Lecture 3: Medical Conditions Flashcards
Type I Diabetes
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
Type II Diabetes
inadequate insulin produced by the pancreas and/or
significant resistance at the cellular level (more frequent)
Hypoglycemia
Minimal sugar in blood stream
- too much insulin
- not enough food
- excessive exercise
- decreased nutrients to brain
- hunger
- double vision
- insulin shock/rxn.
Hyperglycemia
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
Signs and Symptoms of hypoglycemia and hyperglycemia
- altered level of consciousness (dizzy, drowsy, confused)
- rapid breathing
- rapid pulse
- feeling ill
Management of Diabetes
- 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)
Epilepsy
Condition defined by recurrence of unprovoked seizures
Must have more than TWO (2) to be termed epilepsy
Seizure
A result of a discharge of electrical activity within the brain
could be focal (one part) or throughout the brain
Classification of Seizure Types
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
Focal Seizures
occur in one part of brain and activate only a small number of neurons
- aware: usually BRIEF sensory, motor or memory-related symptoms
- 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)
Generalized seizures
bilateral discharge involving entire cortex
impaired awareness
can be motor or non-motor
Generalized motor seizures
ex. tonic/clonic (formerly Grand Mal)
- motor
- athlete falls to ground
- goes through a tonic phase of stiffness
- followed by “clonic” phase of twitches
Generalized non-motor seizures
ex. absence (formerly petite mal)
- non-motor
- sudden interruption of activity followed by a blank stare
- eye fluttering and head nodding
Unknown onset seizures
- Motor
- athlete falls to ground
- goes through a tonic phase of stiffness
- followed by “clinic” phase of twitches - Non-motor
- sudden interruption of activity followed by a blank stare
- may or may not realize it happened
Management of seizures
- 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
Epilepsy and exercise
- 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
Sports Participation and seizures
- 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
What needs to be stressed to patients with seizures?
Proper diet, rest and adherence to medication
Asthma
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)
Signs and Symptoms of Asthma
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.)
EIB
Exercise Induced Bronchospasm
A temporary narrowing of the airways INDUCED BY STRENUOUS EXERCISE
- symptoms peak 8-12 minutes after exercise
Pathiphysiology of EIB
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
Diagnosis of EIB
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
Management of EIB
- 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
PPE
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.
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 requirements (main reason)
- initiate and establish a rapport with the athlete
- provide an opportunity for counseling
- establish a database and record keeping system
When does a PPE occur?
Preferably 4-6 weeks prior to season
- allows time for additional tests and treatment
- occurs generally closer to start of season
- usually 1x/year
PPE Team
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
Office Based Method of Evaluation
Method of Evaluation for PPE
- clinic or MD’s office
- usually just one examiner
- very TIME CONSUMING for large team
- more expensive
Station-Based Method of Evaluation
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
Methods of Evaluation for PPE
Office based and station-based
No difference between both
Components of PPE
- complete medical history (most important)
- medical eval form
- musculoskeletal eval form
- visual acuity
- concussion
- player status form
Typical PPE Set Up
- fees, drug education
- history: self-report form and questions
- trainer: height, weight, vision, SCAT5 (concussion)
- team PT/trainer: MSK screen
- team physician: medical exam
Medical History
- 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
Red Flags
- 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
Bone and Soft Tissue Tumors
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)
Rheumatologic conditions
- 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)
Bone/Joint Infection
- 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)
Vascular conditions
- 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
Optimizing medical history
Best for parents and athletes to do medical histories together to ensure agreement
medical histories reveal about 75% of problems affecting initial athletic participation
Strongest independent predictors of sport injuries
Previous injury (higher odds ratio) and exposure time
Medical examination
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)
Hypertrophic cardiomyopathy (HCM)
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
Aortic stenosis
aortic valve does NOT OPEN fully
- decreases blood flow from the heart
Asymptomatic athletes MSK exam
For asymptomatic athletes w/ no previous injuries, a 90-SECOND screening MSK test will detect 90% of significant MSK injuries
What should prevent an athlete from participation in contact sports?
- 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)
What makes an effective screening test?
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
Does PPE satisfy requirements of an effective screening test?
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
Complaceny and PPE
Complacency must be avoided when a PPE is unremarkable, yet the athlete displays early signs of distress (CV, orthopaedic or otherwise)
