Dec 14, 2017
Info at the Ready
David Csillan

What is the most important item in your medical kit? Is it tape or underwrap? Wound cleaners, gauze, or ointment? A sphygmomanometer or stethoscope? For me, it’s my blue folder. The first and second sleeves contain concussion evaluation forms and insurance forms, should an athlete need transportation to the emergency room for medical care. However, the most valuable information can be found in the last thin, plastic sleeve. This is where I keep a list of athletes’ names, dates of birth, and pre-existing medical conditions (PMCs) so it is quickly at my disposal when an injury occurs.

The setup is fairly simple. Rosters and corresponding PMCs are entered on individual team spreadsheets. Different colored markers are utilized to “tag” athletes who have potentially emergent PMCs. For example, athletes with cardiac issues or hypertension are tagged with a red dot next to their name, athletes with asthma are tagged with a blue dot, those with allergies are tagged with a green dot, and so forth. Athletes with multiple conditions have multiple colored dots next to their names. In the heat of the moment, a quick glance at the spreadsheet will alert me to the PMCs either directly related, or secondary, to the initial injury.

Different colored markers are utilized to “tag” athletes who have potentially emergent PMCs… In the heat of the moment, a quick glance at the spreadsheet will alert me to the PMCs either directly related, or secondary, to the initial injury.

This came in handy years ago, when an athlete entered fall preseason camp just coming off a partial hamstring tear during the summer. The individual had been exercising on a stationary bike, but the treating physician had given clearance to begin weight-bearing activities. On a slightly warm August morning, the athlete performed a light 20-minute jog around the outdoor track. Upon completion, they reported hamstring soreness, so we applied ice.

Lying on the treatment table, all was going well until an increase in discomfort was noticed in the hamstring. Shortly after, the athlete’s skin turned pale, profuse sweating was evident, nausea quickly took over, and the upper and lower extremities went into a full-body contraction. Within minutes, a routine orthopaedic treatment regimen was interrupted by signs and symptoms of an emergent nature.

A quick reference to the PMC spreadsheet revealed the athlete had an anxiety disorder and previously experienced heat stress issues. While remaining on the table, the athlete was treated for shock and cooled at the same time. Controlled breathing techniques were provided, and the athlete was stabilized by a “what I did over summer vacation” discussion.

As I soon found out, the athlete had been hospitalized with rhabdomyolysis just five weeks prior to preseason camp. Unfortunately, flashbacks of this experience created an instant onset of signs and symptoms again. Was the incident a relapse of rhabdomyolysis? Perhaps exertional heat stroke? Knowing about the documented anxiety disorder and the fact that the other two possibilities wouldn’t result in the athlete bouncing from good to bad, the case was easily downgraded. EMS was notified and transported the athlete to the emergency room for which treatment was provided for acute anxiety.

Another instance where my blue folder came in handy dealt with a football player. He had complained of feeling sluggish during practice. Upon questioning, he revealed he had eaten very little at lunch but didn’t complain of hunger. Also, he didn’t sleep well the previous night. No food, no sleep. Yes, that must be the problem. However, a quick reference to the PMC spreadsheet alerted this athlete was a diabetic. His blood glucose reading was very low, and we quickly administered glucose gel in order to elevate his numbers. Within 15 minutes, he reached baseline and felt fine.

In the day-to-day operations of an athletic trainer, it’s very easy to either get caught up in the complexities of an injury or not see the forest for the trees. Most injuries seen are of an orthopaedic nature. For those that may turn into an emergency event due to PMCs, a PMC spreadsheet like mine ensures that expedient and appropriate medical care is close at hand.

David Csillan, MS, LAT, ATC, is Athletic Trainer at Ewing (N.J.) High School and a member of the New Jersey State Interscholastic Athletic Association's (NJSIAA) Sports Medicine Advisory Committee. He also serves as the NATA District 2 Secretary, Secretary Vice-Chair of the NATA District Secretaries/Treasurers Committee, and the NJSIAA Liaison with the NATA and NFHS. Csillan was inducted into the Athletic Trainers' Society of New Jersey Hall of Fame in 2008 and received both the NATA's Most Distinguished Athletic Trainer Award and Athletic Trainer Service Award in 2016. He can be reached at: [email protected].

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