PREPARTICIPATION PHYSICAL EVALUATION Flashcards
(56 cards)
What is the PPE (preparticipation physical evaluation)
sports physical…
- this is an important first step in assisting athletes in maintaining health and ensuring safe participation in training & competition
- wide variation in recommendations / requirements of what makes up a PPE
most PPE recommendations carry a level____ supported data recommendations
level C
STATE DIFFERENCES: MONTANA VS TEXAS
o Montana = annual exam completed after May 1st for next year - can be performed by any licensed medical professional
o Texas = need 2 forms (medical HX & PE). Medical hx completed yearly, but PE performed every other year unless yes to any hx questions that warrant PE
OBJECTIVES OF PPE
- primary (essential) vs secondary (ideal)
o Primary or Essential
⦁ This is the only medical contact for 30-88% of these adolescents (not getting other contact with any other medical professional that year other than for PPE)
⦁ To detect conditions that may limit participation
⦁ To detect conditions that may predispose patient to injury
⦁ Meet legal & insurance requirements
o Secondary or Ideal Objectives
⦁ Assessing general health & identifying health risk behaviors (ie: CV health, mental health
⦁ Assess physical maturity
⦁ Determine fitness & performance level
TIMING & FREQUENCY OF PPE
- Should be performed at least 6 weeks before starting sports season to allow adequate time to address any issues
- Montana regulations = must be done annually for high school athletes
- Need a comprehensive baseline PPE before initiating a sports season
- Subsequent annual PPEs may be limited to recent injuries that may have occurred (focus on that), but also includes a review of Cardiopulmonary system
PPE should be formed at least _________ before starting sports season to allow adequate time to address any issues
6 weeks
Need a comprehensive ____________ before initiating a sports season
baseline PPE
- Subsequent annual PPEs may be limited to recent injuries that may have occurred (focus on that), but also includes a review of ____________ system
Cardiopulmonary
PPE FORMAT
OFFICE-BASED VS GROUP SCREENING
o OFFICE BASED
⦁ Advantages = physician-patient familiarity, privacy, and continuity of care
⦁ Disadvantages = cost, limited appointment time, and lack of communication back to the school’s athletic staff
o GROUP SCREENING
⦁ Advantages = specialized personnel, time, and cost-efficiency
⦁ Disadvantages = rushed, lack of privacy, and potential for poor follow-up of identified problems
⦁ Mayo Clinic study of PPE - found that station type formats (group screening) = effective and safe
advantages & disadvantages to an office-based PPE
⦁ Advantages = physician-patient familiarity, privacy, and continuity of care
⦁ Disadvantages = cost, limited appointment time, and lack of communication back to the school’s athletic staff
advantages & disadvantages to a group screening PPE
⦁ Advantages = specialized personnel, time, and cost-efficiency
⦁ Disadvantages = rushed, lack of privacy, and potential for poor follow-up of identified problems
⦁ Mayo Clinic study of PPE - found that station type formats (group screening) = effective and safe
cornerstone of PPE
history
may identify 75% of problems affecting athletes
key history questions of PPE = focus on
CARDIOVASCULAR QUESTIONS
Cardiovascular Questions of PPE
⦁ Identifies hypertrophic cardiomyopathy - leading cause of sudden cardiac death in athletes
⦁ Marfans (leads to aortic rupture)
⦁ Premature atherosclerosis
EKG DEBATE IN PPEs
not currently used on all athletes; consensus = not cost effective or time-effective. Don’t have resources for pediatric cardiologists to read all of these EKGs, so general consensus = not needed
MOST COMMON CARDIOVASCULAR CAUSE OF SUDDEN DEATH
HYPERTROPHIC CARDIOMYOPATHY
CARDIOVASCULAR CAUSES OF SUDDEN DEATH
⦁ Hypertrophic cardiomyopathy = MC*** ⦁ Anomalies of the coronary arteries ⦁ Atherosclerotic Heart Disease ⦁ Marfan's Syndrome ( --> aortic rupture) ⦁ Aortic Stenosis ⦁ Mitral Valve Prolapse
what is hypertrophic cardiomyopathy
- Primarily a disease of the myocardium with hypertrophy without any obvious cause
- FREQUENTLY ASYMPTOMATIC until sudden cardiac death
- May be identified by ECG or PE
danger of hypertrophic cardiomyopathy is that it is frequently
ASYMPTOMATIC until sudden cardiac death
Hypertrophic cardiomyopathy may be identified via:
- EKG
- PE
specific CV questions from PPE
⦁ Have you ever passed out during exercise?
⦁ Have you ever been dizzy or lightheaded during or after exercise?
⦁ Chest Pain during or after exercise?
⦁ Have you ever passed out during or after exercise?
⦁ Have you ever noticed a racing heart or skipped beats?
⦁ Have you ever been told you have a heart murmur or heart condition?
IF YES TO ANY OF THESE QUESTIONS —> FULL CV WORK-UP
PPE PHYSICAL EXAM
- Should be comprehensive, however, focused on any pertinent findings from HX
- Should not be in such an environment that specific findings of concern cannot be adequately addressed at the time
BP values during PE
if pt is < 10 =
if pt > 10 =
pt < 10 = > 125/75
pt > 10 = > 135/85
Palpation of UE & LE pulses
⦁ brachial - femoral delay may mean
coarctation of the aorta
MURMURS DURING PPE EXAM
- Heart auscultation in 2 positions, and with provocative maneuvers - may help detect murmurs
⦁ Valsalva, Position change - Location of Murmur
- Precordial Palpation (increased)
- PMI displaced laterally
