Sports Medicine and Wellness - Dr. Rice

Question 1

What is the first thing that should change in beginning a wellness program?

Answer 1

get the pt to exercise

Question 2

What aspects of a lipid profile will be improved with exercise?

Answer 2

• Total cholesterol and LDL decrease only slightly (<10%)
• Major increases in HDL
• Major decreases in Triglycerides

Question 3

What is a PPE? What are the elements of PPE?

Answer 3

A screening physical exam prior to the participation in an athletic endeavor (intended to ID possible risks)

perform 6-8 weeks before the onset of a sports season

• Medications and Allergies
• Pre-existing Conditions
• Cardiac screening* (spend a lot of time here)
• Family history of cardiac disease
• Musculoskeletal injuries
• Medical questions

Question 4

What is the role of PPEs (pre-participation exams)?

Answer 4

to determine if a pt is physically fit enough to participate in a particular sport (sport specific)

Question 5

What are the 3 types of clearance?

Answer 5

• unrestricted clearance
• clearance pending treatment/evaluation of a particular problem
• no clearance

Question 6

What is a concussion?

Answer 6

a head injury with a change in mental status (can be really short and not super obvious)

peak at 15-24 and over 75 yo

Question 7

What are the components of the glascow coma scale?

Answer 7

motor:
Obeys            6
Localizes       5
Withdraws     4
Flexion           3
Extends         2
None              1

verbal:
Oriented 5
Confused 4
Inappropriate words 3
Incomprehensible sounds 2
None 1

eye opening:
Spontaneous   4
To speech        3
To pain             2
None                 1

12-15=minimal brain injury
9-12=moderate
<8=severe

Question 8

What is a minimal brain injuries?

Answer 8

50% - 80% of head injuries

LOC 0- 20 minutes

GCS > 13

Normal neurologic exam

PTA < 48 hours

Question 9

What should pts with head trauma immediately be transported?

Answer 9

Diplopia
Severe or increasing emesis
Seizure
Focal neurologic findings
Pupillary changes
Rapidly progressive headache Penetrating injury
LOC > 5 min
Confusion > 30 min
High risk patient
> 1 concussion this season

Question 10

What is part of the sideline evaluation of concussion pts?

Answer 10

Maddocks questions (ex who are you, ask them a play, ask them who they are playing, what period is it, did they win last week)

SAC (standardized assessment of concussion)

Question 11

What should be done before a concussive pt returns to a game?

Answer 11

observe for 20 minutes

exertional maneuvers (5 jumping jacks, 5 sit-ups, 5 push-ups, 5 knee-bends) to make sure can handle increase BP and HR

Question 12

Who needs to be scanned in concussion injuries?

Answer 12

GCS < 15

Abnormal MSE

? Any LOC

Focal neurologic findings

progressively getting worse

Question 13

What follow up care should be taken with concussion pts?

Answer 13

First 24 hrs:

• Serial neurologic evaluations
• Every 2-3 hrs

Avoid sedating medications: narcotics, alcohol, antihistamines

Ice, Tylenol, light diet

Avoid contact activities

Warn about possible difficulty with reading, homework, and testing (studying delays the physiologic healing of the brain)

Question 14

What is second impact syndrome?

Answer 14

one injury–> get concussion and nobody knows–> hit again then die

Abnormal autoregulation
Cerebral vascular congestion
Diffuse edema/ ICH
Midbrain herniation

Sudden collapse
Dilated pupils
Respiratory failure
Rapid deterioration and death

Question 15

What 3 things interact to affect our wellness?

Answer 15

*epigenetics (behavior and environment) –> influence can modify outcome of genetic potential

genetics

mind

Question 16

What’s the most important 1st step in the life wellness action plan?

Answer 16

clarity of purpose