Chapter 46. The sports arena
Sport-related deaths
Most deaths that occur at sporting events are from natural causes such as myocardial infarctions. Occasionally, congenital heart diseases such as hypertrophic cardiomyopathy can affect young athletes.
Nature of injuries in sport
Most sports injuries are soft tissue injuries. Injuries to the lower limbs are most common, followed by the upper limbs, head and face, and finally the chest and abdomen. The majority are minor and self-limiting; however, serious injuries such as ligament and tendon tears, fractures, spinal and head injuries and damage to viscera do occur.
Paramedics must decide whether the problem must be dealt with in hospital immediately or whether the patient can be left to arrange independently for treatment at hospital or by a general practitioner later in the day. Many injuries do not require medical intervention and can be readily treated with rest, ice, compression and elevation (RICE), plus analgesia:
R – Rest
I – Ice
C – Compression
E – Elevation
Athletics and field sports
• The majority of athletes suffer soft tissue injury and sprains. Overuse predisposes them to chronic muscle and ligament problems that may be suddenly exacerbated in competition
• High jumpers and pole vaulters are liable to neck injury if they land badly
• Heat exhaustion is frequent during hot conditions.
Combat sports
• Of greatest concern in combat sports are head and neck injuries as a result of direct blows or from falls following throws. Facial fractures and eye injuries are also common
• Soft tissue injury and fractures are features of the martial arts.
Football
• The majority of association football injuries are to soft tissues, with strains and complete tears of leg muscles and tendons being most common
• Severe knee and ankle injuries occur less frequently and fractures to the lower limb are relatively rare
• Head and neck injuries can occur in bad falls or clashes of heads.
Hockey
• Hockey players are prone to the same injuries as footballers; they also run the risk of being hit by a stick or a very hard ball travelling at high speed
• Facial injuries are commonly caused by follow-through of a stick.
Horse riding
• Falls and head injuries may lead to as many as 50% of riding-related deaths
• Kicking injuries and involvement in road traffic accidents also cause serious injury
• Severe injuries to the head, neck and spine are common
• Maxillofacial injuries arising from kicks can be severe and airway care may pose major problems
• Crushing injury can occur if a horse rolls onto its rider, causing severe blunt chest and abdominal injury.
Motor sports
• The speeds involved in motor racing and motorcycle racing can lead to life-threatening multisystem injury
• Extracting the casualty from the wreckage may be prolonged and difficult
• Burns, fractures and head and neck injuries are common and crash-helmets can lead to problems with management
• Spectators are at risk from flying debris and wheels or from direct contact with vehicles whose drivers have lost control
• Rescuers too are at risk as, unless the track is dangerously affected, the race will continue.
Mountaineering and hill walking
Strains, sprains and minor fractures are the most common injuries in these sports. They take on a greater significance when they occur many miles from help in hostile terrain. The weather poses significant problems and the risk of hypothermia and frostbite is ever present. Falls can lead to significant multiple injuries. Hill walkers often have medical conditions and the most common cause of death on the hills is myocardial infarction rather than trauma.
Remember intercurrent medical illness
Racket sports
Soft tissue sprains and strains are the most common injuries. The upper limb is more often injured in these sports. Facial injury from contact with a racket can occur. Of greatest concern in this group is eye injury. Squash balls and shuttlecocks can produce severe damage if they strike a player’s orbit at close range.
Rugby football and American football
Players suffer upper limb problems with fractures to the hand, arm and clavicle; lower limb problems include meniscal tear and knee ligament injury, ankle ligament damage (sprain) and fractures of the tibia and fibula. These fractures are often spiral, resulting from a twisting injury on a planted foot. Head injury with lacerations and fractures to the facial bones can be associated with concussion and loss of consciousness. Neck sprains are common and severe neck injury can occur. The majority of severe neck injuries occur in collapsed scrums or in head-on tackles where hyperflexion of the neck combined with axial loading of the spine is common. Crush injury in the regular ‘pile-ups’ of rucks and mauls may also occur with resultant damage to chest and abdomen.
Scuba diving
Sudden pressure changes can then lead to major problems with barotrauma or the ‘bends’ (decompression sickness).
Faulty technique on descent can lead to significant ear problems, with rupture of the tympanic membrane: cold water rushes into the middle ear and disequilibrates the balance mechanism and as a result, the diver loses all sense of direction, with drowning being a real risk.
Too rapid an ascent can lead to overdistension of the lungs and air spaces, resulting in barotrauma to these areas, as the enclosed air expands rapidly with the reduction in ambient pressure. Pulmonary barotrauma can lead to pneumothorax. Air embolus can also occur. Decompression sickness develops because nitrogen bubbles are released from solution in the blood when a diver ascends too quickly. Symptoms include:
• Pain, especially in the joints
• Itchy skin (the ‘creeps’)
• Headache
• The feeling of being strangled (the ‘chokes’)
• Neurological abnormalities including spinal cord problems (the ‘staggers’).
Nitrogen narcosis (euphoria and loss of judgement) occurs in air divers who go too deep.
Divers can develop the bends many hours after a dive, especially if they fly in an aircraft, when the ambient pressure is further reduced. This results in an enhanced release of dissolved nitrogen; any diver who exhibits strange symptoms after a flight that closely follows a dive should be viewed with concern.
Helicopter aeromedical evacuation poses theoretical risks to injured divers, although with transport at altitudes of less than 1000 feet, the pressure changes will not be clinically relevant.
Injured divers must never be given Entonox
Water sports
Hypothermia is possibly the greatest risk in water sports in the UK. Many sailors, windsurfers and canoeists are ill prepared for sudden changes in the elements. Drowning is an ever-present risk. Head and neck injuries are common in those who dive into shallow water. Sailors can receive head injuries from flailing booms and suffer limb injuries in falls on wet decks. Jet-skiing predisposes to head and neck injury as a result of high-speed falls and collisions. Powerboat racing poses similar risks to motor racing with multiple injuries and the extra risk of drowning for unconscious or incapacitated drivers.
Drugs and the athlete
Many competitive athletes are governed by strict rules about the use of drugs.
It is incumbent upon medical personnel who attend competitors to ensure that they do not inadvertently provide them with banned substances in the course of treating an injury or illness.
