The airway can be compromised by a primary injury, usually by a trauma incident, or by a secondary injury, which can result to a decreased conscious level, and can be evaluated through Glasgow Coma Scale [9].

When assessing or treating problems related to the airway, four options may be available [6]:

Within the airway clearance techniques, there are two major ones. The jaw-thrust maneuver is made every time a cervical injury is suspected. The clinician may approach the airway with manual inline stabilization or neck immobilizers without losing the control of the cervical spine [6, 8, 10]. If cervical trauma is excluded, the clinician may opt for extension of the head while lifting the chin. If these techniques do not clear the airways, then airway aids must be used [6, 8].

In regard to the airway aids, in more simple cases, it may be used with the Guedel pattern airway. It is inserted into the airways, which will further help to prevent the tongue from covering the epiglottis and maintain or open the patient’s airways [6, 8]. It has the advantage to be easy to apply. However, if applied incorrectly, it can result in vomit reflex. As an alternative, or in combination, a nasopharynx tube can be used, which will facilitate the air flux within the pharynx. If fracture of the skull base is suspected, the nasopharynx tube should not be used because, if inserted incorrectly, it can worsen the condition. In more complicated cases, advanced airway aids are required. The endotracheal intubation is still the gold standard to assure airway security; however it requires domain over technique and a progressive learning curve. The laryngeal mask can further help the basic aids to protect the airway against secretions and is an adequate option to secure the airway function when an endotracheal intubation is not possible. If none of the above is functioning or possible to perform, surgical intervention will be required [6].

It is crucial to assess the thoracic movements, hear the player’s respiratory sounds, and palpate the thoracic anatomical structures, searching for asymmetries or anomalies [5, 6]. Special caution should be taken if the player presents dyspnea and/or tachypnea, in which case the problem may be associated with an airway commitment. Nonetheless, if the inadequate airway is caused by a pneumothorax or tension pneumothorax, using an intubation with a vigorous bag-mask ventilation can lead the player to even further deterioration [5]. Special attention must be taken in regard to the tension pneumothorax that can be a life-threatening condition due to a “one-way valve” mechanism from a perforated lung or penetration on the chest wall. This condition usually presents tracheal deviation, diminished or absent breath sounds unilaterally, hyperresonance on percussion, hypotension, and pulse rate more or equal to 140 beats per minute. Emergency treatment can be performed by chest decompression using an intravenous 14G catheter over a 3–6 cm needle at the second intercostal space, in the midclavicular line just on the superior border of the third rib. A sudden rush of air or aspirating free air into the syringe means that the needle is in the pleural space. The needle is then removed and the catheter left in place [11, 12].

Hemorrhage has been considered as one of the main causes of preventable death [5]. Therefore, reassuring the patient circulation is essential to decide if the vital organs are being correctly perfused and to exclude a potential internal hemorrhage. In this sense, it is important to check for the player’s paleness, localized pain, and/or possible internal or external bleeding and assess the cardiac frequency, the capillary filling, the arterial pressure, and the glycemia. It is also important to check for abdominal hematomas or other trauma secondary signs, pelvic instability, and femur fractures [3–6].

It should perform a basic neurologic evaluation in order to confirm the suspicion of cranial and vertebral injury. Hence, it is necessary to assess the player’s status of consciousness [8], the condition of the pupils, and the any lateralizing signs [5]. The first can be accomplished through Glasgow Coma Scale [9] or simply by a scoring system:

Regarding the condition of the pupils, it should assess the size, symmetry, and reaction to stimuli. In addition, it is also important to assess the mobility and sensibility of the upper and lower limbs and search for any lateralizing signs [5, 6].