The ability to recognize physiological signs of injury is essential to the proper handling of potentially critical injuries. When evaluating the seriously ill or injured athlete the athletic trainer or physician must be aware of nine response areas: heart rate, breathing rate, blood pressure, temperature, skin color, pupils of the eyes, movement, the presence of pain, and level of consciousness.
Pulse- The pulse is a direct extension of the functioning heart. It is usually checked at the carotid artery of the neck or the radial artery of the wrist. A normal adult pulse rate per minute ranges between 60 and 80 beats per minute and children 80-100 beats per minute. An alteration of a pulse from the normal may indicate the presence of a pathological situation.
Example 1. A rapid but weak pulse could indicate shock.
2. A rapid and strong pulse may mean heatstroke.
3. A strong but slow pulse may indicate skull fracture or stroke.
4. No pulse indicates cardiac arrest or death.
Respiration- Normal breathing rate from adults is about 14-18 respirations per minute and 20-25 respirations per minute for a child. Breathing may be shallow, irregular, or gasping. Frothy blood being coughed up indicates a chest injury, such as a fractured rib that has affected a lung. Look, listen and feel to determine respirations.
Blood pressure- Blood pressure indicates the amount of pressure exerted against the arterial walls. It is indicated by two pressure levels, systolic and diastolic. Systolic is the pressure caused by the hearts pumping. Diastolic is the residual pressure when the heart is between beats. The normal systolic pressure for young males is between 115-120 mm Hg. The diastolic pressure usually ranges from 75-80. Young females are usually 8-10 mm Hg lower in each than males.
Temperature- Body temperature is maintained at 98.6 degrees F. Temperature is measured with a thermometer, which is placed under the tongue, in the armpit, against the tympanic membrane, or in case of unconsciousness in the rectum. The most accurate readings are from the ear or the rectum. Changes in body temperature can be reflected in the skin.
Skin color- For individuals who are lightly pigmented the skin can be a good indicator of the state of health. Three colors are commonly indicated in medical emergencies, red, white, or blue. Red may indicate heatstroke, high blood pressure, or elevated temperature. A pale, ashen, or white skin can mean insufficient circulation, shock, hemorrhage, or heat exhaustion. Skin that is bluish in color (cyanotic) primarily noted at lips and fingernails usually means there is an airway obstruction or respiratory insufficiency.
Pupils- The pupils are extremely sensitive to situations affecting the nervous system. If one or both of the pupils are dilated the athlete may have sustained a head injury, experiencing shock, heatstroke, or hemorrhage. The pupils response to light should also be noted. If one or both pupils fail to accommodate to light, there may be a brain injury. In evaluating an injured athlete pupil response is more important than pupil size. PEARL is an acronym often used to describe a normal state and stands for Pupils Equal And Reactive to Light.
Movement- The inability to move a body part can indicate a serious central nervous system injury that has involved the motor system. Bilateral tingling and numbness or sensory or motor deficits of the upper extremity may indicate injury to the cervical spine. Weakness or inability to move the lower extremity could mean an injury to the lumbar spine.
Level of consciousness- Normally the athlete is alert is aware of their environment and responds quickly to vocal stimulation. Head injury, heat stroke, and diabetic coma can alter the athlete’s level of consciousness.
Presence of pain- Location and type of pain can be indicators of what type of injury an athlete may have incurred.
For your lab today you will check vital signs of your lab partners at rest and immediately following activity. You will monitor your partners until they return to their resting levels.
I want you to check pulse, blood pressure, respirations, changes in skin color, and pupils to see the reaction to light. Each individual in your group should get a chance to check and monitor all these vital signs.