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athletic injuries 2036 > lecture 3: medical issues > Flashcards

lecture 3: medical issues Flashcards

1
Q

diabetes

A
  • type 1 and type 2
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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
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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
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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
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5
Q

types of diabetic problems

A
  1. hypoglycaemia
  2. hyperglycaemia
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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
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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
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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
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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
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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
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11
Q

what are the 3 main types of seizures?

A
  1. focal onset
  2. generalized onset
  3. unknown onset
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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
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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
      1. 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
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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
      1. non- motor
    • sudden interruption of activity followed by a blank stare
    • may or may not realize it occured
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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)
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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
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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
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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
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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
    1. symptoms (shortness of breath, coughing, chest tightness/ wheezing)
    2. 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
Q

management/coping strategies for broncho

A
  • 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
Q

what is a PPE?

A
  • 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
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 requirement
  • initiate and establish a rapport with the athlete
  • provide an opportunity for counselling
  • establish a data base and record keeping system
28
Q

when does a PPE occur?

A
  • 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
Q

the PPE team

A
  • may include:
  • physician
  • P.T./ A.T/ Kinesiology
  • orthopedics surgeon
  • nurse
  • dentist
  • sport psychologist
  • dietician
  • opthamologist
  • coach?
30
Q

methods of evaluation for PPE

A
  1. office based
  2. station based
31
Q

office based method of PPE

A
  • 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
Q

station based method of PPE

A
  • 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
Q

typical PPE set up

A
  • 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
Q

medical history for PPE

A
  • 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
Q

red flags in athletes health

A
  • 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
Q

bone and soft tissue tumors

A
  • 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
Q

Rheumatologic conditions

A
  • 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
Q

infection

A
  • 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
Q

vascular conditions

A
  • 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
Q

medical examination

A

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
Q

Hypertrophic cardiomyopathy (HCM)

A

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
Q

aortic stenosis

A
  • when the aortic valve does not open fully. this decreases the blood flow from the heart
43
Q

MSK examination

A

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
Q

physical examinations

A
  • previous injuries
  • fractures, ligament and tendon injuries
  • general strength/weakness
  • laxity
  • posture / scoliosis
45
Q

AAP committee on sports medicine

A
  • 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
Q

carditis

A
  • inflammation around your heart (was in issue coming out of covid because a lot of people were experiencing it)
47
Q

an effective screening test has been described by the United States Preventative Services Task Force as satisfying two requirements

A
  1. can detect target condition earlier than without screening
  2. screening and treating should improve likelihood of a favourable outcome

athletic injuries 2036 (20 decks)

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