, it is frustrating that many of the players continue to tape themselves before practice
and that they ignore our advice to do a physical warm-up before playing.
February 16, 2014 Ebb Tide: 3 hours

Arrive to field at 12:30 pm, filled team water bottles and set up medical kit.
Weather/Field conditions: Cold, windy and cloudy. Chance of rain. Field was muddy but
there were no large pools of water.
Katie and I reviewed and discussed the EAP, and Katie met with the referee to discuss
hand signals and the EAP with him while I was taping the players, then we talked with
each other to clarify the EAP.
Game ceased at 2:45 pm; left at 3:30 pm.

Follow-ups:

BaW no pain in thumb, but feels like it hasnt fully re-gained strength and is not fully
confident in it. Full passive and active ROM, but re-taped thumb (see below).

Taping:

I taped wrists of MuT (frequently receives wrist tape; see above).

I taped thumb of BaW (see February 13 for SOAP)

AaC: Chief complaint Right shoulder sore and weak.

Subjective:

Stephanie Norman
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EPHE 344
March 28, 2014

History of Present injury: subluxed right shoulder 7 days ago while playing rugby. Fell
down on right arm, after being tackled. Felt shoulder push forward as he fell on it.
Currently only mild pain (2/10) but worried about re-injury and would like extra support.
Previously taped? Yes
Allergies to tape? None reported
Objective:
AaC appears energetic and in no pain or distress
No swelling/bruising apparent.
No guarding or favouring of right shoulder or arm.
Full active and passive ROM of shoulder, however, ROMs performed cautiously on
injured side. AaC reports it feels weak on the anterior side of the shoulder when he
moves it, but this does not affect ROM. Resisted ROM Right shoulder mildly weaker
when abducting and when pushing forward when partially abducted. Pain with palpation.
Analysis:
Right shoulder grade 1 joint sprain to glenohumeral joint.
Plan:
Shoulder taped to provide support and help prevent re-injury & re-assessed ROM.
Informed to come back if tape begins to fall off, or if tape causes irritation, or if shoulder
re-injured.
Follow-up:
Discussed with AaC after the game tape worked well and maintained integrity well.
Will follow-up with AaC next practice.
DaK: Chief complaint weak wrists; wants tape for stabilization
Subjective:
History of Present Injury: No recent wrist injuries, just prefers to have wrists taped prior
to games. No pain. Believes it helps support when he falls.
Previously taped? Yes
Allergies to tape? None reported
Objective:
DaK in no pain or distress.
No swelling/ bruising
No guarding or favouring of wrists
Full active and passive ROM of both wrists. No signs of pain during ROM assessment.
Analysis:
Old hyperextension injuries damaging contractile tissues of wrist flexors resulting in scar
tissue build-up and decreased integrity of the contractile tissues.
Plan:
Taped both wrists. ROM re-assessed.

Stephanie Norman
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EPHE 344
March 28, 2014

Informed to come back if tape begins to fall off, or if tape causes irritation, or if area reinjured.
Follow-up:
Discussed with DaK after the game tape worked well and maintained integrity well.

DaK: Chief Complaint Right ankle felt a bit sore during last practice
Subjective:
History of Present Injury: no memory of a specific event that caused ankle to start
hurting; just stated that it started to feel a bit sore last practice pain did not persist the
day after practice. Currently in no pain. Believes it is from slight inversion of the ankle.
Previously taped? Yes
Allergies to tape: None reported
Objective:
DaK appeared in no pain or distress.
No swelling/ bruising
No guarding or favouring of right ankle
Full active and passive ROM of right ankle WRT left ankle. No signs of pain during
ROM assessment.
Analysis:
Old right ankle inversion injury to anterior talofibular ligament and perhaps other ankle
ligaments that have now lead to ankle instability.
Plan:
Taped left ankle. Used heel/lace pads and pre-tape spray. ROM re-assessed.
Informed to come back if tape begins to fall off, if tape causes irritation, or if area reinjured.
Follow-up:
Discussed with DaK after the game tape worked well and maintained integrity well.
Will follow up with DaK next practice.

HaB: Chief Compliant Both ankles are weak and frequently invert during games
causing pain.
Subjective:
History of Present Injury: Both ankles frequently over-invert during play; the right ankle
was injured last practice due to hyperinversion. Left ankle currently in no pain; Right
ankle currently 1/10 on pain scale.
Previously taped? Yes
Allergies to tape: None reported
Objective:
HaB appeared in no pain or distress.
No swelling/ bruising
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Stephanie Norman
V00482420

EPHE 344
March 28, 2014

No guarding or favouring of ankles

Full active and passive ROM of both ankles. No signs of pain during ROM assessment
for left ankle, pain increased to 2/10 during passive ROM of right ankle; passive ROM of
right ankle was performed smoothly but a little more cautiously than left ankle.
Analysis:
Old inversion injury to anterior talofibular ligament and perhaps other ankle ligaments
that are weak due to scar tissue and not strengthening the area with specific exercises;
force of habit.
Plan:
I taped right ankle; Katie taped left ankle. Used heel/lace pads and pre-tape spray. ROM
re-assessed in both ankles.
Informed to come back if tape begins to fall off, if tape causes irritation, or if area reinjured.
Follow-up:
Discussed with HaB after the game tape worked well and maintained integrity well.
Ice:

MiX: Chief complaint pulled right calf 30 minutes into the game.
Subjective:
History of Present Injury: Has not recently (past year) injured his right calf. Pulled calf
while running.
Objective:
MiX did not appear distressed, but looked in mild pain
MiX limped slightly and favoured his right leg
No bruising or swelling apparent
Full active ROM. Pain 3/10 when performing active ROM and was performed slowly and
cautiously. Slight radiation of pain down calf (approx. fist-sized).
Analysis:
Grade 1 muscle strain to muscles of right calf.
Plan:
Calf was iced for 10 minutes on/10 minutes off. Advised to continue icing 10 min on/ 10
min off at home that night.
MiX was advised to discontinue play, which he did. He rested the rest of the game.
Follow up:
Checked area after icing to ensure not over-iced. I will re-assess injury and ROM next
practice.
BoL: Chief complaint medial side of left knee sore
Subjective:

Stephanie Norman
V00482420

EPHE 344
March 28, 2014

History of present injury: Left knee injured by knee-on-knee contact from another player
during a tackle 40 minutes into game. Medial side of knee injured. No recent history of
left knee injury.
Objective:
BoL did not appear distressed, but looked in mild pain
BoL limped slightly and favoured his left leg
No bruising, bleeding, or swelling apparent
Full active ROM. Pain 4/10 when performing active ROM when knee is flexed or
internally rotated, and was performed slowly and cautiously. Pain radiated very slightly
about fist-size of radiation. Pain in passive ROM when leg is flexed or doing valgus
stress test.
Analysis:
Non-contractile (likely ligament) tissue damage to medial side of knee; perhaps medial
collateral ligament.
Plan:
Medial side of knee was iced for 10 minutes on/10 minutes off.
BoL was advised to discontinue play, which he did. He rested the rest of the game.
Advised to continue icing 10 on/10 off at home.
Follow-up:
Checked skin after icing to ensure not too iced or showing signs of frost bite. I will reassess injury and ROM next practice.
Bleeds:
Man on opposing team: Chief complaint right ear bleeding.
Subjective:
History of present injury: Right ear was cut open during a scrum. No recent history of
right ear injury.
Objective:
5 mm abrasion at the very top of the right ear.
Mild capillary bleed (~1.5 tsp blood oozing over ear)
No bruising/Swelling apparent
Pain 0/10. No headache; no other injuries reported.
Analysis:
Small abrasion to right ear.
Plan:
I put gloves on and applied some gauze. Taped gauze on with electrical tape wrapped
around players head at players request. Player assisted in wrapping tape around head to
ensure it was not too tight.
Concussion:
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EPHE 344
March 28, 2014

HaB: Chief complaint possible concussion

Subjective:
History of present injury: Hard tackle that hit head in last 10 minutes of game. Reports
blurry vision immediately after tackle. Currently vision is no longer blurry. 3 previous
concussions, all over 1 year ago.
Objective:
No loss of consciousness
No bruising/swelling/bleeding anywhere on head.
No difficulty walking/ balancing.
20 minutes after occurrence, walked HaB to quiet room to perform SCAT 3.
SCAT3: - see Appendix A for SCAT.
Sideline Assessment: all no
1) GCS = 15/15
2) Maddocks score = 5/5
3) Symptom Evaluation all 0s except for pressure in head = 1; and trouble falling
asleep which cannot yet be determined.
4) Cognitive assessment = 5/5
5) Neck Examination = full ROM; no tenderness; full strength and sensation in limbs
6) Balance Examination = no errors
7) Coordination examination = 1/1
8) SAC delayed recall = did not assess, but remembered the game before getting hit,
remembered the hit, and remembered after the hit
Analysis:
Either no concussion or very mild.
Plan:
Will talk with HaB next practice to see if he had headaches later in the day, if he had
trouble sleeping, or if any other symptoms arose.

Notes and Personal Reflections: The game was terrifying! Definitely more intense than
practices. It was exciting that we had so much to do, with so many tape jobs and even a
concussion. However, I feel like some of the players refused to report their injuries so they could
keep playing in the games. Should have used Tuffskin before taping the shoulder, but it managed
to hold together anyways.
February 18th, 2014 practice cancelled
February 20th, 2014 practice cancelled
February 23rd, 2014 game cancelled
February 25th, 2014 practice cancelled
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EPHE 344
March 28, 2014

February 27th, 2014 2 hours

Arrive to field at 5:00 pm, filled team water bottles, set up medical kit and informed
recreation centre staff to turn on field lights.
Weather/Field conditions: Cold and cloudy with a chance of rain. The upper field was
wet but the lower field was slightly more dry. This is where the majority of practice
occurred.
Practice ceased at 6:35 pm; left at 7 pm.

Follow-ups:

HaB: Concussion
o Talked to HaB about any concussion symptoms he may have felt after the last
game. He said that he had a slight headache and blurred vision very briefly while
out drinking after the game (had 2 beers after the game). However, this headache
and blurred vision were very transient and went away within 5 minutes.
o He had no difficulty sleeping the following night and woke up asymptomatic.
However, the next day he sneezed and got a sharp headache after sneezing. The
headache was a 5/10 on the pain scale, but lasted only 10 minutes, after which he
experienced no symptoms.
o Completed the SCAT3 (the parts about sleep and longer-term effects).

BoL: Said a small bruise appeared that evening, and there was mild swelling, but he had
no pain or swelling the next day. Full passive, active and resisted ROM.

MiX: No bruising or swelling appeared, but was very stiff the next day. Currently in no
pain, and full passive ROM. Would not allow further assessment.

AaC: Shoulder feeling okay, no increase in pain since the game and doesnt feel like he
requires it for todays practice. Full active and passive ROM.

DaK: Right ankle feels completely healed, pain 0/10 and confident that strength has been
regained. Could jump from side-to-side with no pain or complications.

Taping:

Taped Right thumb of BaW gets thumb taped for every practice and game since prior
hyperextension (see above). He said he was happy with the tape job I did last time and
that it held together well. Is gaining more confidence in thumb and thumb strength, but
likes the re-enforcement.

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EPHE 344
March 28, 2014

Notes and Personal Reflection: I was surprised and happy that HaB came to me to discuss
his concussion follow-up before I even went to approach him! I was glad to see that he is
taking his concussion seriously. Other than that, it was not an eventful night.
March 2nd, 2014 game cancelled
March 4th, 2014 practice cancelled
March 6th, 2014 practice cancelled
March 9th, 2014 game cancelled
March 10, 2014 St John Ambulance: 2 hours
Respiratory Emergencies
o
o
o
o
o
o
o

Reviewed signs, symptoms, and the physiology of, as well as how to treat patients with:
Asthma
Chronic Obstructive Pulmonary Disease
Anaphylaxis
Pneumonia
Pneumothorax
Hemothorax
Tension pneumothorax

Practiced simulations with varying respiratory emergencies, performing primary and secondary
survey, giving oxygen and assisted respirations, and patient positioning
Notes + Personal review: I found there were a lot of details to memorize, so I need to go home
and review what I have learned. I do definitely think my primary and secondary survey abilities
have improved from going through the BST last weekend, which was nice to see. I did okay at
trying to determine what was wrong with the patient, but knowing which diseases present with
high blood pressure vs. low BP and high heart rate vs. low HR was difficult.
March 11, 2014 2 hours

Arrive to field at 5:00 pm, filled team water bottles, and set up medical kit. No need for
the field lights because of daylight savings.
Weather/Field conditions: Slightly milder than usual, clear and sunny. The field was still
damp and soft, but no pools of water. Grass is beginning to grow a bit better.
A new player (JcH) joined the team; we introduced ourselves to him and gave him a
medical form to fill out.
Practice ceased at 6:30 pm; left at 7 pm.

Taping:
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EPHE 344
March 28, 2014

DaK: Chief complaint sore middle finger of left hand. Wishes to have it taped for extra
support.
Subjective:
History of present injury: Jammed finger during the last game (3 weeks ago) while
catching the ball, and is worried that it will be re-injured in practice. Doesnt feel
confident in falling on that finger without extra support. Pain 1/10 and finger is a little
stiff.
Allergies to tape? None reported.
Taped area before? Not for years (hasnt played since injury due to practices and games
being cancelled, and missing last practice).
Objective:
DaK did not appear distressed; no bruising, bleeding, or swelling apparent.
Full passive and active ROM. Pain 2/10 when performing active ROM in extension of
finger. Passive ROM pain in extension. No radiation of pain.
Analysis:
Non-contractile tissue damage to ligaments in left middle finger.
Plan:
Buddied middle finger to ring finger of DaK, placing a strip of heel/lace pad between
fingers to prevent chaffing. Did not tape over the joints in the fingers to allow finger
flexion.
Follow-up (after the game):
After the game, he said the tape worked well, but now his pinky finger hurts a bit due to
falling (unrelated to tape job). Will follow up on finger injuries next practice.

BaW: taped thumb, as usual. Now there is no pain and no limitations to ROM, but simply
feels more confident when tape is on.

Notes + Personal Reflection: Only 6 people showed up to todays practice because it is more of
a skills, drills, and fitness practice than Thursdays more game-like practices. I believe I taped
DaKs finger well and other than that, the practice was largely uneventful.

March 13th, 2014 2 hours

Arrive to field at 5:00 pm, filled team water bottles, and set up medical kit. No need for
the field lights because of daylight savings.
Weather/Field conditions: Back to being cold and cloudy with threat of rain. The field
was still damp and soft, but no pools of water.
JcH his medical form, but it was filled out very very vaguely (ie: list any broken bones or
surgeries and when they occured = broke stuff)
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Practice ceased at 6:40 pm; left at 7:05 pm.

Follow-ups:

Talked with DaK about his fingers, he said his pinky finger was fine now, but still not
confident in his middle finger. Wishes to have it taped again. No (0/10) pain and full
AROM and PROM.
Taping:
Taped thumb of BaW.
Taped finger of DaK.
Icing and Assessment:
SeB: Chief complaint Injured bottom floating rib on right side after being tackled.
Subjective:
History of present injury: Got tackled during practice and reported sudden pain in rib.
Pain 5/10. No previous rib injuries.
No allergies reported.
Objective:
SeB appeared to be in pain and slightly guarded rib. No bruising, bleeding or swelling
apparent.
In active ROM, most painful went bending backwards. Pain end feels for active ROM;
would not bend fully in any direction. Pain did not change with inhalation or exhalation.
Palpation of area revealed the muscles surrounding the painful area were much tighter
than the opposite side. Pain increased with palpation. No radiation of pain. Passive ROM
pain when bending backwards.
Analysis:
Potentially bruised the lower right rib.
Plan:
Katie massaged area and applied atomic balm. Advised player to not return to practice
and go home and rest and ice the area.
Follow-up:
Left practice for home. Will follow-up with SeB next practice.
MiP: Chief complaint Base of 5th metatarsal on right foot hurts.
Subjective:
History of present injury: Pain in the lateral side of food started during the last game, but
he failed to report it. Pain not severe unless is wearing rugby shoes and running around.
At rest, pain 2/10, while running, pain 5/10. No previous injury to area reported.
No allergies reported.
Objective:
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MiP appeared at ease and not too concerned about it. Reported it to us after the practice
because did not want to be told to sit out. No bruising, bleeding or swelling apparent.
In active ROM, pain on eversion of foot, but full ROM. For passive ROM, pain on full,
end-range eversion but had hard end-feel. No radiation of pain pointed exactly to the
base of the 5th metatarsal. No pain in resisted ROM. Pain increased with palpation. Not
painful in morning.
Analysis:
Because its not painful in the morning, its probably not plantar fasciitis. Noncontractile tissue damage, perhaps minor damage to 5th metatarsal bone or ligaments in
the joint. May be due to tight-fitting shoes.
Plan:
Told to go home and rest, ice, and elevate foot.
Follow-up:
Will follow-up with MiP next practice. Worried about this pain because of the Ottawa
rules, but pain is not severe and MiP not concerned, so will wait and see if it soon
resolves itself.
Notes and Personal Reflection: I think I did a good assessment of MiP, and I thought it was a
really interesting case. Again, I am a little worried about the Ottawa ankle rules and the pain in
the 5th metatarsal, so I will have to research this further and keep an eye on it. I am doing a first
aid course over the weekend, but Katie will follow up with him before the game.
Glad to see that they are beginning to do a bit of a warm-up before practice now! All of our
heckling is beginning to pay off!

March 14th, 2014 St. John Ambulance: Medical First Responder (MFR) course; 4 hours

Anatomy and Physiology basics of the human body

o Infant < 1 year, child < puberty, adult > puberty
Responsibilities of the volunteer
o Legal and ethical issues
o Communication
o Documentation and paper work
o Critical Incident Stress
Infection control + PPE
Primary Survey:
o Hazards: Hazards Environment Mechanism Patients
o Personal Protective Equipment
o Airway see if clear
o Breathing check for 5-10s
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o Breathing count rate for 15 s

o Circulation check carotid and radial pulse, and skin
Check cap refill in palms of children < 6
o Rapid body survey
o Blanket
Medical emergencies
o Diabetes
o Seizures

Notes + personal review: I feel like Ive gained confidence in my primary survey abilities and
was refreshed as to what ages are considered child, infant, and adult. Also learned about
negligence and liability, and the good Samaritan act. I believe that I need to communicate what I
am going to do with the patient and why I am doing it. The MFR course goes much more indepth into the mechanism, causes and physiology of each injury and disease, which was nice.
March 15th, 2014 St. John Ambulance: MFR course: 9 hours

Secondary Survey
o History: SAMPLE = signs and symptoms, allergies, medication, past medical
history, last meal, events leading up to injury; OPQRST = onset, pain, quality,
radiation, severity, timing
o Vitals: blood pressure, heart rate (30s), breathing rate (30s), skin, pupils
o Head to Toe
o Treatment
Airway management
o Head tilt, chin lift; jaw thrust; O2, bag-valve mask, oralpharangyal airways,
nasopharangeal airways, simple mask, nasal cannula, non-rebreather mask,
suction
Choking
Major Bleeds
o Apply direct pressure, dressings and bandages do not get removed
o Different bandaging techniques: loop bandage
Poisons: inhaled, injected, absorbed, ingested
o Warning signs of each method and how to help
o Call 911, poison control, apply oxygen
Insect bites and management
Notes and personal review: I appreciated the review of the secondary survey, and how to
deal with major bleeds, both of which I could come into contact with during a sports
game. I feel like I did well at performing the flow of the secondary survey, but need to
work on calling the ambulance as soon as I realize I need more help. Also need to work
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on speeding up the flow of the secondary survey.MFR goes much more into the treatment
options for each injury and disease, which was definitely a necessary review. For
example, learning the different dressings for the major bleeds was handy.
March 16th, 2014 St. John Ambulance: MFR course - 9 hours

Head injuries and concussions: learning to identify when to suspect head injuries
o Signs and symptoms:
Unstable vital signs really high blood pressure
Mechanism of injury
Loss of sensation, projectile vomiting, paralysis, decreased level of
consciousness, impaired speech, sensation
Spinal cord injuries:
o Signs and symptoms:
Mechanism of injury
Deformity, pain along the spine, deformity, numbness/tingling in
extremities, loss of bladder/bowel function, priapism
Pelvic injuries: To be cared for as a spinal injury because takes a lot of force to break

Management of head/spinal/pelvic injuries:

Maintain airway, check breathing and circulation

Dont move!
Do not apply traction, control bleeding, but dont stop flow of fluid from ears or nose
Immobilize head and neck, even when hard collar applied
Monitor vitals, give nothing by mouth

C-spine control:

Ensure head is in neutral position, move in one plane at a time and stop if pain,
resistance, or crepitus
Jaw thrust, not head tilt chin lift
Spinal rolls

Helmet removal with spinal precautions; standing take-downs

Cardiovascular diseases prevention + risk factors, recognition and management
o
o
o
o

Angina
Congestive heart failure
Myocardial infarction blockage of coronary arteries
Cardiac arrest heart not beating effectively or at all

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Treatment: oxygen, give their nitro if BP systolic >100 mmHg (max 3 doses of nitro), chew 2
baby aspirin, contraindications: viagara, cialis and lavitra, sit upright or semi-sitting
Stoke cerebrovascular accident (CVA) and Tansient ischemic attack lack of blood or oxygen
to brain
o Signs and symptoms: FAST = facial droop, arm drift, speech, time
CPR: 1 person and 2 person; adult; child; infant
o Adult witnessed or unwitnessed = call ambulance immediately; asphyxia arrest = give 2
minutes CPR then call ambulance
o Child or infant witnessed = call ambulance immediately; unwitnessed or asphyxia arrest
= give 2 minutes CPR then call ambulance
o Child or infant with HR < 60 and showing signs of poor perfusion start CPR
o 2 person CPR in child/infant: 15:2 compressions to breaths but 1 person = 30:2
Chest injuries: penetrating chest wound, rib fracture, flail chest wound: 2 or more ribs are broken
in 2 or more places, open chest wound
o Signs and symptoms: pain while breathing, unequal chest movement, guarding
o Treatment: flail chest stabilize flail section with bulky dressing and tape
o Penetrating chest wound do not pull object out; stabilize the object
o Closed pneumothorax pressure builds in chest wall; Tension pneumothorax when
pressure builds so much as to collapse of the other lung and can compress the heart.
Jugular vein distension.
o Hemothorax blood is filling up chest space may cough up frothy blood
o Pericardial tamponade blood enters the pericardial sac, compresses the heart
o Thoracic aorta tear tearing of aorta caused by sudden deceleration
o Pulmonary and cardiac contusions most common lethal chest injuries
o Blast injuries injuries by pressure wave, flying debris, or pt thrown by blast
Pediatrics trauma is #1 cause of injury
o
o
o
o

Begin assessment as you approach from other side of room

Anatomical differences from adult tongue larger, head is larger, trachea is smaller
50% of deaths occur in the first hour
Sudden infant death syndrome leading cause of death for infants between 1 month 1
year

Notes and Personal reflection: Remembering what to do for each type of chest wound was a little
difficult. I feel sufficient at CPR but find it difficult to do jaw thrust while bag-valve-masking.
Sometimes I get too excited and focused on the chief complaint that I forget to go through the full
primary survey.
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March 18th, 2014 2 hours

Arrive to field at 5:00 pm, filled team water bottles, set up medical kit. Field remains
light enough so that lights dont have to be turned on.
Weather/Field conditions: Cloudy, slightly rainy, and cold. Field was wet from the rain,
but no pools of water. Definite slipping hazard, especially because some pieces of the
field were torn up and muddy.
Practice ceased at 6:30 pm; left at 7 pm.

Follow-ups:

Referred follow up of MiP to Katie because I was unable to attend the game due to my
first aid course. She said it was a dropped cuboid and was taught how to tape it by the
chiropractor on the team.
Taping:
Taped thumb of BaW (as above).
Taped fingers of DaK (as above).
Taped Shoulder of AaC (as above) generally he just likes it done for games, but feels
that todays practice may aggravate it because of the skills and drills they were doing
tonight. Feels more confident in his shoulder and it causes him no pain, even when
performing active and passive ROM, but likes the added support sometimes.

Notes and Personal Reflection: Hardly anyone ended up showing up tonight, and no new injuries
were reported. Good practice with taping the shoulder of AaC though. Also glad to see them
practicing their skills and doing a bit of a warm up.

March 20th, 2014 2 hours

Arrive to field at 5:00 pm, filled team water bottles, set up medical kit.
Weather/Field conditions: Variable rain, and cold. Field was wet from the rain, but no
pools of water.
Practice ceased at 6:40 pm; left at 7 pm.

Taping:
Taped wrists of MuT (as above).
Taped fingers of DaK (as above).
MuT: Chief complaint right thumb feels a little aggravated. Wishes to have it taped.
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Subjective:
History of present injury: Caught the ball awkwardly during the last game, and
hyperextended thumb a bit. Pain 1/10 and thumb is a little stiff. No previous surgery to
area or recent injury.
Allergies to tape? None reported.
Taped area of interest before? Not for years.
Objective:
MuT did not appear distressed; no bruising, bleeding, or swelling apparent.
Full passive and active ROM. Pain 1.5/10 when performing active ROM and flexing
thumb. Pain 2/10 when passively extending thumb. Resisted ROM strong and no pain.
No radiation of pain.
Analysis:
Grade 1 strain of right thumb flexors.
Plan:
Taped thumb, checked capillary refill after and ensured it was snug but not too tight.
Advised to come back to me if tape begins to cut the skin or rub excessively, or if thumb
re-injured.
Follow-up (after the game):
After the game, he said the tape worked well. Afterwards mentioned he wished I put prewrap on before taping though.

Notes and Personal Reflection: I felt that I taped the thumb well, but did not put the wrist tape
high enough on the wrists. Still struggle to rip tape when my hands are cold. I need to remember
which players prefer pre-wrap under their tape, because MuT wasnt very impressed that I
applied tape straight to his skin!
March 21st, 2014 - St. John Ambulance: MFR course 4 hours

Automated External Defibrillator (AED) use on adults, children (1-8), and infants
o Shockable rhythms ventricular fibrillation; ventricular tachycardia
o Pulseless electrical activity (will not shock)
Burns classification (1st, 2nd, 3rd degree burns) & management
o Rule of nines (percent of body area burned, estimated by palm = 1%)
Hot/Cold related injuries
o Hyper/Hypothermia
o Frostbite
o Heat cramps, heat exhaustion, heat stroke

Notes and Personal Reflection: I am surprised by how quickly I forget all the CPR rules (child
and infant 15:2 for 2 person, 30:2 for 1 person; unwitnessed for child/infant: do 2 min CPR

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before using AED), so it was good to review. Burns was interesting, but it is difficult to
remember the rule of 9s for burns.
March 22nd, 2014 St John Ambulance: MFR course 9 hours

Wound management
o Dressings vs. bandages
o Bandaging techniques
o Signs of infection: swelling heat ache red pus
Slings
o Tubular and regular arm sling
Wrapping elbows and feet
Embedded objects
Tetanus
Eye injuries
Musculoskeletal injuries
o Sprains, strains and fractures
o Dislocations
o Splinting arms, elbows, legs, shoulders
o RICE

Notes and Personal Reflection: I believe the wound management section, the tetanus section and
the sling section was good knowledge and practice that can be directly applied to my athletic
training for the team care. There is potential that I could encounter nearly any of these subjects
during a game or rough practice. I found that trying to wrap the foot with a triangular bandage
was much less effective than taping bandages on directly, and I tended to want to tape the foot
and ankles as we learned in class. However, I understand that in crush-type injuries to the foot
where swelling is likely to occur and where ice will be applied, a triangular bandage is a good
alternative.
Reviewing musculoskeletal injuries was particularly useful for this class.
March 23rd, 2014 St John Ambulance: MFR course 9 hours

Saeger Splints for traction

Practice simulations
Written test
o CPR written test
o General written examination
Practical examination
o Major burn with spinal precautions
o Chest pain and cardiac arrest
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Notes and Personal Reflection: I received exceeds expectations on both of my practical

exams, which was nice. I need to work on speeding up my call to get through things more
efficiently, but that will come with time. The written test was much more difficult than expected,
but I passed both the CPR test and the General written test, so I am once again MFR qualified!
March 25th, 2014 2 hours

Arrive to field at 5:00 pm, filled team water bottles, set up medical kit.
Weather/Field conditions: Raining hard and cold. Field was wet from the rain and starting
to pool. The lawn was recently cut; may aggravate allergies.
Practice ceased at 6:35 pm; left at 7 pm.

Follow-ups:

Talked with AaC about his shoulder again, he said it still feels weak and a little painful. I
referred him to a physiotherapist.
Taping:
Taped fingers of DaK (as above) added some electrical tape on top of the athletic tape
in an attempt to keep it on in the rain and mud.
Taped Shoulder of AaC (as above).

Notes and Personal Reflection: Many of the players did some warm up with the ball... mostly
tossing it around a bit with each other, but still great to see! I think my tape job of DaK was too
tight though, especially with the electrical tape on top. I have to keep that in mind next time and
ensure to check capillary re-fill.
March 27th, 2014 2 hours

Arrive to field at 5:00 pm, filled team water bottles, set up medical kit.
Weather/Field conditions: Slightly cloudy, but not as cold. Field soft but no pools of
water.
Practice ceased at 6:35 pm; left at 7 pm.

Follow-ups:

Talked with AaC about his shoulder again, he said he started doing some of the exercises
I recommended.
Taping:
Taped fingers of DaK (as above) added some electrical tape on top of the athletic tape
in an attempt to keep it on in the rain and mud.
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Taped Shoulder of AaC (as above).

Notes and Personal Reflection: It was nice to have decent weather for once! I also made sure to
not make DaKs tape not too tight around his fingers this time; he said it was much better. Also,
another player came to me saying that he strained his Teres minor the other day (he went to a
Physiotherapist who told him it was his Teres minor), and asked if I could tape it for him this
weekend. Again, I am glad for the fore-warning, though I believe AaC has a rotator cuff strain,
so the same tape job for both players should work. I will check on Youtube though before the
next game.

3. Personal Reflection of Training Experience

a). What went well:
The things that went well during this placement was that the players did gain more
confidence in me and started coming to me more as I learned different tape jobs and modalities,
and became more proficient in what I was doing. The first practice, Katie and I didnt have a
single player come to us, but before the games, everyone wanted to taped or massaged, and they
were much more forward with reporting injuries during the game and agreed to ice and let us
analyze their injuries. That was both a positive learning experience and nice to see that they
trusted as more as the semester progressed.
I definitely became more proficient at taping at the beginning I really struggled to rip
tape, and my tape jobs were lumpy and messy. It took me a long time to tape anything, and I was
really not confident in what I was doing or even why I was doing it. Now I am capable of ripping
tape and even some of the players have commented that I am much faster and the tape jobs hold
together better!

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Another thing that went well was how Katie and I worked together. We were good at
letting each other alternate in treating the players and getting a variety of tape job experiences,
instead of each one of us taping the exact same players each week and therefore only learning
how to tape an ankle and a thumb. It was also useful to have another classmate there for
consultation of what we should do and to catch anything one of us missed!

b). What things I would change:

i. With my overall placement experience:
Although it was nice to have another classmate there, I really wish I had chosen a team
that had a professional athletic trainer or physiotherapist as a part of the team to consult with.
Particularly at the beginning of the term, Katie and I were unsure of how to tape or deal with
certain injuries that we had not come into contact with before. It would have been really helpful
to have the guidance of a professional athletic trainer or physiotherapist in those times to show us
how to tape different areas, and to let us know what we were doing wrong and what we should
improve. We had a fairly thorough taping guide that we consulted sometimes, and one of the
players warned us that he was going to need his shoulder taped before the game so we could go
home and Youtube it beforehand, but neither were as ideal as having a professional there to take
us step-by-step through it.
Furthermore, although being with an over-40 rugby team provided a lot of injuries; it
definitely had its drawbacks. First of all, they practiced on a field that got shut down at pretty

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much any sign of rain or snow, so the majority of the practices were cancelled. The games were
played on a different field that didnt get shut down in bad weather, but the players didnt like
playing in the cold or bad weather, so the majority of games were also cancelled. Furthermore,
both the games and practices were often cancelled at the last minute, preventing us from finding
alternate teams to practice with on those days. Therefore, many hours of taping and athletic
training experience were lost, which would have been beneficial for this course.
Another drawback of the placement with the mens over 40 rugby team was that all of
these players have been playing for so long that they are so set in their ways and refuse to get
help from or listen to my advice sometimes. Many of them were used to taking care of
themselves throughout the years, so they just taped themselves before practice, or grabbed bags
of ice and taped them on their bare skin without coming to us for assessment and assistance, or
got their wives to massage them when they got home. They were confident that their thin (and
old) rugby caps and mouth guards hugely reduced the risk of concussion, and refused to listen to
our suggestions to the contrary. So although the players were nice and respectful towards us, and
some of them were grateful for our help, there were others who refused to acknowledge our
abilities, which was a little disheartening.
ii. With my athletes to help minimize the injuries:
When I first joined the rugby team, none of the players ever did any sort of warm-up or
stretching before practice. After months of our gentle heckling to get them to start doing some
sort of warm-up though, a few of the players listened and tried to fit in a few static and dynamic
stretches, and one of the players even started jogging the length of the field before starting to
stretch, which was really nice to see. Nonetheless, the majority of the players did not do a warm-

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up, so I would have changed that if I were the coach of the team. I believe that doing a warm-up
and a few stretches before starting to play or do the practice would decrease the number of
injuries that occurred near the beginning of practice, when they start sprinting and changing
direction rapidly when their bodies are still cold.
Another thing that I would like to see change is the number of people who show up to
skills and drills practice. Each Tuesday is skills and drills practice, where the players really work
on their technique, and focus on different skills. Only about 5-7 players show up on Tuesdays.
Thursdays, however, is a more game-like practice, where the players run around and play rugby
the whole time, rather than working on any specific skills. Thursdays have a crowd of about 30 +
players. Therefore, hardly anyone shows up to develop their skills further, and arent there to
hear advice from the coaches and learn new techniques. I think if more of the players worked on
their skills of how to tackle, how to fall, how to catch the ball, etc., it would reduce the number
of injuries seen. Furthermore, practicing twice a week would improve their strength and
cardiovascular fitness, which I believe is important in such an old age group.
iii. Communication:
As mentioned above, some of the players refused to communicate with me and Katie, and
refused our help. It would have been nice to have better communication with these players, and
to be able to help assess them and tape them.
Also, there was poor communication amongst the team with when practices were
cancelled, with one situation where one of the coaches posted that practice was cancelled but
another coach posting elsewhere that practice was on. There were two practices were both Katie
and I were not informed of practice cancellation, so we showed up and waited for 45 minutes
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before finally heading home. On these occasions, 1-3 of the players would also show up,
demonstrating the lack of communication in the team.
c). What I learned:
I learned to be more confident in my tape jobs and to not be afraid to assess the players
ROMs (with permission, of course). I learned that I am good at asking mechanisms and taking
histories, but hesitant to actually get my hands on the players sometimes, especially when I am
unsure exactly what is wrong. I learned that I enjoy communicating with the players, and trying
to figure out what is wrong and what I can do to make it better. It was really rewarding hearing
positive feedback from the players after the practices and the games, and although Im not an
expert at ripping tape, I do enjoy taping others and seeing if they do feel whether it provides
extra support.
I have learned that I need to be more assertive towards some of the players, particularly
those who try to avoid treatment, especially after I witness them fall and hit their head and get up
looking a little disoriented. Overall though, I have enjoyed being a team therapist, and can see
myself enjoying a job in physiotherapy or athletic training, which is valuable knowledge to take
away from such a class.

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5. Further Analysis of One Injury

a). Description of the events prior and during the incident.
The player, AaC, was playing in a game 7 days ago (not an Ebb tide game so I was not
there) when he got tackled from his left side and fell hard onto his right side, with the opponent
player falling directly on top of him. AaC said he fell with his arm adducted by his side, but
extended a little backwards he did not put his arm out to catch his fall because he was unaware
that he was going to be tackled at that instant and it happened so quickly that he couldnt get his
arm out in time. When he fell down, he said that his shoulder took much of the hit to the ground,
and he felt his right shoulder pop out anteriorly and pop back in. He said there was immediate
pain.
b). SOAP notes of the incident:
Subjective:

Chief complaint: AaC presented with a chief complaint of his right shoulder hurting.
History of Present Injury:
S signs and symptoms no swelling or bruising currently apparent. No deformities
noticeable; no guarding of right shoulder.
A allergies none reported by AaC; not allergic to tape or tuf skin (has been previously
taped).
M medications none reported by AaC
P past medical history - AaC has never dislocated, sub-luxed, or severely injured his
right shoulder before, and has never had surgery on the area. Has been taped
before, but has not had this shoulder taped before.`
L last meal two hours prior to incident (11 am); had an Cliff protein bar and some
orange juice.
E events leading up to injury see above.
O onset Immediate pain upon falling 7 days ago.
P position of pain Right shoulder. Most painful on the anterior side of the
glenohumeral joint.
Q quality Dull and aching; feels weak when moving it.
R radiation the pain does not radiate; point tenderness.
S severity currently 2/10 pain when at rest; 3/10 pain when abducting shoulder
T timing feels weak and more painful particularly when abducting arm above
shoulder, and when performing resisted ROM when pushing forward in an
abducted position.

Mechanism of injury: See above.

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Objective:

AaC appears energetic and in no pain or distress

Skin inspection: no swelling/bruising apparent; skin not irritated.
No guarding or favouring of right shoulder or arm.
Full active and passive ROM of shoulder, however, ROMs performed cautiously on
injured side. AaC reports it feels weak on the anterior side of the shoulder when he
moves it, but this does not affect ROM. Resisted ROM Right shoulder mildly weaker
when abducting and when pushing forward when partially abducted. Pain with palpation.

Analysis:

Right shoulder grade 1 joint sprain to glenohumeral joint. Possible rotator cuff injury.

Plan:

Shoulder taped to provide support and help prevent re-injury & re-assessed ROM.
Informed to come back if tape begins to fall off, or if tape causes irritation, or if shoulder
re-injured.

c). Analysis and description of the injury:

The glenohumeral joint is the most commonly dislocated joint in the human body, with
over 95% of glenohumeral dislocations being anterior dislocations (Cutts, Prempeh, & Drew,
2009). This is because the glenohumeral joint is a highly mobile ball and socket joint, which
comes at a cost to stability. Stability of the joint is provided by: 1. The suction cup effect of the
labrum on the humeral head; 2. Limited joint volume and negative intra-articular pressure; 3.
Static stabilizers such as the fibrocartilage of the labrum and the glenohumeral ligaments; 4.
Dynamic stabilizers such as the rotator cuff muscles and their corresponding tendons
(Cunningham, 2005).
Violent external rotation in abduction and extension is often the cause of anterior
dislocations and subluxations, so these injuries are commonly seen in ruby and players reach out
to catch themselves when they fall after being tackled by another player, or after slipping and

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falling while sprinting on mud (Cunningham, 2005; Cutts et al., 2009). Furthermore, with
tackling, the players often fall with their opponent on top of them, adding more weight to the fall
and therefore increasing the forces exerted on the shoulder as the player on the bottom tries to
brace his fall with his outstretched arm. However, Cunningham (2005) notes that a fall onto the
point of the shoulder which forces the humeral head anteriorly is also a common mechanism of
anteroinferior dislocations and subluxations, which appears to be the case with AaC.
Important injuries to consider when dealing with anterior shoulder dislocations and
subluxations are the following (Cunningham, 2005):
Damage to the glenohumeral ligaments:
These are static stabilizers and are damaged in about 55% of cases, though more commonly in
the young.
Rotator cuff injury:
The rotator cuff is more commonly damaged in the older age group (>40 years old) and occurs in
approximately 3586% of cases. AaC is 41 years old, so this is a particular concern. Rotator cuff
muscles include the Supraspinatus muscle, the Subscapularis muscle, the Infraspinatus muscle
and the Teres minor muscle.
Neurological injury:
Some form of neurological damage occurs in 2150% of cases of anteroinferior dislocation.
The axillary nerve is the most commonly damaged (3%), the brachial plexus and other isolated
nerve injuries can occur.
Vascular injury:

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Axillary artery rupture is very rare, though 86% of axillary artery complications occur in patients
aged more than 50 years, indicating AaC is at a higher risk than varsity athletes with similar
mechanisms of injury.
Recurrence:
Age is a major factor in likelihood of recurrence. In the >40 years group, as the case here, only 015% develop recurrence of the injury, with the major pathology being rotator cuff tear.

For AaC, I think the subluxation primarily caused a rotator cuff injury, where it may have
strained the subscapularis muscle, causing the pain to be primarily concentrated on the anterior
side of the glenohumeral joint.
When AaC first came to me about this injury, I do not think he was very concerned about
it at all. He rested the shoulder for the week before he came to me the first time, and he did not
worry about getting it taped for practices, and just alerted us of it for the next upcoming game.
However, when the discomfort and weakness did not go away after the first 2 3 weeks, he
started to become more concerned about it and now wishes to have it taped prior to every game
and every practice, and last time I spoke with him, he even considered my advice to go see a
physiotherapist and start doing some strengthening exercises targeted at the dynamic stabilizers,
such as externally rotating the arm while maintaining the elbow at 90, abducting the arm, and
doing rows (arm extension/flexion) while using Therabands looped around doorknobs for
added resistance. Cutts et al. (2009) states that the current expert opinion for return to sport for
such an injury is permissible when the range of motion and strength are near normal, which has
always been the case for my experience with AaC.

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d). Reflection of what I did right and what things I would change:

I am very glad that AaC warned us that he was going to want his shoulder taped for the
upcoming game, so I could research how to properly tape a shoulder before having to do it! I am
happy with the tape jobs that I have done for the shoulder, though I definitely should have used
Tuf skin the first time I taped him. Luckily, the tape job held together, but I have learned from
that mistake and have since used Tuf skin when taping his shoulder. I also wish I would have
referred him to a physiotherapist sooner, but he just did not seem at all concerned or bothered by
his injury when he first came to me for tape, so I thought it would heal on its own over the next
few days. I also wish AaC would ice the shoulder after practice and games, but all the players go
and drink beer at the clubhouse following the games, so he was not very interested in ice.

Overall, I found this injury to be interesting to deal with and learning how to tape it was a
good experience. I will keep in contact with AaC for the next 2 weeks, so I hope to see some
progress on the healing of the shoulder, and am interested what the physiotherapist will tell him.

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6. References
Cunningham, N. (2005). Techniques for reduction of anteroinferior shoulder dislocation.
Emergency Medicine Australia, 17(1), 463-471.
Cutts, S., Prempeh, M., & Drew, S. (2009). Anterior shoulder dislocation. Annals Royal College
Surgery of England, 91(1), 2-7.

33