First Aid Question

[tri-rn]

I was at my daughter's softball game the other day when a girl sliding into third injured her ankle. Normally we have an athletic trainer but she'd been pulled to go to a soccer game, so there was no official medical support. My daughter came running up to the bleachers where I was sitting and asked me to go have a look. I went over and was trying to figure out where she was hurt and assessing for swelling when the coach walked up behind me. I said "can I take her shoe off?" I was concerned that she'd swell inside the shoe. The coach snaps "NO I want her to have the compression!" and more or less elbows me out of the way.

Having been a personal trainer before I was an RN I'm familiar with RICE (rest, ice, compress, elevate) but wouldn't her swelling in the shoe be more concerning? Also, it was a softball cleat...no compression at all near the ankle.

I'm just wondering if I'm missing something. I don't see this stuff in the ICU.

[marissa795]

Im pretty sure that if she wound up going to the ED they would want to take the cleat of anyways... Not to mention that a lot of cleats have some sort of metal in the sole or toe so that wouldnt exactly be compatible with xrays/mri. I think the coach may have been overreacting. Eventually the shoe has to come off in order to fully assess the extent of her injuries.

[simboka]

I'm curious what his rationale for keeping the shoe on would be: "because that's what you're supposed to do?" (aka: uneducated concerning injury/illness assessment and care) vs "if it's not too bad, she may be able to play some more" (aka: coach not wanting to have to sit out a player), or something else entirely.

But yeah, first thing they'd do, would be take the shoe and sock off. But as long as what I could assess wasn't making me nervous, I'd let the coach have his way and leave the shoe on.

[Zookeeper3]

being crazed with circulation, I'd need the shoe off to check pedal pulsed, capillary refill.... But I'm an ICU nurse as well, I HAVE to see it, touch it and the shoe on the foot would have lasted all of one minute;)

[Emergency RN]

Personally, I think the coach was basically saying "I'm in charge and you're not" and it became an ego thing.

Keeping any freshly injured tissue in a solid container risks compartment syndrome because the container cannot expand. One should recognize that prevention of swelling at all costs, is not the ultimate treatment goal. Limiting the effects of the original injury while not doing any further harm requires therapeutic balance.

Applying an ACE WRAP and then ice may be a better option. The ACE WRAP will allow for elastic compression; that is, it employs circumferential pressure but permits a degree of expansion as needed. Topical ice over the ACE WRAP will then cool the tissue, which also keeps the swelling down and reduces pain too. Elevation would further help to keep the injured limb from swelling.

The OP already had the right answer with the R.I.C.E. technique.

[MissIt]

I just took an ARC first aid class a month ago. They said don't remove shoes. And she told us that they no longer recommend compression. It's Rest, Immobilize, Cold, and Elevate if it isn't too painful. You immobilize the ankle and foot by using a soft splint ( a blanket or towel looped under the foot, for example. The shoe helps immobilize it.

[Emergency RN]

I just took an ARC first aid class a month ago. They said don't remove shoes. And she told us that they no longer recommend compression. It's Rest, Immobilize, Cold, and Elevate if it isn't too painful. You immobilize the ankle and foot by using a soft splint ( a blanket or towel looped under the foot, for example. The shoe helps immobilize it.

I stand corrected then, and thanks for the update

[MissIt]

I think it's a new thing because all of us in the class were nurses and we all kept forgetting during the 'practice your skills' bit and taking off people's shoes. LOL Also, they said that if you can't check the pulse and whatnot, you can still check sensation if you feel like doing an assessment. :)