Lecture 15: Pre-Participation Sports Physicals Flashcards
(39 cards)
What is the ultimate goal of a Pre-Participation Physical Exam (PPE)?
Promote health and safety of student athletes
When is a PPE usually done?
6-8 weeks prior
Perform annually
Before whatever sport you wanna play
What are the 3 methods for doing a PPE?
- Locker-room
- Station
- Office-based
Describe locker-room PPEs
- LINE UP single file
- Line inspection one by one
- Little privacy & loud but efficient!
When is the station method for PPE best?
Large numbers
Efficient, but little privacy also. Conveyor belt
Splitting up duties.
Pros and Cons of Office PPE
- Pros: established relationship, privacy
- Cons: Lack of consistency, unfamiliarity with sports, lack of cost effectiveness
What is the main issue with pediatric providers providing PPEs for sports?
They’re not sports med people!
What is the most important part of PPE?
Medical history
What do we mainly care about in CV Medical Hx for a PPE?
Anything that can predispose them to sudden death
Kawasaki, Heart infection, CP w/ exercise, Murmur, HTN
What FMHx is significant for potential cardiac complications in a PPE?
- Premature deaths before 50 d/t heart dz
- Disability before 50
- FHx of PPM
- HOCM/DCM, Long QT, Marfan syndrome, arrhythmia
Age 50 seems important
What associated symptoms make a concussion complicated?
- Amnesia (either)
- Loss of consciousness (LOC)
- Seizure
- Prolonged symptoms
When is a child able to return to learn post concussion?
- Able to concentrate on a task
- Tolerable of visual and auditory stimulus for 30+ mins
- Return them with academic adjustments
Can they handle the noise/distractions of a classroom and focus
What are the requirements to begin return to play?
- Successful return to school
- Symptom-free and free off meds
- Normal neuro exam
- Baseline balance and cognitive function
How long is each step of the Return to Play protocol?
1 day
Must be symptom free for 24 hrs to move onto next step.
What two indications mean you MUST retire from contact/collision sports?
- Structural brain abnormality (AKA your brain is like permanently damaged)
- Nonresolving/Prolonged neurocognitive defects
Post-concussion
What are the 3 accepted/appropriate indications for a kid to retire from contact sports?
- Increased recovery times
- Repeat concussions with decreased thresholds and persistent symptoms
- Multiple concussions
AKA too many concussions and can’t recover well anymore.
What are the high-risk areas on the MSK exam for kids?
- Shoulder
- Knee
- Ankle
Which murmur gets quieter upon standing?
Aortic stenosis/regurg
so much blood, can’t close valves as hard
What murmur gets louder on standing?
Hypertrophic CM
More venous return
Imagine a stiff balloon getting filled more and then squeezing it so it pops even louder.
What is the MCC of sudden cardiac death in children?
HCM (1/3 of all cases)
What is the second MCC of sudden death in athletes?
Coronary artery abnormality
Left main coming off R sinus
Anomalous origin of LCA
What congenital heart defects are most associated with anomalous coronary arteries?
- TGA
- ToF
- Pulmonary atresia
The cyanotic CCHD
Why is ACA not caught early?
We don’t regularly cath kids, and there are rarely symptoms prior to a severe event.
Anomalous coronary artery
What is the most serious concern with Marfan’s?
Progressive aortic root dilation
also can cause MVP
CT Disorders = aortic dissection
