baseball vs. coach

[AJemt]

23 y/o/m, assistant head coach for boys varsity baseball team. He is throwing batting practice for the guys before a game. Coach is standing and throwing from behind two nets, one L net and one straight net. Ball is hit back towards coach, bounces off pole on straight net, and hits coach in the head - R temple area. Coach does not lose consciousness, but does drop to one knee.

Questions will be answered numbers will be given, all on request.


GO

 

[BossyCow]

23 y/o/m, assistant head coach for boys varsity baseball team. He is throwing batting practice for the guys before a game. Coach is standing and throwing from behind two nets, one L net and one straight net. Ball is hit back towards coach, bounces off pole on straight net, and hits coach in the head - R temple area. Coach does not lose consciousness, but does drop to one knee.

Questions will be answered numbers will be given, all on request.


GO

Okay, so conscious... so I'm assuming ABC's are all clear and working. What is his alertness level? Does he remember what happened? Does he know person/place/time?
What are his vital signs?
Is he bleeding or oozing any vital fluids from any orifice in his head?
What are his pupils like? What is the visible signs of the injury? Hematoma? Has he had anything to eat or drink? Meds? Allergies? Hx?

With a shot to the head in the temple, I'm calling ALS. I'd also be concerned about C-spine because of the force of the blow to one side of his head possibly tweaking his neck. So while ALS is on their way, I'd have him backboarded, checked for other injuries from the drop to his knee, with O2 and in the ambulance on my way towards the ALS rendezvous.

 

[AJemt]

Okay, so conscious... so I'm assuming ABC's are all clear and working. What is his alertness level? Does he remember what happened? Does he know person/place/time?
What are his vital signs?
Is he bleeding or oozing any vital fluids from any orifice in his head?
What are his pupils like? What is the visible signs of the injury? Hematoma? Has he had anything to eat or drink? Meds? Allergies? Hx?

With a shot to the head in the temple, I'm calling ALS. I'd also be concerned about C-spine because of the force of the blow to one side of his head possibly tweaking his neck. So while ALS is on their way, I'd have him backboarded, checked for other injuries from the drop to his knee, with O2 and in the ambulance on my way towards the ALS rendezvous.

ABCs are fine. relatively alert, knows what happened remembers everything, inc. person place time, remembers getting hit and all after.
pt initially got up w/ assist from a player and walked off the field (but slightly unsteadily). sat in dugout and attempted to keep score for about 20 minutes before deciding he was a little more messed up than he realized.
vitals are 130/80 P96 R20 PEARRL, no fluids, has a bump where the ball hit him but no crepitus; ate lunch (hot dogs and chili) has been sipping on water during game. A - cortisone injection (anaphylactic) M - albuterol PRN P - asthma, CP, recently dx with MS

c/o head pain, pressure, dizzy, feeling displaced (almost like a hangover). denies neck/back pain, any other injuries, no SOB, does admit to nausea. also c/o numb/tingly feeling in L hand, not up his arm or anywhere else. wants to sleep. as time progresses pt wants to sleep more and becomes more adamant, pushing the hand away that is trying to keep him awake, but does not have any other signs of combativeness. no other changes in vitals pupils or pt condition.

 

[skyemt]

i would be concerned about a possible epidural hematoma...
the temple bone is the thinnest of the skull, and it is classic injury site leading to epidurals...

considering the last S/S also suggestive of a head injury, i would seriously consider shortest trip to trauma center for CT scan...

 

[Jon]

Based on what you've described so far, especially the slightly altered LOC, I'm worried about the blunt trauma to his head. Full C-spine, ALS intercept, go to a TC. (by air or ground based on transport time).

This guy needs, at least, a CT scan, and possibly has a very serious bleed with increased ICP.

 

[BossyCow]

Recently diagnosed with MS? Wow, talk about a history!

The impact to the brain, with a history of a disease that impacts the brain.. hmmm does this sound serious to you?

I know that MS has these 'events' which lead to an exacerbation of symptoms. I'm not sure if a head trauma could affect the MS but I sure wouldn't be taking any chances. Guy would be backboarded, in the rig and going hell bent for leather towards the ER with a hope and a prayer that an ALS unit will be available for rendezvous.

 

[AJemt]

forgot to mention pt has a hx of concussion....8 documented, about 17 total (ex baseball player).....the MS hasn't caused any issues, no meds for it the drs are just watching to see if and how quickly it progresses. as i said before, pt is answering questions still awake just wants to go to sleep and is a little grouchy that he's not being allowed to go to sleep.

closest facility is a level 2 trauma center, they are 10-15 minutes away nice and easy. all neuro checks are normal (PMS, etc.) and pt does not know if the feelign in his fingers is because of the MS or not.

 

[AJemt]

so what actually happened was coach went enroute to hospital POV (EMT family member driving). since coach was up walking around for ~30 minutes prior to heading to the hospital and was alert enough (albeit with knowing this was a concussion due to past concussions) they did not call 911 at the field. before getting halfway to the hospital pt was wanting to sleep and the EMT driving the car could not keep him awake safely and so pulled into a fire company parking lot (knowing a bls squad was there to assist) and called 911. obtained vitals and provided ice pack for pt while awaiting EMS arrival. pt was then boarded and txpt to the hospital nice and easy, where he was placed in the er. CT showed no fracture, but temporal hematoma with mass effect but no cerebral shift (little bleeding, some swelling, good bit of bruising without causing the brain to move). pt was admitted to trauma/neuro intensive care for 36 hrs for observation. 2nd CT showed slight increase in bleeding and swelling, 3rd CT showed no further change and pt was released to home on work, driving, and activity restrictions.

 

[skyemt]

i'm just curious...

are you saying that EMT's were present for this injury, and did not call 911?

 

[AJemt]

no ems was present when pt was injured. pts wife showed up for the game and coach (husband) said lets go to the hospital telling wife (emt) on the way - did not give wife all the pieces of the puzzle until heading down the road. when wife started having problems keeping him awake and driving she pulled off and called 911.

 

[mycrofft]

Now that's what it takes to keep a marriage exciting.

(Geez!!!:wacko