A Look at the Wisniewski Injury

This past Saturday, the crowd at Nationwide Arena held it’s collective breath when James Wisniewski careened into the boards and laid motionless on the ice. After what seemed like a half an hour, Wiz thankfully skated off the ice under (mostly) his own power. We now know that Wiz is out for some period of time but, emotion aside, many of us didn’t really know what was happening while Wiz was down and what might be good and what might be bad. The Union Blue team was fortunate to be attending the game with a soon-to-be medical resident who took a few moments to answer our questions and explain the medical protocols that are in place.

***Please note that this content represents one physician’s opinion. This article in no way presumes to know the specifics of Wiz’s injury, diagnosis or treatment and should not be considered as such. DO NOT attempt to perform any of the assessments or procedures outlined below, unless you also happen to be a medical professional***

1. When Wiz went down it looked awful – what were your immediate thoughts?
Upon the loud “thud,” I felt exactly how every spectator in the arena felt.  I held my breath, focused on Wiz’s prone body on the ice, and hoped for movement.  Within 2 seconds, seeing no movement, I jumped to the worst possible outcomes and wanted to know if he was conscious and breathing.

2. What kind of doctors/specialists (if any) do you think were part of the team that went on the ice?
A sports medicine physician led the team on the ice.  A sports medicine physician is one that completed residency (3-7 years of a specialty ie. family, internal, emergency, pediatrics, orthopedic surgery) and a fellowship (1-2 years additional training following residency) specific for sports medicine.  They have extensive knowledge of musculoskeletal medicine and provide emergency care with a focus on trauma.  If needed, they will begin CPR and/or Advanced Cardiac Life Support.  The physicians for the Blue Jackets specifically are a 4-man team: 2 family med/sports med (primary care background) and 2 orthopedic surgery/sports med (surgical background).

3. Where did it appear he hit and what are the impacts of that type of impact?
From our seats, it looked as though he hit his central upper back (T1-T4) and head.  Once the seconds of shock wore off, and I stopped holding my breath, I began running through quick differentials (the possible diagnoses/injuries) by looking at the potential areas of risk in those areas of the body:

4. What was happening when the doctors were with him on the ice all that time?

In the event of trauma, emergency protocols follow a specific algorithm outlined in the Advanced Trauma Life Support (ATLS) program provided by the American College of Surgeons.

1. Primary survey – assess the most essential functions for life
   1. Airway
      1. is anything obstructing? A mouthpiece perhaps?
   2. Breathing (note my first worry…)
      1. are they breathing or struggling to breath?
   3. Circulation
      1. Do they have a pulse?
      2. Are they bleeding?
      3. Are they in shock?
   4. Neuro
      1. Are they conscious? (Who are you?  Where are you? What period is it?)
      2. Are their pupils equal?

In the case of Wiz, the doctors on the ice had established consciousness and breathing and quickly moved onto their secondary survey, which includes a history and physical (all with Wiz still face down in the ice making no sudden movements).  I was relieved as the red backpack brought onto the ice remained unused.  I assume it held the essentials for life saving measures (trauma shears, an automated external defibrillator (AED), tools to establish an airway, IV’s).

At this point, the scary problems that could kill him quickly on the differential were moving lower on the list of possibilities (rapid brain hemorrhage, pneumothorax, myocardial rupture).  The next most concerning possible diagnosis would have been a spinal cord injury.  Adding to the drama, the double doors to the rink opened and more staff ran to our injured player.  At this point, the fear in the room was palpable as the spinal board was wheeled in for precautions. I kept my eyes on Wiz while he wiggled his feet and (I assume) confirmed sensation in both of his legs.  I leaned over to my neighbor and whispered, “They’re clearing his spine.  That’s good!”  The remainder of the exam required cervical spine (neck) immobilization while the team on the ice rolled him over. They sat him up, touched the back of his neck to assess for tenderness (which I assume he did not have).  They finally asked him to rotate his head from side to side, and voila! His c-spine was cleared, and he heroically skated off the ice.

5. What is the difference maker between putting someone on a board versus letting them get off the ice on their own power?
The stability of the player – unconscious, poor respirations, unable to clear c-spine are all reasons to call for the board

6. What kind of examinations might have happened back in the training room after he got off the ice?
Given the strong possibility of a head injury, he may have been transported directly somewhere for imaging to rule out bleeds.  We do know Jack Johnson said he talked to him after the game so it’s possible such facilities were on-site at the arena. With the suspected cervical injury, he would have been closely monitored for changes in neurological status (neck pain, numbness, weakness, loss of consciousness) as cervical injuries evolve over time.

7. What are the next steps medically if we assume this is a concussion?
The most worrisome problem affecting play is second-impact syndrome.  This is where a player still experiencing symptoms of a concussion incurs a second head injury causing the brain to swell and herniate.  Assuming this is a concussion, Wiz needs some TLC and rest.  He’ll be prescribed a length of rest based on the severity of his concussion and his medical history.  After completing this time, he must have no concussion symptoms for an additional week before allowed back on the ice.

8. How long is “too long” when someone is laying on the ice like that?
This depends on the situation, although, rushing someone off the ice is more worrisome as it indicates rapid life saving procedures are needed.

Hits like what we saw this past Saturday can be pretty scary stuff. Hopefully this piece helps us all understand a little bit more what’s at stake when a player goes down as well as what to look for and consider when we see another possible injury scenario. As of this writing, the team remains mum on the extent and severity of Wisniewski’s injuries to date, but we can be thankful that many of the worst case scenarios described above didn’t come to fruition and we all wish Wiz a speedy and safe recovery.