Upload
jls10
View
1.358
Download
3
Embed Size (px)
DESCRIPTION
Citation preview
KIN 188 – Prevention and KIN 188 – Prevention and Care of Athletic InjuriesCare of Athletic Injuries
Pre-Participation Physical Pre-Participation Physical ExaminationsExaminations
PPEPPE Goals of the PPEGoals of the PPE
Preparation for the PPEPreparation for the PPE
Medical historyMedical history
Components of the PPEComponents of the PPE
Clearance for participationClearance for participation
Goals of the PPEGoals of the PPE Determine general health and current Determine general health and current
immunization statusimmunization status
Establish rapport with participantEstablish rapport with participant
Detect medical conditions that can predispose one Detect medical conditions that can predispose one to injury/illness so treatment can be to injury/illness so treatment can be continued/initiatedcontinued/initiated
Identify health risk behaviors that can be Identify health risk behaviors that can be addressed with counselingaddressed with counseling
Goals of the PPEGoals of the PPE Establish baseline parameters for return to play Establish baseline parameters for return to play
decisionsdecisions
Assess physical maturityAssess physical maturity
Evaluate physical fitnessEvaluate physical fitness
Make recommendations regarding Make recommendations regarding participation/exerciseparticipation/exercise
Meet legal requirements to athletic participationMeet legal requirements to athletic participation
Goals of the PPEGoals of the PPE Specific focus of PPE varies amongst Specific focus of PPE varies amongst
populationspopulations Pre-pubescentPre-pubescent
Undiagnosed congenital abnormalitiesUndiagnosed congenital abnormalities PubescentPubescent
Maturation level, establishing healthy behaviorsMaturation level, establishing healthy behaviors Young adultYoung adult
History of previous injury, sport-specific examHistory of previous injury, sport-specific exam AdultAdult
Overuse conditions predominateOveruse conditions predominate
Preparation for the PPEPreparation for the PPE No one best/right way to do PPENo one best/right way to do PPE
Influenced by several factorsInfluenced by several factors Level of competitionLevel of competition Availability of personnel and facilitiesAvailability of personnel and facilities Number of PPE being conductedNumber of PPE being conducted Personal preference/historyPersonal preference/history
Preparation for the PPEPreparation for the PPE FormatFormat
TimingTiming
FrequencyFrequency
PPE FormatPPE Format Primary care physician modelPrimary care physician model
Enhanced knowledge of medical history, Enhanced knowledge of medical history, immunization status and prior injuries immunization status and prior injuries that could limit participationthat could limit participation
Generally a more thorough examGenerally a more thorough exam Affords best privacy and better Affords best privacy and better
environment for counselingenvironment for counseling Cost is expensive – insurance?Cost is expensive – insurance?
PPE FormatPPE Format Group/station modelGroup/station model
Good for large number of PPE in given Good for large number of PPE in given period of timeperiod of time
Allows better understanding of demands of Allows better understanding of demands of activityactivity
Individual personnel responsible for given Individual personnel responsible for given element of PPE at “station”element of PPE at “station”
Clearance verified by team MD at end of PPEClearance verified by team MD at end of PPE Typically free of chargeTypically free of charge
PPE TimingPPE Timing Ideally completed several weeks prior to Ideally completed several weeks prior to
initial practiceinitial practice
Allows ability to address any problems Allows ability to address any problems identified on PPE (labs, tests, records) identified on PPE (labs, tests, records) without impeding participation statuswithout impeding participation status
Typically done within 1 week prior to first Typically done within 1 week prior to first scheduled activity – high schools often scheduled activity – high schools often over summerover summer
PPE FrequencyPPE Frequency Entry-level PPE (complete) at outset Entry-level PPE (complete) at outset
of participation for of participation for school/organizationschool/organization
Recommended annual re-evaluation Recommended annual re-evaluation without complete PPE unless without complete PPE unless warrantedwarranted
Medical HistoryMedical History Generally accomplished ahead of Generally accomplished ahead of
time in yes/no formattime in yes/no format Often a supplemental form for femalesOften a supplemental form for females
For station model, qualified evaluator For station model, qualified evaluator must review history and red flag must review history and red flag potential concerns for further potential concerns for further scrutiny/evaluationscrutiny/evaluation
Components of the PPEComponents of the PPE Vital signsVital signs General medical General medical
problemsproblems CardiovascularCardiovascular Pulmonary Pulmonary MusculoskeletalMusculoskeletal NeurologicNeurologic EyesEyes
Dental Dental Gastrointestinal Gastrointestinal GenitourinaryGenitourinary DermatologicDermatologic Examination for Examination for
heat disordersheat disorders Laboratory testsLaboratory tests
Vital SignsVital Signs Establishes individual’s baseline Establishes individual’s baseline
parametersparameters Height/weightHeight/weight
Comparison to normative dataComparison to normative data Pulse/respiratory rate (60-100/12-16)Pulse/respiratory rate (60-100/12-16)
Observe quantity and qualityObserve quantity and quality Blood pressure (120/80)Blood pressure (120/80)
Cuff size very importantCuff size very important Body temperature (98.6/37.0)Body temperature (98.6/37.0)
Oral vs. tympanic vs. axillary (rectal)Oral vs. tympanic vs. axillary (rectal)
General Medical ProblemsGeneral Medical Problems Questions asked regardingQuestions asked regarding
Currently being treated for illness/injuryCurrently being treated for illness/injury History of hospitalization or surgeryHistory of hospitalization or surgery History of progressive disease (MS, MD, History of progressive disease (MS, MD,
cancer)cancer) Current use of OTC/Rx medsCurrent use of OTC/Rx meds Allergies to meds, food, environmentAllergies to meds, food, environment
Cardiovascular ExaminationCardiovascular Examination Done in quiet area to maximize validityDone in quiet area to maximize validity
Auscultation of heart soundsAuscultation of heart sounds
Questions asked regardingQuestions asked regarding Fainting (syncope), dizziness, SOB, chest pain with exertionFainting (syncope), dizziness, SOB, chest pain with exertion Heart palpitations, tachycardia, dysrhythmia, known Heart palpitations, tachycardia, dysrhythmia, known
murmurmurmur Family member with sudden, early cardiac deathFamily member with sudden, early cardiac death
Positive responses to any necessitate referral to Positive responses to any necessitate referral to cardiologist for further evaluationcardiologist for further evaluation
Pulmonary ExaminationPulmonary Examination Done in quiet area to maximize validityDone in quiet area to maximize validity
Auscultation of breath sounds in all lung Auscultation of breath sounds in all lung lobes – look for symmetrical movement of lobes – look for symmetrical movement of diaphragmdiaphragm
Questions asked regardingQuestions asked regarding Excessive coughing during/after activityExcessive coughing during/after activity History of asthma, EIA, bronchitis, allergiesHistory of asthma, EIA, bronchitis, allergies SOB, unusual breath sounds during/after activitySOB, unusual breath sounds during/after activity History of collapsed lung (pneumothorax)History of collapsed lung (pneumothorax)
Musculoskeletal Musculoskeletal ExaminationExamination
Basic exam consists of observation for Basic exam consists of observation for symmetry, ROM, strength tests for major symmetry, ROM, strength tests for major muscles and specific tests for previously muscles and specific tests for previously injured areasinjured areas
Questions asked regardingQuestions asked regarding Focus on history of injury, time frame, Focus on history of injury, time frame,
evaluation, treatment and rehabilitationevaluation, treatment and rehabilitation Use of protective devicesUse of protective devices
Neurologic ExaminationNeurologic Examination Evaluation consists of cranial nerve tests Evaluation consists of cranial nerve tests
including pupil function, sensory/motor including pupil function, sensory/motor tests of UE/LE, deep tendon reflexestests of UE/LE, deep tendon reflexes
Questions asked regardingQuestions asked regarding History of head injuriesHistory of head injuries Any previous loss of consciousnessAny previous loss of consciousness Numbness/tingling, loss of motor function in Numbness/tingling, loss of motor function in
bodybody History of seizures, burners/stingersHistory of seizures, burners/stingers
Eye ExaminationEye Examination Visual acuity assessed via Snellen chart, both Visual acuity assessed via Snellen chart, both
monocularly and binocularly (use corrective lenses)monocularly and binocularly (use corrective lenses) Emmetropia (20/20 vision)Emmetropia (20/20 vision) Myopia (nearsightedness)Myopia (nearsightedness) Hypermetropia (farsightedness)Hypermetropia (farsightedness)
Questions asked regardingQuestions asked regarding Use of corrective lenses/typeUse of corrective lenses/type Blurring or double visionBlurring or double vision Color blindness, peripheral vision lossColor blindness, peripheral vision loss History of eye trauma, retinal detachmentHistory of eye trauma, retinal detachment
Dental ExaminationDental Examination Typically done by dentist – not meant Typically done by dentist – not meant
to perform preventative care but to to perform preventative care but to establish pre-existing conditions for establish pre-existing conditions for liability reasons in case of dental injuryliability reasons in case of dental injury
Allows opportunity for dental molds to Allows opportunity for dental molds to be made for crafting of custom be made for crafting of custom mouthguardmouthguard
Gastrointestinal Gastrointestinal ExaminationExamination
Evaluation of digestive system, eating habits and Evaluation of digestive system, eating habits and nutritionnutrition Concerns for athletes where image is important to activityConcerns for athletes where image is important to activity
Evaluation done supine with palpation for masses Evaluation done supine with palpation for masses or organomegalyor organomegaly
Questions regardingQuestions regarding History of heartburn, indigestion, diarrhea or constipationHistory of heartburn, indigestion, diarrhea or constipation Prior history of organ injury (spleen, liver, kidney)Prior history of organ injury (spleen, liver, kidney)
Genitourinary ExaminationGenitourinary Examination For males, questions asked regardingFor males, questions asked regarding
Hernias, testicular torsion, absent or undescended testicleHernias, testicular torsion, absent or undescended testicle
For females, questions asked regardingFor females, questions asked regarding Menstrual cycle, pregnancyMenstrual cycle, pregnancy
General questions asked regardingGeneral questions asked regarding History of bladder/urinary tract infections, STDsHistory of bladder/urinary tract infections, STDs Absence of one kidneyAbsence of one kidney
Can include urinalysis to look for proteins, blood, Can include urinalysis to look for proteins, blood, sugar and hemoglobin in urinesugar and hemoglobin in urine
Dermatologic ExaminationDermatologic Examination Skin evaluated for rashes, lesions, Skin evaluated for rashes, lesions,
infections that can be contagious to othersinfections that can be contagious to others Herpes, fungal infections (tinea), impetigo, Herpes, fungal infections (tinea), impetigo,
STDs, acne/treatmentSTDs, acne/treatment
Also look at existing blemishes (warts, Also look at existing blemishes (warts, moles, etc.)moles, etc.) Change in appearance (size, color, border, etc.) Change in appearance (size, color, border, etc.)
in recent pastin recent past
Examination for Heat Examination for Heat DisordersDisorders
Especially important for activities taking Especially important for activities taking place under conditions of high place under conditions of high temperature, high humidity or a temperature, high humidity or a combination of the twocombination of the two
Questions asked regardingQuestions asked regarding History of heat illness (cramping, syncope, History of heat illness (cramping, syncope,
exhaustion, stroke)exhaustion, stroke) Current meds (diuretics, antihistamines)Current meds (diuretics, antihistamines) Use of caffeinated/alcoholic beveragesUse of caffeinated/alcoholic beverages Nutritional and hydration habitsNutritional and hydration habits
Laboratory TestsLaboratory Tests Not typical associated with PPE – Not typical associated with PPE –
usually due to cost of testing usually due to cost of testing proceduresprocedures
Often used when/if red flags appear Often used when/if red flags appear during PPEduring PPE UrinalysisUrinalysis Blood workBlood work ECGECG
Clearance for ParticipationClearance for Participation Conditions to be met to allow clearance by Conditions to be met to allow clearance by
ME at end of PPEME at end of PPE Will condition increase risk of injury to Will condition increase risk of injury to
individual or others?individual or others? Can participation be allowed if meds, rehab or Can participation be allowed if meds, rehab or
protective bracing/padding is used? If so, can protective bracing/padding is used? If so, can limited participation be allowed in interim?limited participation be allowed in interim?
If clearance is denied for particular activity, If clearance is denied for particular activity, can other safe activities be identified and can other safe activities be identified and clearance be granted for them?clearance be granted for them?
Clearance for ParticipationClearance for Participation Individuals have right to participate in any Individuals have right to participate in any
activity regardless of pre-existing medical activity regardless of pre-existing medical condition/scondition/s
Physician’s cannot exclude individual from Physician’s cannot exclude individual from participation – can only recommend participation – can only recommend against participationagainst participation
Often use exculpatory waiver to identify Often use exculpatory waiver to identify and acknowledge assumption of riskand acknowledge assumption of risk
Clearance for ParticipationClearance for Participation Examples of recommended disqualifying Examples of recommended disqualifying
conditions (American Academy of Pediatrics)conditions (American Academy of Pediatrics) Atlantoaxial instabilityAtlantoaxial instability Aortic disordersAortic disorders Convulsive disordersConvulsive disorders Serious bleeding tendenciesSerious bleeding tendencies Absence of paired organ for contact activitiesAbsence of paired organ for contact activities Repeated concussionsRepeated concussions Uncontrolled diabetesUncontrolled diabetes