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40 Cards in this Set
- Front
- Back
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Diabetes Type I |
10% of people with diabetes are Type I Used to be known as juvenile diabetes Problem: pancreas fails to produce enough endogenous insulin Cannot get sugar out of blood into cells - usually it is transported when insulin connects to receptor and Glut-4 channels open Glucose ends up being filtered out by kidneys Leads to dependence on exogenous insulin - injections |
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Diabetes Type II |
90% of people with diabetes are Type II Inadequate insulin produced by pancreas and/or significant resistance at cellular level Issue w/receptors - insulin still present and being made but Glut-4 transports still don't open |
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Hyperglycemia |
Sugar present in blood stream but cannot get into cell/tissue Cells begin to start Body starts converting fat leading to acidosis - Ketoacidosis present in breath (smells fruity) Possible coma - not getting sugar to the brain |
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Hypoglycemia |
Minimal sugar in the blood stream Can be caused by too much insulin, not enough food, or excessive exercise (used up all the glucose) Decreased nutrients to brain Insulin shock/reaction Can cause hunger, double vision |
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Signs and Symptoms of Hyper and Hypo glycemia |
Altered level of consciousness - dizzy, drowsy and/or confused Rapid breathing Rapid pulse Feeling ill |
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Management of Hyper and Hypo Glycimia |
Check for medic alert - bracelet, anklet, tattoo Ask if they have eaten or taken insulin (ask if they are diabetic) Give sugar - juice, hard candy, glucose tablets, non-diet soft drinks Monitor for 5 minutes - if no change move on to activate further treatment If hypoglycemic they will improve If hyperglycemic, there will most likely be no change - refer for advanced emergency medical care |
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Epilepsy |
Condition defined by recurrence of unprovoked seizures 10% of population will have at least 1 seizure but only 2% will go on to have recurrent unprovoked seizures or epilepsy Likely that many newly diagnosed patients will be participating in athletics at time of diagnosis A seizure is a result of a discharge of electrical activity within the brain |
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Types of Seizures - Generalized |
Bilateral discharge involving entire cortex Convulsive Tonic-Clonic Seizure (Gran Mal): athlete falls to ground; goes into tonic phase of mm stiffness; followed by clonic phase of mm twitches Non Convulsive - Absences (petite mal): sudden interruption of activity fallowed by blank stare; may or not realize it occurred |
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Types of Seizures - Partial |
Focal; occur in one part of brain and activate only a small number of neurons Simple: without loss of awareness, usually consisting of brief sensory, motor, or memory-related symptoms Complex: alteration of awareness, usually associated w/behaviour arrest, staring, blinking, and automatisms lasting minutes wi/postictal amnesia (finger moving, lip smacking, muscle spasms, blinking) |
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Management of Seizures |
Protect their head Remove objects close by Do not restrain the athlete Do not place an object in their mouth - choking Position on side in recover position - prevents hazards if vomit Asses for injury - contusions, dislocations If they have seizures often and the athlete is in good condition, EMS not required If seizures don't typically happen, or situation seems different than usual, EMS activated |
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Epilepsy and Exercise |
Fatigue, exertion, and stress may be a trigger of seizures - only 2/400 listed exercise as a precipitant Stress, sleep deprivation, fever/illness, and menses far more common 2% have seizures in more than 50% of training sessions - typically related to intense activity; most had structural lesion Main point: exercise is safe for people w/epilepsy |
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Benefits of Exercise for Epileptics |
Can decrease seizure frequency - normalizes EEG therefore increasing seizure threshold; decreasing likelihood of seizures Decreased discharges in EEG during exercise Acidosis - decreased irritability of cortex PA also enhances altertness and focus, increasing seizure threshould May also decrease other factors that are common triggers for seizures |
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Epilepsy and Sport Participation |
Avoid scuba, rock climbing, motor racing, and downhill skiing - potentially fatal for them or others Frequency of seizures important when considering activities such as swimming (4x more likely to be involved in submersion accidents; swim w/buddy) No adverse effects with contact sports Shooting, archery, horseback riding - debate Must stress: proper diet, rest and adherence to meds for seizure control |
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Asthma |
Chronic inflammatory disorder of the airways Excess mucus production + bronchial smooth muscle constriction which result form a release of inflammatory mediators Max expiratory flow rate reduced, residual lung volumes increased; air trapped behind blocked airways Harder work to breath as thorax becomes over inflated Diaphragm and costal muscles must compensate - muscle efficency lost leading to fatigue and physical stress that may result in death |
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Asthma Triggers |
smoke; night time; dust mites; pollen/molds; weather and air pollution; animal dander; pests; strong scents/odors; exercise; respiratory infections; emotions |
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Asthma - Signs and Symptoms |
Causes an increase in airway hyper-responsiveness leading to: recurrent wheezing episodes; breathlessness; chest tightness/pain; dry coughing (particularly at night or early morning or exercise in cold dry environments) |
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Exercise Induced Bronchospasm |
A temporary narrowing of airways (bronchospasm) induced by strenuous exercise in which the patient has no other symptoms When other symptoms present = exercise induced asthma (80% of asthmatics; 40% season allergies; 12-15% general pop) |
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Pathology and Symptoms of EIB |
Exercise triggers b/c dehydration of lung's airways - workout in cool environment; dehydration from making air moist Symptoms peak 8-12min after exercise Inhaled air is dry and cool. Air warmed/humidified in lungs = drying out. After exercise, cells rehydrate via hyperemia, leading to cascade of biochemical changes triggering bronchoconstriction Degree is dependent upon exercise intensity, temperature and humidity of inhaled air |
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Diagnosis of EIA |
Need 2 things: symptoms (shortness of breath, coughing, chest tightness/wheezing) and obstructed airways 10-15% decreased FEV1(forced expiratory volume) both associated w/exercise To test: Athlete works 6-8 min at 80%max. Better if test is sport specific. May need cold air, if testing winter/outdoor athlete |
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Management of Asthma/EIB/EIA |
Educate on signs and symptoms and triggers Avoid exercising near irritants if possible Use bronchodilators (beta 2 agonists) as prescribed, prior to exercise - note most inhalers are banned in sport If bronchospams occurs: use bronchodilator as prescribed; position for ideal breathing - hands on head - increases ability to get air in lungs. Begin by slowing exhalation then inhalation, helps bring HR and RR down, calming them down and relaxing muscles |
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PPE - Pre-participation Physical Examination |
Medical physical examination assessing the ability to safely participate in sport activity Not intended to disqualify or exclude individuals - sometimes you have to do this to protect athlete, but not the therapist's/doctor's job, they want athletes participating Helps maintain health and safety in training and competition |
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Objectives of PPE |
Detect conditions that would restrict participation Detect conditions that may be life threatening or disabling Injury prevention evaluation - identifying weaknesses (aids in prevention) Meet legal and insurance requriements Initiate and establish a rapport with the athlete Provides an opportunity for counseling - tell clinicians things they won't tell coaches Establish a data base and record keeping system |
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When to do a PPE |
Preferably 4-6 weeks prior to season start. Allows time for additional tests and treatment. Generally occurs closer to start of season - hard to collect athletes so early End of preceding season is common - if something happens during off season, won't show on PPE Usually done 1x/year |
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PPE Team |
Phsyscician; PT/AT/Kinesiologist; Orthopedic Surgeon; Nurse Can also have: Dentist (hockey); sports psychologist; dietician; opthalmologist; coach (people may not be 100% honest if they are there...) |
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Methods of Evaluation - Office Based |
Clinic or M.D.'s office Usually just one examiner - highly personable May be one PT but consultations if necessary Very time consuming for (large) teams and is more expensive |
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Methods of Evaluation - Station Based |
Less expensive and more efficient Athletes meet more members of support team and other players Divided into medical and musculoskeletal Includes MD and other health professionals Fosters improved communication by medical team - all in same rooom May reduce staff burn-out Less personal - athletes feel like cattle |
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Components of PPE |
Complete medical history (most important) Medical evaluation form - physician fills this out Musculoskeletal evaluation form - therapist Visual acuity Quick mental processing form (SCAT3,McGill) - baseline concussion testing Player status form (MSK, Medical clearance) |
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Typical PPE Set Up |
Fees, drug education as per CIS History - self report form and questions Trainer - height, weight, vision, mental tasks Team PT/Trainer - MSK Screen Team Physician - Medical Exam |
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Medical History |
7-10 days in advance; facilitate complete family+ past medical information Symptoms w/exercise (cardio/syncope) requiring further evaluation - fainting and should be completed w/parents (75% of problems) Concussion history Medications, alcohol+drug use Recent infections Female athletes: triad of amenorrhea, anorexia/bulimia, osteoporosis Red Flags: conditions hiding as sport injuries; if there is something about history not fitting, consider alternative less common conditions Has been successful in identifying eating disorders; alcohol+drug abuse Strongest independent predictors of injuries is a previous one (9.4x) and exposure time (6.9x) |
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Red Flags - Bone and Soft Tissue Tumors |
Primary malignant tumors are rare - usually found in young 2nd-3rd decade (ages 10-30) Pain is aggravated by activity Red Flags: night pain, fever, loss of appetite, unwarranted fatigue, weight loss (10-15lbs in weeks) |
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Red Flags - Rheumatologic Conditions (Inflammatory Issues) |
Rheumatoid arthritis, ankylosing spondylitis, psoratic arthritis Could report single or multiple swollen joints - no history of trauma or injury (sore wrists, ankles, knees) Red Flags: morning stiffness; rashes; fingernail pitting; bowel disturbances; eye irritation (conjunctivitis, iritis) |
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Red Flags - Infection |
Bone and joint infections/osteomylitis are uncommon May report a single or multiple swollen joints - no injury or history of trauma (back joints) Kids aren't supposed to have joint pain Red Flags: bone pain in children (both at night or w/activity); hot and swollen (no history of major trauma) |
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Red Flags - Vascular Conditions |
Deep Vein Thrombosis (blood clot) Presents w/single limb pain Aggravated by exercise Possible precipitants - recent surgery and air travel Red Flags: tenderness on palpation over tissue; warmth; swollen; red, pale or bluish in colour |
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Medical Examination |
Observation (look for health markers); dermatologic conditions; vital signs (HR, BP, RR, temp); cardio exam (R/O; Hypertrophic cardio-myopathy; aortic stenosis; etc.); head, eyes, ears, nose, throat; blood tests; ECG, diagnostic tests; diabetes; allergies Routine screening need not include noninvasive cardiac testing or lab tests (urinalysis, blood count) |
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Cardiovascular Conditions Defined |
Hypertrophic cardiomyopathy (HCM): heart muscle becomes thick. Thickening makes it harder for blood to leave the heart, forcing the heart to work harder to pump more blood Aortic Stenosis: aoritc valve doesn't open fully, decreasing blood flow from the heart |
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MSK Evaluation |
PT/AT/Chiropractor; screening exam Specific tests based on history provided; functional tests Perfect area for clearing tests as well Neurological scans Screening physical exam is 50% sensitive and 97% specific Asymptomatic athletes w/no previous injuries - 90-sec screening detects 90% of significant musculoskeletal injuries Focused exam for those w/previous injuries |
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AAP Committee on Sports Medicine |
Individuals may be precluded from participation in contact sports or require further testing for following areas: atlanto-axial (upper c-spine) instability; history of sign. head or spine trauma; acute/contagious illnesses; carditis; congenital heart disease; pulmonary compromise; absence of one kidney; enlarged liver/spleen; fever; sign, musculoskeletal disorders; convulsive disorders (debatable) |
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Clearance to Play Questions |
Is there a problem that places the athlete at risk of injury? Is any other participant at risk of injury because of this problem? Can the athlete safely participate w/treatment of the problem? Can limited participation be allowed while treatment is initiated? If clearance denied, what activities can be safely done? Is consultation w/another healthcare provider necessary to answer above questions? |
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PPE Cautions |
US Preventative Services Task Force describes an effective screenign test as satisfying: can detect target condition early than w/o screening; screening+treating should improve likelihood of favourable outcome Found that based on review of 176 articles that PPE did not satisfy these basic requirements Not compelling evidence that PPE can accurately predict orthopedic injury or cardio sudden death Advising students/athletes about rules+equip. may decrease mortaility and morbidity more effectively than exam |
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PPE Conclusion |
Can be done quickly and efficiently Goals for PPE to achieve: identify medical+orthopedic problems of sufficient severity to place athlete at risk o injury/illness; identify correctable problems that may impair athlete's ability to perform; help maintain health and safety of athlete; asses fitness level for specific sports; educate athletes+parents concerning sports, exercise, injuries, other health related issues MEET LEGAL AND INSURANCE REQUIREMENTS - avoid complacency in circumstances where PPE was unremarkable, yet athlete displays early signs of distress, be it cardio, ortho, or otherwise |
