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64 Cards in this Set
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- Back
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Acclimatization of high altitude
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Length depends on the altitude. For >6,800 feet requires acclimatization for 10-20 days. Highly anaerobic activities at intermediate altitudes do not require arrival in advance of the event. Benefits of acclimatization are lost within 2-3 weeks after returning to sea level.
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Athlete with Sickle Cell Trait
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Mostly in AA, abnormalities in hemoglobin structure and makes RBC fragile/ unable to transport oxygen. B/c of rigidity and irregular shape they clump together and block small blood vessels leading to occlusions or infarcts.
Exercising in high heat or humidity or at high altitude may lead to dehydration, increased body temp, hypoxia, acidosis, leading to increased concentration of circulating blood cells. This causes increased viscosity, impairs blood flow, and may lead to stroke/ CHF/ renal failure/ pulmonary embolism/ sudden death. Tx: Proper hydration, limit running to <1 mile without rest breaks, avoid hot/ humid weather and altitudes >2,500 feet. |
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Assessment of Hydration Status
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1. Mostly consistent body weight
2. LIght Urine color - Less than or equal to 4 on chart 3. Measuring urine specific gravity with refractometer - Less than or equal to 1.020 Body weight change during exercise is best predictor of hydration status during exercise. Loss of 2% of body weight leads to change in performance. |
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Rehydration and Exercise
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Pre- Exercise hydration= 17-20 oz 2-3 hours before and 7-10 oz 10-20 minutes before exercise. Cold water empties from stomach and small intestines faster.
Fluid replacement during exercise should be equal to the losses of sweat and urine so total fluid loss is <2%. Usually this requires 7-10 oz of fluid every 10-20 minutes. Post exercise hydration should be complete by 2 hrs post. |
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Muscle Fibers types
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Type I/IC- Slow, aerobic, oxidative
Type IIC, IIAC, IIA, IIAB- Intermediate, fast twitch- oxidative, anaerobic Type IIB- Fast twitch-glycolytic |
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Muscle Fiber recruitment
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Heavier loads such as wtih 3RM or 5RM are most effective in stimulating growth of all muscle fibers b/c all fibers are recruited.
-Increased recruitment of both Type I and Type II with with heavy resistance training d/t greater anabolic mechanisms enhancing growth -Decrease in number of Type I overall and decrease in overall size of fibers in aerobic endurance training d/t degradation and catabolism |
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Energy Systems
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3 systems: Phosphagen (anaerobic), Glycolysis (fast and slow glycolysis), Oxidative (aerobic)
The anaerobic energy system is divided into alactic and lactic components, referring to the processes involved in the splitting of the stored phosphagens, ATP and phosphocreatine (PCr), and the nonaerobic breakdown of carbohydrate to lactic acid through glycolysis. The aerobic energy system refers to the combustion of carbohydrates and fats in the presence of oxygen. The anaerobic pathways are capable of regenerating ATP at high rates yet are limited by the amount of energy that can be released in a single bout of intense exercise. In contrast, the aerobic system has an enormous capacity yet is somewhat hampered in its ability to delivery energy quickly. 1. Phosphagen system provides ATP for short term activity and is active at the start of all exercise regardless of activity. Relies on chemical reaction between ATP and creatine phosphate (both phosphagens) as well as enzymes myosin and ATPase and creatine kinase. 2. Glycolysis- breakdown of carbohydrates either glycogen stored in muscle or glucose delivered in the blood to produce ATP. During fast glycolysis pyruvate is converted into lactic acid providing ATP. During slow gylcolysis pyruvate is transported to mitochondria instead of being converted to lactic acid and is then used in the oxidative system. Once pyruvate enters mitochondria it is converted into acetyle CoA and pyruvate dehydrogenase complex. Acetyle CoA then enters the Krebs cycle for further ATP production. The oxidative system is the primary source of ATP at rest and during low intensity activities and uses primarily carbs and fats. During intense exercise 100% of energy is derived from carbohydrates if an adequate supply is available. This includes the Krebs cycle and oxidative phosphorylation. |
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Aerobic Training Metabolic Adaptations
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-Resistance training together with aerobic training improves aerobic performance and development.
-Often catabolic effects with endurance events such as running so resistance training is needed to offset these effects -Increases testosterone and cortisol at both rest and during exercise though in long term there is a decrease in testosterone with aerobic training. -Aerobic training leads to a decrease in Type I fibers as well as a decrease in the size of the fibers likely as an adaptation to help with efficient oxygen transport. |
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Anaerobic Training Metabolic Adeptations
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Increases stimulation of catecholamines (epinephrine, norepinephrine, and dopamine).
Increases ability to secrete greater amounts of epinephrine during maximal exercise. Improvements in insulin resistance. -Hormones in blood increase 10-20 times resting levels |
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Female Athlete Triad
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1. Disordered Eating
2. Altered Menstrual Function 3. Abnormalities in Bone Mineralization |
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Hormonal Control of Glucose Metabolism
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Insulin must be available to stimulate uptake of blood glucose into body's cells. As cells use glucose blood levels decline and liver responds by releasing glucagon into blood stream. Glucagon stimulates liver cells to break down stored gylcogen and release glucose into blood to raise blood glucose levels.
Main effect of insulin is to lower BS levels. It also stimulates amino acid uptake, fat metabolism, and protein synthesis in muscle tissue. It promotes oxidation of glucose for ATP production. |
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Hormonal Control of Fat Metabolism
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Insulin helps convert glucose to fat for storage.
cortisol and insulin facilitate lipid accumulation by expressing lipoprotein lipase (LPL). Growth hormone (GH) abolishes this and turns metabolism towards lipid mobilization. Testosterone and GH inhibit LPL and stimulate lipolysis markedly. |
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Hormonal Control of Electrolyte Balance
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Renin-angiotensin-aldosterone system... as well as chloride ion and prostaglandins. Renin release is stimulated by hyperpolarisation of the juxtaglomerular cell induced by beta 1-agonists, parathyroid hormone, glucagon, magnesium and low cytosol calcium. Renin release is inhibited by high calcium, potassium and angiotensin II. Subsequent to renin release, hormonal regulation includes stimulation of converting enzyme activity by cortisol and prostaglandin (PGE2). Other hormonal control includes antidiuretic hormone producing dilution of extracellular electrolytes and augmented peripheral resistance. Other electrolytes-. Chloride may play a dominant role in renal sodium reabsorption, responding to prostaglandin levels. Calcium has been recognised as a basic regulator of the secretion of such hormones as noradrenaline, renin, and aldosterone. As well, calcium ion changes are the means by which smooth muscle contraction is effected. Parathyroid hormone and vitamin D regulate the level of this ion in the body. Endocrine systems play a major role in the protection against acute elevations in serum potassium by means of insulin action and adrenergic modulation of extrarenal potassium disposal. Aldosterone is recognised as the delayed regulator of potassium excretion. Magnesium levels fall in hyperaldosteronism, hyperparathyroidism, and diabetic keto-acidosis, as well as in malnutrition states. The integrated action of these hormones and electrolytes are of major importance in regulation of the cardiovascular system.
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Heat Exhaustion
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Functional illness and not associated with organ damage. Caused by ineffective circulatory adjustments compounded by depletion of extracellular fluid, especially plasma volume, as a result of excessive sweating.
Sx:ashen an gray with cool, clammy skin, rapid weak pulse, low BP, profuse sweating, *temp <103F/39.5C |
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Heat Stroke
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Thermoregulatory system is overloaded and body's cooling mechanisms fail to dissipate the rising core temp. Hypothalamus shuts down all heat-control mechanisms including sweat glands to control water.
Sx: skin hot and dry, *temp >103F/39.5C, confusion, disorientation, irrational behavior, agitation |
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Cold-Induced Bronchospasm
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cold-DRY air leading to bronchospasm with SOB, coughing, chest tightness, and wheezing.
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Frostbite Injuries
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Individuals with cold urticaria (cold allergy) or Raynaud's syndrome are at higher risk.
1st degree/ superficial= involves skin and underlying tissues but deep tissues remain soft and pliable 2nd degree=damage into subcutaneous tissues 3rd degree/deep= involves tissues deep to subuctaneous layers and may result from complete destruction of injured tissues Management= rapid warming with warm water or whirlpool. Dry skin then and cover in sterile dressing |
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Hypothermia
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Body temp =/~95F/35C for mild or 90-94F/28-35C for moderate and <90F for severe forms.
For mild for Sx= shivering, slurred speech, confused, apathetic, stumbling, clumsy For moderate to severe= no pain, jerky movements and individual unaware of surroundings |
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Chilblain (Pernio)
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a tissue injury that occurs when a predisposed individual is exposed to cold and humidity. The cold exposure damages capillary beds in the skin, which in turn can cause redness, itching, blisters, and inflammation.[2] Chilblains are often idiopathic in origin but can be manifestations of serious medical conditions that need to be investigated. Chilblains can be prevented by keeping the feet and hands warm in cold weather. A history of chilblains is suggestive of a connective tissue disease.
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Heat Syncope
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another stage in the same process as heat stroke, it occurs under similar conditions, and it is not distinguished from the latter by some authorities. The basic symptom of heat syncope is a body temperature above 40°C (104°F) with fainting, with or without mental confusion, which does occur in heat stroke. Heat syncope is caused by mild overheating with inadequate water or salt.
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Paget–Schroetter disease/syndrome
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a form of upper extremity deep vein thrombosis (DVT), a medical condition in which blood clots form in the deep veins of the arms. These DVTs typically occur in the axillary or subclavian veins.
The traditional treatment for thrombosis is the same as for a lower extremity DVT, and involves anticoagulation with heparin (generally low molecular weight heparin) with a transition to warfarin. |
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Personal Protective Equipment (PPE)
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Glove, gowns, goggles, masks
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Universal Precautions
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avoiding contact with patients' bodily fluids, by means of the wearing of nonporous articles such as medical gloves, goggles, and face shields.
practiced in any environment where workers were exposed to bodily fluids, such as: Blood Semen Vaginal secretions Synovial fluid Amniotic fluid Cerebrospinal fluid Pleural fluid Peritoneal fluid Pericardial fluid Feces Urine |
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Short Acting Beta 2 agonists/ β2-adrenergic receptor agonists
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act on the beta2-adrenergic receptor thereby causing smooth muscle relaxation, resulting in dilation of bronchial passages, vasodilation in muscle and liver, relaxation of uterine muscle, and release of insulin.
Short-acting beta2 agonists generic name (Trade Name) salbutamol (albuterol (US name), Ventolin) levosalbutamol (levalbuterol (US name), Xopenex) terbutaline (Bricanyl) pirbuterol (Maxair) clenbuterol metaproterenol (Alupent) |
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Long Acting Beta Agonists
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Long-acting beta2 agonists
salmeterol (Serevent Diskus) formoterol (Foradil, Symbicort) |
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Pharmacokinetics
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Method by which drugs are absorbed, distributed, metabolized, or excreted by the body
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Pharmacodynamics
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Effect of a drug
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Abscess
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circumscribed collection of pus appearing in an acute or chronic localized infection. Appears as an encapsulated pocket of pus. Pain, redness, fever, and swelling usually present.
Tx: ice or hot bath may relieve pain. Clear fluids and bed rest helpful. Most require antibiotics and some require surgery. |
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Bacterial skin conditions
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Typically caused by staphylococcal or streptococcal infection.
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Onychia
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inflammation of matrix of the nail plate
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Paronychia
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inflammation of lateral border of nail or nail fold. Often follows a hangnail.
Tx: warm water soaks with germacide may reduce inflammation. Keep hands dry and avoid wearing rubber gloves. |
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Folliculitis
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Infection of upper portion of hair follicle and surrounding areas caused by staphylococci. Commonly referred to as an ingrown hair and develops d/t friction with pads or during shaving. Chemical irritants, inadequate chlorination, and superhydration from things like hot tubs are also causative factors.
Tx: Eliminating friction and applying mupirocin ointment. In widespread infection antibiotics such as dicloxacillin are required 3x/day for 10-14 days. |
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Furnucles and Carbuncles
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Also commonly called a abscess or boil, it is a complication of folliculitis from repeated trauma. Presents as well defined erythematous nodule that progresses into a pustule.
Tx: immediate referral for incision, drainage, and in severe cases hospitalization. Physical activity contraindicated until infection is gone as trauma can lead to cellulitis or thrombophlebitis. |
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Lightening Safety
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Risk of thunderstorms is greatest from 3-9pm when most outdoor sport activities occur. Thunderstorms can become threatening within 30 minutes of first sign of thunder. Games should be suspended when the "flash-to-bang" is within 30 seconds or if a thunderstorm appears imminent.
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Lightning injury mechanisms
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1. Direct Strike
2. Contact Injury 3. Side flash (splash) 4. Ground current (step voltage) 5. Blunt Trauma |
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Raccoon Eyes may indicate:
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Possible fracture at the eyebrow level causing swelling to travel into the anterior cranial fossa and sinuses
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Battle's Sign
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Discoloration that appears within minutes behind the ear at the mastoid process likely indicates a basilar fracture.
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Ultrasound Paramaters
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Frequency= 1 MHz for deep tissue of 3-5cm
3 MHz for tissues less than 2 cm deep but may have an affect on tissues from 2.5-3.0 cm deep Intensity (W/cm2)= ranges from 0.25-2.0. Greater intensity= greater resulting temperature elevation and can increase 7-8F up to 2.5 cm deep with the application of US at 1.5W/cm2 for 10 minutes. Superficial wounds=intensity of .5-1.0 W/cm2 pulsed at 20% with a frequency of 3 MHz. Elevating tissue temperature over a large quantity of tissue (hip/back)= continuous mode at 1.5-2.0 W/cm2 -Less soft tissue/over bones= 0.5-1.0 W/cm2 *Elevated temps should be maintained at least 5 minutes after Pt reports sensation of gentle heat to allow an increase in extensibility. For tissues >3cm deep 10 minutes of treatment after Pt reports warms is the minimum. |
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Commotio Cordis
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Cardiac arrest from a low-impact blunt blow in the absence of structural cardiovascular disease.
-Usually fatal and focus is on prevention |
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Epidural Hematoma
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Usually results from a blow to the side of the head and usually associated with a scull fracture.
Sx's: initial loss of consciousness followed by lucid interval when individual feels normal an asymptomatic. Shortly thereafter (10-20 min.) gradual decline in mental status occurs as hematoma develops. Other Sx's: headache, drowsiness, nausea, vomiting, decreased consciousness. Occasionally present- Ipsilateral dilated pupil on the side of the hematoma, contralateral weakness, and decebrate posturing. |
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Subdural Hematoma
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More frequent than epidural hematoma and leading cause of catastrophic death in football players. Hemorrhage occurs between brain and dura mater then they are torn. This is caused by acceleration forces not impact. May be classified as acute and either simple or complicated.
Sx's: Pupillary dilation and retinal changes on affected side, irregular eye tracking, severe headache, nausea and/or vomiting, confusion or difficulty with emotional control, impairment of consciousness, rising blood pressure, falling pulse rate, irregular respirations, increased body temp. |
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Legg-Calve-Perthes Disease
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Avascular necrosis of capital femoral epiphysis. Noninflammatory, self-limiting disorder seen in young children. Considered a ostechondrosis condition of femoral head caused by diminished blood supply.
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Sever's Disease
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Calcaneal apophysitis seen in 7-10 yr old children. Associated with growth spurts, decreased heel cord and hamstring flexibility. Often associated with heel pain or pain with standing on tiptoes.
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Scheuermanns Disease
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Degeneration of epiphyseal end plates in the thoracic spine of the vertebral bodies and typically includes at least three adjacent segments. Commonly effects children between age of 8-16.
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Kienbocks Disease
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Osteochondritis of the Lunate
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Depuytrens Contracture
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Nodules in the palmar aponeurosis limiting extension and cause a flexion deformity.
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Boutonnier Deformity
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PIP flexes while DIP hyperextends
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Mallet or Baseball finger
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Occurs when object hits end of finger when the extensor tendon is taut such as when catching a ball. Causes forceful flexion and can avulse lateral bands of extensor mechanism. Pt will be unable to extend DIP.
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Jersey Finger (Profundus Tendon Rupture)
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Rupturing of the flexor digitorum tendon from its attachment on the distal phalanx.
Sx's: One finger lying in comlete extension while others are in slight flexion at the IP joints. |
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De Quervains Tenosynovitis
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Pain over radial styloid process that increases with thumb and wrist motion. Caused by repetitive use from a forceful grip secondary to friction between abductor pollicis longus and extensor pollicis brevis.
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Costochondritis/ Costochondral sprain
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May be insidious and occur long after initial trauma.
Sx's: pain with deep inhalation, sharp clicks during bending maneuver as displaced cartilage overrides bone. Deformity can be palpated at involved joint. |
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Volkmanns Contracture
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Supracondylar fracture caused by falling on an outstretched hand causing ischemic necrosis of forearm muscles.
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Basic Nutritional Guid lines for Athletes
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Food ration breakdown:
15% protein 55% Carbohydrates 30% Fat Strength athletes= 1.5-2.2 g protein/kg Endurance athletes= 1-1.5 g/kg |
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Skin Lesions- Corns
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specially shaped callus of dead skin that usually occurs on thin or glabrous (hairless and smooth) skin surfaces, especially on the dorsal surface of toes or fingers. They can sometimes occur on the thicker palmar or plantar skin surfaces. Corns form when the pressure point against the skin traces an elliptical or semi-elliptical path during the rubbing motion
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Intertrigo/chafing
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inflammatory condition of skin folds
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Impetigo
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Highly contagious bacterial inflammation caused by staphy either alone or in combination with B-hemolytic streptococci (GABHS).
Can be transmitted by direct contact or through sharing unclean towels/cloths. Sx's: 2 types- bollous= fluid filled blisters that collapse centrally and has honey-crusted crusts. Ecthyma or nonbullous type is more serious and penetrates deep. |
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Hidradenitis Suppurativa
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Serious chronic inflammatory, suppurative disorder affecting follicles and sweat glands.
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Erysipelas
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Acute, superficial, bacterial infection of the dermis and hypodermis that extends into lymphatics.
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Erythrasma
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causes brown, scaly skin patches. It is caused by the Gram-positive bacterium Corynebacterium minutissimum. It is prevalent among diabetics and the obese, and in warm climates; it is worsened by wearing occlusive clothing.
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Otitis Externa (Swimmers Ear)
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Inflammation of outer ear an ear canal
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Methicillin-resistant Staphylococcus Aureus (MRSA)
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Tx: Vancomycin and Linezolid
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Dermatophytosis (Ringworm)
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Fungal skin infection
Tx: Anti-fungal topicals |
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Viral skin conditions
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Herpes, warts (human pipilloma virus), molluscum contagiousum
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Molluscum Contagiosum
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pox virus common in swimmers/wrestlers, gymnasts presents with small papules and is mostly a cosmetic problem. Moderately contagious but activity can be resumed once lesions are removed. May clear spontaneously. If localized can be covered for participation.
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