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Kin 2236 Athletic Injuries > Lecture 3: Medical Conditions > Flashcards

Lecture 3: Medical Conditions Flashcards

1
Q

Type I Diabetes

A

aka juvenile diabetes

Problem: pancreas doesn’t produce enough endogenous insulin
- can’t get sugar out of blood and into cells
- filtered out by kidneys

Leads to dependence on exogenous insulin

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2
Q

Type II Diabetes

A

inadequate insulin produced by the pancreas and/or

significant resistance at the cellular level (more frequent)

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3
Q

Hypoglycemia

A

Minimal sugar in blood stream
- too much insulin
- not enough food
- excessive exercise

  • decreased nutrients to brain
  • hunger
  • double vision
  • insulin shock/rxn.
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4
Q

Hyperglycemia

A

EMERGENCY

  • sugar present in blood stream but can’t get into tissue
  • cells starving
  • body starts converting fat
  • acidosis : ketoacidosis present
  • breath FRUITY smell
  • frequent urination
  • thirst
  • possible coma
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5
Q

Signs and Symptoms of hypoglycemia and hyperglycemia

A
  • altered level of consciousness (dizzy, drowsy, confused)
  • rapid breathing
  • rapid pulse
  • feeling ill
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6
Q

Management of Diabetes

A
  • ask if they have eaten or taken insulin
  • give sugar (juice, hard candy, glucose, non-diet soft drinks)
  • monitor for FIVE minutes
  • if hypoglycemic, it will improve
  • if hyperglycemic, there will be NO change (contact emergency medical care)
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7
Q

Epilepsy

A

Condition defined by recurrence of unprovoked seizures

Must have more than TWO (2) to be termed epilepsy

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8
Q

Seizure

A

A result of a discharge of electrical activity within the brain

could be focal (one part) or throughout the brain

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9
Q

Classification of Seizure Types

A

Focal onset
- aware, impaired awareness
- one part of brain
- motor and non-motor

Generalized onset
- throughout brain
- impaired awareness
- motor

Unknown onset
- motor and non-motor

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10
Q

Focal Seizures

A

occur in one part of brain and activate only a small number of neurons

  1. aware: usually BRIEF sensory, motor or memory-related symptoms
  2. impaired awareness: behavioural arrest, staring, blinking and automatism (ex. smacking lips), lasting minutes with postictal amnesia
    - might not remember what is going on around them
    - might know they had one or will have one

They may be motor to non motor (classified by first prominent sign/symptom)

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11
Q

Generalized seizures

A

bilateral discharge involving entire cortex

impaired awareness

can be motor or non-motor

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12
Q

Generalized motor seizures

A

ex. tonic/clonic (formerly Grand Mal)

  • motor
  • athlete falls to ground
  • goes through a tonic phase of stiffness
  • followed by “clonic” phase of twitches
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13
Q

Generalized non-motor seizures

A

ex. absence (formerly petite mal)

  • non-motor
  • sudden interruption of activity followed by a blank stare
  • eye fluttering and head nodding
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14
Q

Unknown onset seizures

A
  1. Motor
    - athlete falls to ground
    - goes through a tonic phase of stiffness
    - followed by “clinic” phase of twitches
  2. Non-motor
    - sudden interruption of activity followed by a blank stare
    - may or may not realize it happened
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15
Q

Management of seizures

A
  • protect their head
  • remove objects close by
  • do NOT restrain the athlete
  • do not place object in their mouth
  • position on side in RECOVERY position
  • TIME the seizure (activate EAP if >5 minutes)
  • assess for injury (contusions, dislocations; posterior shoulder dislocation is common)
  • 1st time = take them to hospital
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16
Q

Epilepsy and exercise

A
  • very few ppl have exercise as a precipitant
  • studies show that exercise actually decreases seizure frequency
  • normalize the EEG = increase seizure threshold and decreases likelihood of seizures ( decrease in EEG during exercise)
  • regular exercise = decrease in seizures compared to those who did not exercise
  • physical activity also enhances alertness and focus, which increases seizures threshold
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17
Q

Sports Participation and seizures

A
  • avoid activities where you can’t control environment (scuba, rock climbing, motor racing, downhill skiing)
  • frequency of seizures are important when considering swimming (ok with a buddy but risk for submersion accidents)
  • no adverse effects with regards to contact sports
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18
Q

What needs to be stressed to patients with seizures?

A

Proper diet, rest and adherence to medication

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19
Q

Asthma

A

Chronic inflammatory disorder of airways

  • excess mucus production and bronchial smooth muscle constriction = airway narrowing
  • max expiratory flow rate is reduced as air is trapped behind blocked airways (problem breathing out)
  • athlete must work harder to breathe b/c thorax becomes over-inflated
  • leads to respiratory muscle fatigue and physical distress (intercostal muscles must compensate)
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20
Q

Signs and Symptoms of Asthma

A

Airway hyperresponsiveness, leading to

  • recurrent episodes of wheezing
  • breathlessness
  • chest tightness
  • coughing (dry)
    – especially at night or in the cold morning
    – after exercise (especially in cold, dry env.)
21
Q

EIB

A

Exercise Induced Bronchospasm

A temporary narrowing of the airways INDUCED BY STRENUOUS EXERCISE

  • symptoms peak 8-12 minutes after exercise
22
Q

Pathiphysiology of EIB

A

After exercise, cells of lung rehydrate via hyperemia = bronchoconstriction + mucus production b/c the lung airways are dehydrated
- due to inhaled air being dry + cool
- lungs are dried out when they warm/humidify air

Degree is dependent on exercise intensity, temperature and humidity of inhaled air

23
Q

Diagnosis of EIB

A

Need TWO (2) things to diagnose
- symptoms (shortness of breath, coughing, chest tightness/wheezing)
- obstructed airways (10-15% DROP in FEV1) - FEV1 = amount of air you can breathe out in 1 sec

To test
- athlete works 6-8 mins at 80% max
- better if test is sport-specific
- may need cold air
- test w/ spiromete to see if there’s a 10-15% drop

24
Q

Management of EIB

A
  • educate on signs, symptoms, triggers
  • avoid exercising around irritants
  • using bronchodilators prior to exercise (if prescribed)

If bronchospasm happens:
- use bronchodilator
- position for ideal breathing (hands on heads, seated leaning forward)
- begin by slowing exhalation then inhalation

25
Q

PPE

A

Preparticipation Physical Examinations

Assess the ability to safely participate in sport activity
- NOT intended to disqualify/exclude
- help maintain health and safety in training/comp.

26
Q

Objectives of PPE

A
  • detect conditions that would restrict participation
  • detect conditions that may be life-threatening or disabling
  • injury prevention evaluation
  • meet legal and insurance requirements (main reason)
  • initiate and establish a rapport with the athlete
  • provide an opportunity for counseling
  • establish a database and record keeping system
27
Q

When does a PPE occur?

A

Preferably 4-6 weeks prior to season
- allows time for additional tests and treatment
- occurs generally closer to start of season

  • usually 1x/year
28
Q

PPE Team

A

Can include many different people
- physician, PT/kinesiologist, orthopedic surgeon, nurse, etc

Don’t recommend including coach b/c athlete might not want to give coach some info

29
Q

Office Based Method of Evaluation

A

Method of Evaluation for PPE

  • clinic or MD’s office
  • usually just one examiner
  • very TIME CONSUMING for large team
  • more expensive
30
Q

Station-Based Method of Evaluation

A

Method of Eval for PPE

  • usually what we do
  • less expensive
  • athlete meets more members
  • divided into medical and MSK
  • includes M.D. and other health professionals
  • fosters improved communication by medical team
  • may reduce staff burn-out
  • less personal
31
Q

Methods of Evaluation for PPE

A

Office based and station-based

No difference between both

32
Q

Components of PPE

A
  • complete medical history (most important)
  • medical eval form
  • musculoskeletal eval form
  • visual acuity
  • concussion
  • player status form
33
Q

Typical PPE Set Up

A
  • fees, drug education
  • history: self-report form and questions
  • trainer: height, weight, vision, SCAT5 (concussion)
  • team PT/trainer: MSK screen
  • team physician: medical exam
34
Q

Medical History

A
  • given 7-10 days in advance to facilitate complete family and past medical information
  • symptoms w/ exercise requiring further evaluation
  • female athletes : relative energy deficiency in sport (RED-S) – weight loss, low mineal density
35
Q

Red Flags

A
  • if something about history doesn’t fit the pattern, consider alternative less common conditions

Conditions
- bone and soft tissue tumors
- rheumatological conditions
- cardiovascular disorders
- infections
- genetic disorders

36
Q

Bone and Soft Tissue Tumors

A

Primary malignant tumors are rare
- usually in young (10-30/2nd decade)
- pain aggravated by activity

Red Flags
- night sweats
- fever
- loss of appetite
- unwarranted fatigue
- weight loss (one of biggest red flags)

37
Q

Rheumatologic conditions

A
  • rheumatoid arthritis, ankylosing spondilytis
  • could report a single or multiple swollen jts. (no history of trauma or injury)

Red Flags
- morning stiffness
- rashes
- fingernail pitting
- bowel disturbances
- eye irritation (conjunctivitus, iritis)

38
Q

Bone/Joint Infection

A
  • bone and jt. infections/osteomyelitis are uncommon
  • may report a single multiple swollen jts. (no history of trauma or injury)

Red Flags
- bone pain in children (at night or with activity)
- night sweats
- hot and swollen (no history of injury or trauma)

39
Q

Vascular conditions

A
  • deep vein thrombosis (blood clot)
  • presents w/ single limb pain
  • aggravated by exercise
  • possible precipitants (recent surgery, air travel)

Red Flags
- tenderness on palpation over tissue
- warmth
- swollen
- red, pale or bluis

40
Q

Optimizing medical history

A

Best for parents and athletes to do medical histories together to ensure agreement

medical histories reveal about 75% of problems affecting initial athletic participation

41
Q

Strongest independent predictors of sport injuries

A

Previous injury (higher odds ratio) and exposure time

42
Q

Medical examination

A

Physican

  • observation : look for health markers
  • dermatologic conditions (especially for rugby/wrestling)
  • vital signs
  • CV exam: listen to heart sounds (rule out cardiomyopathy, aortic stenosis)
43
Q

Hypertrophic cardiomyopathy (HCM)

A

Condition in which the heart muscle becomes THICK
- thickening makes it harder fro blood to leave the heart, forcing the heart to work harder to pump blood

  • can’t fill ventricle as much
44
Q

Aortic stenosis

A

aortic valve does NOT OPEN fully

  • decreases blood flow from the heart
45
Q

Asymptomatic athletes MSK exam

A

For asymptomatic athletes w/ no previous injuries, a 90-SECOND screening MSK test will detect 90% of significant MSK injuries

46
Q

What should prevent an athlete from participation in contact sports?

A
  • atlantoaxial (upper C-spine) instability = neck instability
  • history of significant head or spine trauma
  • acute/contagious illnesses
  • carditis (inflammation around the heart)
  • congenital heart disease
  • pulmonary compromise
  • absence of one kidney
  • enlarged liver/spleen (mono)
  • fever
  • significant MSK disorders
  • convulsive disorders (poorly controlled)
47
Q

What makes an effective screening test?

A

It must satisfy TWO (2) requirements:
1. can detect target condition EARLIER that without screening
2. screening and treating should IMPROVE likelihood of a favourable outcome

48
Q

Does PPE satisfy requirements of an effective screening test?

A

NO it does not

  • no evidence that the PPE can predict or prevent orthopaedic injury or CV sudden death
  • advising students about rules and equipment may decrease mortality and morbidity more effectively than the exam
49
Q

Complaceny and PPE

A

Complacency must be avoided when a PPE is unremarkable, yet the athlete displays early signs of distress (CV, orthopaedic or otherwise)

Kin 2236 Athletic Injuries (20 decks)

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