lecture 3: medical issues Flashcards
(47 cards)
1
Q
diabetes
A
- type 1 and type 2
2
Q
type 1 diabetes
A
- type 1 - 10% (aka juvenile diabetes
- problem: pancreas fails to produce enough endogenous insulin
- can’t get sugar out of blood and into cells
- filtered out by kidneys
- leads to dependence on exogenous insulin
3
Q
diabetes - type 2
A
- type 2 - 90%
- inadequate insulin produced by the pancreas and/or significant resistance at the cellular level
- there is insulin, however the issue is with insulin receptors
4
Q
hypoglycaemia
A
- hypoglycaemia (not enough sugar in the bloodstream)
- minimal sugar in the bloodstream
- too much insulin
- not enough food
- excessive exercise
- decreased nutrients to brain
- hunger
- double vision
- insulin shock/reaction
- hypo means low, minimal sugar in blood stream
5
Q
types of diabetic problems
A
- hypoglycaemia
- hyperglycaemia
6
Q
hyperglycaemia
A
- sugar present in blood stream, but can not get into tissue
- cells starving
- body starts converting fat
- acidosis
- ketacidosis present
- breath fruity smell
- frequent urination
- thirst
- possible coma
7
Q
typical presentation of hypoglycaemia and hyperglycaemia
A
- major signs are similar
- altered level of consciousness (dizzy, drowsy and or confused)
- rapid breathing
- rapid pulse
- feeling ill
8
Q
management of hypoglycaemia and hyperglycaemia
A
- ask if they have eaten or taken insulin
- give sugar (juice, hard candy, glucose tablets, non-diet soft drinks)
- monitor 5 minutes
- if hypoglycaemic they will improve
- if hyperglycaemic there will be no change
- refer for advanced emergency medical care
9
Q
epilepsy
A
- epilesy… is a condition defined by the recurrence of unproved seizures.
- a seizure is a result of a discharge of electrical activity within the brain
- must have more than 2 to be termed Epilepsy
10
Q
the epileptic athlete
A
- 10% of the population will have at least one seizure, but only 2% will go on to have recurrent unprovoked seizures or epilepsy.
- likely that many newly diagnosed patients will be participating in athletic at the time of diagnosis
11
Q
what are the 3 main types of seizures?
A
- focal onset
- generalized onset
- unknown onset
12
Q
focal seizures
A
- occur in one part of the brain and activate only a small number of neurons
1. aware - usually consisting of brief sensory, motor, or memory related symptoms.
2. impaired awareness - usually associated with behavioural arrest, staring, blinking, and automatisms, lasting minutes with postictal amnesia (having trouble remembering the events that comes before) - these may be motor or non motor and are classified by the first prominent sign or symptom
13
Q
generalized seizures
A
- bilateral discharge involving entire cortex. impaired awareness
1. generalized motor (i.e. tonic/clonic (formerly Grand Mal)- motor
- athlete falls to ground
- goes through a tonic phase of muscle stiffness
- followed by “clonic” phase of muscle twitches
- generalized non - motor (i.e. absence (formerly petite mal)
- non-motor
- sudden interruption of activity followed by a blank stare
- eye fluttering and head nodding
14
Q
unknown onset seizures
A
- do not know why it is happening, could be due to a lesion in the brain or other things)
1. motor- athlete falls to ground
- goes through a tonic phase of muscle stiffness
- followed by ‘clonic” phase of muscle twitches
- non- motor
- sudden interruption of activity followed by a blank stare
- may or may not realize it occured
15
Q
management for 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 ASAP
- time seizure (activate EAP if greater than 5 min
- assess for injury: (contusion, dislocation)
16
Q
epilepsy and exercise
A
- fatigue, exertion and stress may be a trigger of seizures
- only 2 of 400 listed exercise as a precipitant
- more commonly listed: stress (30%), sleep deprivation (18%), fever / illness (14%), menses (21%)
- 2% have seizures in more than 50% of training sessions
- intense activity
- most had structural lesion
17
Q
benefits of exercise for people with epilepsy
A
- multiple studies have shown that exercise actually decreases seizure frequency
- normalize the EEG = increase seizure threshold and decrease likelihood of seizures
- decrease in EEG during exercise
- patients who exercised regularly had significantly decreased seizures than those who did not
- physical activity also enhances alertness and focus, which increases the seizure threshold
18
Q
sports participation for people with epilepsy
A
- should avoid scuba, rock climbing, motor racing and downhill skiing
- frequency of seizures are important when considering activities such as swimming
- 4x more likely to be involved in submersion accidents
- swimming, ok with buddy
- no adverse effects with regards to contact sports
- shooting, archery, horseback riding
- must stress: proper diet, rest and adherence to medication for seizure control
19
Q
asthma
A
- chronic inflammatory disorder of the airways
- excess mucus production and bronchial smooth muscle constriction causing airway narrowing
- maximal expiratory flow rate is reduced as air is trapped behind the blocked airways
- the athlete must work harder to breath as the thorax becomes over-inflated
- with progression of the attack, the diaphragm and intercostal muscles must compensate, and muscle efficiency is eventually lost.
- leads to respiratory muscle fatigue and physical distress that may result in death.
20
Q
disruption of the expiratory flow
A
- they breath in and the mucus begins to block the lungs and basically the athletes can not breath in because of the blockages
21
Q
signs and symptoms of asthma
A
- chronic inflammation causes an increse in airway hyper-responsiveness, leading to:
- recurrent episodes of wheezing
- breathlessness
-chest tightness (or chest pain in children)
-coughing (dry)- particularly at night or in the early morning
- after exercise especially in cold, dry environments
22
Q
exercise induced bronchospasm
A
- by definition, a temporary narrowing of the airways (bronchospasm) induced by strenuous exercise in which the patient has no symptoms is known as EIB
- used to be used interchangeably with EIA - where an asthmatic has exercise as a trigger … that is changing.
-80% of asthmatics- 40% season allergies
- 12-15% in general population
23
Q
pathophysiology of EIB
A
- symptoms peak 8-12 minutes
- exercise triggers bronchoconstriction because it leads to dehydration of the lungs airways
- inhaled air is dry and cool
- air warmed/humidified in the lungs = drying out
- after exercise, the cells rehydrate via hyperaemia, leading to a cascade of biochemical changes that trigger bronchonconstriction
- the degree is dependent upon exercise intensity, the temperature and humidity of the inhaled air
24
Q
diagnosis of exercise induced Bronchospasm
A
- need 2 things to diagnose
- symptoms (shortness of breath, coughing, chest tightness/ wheezing)
- obstructed airways 10-15%
- both associated with exercise
- to test:
- athletes works 6-8 minutes at 80% maximum
- better if test is sport specific
- may need cold air, if testing winter athlete
25
management/coping strategies for broncho
- educate on the signs, symptoms and triggers
- avoid exercising around or near irritant if possible
- using bronchodilators (beta 2 agonists) as prescribed, prior to exercise.
- if bronchospasm occurs:
- use bronchodilator as prescribed
- position for ideal breathing
- begin by slowing exhalation and then inhale
26
what is a PPE?
- medical physical examination assessing the ability to safely participate in sport activity
- not intended to disqualify or exclude
- help maintain health and safety in training and competition
27
objectives of PPE
- detect conditions that would restrict participation
- detect conditions that may be life threatening or disabling
- injury prevention evaluation
- meet legal and insurance requirement
- initiate and establish a rapport with the athlete
- provide an opportunity for counselling
- establish a data base and record keeping system
28
when does a PPE occur?
- preferably 4-6 weeks prior to season
- this will allow time for any additional tests to be ocmpleted as well as treatment of any identified problems
- generally occurs closer to the start of the season
- end of preceding seasion
- usually 1 per year
29
the PPE team
- may include:
- physician
- P.T./ A.T/ Kinesiology
- orthopedics surgeon
- nurse
- dentist
- sport psychologist
- dietician
- opthamologist
- coach?
30
methods of evaluation for PPE
1. office based
2. station based
31
office based method of PPE
- clinic or M.D's office
- usually just one examiner
- may be one P.T. but consultation are necessary
- very time consuming for a large team
- more expensive
32
station based method of PPE
- less expensive
- athletes meets more members
- divided into medial and MSK
- included M.D. and other health professionals
- fosters improved communication by medical team
- may reduce staff burn-out
- less personal
- bottom line
- there is no difference between office based and station based excluded or referred equal number of athletes
33
typical PPE set up
- fees, drug education as per Usport
- history - self report form and questions
- trainer - height, weight, vision, SCAT5 (concussion)
- team PT/ Trainer - MSK screen
- team physician - medical exam
34
medical history for PPE
- given 7-10 days in advance to facilitate complete family and past medical information
- symptoms with exercise (cardio/syncope) requiring further evaluation
- concussions
- meds, alcohol, drugs
- recent infections
- female athletes
- relative energy deficiency in sport (RED-S)
35
red flags in athletes health
- if there is something about the history that does not fit the pattern, then consider alternative less common conditions.
- conditions
- bone and soft tissue tumors
-rheumatological conditions
-cardiovascular disorders
-infections
-genetic disorder
36
bone and soft tissue tumors
- primary malignant tumors are rare
- usually in young (2-3rd decade) but can be any age
-pain aggravated by activity
- red flags:
- night pain/sweats
- fever
- loss of appetite
-unwarranted fatigue
- weight loss
-10-15 lb in a week
37
Rheumatologic conditions
- Rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis
- could report a single or multiple swollen joints
- no history of trauma or injury
- red flags:
- morning stiffness
- rashes
- fingernail pitting
- bowel disturbances
- eye irriation
- conjunctive, iritis
- could be a single joint, but is more common to have multiple joints affects
- it spreads to other joints without any physical trauma
38
infection
- bone and joint infections/ osteomyelitis are uncommon
- may report a single or multiple swollen joints
- no history of trauma or injury
- red flags:
- bone pain in children both at night or with activity night sweats
- hot and swollen
- with no history of trauma
39
vascular conditions
- deep vein thrombosis (blood clot)
- presents with single limb pain
- aggravated by exercise
- possible precipitants
- recent surgery
- air lavel
- red flags:
- tenderness on palpation over tissue
- warmth
- swollen
- red, pale or bluish
40
medical examination
Physician
- observation (look for health markers)
- dermatologic conditions
- vital signs (HR, BP, RR, Temperature)
- cardiovascular examination (listen to heart sounds, Rule out hypertrophic Cardio-Myopathy, aortic stenosis, etc)
41
Hypertrophic cardiomyopathy (HCM)
a condition in which the heart muscle becomes think. the thickening makes it harder for blood to leave the heart, forcing the heart to work harder to pump blood.
42
aortic stenosis
- when the aortic valve does not open fully. this decreases the blood flow from the heart
43
MSK examination
Physio/AT/Chiro
- screening exam
- specific tests based on history
- functional tests
- perfect area for clearing tests
- neurological scans
- the screening physical examination is 51% sensitive and 97% specific
44
physical examinations
- previous injuries
- fractures, ligament and tendon injuries
- general strength/weakness
- laxity
- posture / scoliosis
45
AAP committee on sports medicine
- individuals may be precluded from participation in contact sports or require further testing for any of the following reasons:
- atlantoaxial (Upper c-spine) instability
- history of significant head or spine trauma
- acute/contagious illnesses
- carditis
-congenital heart disease
- pulmonary compromise
46
carditis
- inflammation around your heart (was in issue coming out of covid because a lot of people were experiencing it)
47
an effective screening test has been described by the United States Preventative Services Task Force as satisfying two requirements
1. can detect target condition earlier than without screening
2. screening and treating should improve likelihood of a favourable outcome
