Medical Issues Flashcards
Epistaxis that has clear fluid out of nose
and OR patient reports a sweet post nasal drip
-indicates CSF LEAKAGE
-clear fluid out of nose
-reports a sweet post nasal drip
-can be caused by nasal or cribiform fractures
-PATIENT AT RISK FOR MENINGITIS- NEEDS ANTIBIOTICS
Cribiform Plate Fracture
Thin bone- part of ethmoid bone above nasal cavity and under olfactory bulb
associated w/
-septal hematoma
-oflactory dysfuxn
-CSF leakage
-infection- meningitis
Epistaxis
nosebleed
Rupture to spleen presents:
- can refer to shoulder- Kehr’s sign
-Left UQ TTP
-abd guarding and rebound tenderness
-systemic symptoms
What kind of force poses greatest risk for serious brain injury
Rotational
What kind of head injury presents with a lucid interval followed by declined mental status
Epidural hematoma- where the blood is
-typically involves an artery
-progresses rapidly
Care for knocked out tooth
- rinse and re-implant tooth ASAP and send to dentis
- if can’t place in saline and send to dentist
What is the 1st step when encountering a conscious football player with likely concussion?
Assess for ligamentous or structural disruption or instabilty by testing PROM for bony block or instability
What does SAMPLE stand for?
Signs & symptoms,
Allergies,
Medications,
Past Medical History,
Last Food or Drink
Events leading up to the present injury
Describe Epidural Hematoma
-blood between dura mater and skull–inr pressure in intercranial space
-LOC follwed by lucidity and then gradual progression of symptoms
-decrease visual field
-dizziness/nausea
-dec conciousness
-neck rigidity
-decr pulse and breathing
- deadly and rare
- care: urgent neuro surgery- CT or will be deadly
Describe Subdural Hematoma
Blood in outermost meningeal layer
-tear in venous vessels
-incr pressure
-LOC
dialation of pupils
-HA, dizziness, Nausea, sleepiness
-care- immediate medical care CT/MRI
-can be delayed in onset
Care for trauma to head
-
-PALPATE- check for underlying fracture
-clean with antiseptic soap and water and remove debris
-cut away hair prn
-firm pressure to decr bleeding
-wounds > 1/2 inch- refer
-smaller- cover w pad and gauze
Tongue lacerations
-Refer for
flap, bisection or >1 cm, 30% or more of tongue, U shape or deformity
-
care for chipped tooth
return to play- see dentist after
Crown fracture
-can be complicated
-bleeding and sig pain
-if uncomplicated- - put remainder of tooth in bag of saline, control bleeding w gauze
-can return to play and f/u dentist
Tooth luxation
loose or dislodged- refer in 48 hours
-if tooth out of cavity- replace and refer immediately
Tooth knocked out of cavity
-attempt re-implantation w/in 20 min
-save tooth in saline/saliva/milk
-refer immediately
DONOT
wash tooth
hold by root or wait more than 20 min
Auricular Hematoma
Cauliflower Ear
-caused by compression or shear force
-subcutaneous bleeding
-ear protection prevents
-apply ice
- prevent fluid solidification- pack ear w/ guaze tight in and behind ear
- keep compression on it
- may need to refer to drain
Tympanic Membrain Rupture
-caused by fall or slap to ear (water polo)
- loud pop, intense pain, vommiting dizziness
-sig hearing loss
-can see rupture thru otoscope
-small perferations can heal 1-2 weeks
-monitor for infection
-no flying until sx’s resolved
Otitis Externa
Swimmers Ear
-infected ear canal from trapped water
-can have vestibular sx’s, pain, discharge, partial hearing loss
care: prevention- dry ears, ear drops- asorbic acid and alcohol, avoid overexposure to cold wind
- may need antibiotics
-
Ototitis Media
Middle Ear infection
-local and systemic infection
-sxs: fluid drainage, intense pain, transient hearing loss, fever, HA’s nausea
Care: can be drained
analgesics and antibiotics 24-72 hours
Eipstaxis
nose bleed
causes: high humidity, allergies, trauma
Care: sit upright w/ cold compress over nose w/ pressure on nostril
gauze between upper lip and gum- limits blood supply
- NEVER TIP HEAD BACK
-if bleeding more than 5 min- apply astringent/gauze, nose plug
-don’t blow nose for 2 hours
-wrestles can play
Nasal Fracture
-direct blow
sx: separation of whole frontal process of maxilla
-separation of lateral cartilage
-or both above
-profuse bleeding
-immediate SWELLING
-control bleeding, xray, can be back in 1 week with splint
Deviated Septum
- can accompnay frx
-septum pushed laterally
-if don’t see from front- look superiorly at nostrils
-profuse bleeding
-hematoma
-Care- control bleeding and refer to GP
Closeline Injury
At throat
-laryngeal injury
-severe pain
-spasmodic coughing
- difficulty speaking and swalling
- if frx of cartilage- frothing blooding coughing, inabiilty to breath, cynanosis
-ABC’s!! if airway and circ intact, may need to apply cold
Carotid Artery Dissection
- constant pressure and get to ER
DO NOT STAND UP!!!!!
Mandibular fracture
-trauma/direct blow
-generally at frontal bone
-deformity
-parasthesias of lower lip
- pain biting, bleeding
-Care: temporary immobilization w/ wrap then refer to MD for Sx
Orbital Fracture
blow to eyeball
pushes it posteriorly into orbital area
usually from a baseball
sxs: diplopia
DOWNWARD displacement of eye- pupils may point up in socket
- swelling and bruise
-numbness
-ER and xray
treated w/ antibiotics 2/2 close to sinus- usually surgery
Zygomatic Fracture
sunken face
-sig epistaxis
-diplopia
-CHECK FOR N/T
Care: apply cold, refer to MD
8 weeks to heal, may need 1 year for RTS
Maxillary Fracture
cheekbone
-elongated face
-epistaxis
-may require Airway Management!!!
ruptured globe
damage to outermembrane of ye
blunt trauma or penetration
opthamologic emergency ER
damage to posterior eye
Corneal Abrasion
- scratch on cornea- can be from rubbing
-sudden onset of pain
-watering, photophobia,
-blinking (use patch)
-treated with topical antibiotics
-see opathomolgist
hyphema
SERIOUS
- blunt blow to eye
-collection of blood anterior chamber of eye
- red tinge or pea green in lower iris
-partial vision loss
-usually bed rest / incline to 30-40 degrees
-send to MDx
detached retina
blow or atraumatic
PAINLESS
sx’: specs or flashes of light in vision
-“curtain” falling over field of vision
-immediate referal to opthamologist
conjunctivitis
pink eye
-bracteria, allergens, smoke
-eyelid swelling
-discharge
- can be highly infectious
refer to MD
Eye Hordeolum
Sty
acute infection of eyelid
blocked gland - oil gets backed up
- pain
can have infection
nodule
periorbital lacerations
common
usually at eyebrows
refer if >1/2 inch 2/2 may need sutures and risk of infection
Foreign bodies in eye- what to do?
AVOID RUBBING
flush with saline, eyedrops or blink
which eye injuries need ER
globe ruptures
periorbital fractures
hyphema
Iritis
Detached Retina
MD persistent visual disturbance
corneal abrasion
List the Canadian C SPINE rules
- high risk factor- YES xray
-dangerous mechanism- parasthesisas in extremities
- 65 or older
- Low Risk Factors that allow evaluation of ROM -if none- no xray
if any YES xray- simple rear end MVA
-sitting position in ED
-ambulatory at anytime since injury
-delayed onset neck pain
-abscence of midline TTP
- simple rear end MVA
- Patient able to actively rotate 45 dg bilaterally? if yes- don’t need xray
organ damage
Blunt trauma
can result in internal bleeding or organ failure
can hemorrhage slowly sometimes over weeks before any signs/sx’s
Bladder trauma
hematuria
difficulty urinating
abd rigidity
Kidney injury
mm guarding
back/flank pain
N/V or shock
can affect intestines bloating
changes in bowel fxn
BP changes
Liver trauma
high abdominal- especially R side
rapid HR
low BP
abd pain
N/V,
blood in vomit, feces or urine
Splenic Trauma
systemic illness (mono)
shock, cool pale skin
weak rapid pulse
possibly Kehr’s sign- referred pain to LEFT SHOULDER andn arm
Describe assessment for Abdominal Injuries
- Check rebound tenderness- fingers of one hand over other- pressure and quick release
- check vital signs
if these are abnormal- transport to ER
if unsafe to transport- put in comfortable position-
NO LIQUIDS
if shock- elevate legs for blood flow to head and heart
Heat Acclimitization
14 days of consecutive practice, 1 day of complete rest at least every 6 days
days of rest do not count towards 14
practice no more than 3 hours
Playing in Heat
MATCH PLAY HYDRATION BREAKS: WBGT OF 89.6°F
Provide hydration breaks of 4 minutes for each 30 minutes of
continuous play (i.e., minute 30 and 75 of 90 minute match)
Playing in cold
NATA: if below 30degr- keep watch
if < 15 1 hour practice 20 min at least warming up inside
if 7 degrs 30 min practice and 20 at least warm up
0 degrees cancel practice
athlete hygeine
shower after every practice
avoid body cosmetic shaving
all cothing and gear washed everyday
braces disinfected daily
MRSA
bacterial
community aquired methicillin resistant stphylococous aureus
crusty
higly contagious
can be fatal if untreated
2/2 close contact
red, yellow small scabs, furuncles/carbuncles underskin
Impetigo
Bacterial
streptococcus
raised blisters on nose/mouth; skin- rupture easily
honey colored crust, raw surface
highly contagious
risk hospitization
carbuncles/foruncules
bacterial
areas of high friction or sweat (shoulder pads)
do not pop
Herpes simplex (HSV)
viral
incubation of 3-10 dyas
single vesicle or cluster
flu like sxs, burning
contagious
white bubbles
RTSport- free of systemic sx’s
no new lesion in 72 hors
min 5 days of antivirals
molluscum contagiosum
bubble with flat top or looks like ring on top
dimpled and flesh colored
RTSport- lesions must be removed or curretted
localized lesions can be covered w/ gas permeable dressing, underwrap and stretch tape
Tinea
fungal
Tinea capitus
scalp
gray scaly patches
mild hair loss
topical antifungal
Tinea corporus
Ring worm
well defined scale7 lump on skin
patches, circles, red , raised borders
can be irregular
RX keep skin clean and dry
wash sheets and clothes daily
topical antifungal
Tinea Curis
Jock itch
Tinea Ungium
undernail bed
surfers nails
requires oral meds
general RX of skin lesions non- infectious
- cleanse with saline or potable water
-debrid- irrigation - dress non occlusive or occulisive
-ID infection
What skin lesions are dressed with occlusive covering
abrasions
lacerations
What skin lesions are dressed with NON occlusive covering
infected
puncture wound
wound w cavity
want in in These!!
Talon Noir
black heel
blood blister
frcition from footwear
dark lesion on fat pad
RX proper fitting of shoes and socks
psoriasis
thick red skin- white patches
comes in flares- autoimmune
topical meds
not contagious
Eczema
atopic dermatitis
itchy scaley patches
usually in elbow and popliteal crease
can have infection but not contagious
emmolients, topical steriods
cholinergic Urticaria
red flares, well defined swollen hives
itching, burining, warmth tingling
caused by sweat and heat
allergic reaction
2/2 heat
risk- can have exercise induced anaphylaxis
RX: rapid cooling , antihistamines
hypertrophic scar
does not go beyong borders of wound
Keloid scar
body developes abnormal healing
inc scar collagen tissues goes beyond wound
genetic
adolescents and preganancy
pain, itchy, cosmetic
steroid injection, sx removeal
pediculosos
scabies, lice
rash across body, hair, btwn fingers
white scaely patches
contagious
wrestlers RTplay- abscence of bugs
Considerations for DM 1
- always wear Medic-Alert bracelet or necklace during activity
-Blood glucose levels monitored before, during and after- if above 250 with presence of urine ketones or above 300- postpone exercise
-during prolonged ex- monitor every 30-60 min
-if hypoglycemia occurs- immediately treat with absorbed glucose- hard candy, sugared beverage or fruit juice
IF SEVERE HYPOGLYCEMIA- TREAT WITH GLUCAGON
What are adverse side effects of NSAIDS?
GI ulceration
acute renal failure
bleeding events
dyspepsia, nausea, edema, fluid retention, aphthous ulceration (canker sore), delayed wound healing, tinnitus, dizziness, confusion and stupor
Factors related to COX-2 inhibitors
Pro: choice for moderate/severe OA, does not affect GI mucosa, renal tissue or platelet aggregation
CONS: incr cost, higher rate of Cardiovascular events
NSAIDS and healing
- muscle strains- modest delay
- gastric ulcerations- delayed healing
-impair bone and cartilage healing and incr rate of nonunion and delayed healing of fractures by interfering with endochondral ossification
Contraindication for IBp?
Aspirin bc will antagonize the platelet inhibition induced by aspirin
Mononucleosis
3-5 incubation period
-triad- pharyngitis, fever and lymphadenopathy, sometimes rash and often splenomegaly- more at risk for rupture because enlarged- high risk for rupture is 1st 21 days of illness
commotion cordis
direct impact to heart during T-wave
which causes ventricular fib
-immediate collapse following direct trauma to chest
-ER! Need AED!!!! as is an electrical even not mechanical
Phase 1 of tissue healing
-constriction of blood vessels and clot forming
Phase 2 of healing-
Inflammatory stage- cell released to removed damaged cells and bacteria to prevent infection
Phase 3 of healing
Proliferation: new tissue formed
granulation tissue , epithelium
Laying down of collagen - Type III primarily and then replaced
and angiogenesis
Phase 4 of healing
Tissue Remodeling:
- incr tensile strength of wound with more type 1 collagen
cramping; headaches; poor concentration; physical symptoms of fatigue; and cool, clammy skin
are symptoms of what?
Heat Exhaustion
How do you treat heat exhaustion
bring the athlete into a cool environment, provides fluids, and immerses him into a cold water bath. The athlete should be held out of practice until all symptoms have completely resolved.
After pre participation screenings, paperwork must be sent to athletic department: What must it include
It must include only the page with the athlete’s name and status regarding clearance is required to be forwarded to the athletic department- they do not need all medical info unless requested
what’s the most common fracture of the face?
zygomatic fracture
Athlete autonomy:
All individuals, including contact collegiate athletes, have the right to make decisions about their medical care without their physician trying to influence the decision. Patient autonomy allows for physicians to educate their patients on the risks of participation in contact or collision sports with potentially dangerous medical conditions or anatomy, but it does not permit the physician to make the decision for the patient. Although the physician’s intended beneficence is in the patient’s best interests, the patient’s right to autonomy should be respected.
Can an athlete with concussion return to play same game?
No
Athletes who are suspected of having a concussion are not eligible to play during that same competition. The treating physician should periodically re-evaluate the athlete on the sideline.
What are risk factors for sudden cardiac death?
-basket ball player
-hypertrophic cardiomyopathy (HCM), —–male sex,
-African American race
other causes:
coronary artery anomalies, aortic rupture, Marfan syndrome, myocarditis, arrhythmogenic right ventricular cardiomyopathy, ion channel disorders, Wolff-Parkinson-White syndrome, and commodio cordis.
What is commodio cordis?
-condition where a projectile hits the chest at the same time of an abnormal heart rhythm (ventricular fib)
A 15-year old white male is playing a JV basketball game when he suddenly drops to the ground. He is motionless on the court. He has no significant past medical history. When you arrive on the scene, he is not breathing and has no pulse.
Which of the following is LEAST likely to be observed in this individual’s history?
Right ventricular wall thickness >30mm
What is the recommended treatment course before return to wrestling competition after impetigo infection?
Minimum of 72 hours of antibiotic treatment
Following the appendectomy, what is a football players likely long term prognosis?
He can return to play in 3-4 weeks
between which MT heads does a Morton neuroma usually occur?
3 and 4th
What is a neurotmesis?
s the most severe nerve injury without the chance of recovery.
What population is the most likely to dislocate a shoulder
Teenagers, and individuals in their 20’s, are most likely to dislocate
other factors
-males
Ehlers Danlos
characteristics of ECS- exertional compartment syndrome
-lack of MOI,
-heaviness/weakness of the feet, coupled with the resolution of symptoms after exercise suggest ECS
Characteristics of Impetigo
-honey colored crust
-bacterial infection
-must be without any new skin lesion for 48 hours before a meet or tournament
Management for molluscum contagiosum- small raised lesions with dimple in center, viral
Lesions must be curetted or removed before a meet or tournament. Solitary or localized, clustered lesions can be covered with a gaspermeable membrane, followed by tape
Dependent vs Independent variables
Dependent variables- those that are measured- like ROM, strength
Independent variables- those that are manipulated- like the treatments used in an experienment- like JM, Ultrasound , exercises etc
Side effects of Anabolic steroid use
first- tendon weakness/inury
-acne
-rage
-
What is a contraindication for weightlifting in older adults?
a resting systolic blood pressure of >160mmHg or diastolic blood pressure of >100mHg are relative contraindications to strength training in older adults. This individual should be referred to his MD.
Risk factors for diastasis rectus abdominis
-multiple pregnancies
-obesity,
-a narrow pelvis,
-multipara,
-3rd trimester,
- excess uterine fluid,
-large babies,
-weak abdominal muscles prior to pregnancy
what is the most important action to prevent myositis ossificans after a quad injury?
ice in a fully flexed position
also:
administration of a compression wrap. Utilize crutches if necessary
For Type 1 Diabetic athletes: What is the cutoff glucose level for needing to consume CHO before race
100mg/dL
If level of 100mg/dL-
Administer 10 g to 15 g of fast-acting carbohydrate: eg, 4 to 8 glucose tablets, 2 T honey. Measure blood glucose level. Wait approximately 15 min and remeasure blood glucose. If blood glucose level remains low, administer another 10 g to 15 g of fast-acting carbohydrate. Recheck blood glucose level in approximately 15 min. If blood glucose level does not return to the normal range after second dosage of carbohydrate, activate emergency medical system. Once blood glucose level is in the normal range, athlete may wish to consume a snack (eg, sandwich, bagel)
Difference between primary amenorrhea and secondary amenorrhea
Primary amenorrhea- no menstruation by age 14
Secondary _ absence of menses for more than 90 days
Componenets of Female Triad in RED-S
-disordered eating,
-irregular menstruation, and
-bone loss.
Which of the following represent micronutrients that female athletes are likely to be deficient in?
Calcium
Zinc
Iron
Purpose of a mouthguard
Protects against orofacial injuries
While it may not prevent injuries to the teeth and jaw, it is recommended for use in certain contact sports in order to lessen the risk and severity of injury to these structures.
What is the most common sports overuse injury along the dorsoradial wrist region ?
APL/EPB tendinitis or DeQuervain’s syndrome
What is DeQuervain’s syndrome?
tendinitis of the Abductor Pollicus Longus and Extensor Pollicis Brevis-
Which mm and in what order are involved in lateral epicondylitis?
- ECRB- Extensor Carpi Radialis Brevis
2, EDC- Extensor Digitorum Communis
3, ECRL- Extensor Carpi Radialis Longus
4, ECU- Extensor Carpi Ulnaris
Heat Acclimatization NATA statement
- During the first five days of the heat-acclimatization process, athletes may not participate in more than one practice per day.
- If a practice is interrupted by inclement weather or heat restrictions, the practice should recommence once conditions are deemed safe, but total practice time should not exceed three hours per day.
- A one-hour maximum walk-through is permitted during the first five days of the heat- acclimatization period; however, a three-hour recovery period should be inserted between the practice and walk-through (or vice versa).
- During the first two days of the heat-acclimatization period, in sports requiring helmets or shoulder pads, a helmet should be the only protective equipment permitted (goalies, as in the case of field hockey and related sports, should not wear full protective gear or perform activities that would require protective equipment). During days three through five, only helmets and shoulder pads should be worn. Beginning on day six, all protective equipment may be worn and full contact may begin.
- Beginning no earlier than the sixth day and continuing through the 14th day, double-practice days must be followed by a single-practice day. On single-practice days, one walk-through is permitted, but it must be separated from the practice by at least three hours of continuous rest. When a double-practice day is followed by a rest day, another double-practice day is permitted after the rest day.
- On a double-practice day, neither practice’s duration should exceed three hours total, and student-athletes should not participate in more than five total hours of practice. Warm-up, stretching, cool-down, walkthrough, conditioning and weight-room activities are included as part of the practice time. The two practices should be separated by at least three continuous hours in a cool environment.
What complaints would be most likely to indicate the possibility of sudden cardiac death (SCD)?
Dizziness: This is an indication that not enough oxygenated blood is getting to the brain.
Usually loss of consciousness occurs quickly
prior cardiac arrest or sustained ventricular tachycardia (VT), family history of SCD, unexplained syncope, hypotensive blood pressure response to exercise, nonsustained VT on ambulatory (Holter) monitoring, identification of a high-risk mutant gene, and massive LVH
You are assigned to cover a local spring soccer game. The temperature is in the mid 80s, and the humidity is 60%. In preparation for the event, what fluids should you plan to have on the sidelines?
Whatever the athletes will drink
Explanation
Athletes tend to drink what is most favorable to them individually. But some kind of sports drink
You are assigned to cover a local spring soccer game. The temperature is in the mid 80s, and the humidity is 60%.In preparation for the event, what is the appropriate preactivity hydration?
The athlete needs more liquid during the event and less leading up to the event. Typically, 7–10 ounces every 10–20 minutes during the event is appropriate.
What is appropriate hydration for outside athletic event in heat?
17–20 oz 3 hours prior to the event
and 7–10 ounces every 10–20 minutes during the event is appropriate.
classic signs and symptoms of shock
nausea, dizziness, light-headedness, and pallor.
Symptoms of a splenic rupture
pain in the abdomen and pain in the left shoulder radiating into the upper third of the left arm
Fractured rib sx’s that have not caused internal bleeding
localized pain in the area of the fracture, increased pain with inspiration, localized tenderness, deformity, and crepitus.
Symptoms of an abdominal aortic aneurysm
severe low back pain with elevated blood pressure and pulse
what recommendation would you give to the athlete who has sig concussion symptoms regarding academic and sports participation this week
Provide the athlete and her family with education on concussion,
complete rest from sports and school
No exercise until symptoms free
will need school accommodations
At what wet globe temp do you cancel practice ?
Above 82.4
Wet globe temp is higher at what temps?
73-82
At what percent water loss can cause comprise, physiological function, and dehydration?
1-2%
At what percent water loss can result in exertional heat illness?
3%
Parameters to stay hydrated with water:
17 to 20 ounces three hours prior to activity and 7 to 10 ounces every 10 to 20 minutes
Atlanto dental instability
3.5 mm = instability
7 mm = disruption of transverse ligament
>9-10mm = risk of neural injury also needs surgery
* risks with trauma down syndrome and RA
Jeffersons or burst fracture
C1
Odontoid fracture
C2
hangman’s fracture
C2
Clay shovelers fracture of spinous process
C6-T2- hyperflexion
Cervical radiculopathy test cluster
+ Cervical distraction test, +Spurlings test
+ULNNT Median
+<60 rotation
Persistent symptoms are reported in what % of conclusions?
10-15% - they must be managed in multi disciplinary manner
Cut off age for SCAT 5 vs Child SCAT 5?
12 and younger need CHILD SCAT 5
one would suspect a lower motor lesion of the hypoglossal N if the tongue deviated in which direction of the injury?
it will deviate TOWARD the injury side and may demo fasciculations and or atrophy
Clinical Features of pneumothorax
chest pain
breathlessness
reduced breath sounds
in HR
Decr BP
DRY COUGH
tracheal shift to OPPOSITE side
athlete complains of EI asthma
- PEF rate is 12% below baseline, what do you do?
remove from play
administer 2 puffs short acting B-agonist in haler with spacer, after 5 minutes check PEF, if PEF return to baseline athlete can return t play
if PEF 10-15% below baseline- inhaler
RTP tinea corporis
72 hours and with topical gas permeable dressing
RTP tinea capitus
2 weeks systemic anti fungal
RTP Herpes
no systemic signs
no new lesions 72 hrs
firm adherent crust
120 hrs antivirals
RTP molluscum contagiosum
raised with dimple in center
lesions removed
localized lesions covered w/ gas permeable membrane
RTP furncles, carbuncles, folliculitis, impetigo, MRSA
no new lesions 48 hours
72 hours of antibiotic
no drainage
active lesions may not be covered
What blood glucose level is too low?
< 100mg/dL
ideal for exercising:
100-250
if less- administer
suggested glucose levels for start of ex
90-200 mg/dL
What blood glucose is too high?
250 or above- usually happens if miss medication, eat too much or don’t exercise enough
