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Flashcards in Preparticipation PE Deck (19)
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1
Q

Purpose of PPE?

A
  • impt 1st step in assisting athletes in maintaining health and ensuring safe participation in training and competition
2
Q

Objectives of a PPE?

A

primary or essential:

  • detect conditions that may limit participation
  • detect conditions that may predispose to injury
  • meet legal and insurance requirements
  • f/u previous injuries conditions, surgeries

secondary or ideal:

  • assess general health and ID health-risk behaviors: potential for discovering previously undetected condition
  • assess physical maturity
  • determine fitness and performance level
3
Q

When should PPEs be done?

A
  • should be performed at least 6 wks beginning of sports to allow adequate time to address any issues
  • must be done annually for high school athletes by montana regulations
  • comprehensve baseline PPE before initiating sports season
  • subsequent annual PPes may be limited to recent injuries but also include review of cardiopulm system
4
Q

Diff formats of PPE?

A

office based:

  • advantages of physician-pt familiarity, privacy, and continuity of care
  • disadvantages: cost, limited appt time and lack of communication back to school athletic staff

group screening:

  • specialized personnel, time, and cost efficiency
  • disadvantages: rushed, lack of privacy, potential for poor f/u of ID problems
5
Q

Diff stations for a PPE?

A
  • sign in
  • ht/wt
  • vitals
  • vision
  • hx review
  • PE
6
Q

What are impt questions to ask in medical hx?

A
- CV questions are key:
ID hypertrophic cardiomyopathy
marfans
premature atherosclerosis 
- health: risk behaviors, femal athletic triad
7
Q

What are CV causes of sudden death?

A
  • hypertrophic cardiomyopathy
  • anomalies of coronary arteries
  • atherosclerotic heart disease
  • marfans syndrome (Aortic rupture)
  • aortic stenosis
  • mitral valve prolapse
  • myocarditis
8
Q

What is hypertrophic cardiomyopathy?

A
  • primarily a disease of myocardium w/ hypertrophy w/o any obvious cause
  • frequently asx until sudden cardiac death
  • 0.2% of general pop
9
Q

Specific ?s to ask that focus on CV health?

A
  • have you ever passed out during or after exercise?

- has anyone in your family died of heart problems or sudden death b/f age of 50? - if yes, need very thorough w/u

10
Q

HEENT part of PE?

A
  • pupils (for anisocoria - unequal pupil size) and visual acuity
  • swimmer, scuba divers, and wrestlers may reqr special evals
  • smokeless tobacco users reqr oropharynx eval
11
Q

CV part of PE?

A
  • BP measurements w/ appropriate cuff size:
    Younger than 10: greater than 125/75
    older than 10: over 135/85
  • palpation of upper and lower extremity pulses: brachial-femoral delay may mean coarctation of aorta
  • heart auscultation in 2 positions and w/ provocative maneuvers (valsava, deep inspiration, squatting) may help detect murmurs
  • isolated premature ventricular contractions (PVCs) most commonly found - rarely of consequence
  • benign arrhythmias:
    unifocal in origin
    disappear w/ exercise
    no hx of syncope w/ exercise
  • coupling w/ PVCs may indicate myocarditis
12
Q

MSK part of PPE?

A
  • impt to ID musculotendinous, bone or jt probs that may limit participation or predispose to injury:
    shoulder instability, ACL deficiency, unrehabbed ankle instability
  • any positive responses in hx reqr thorough eval
  • screening for flexibility
  • screening for general neuro exam, soliosis
13
Q

Are routine screening tests recommended?

A
  • not recommended and remains unproven:
  • CBC, UA, chem profikes, sickle cell trait
  • EKG, echo
  • radiographs
14
Q

What questions should you consider b/f you clear an athlete to play?

A
  • must be familiar w/ demands of specific sports
  • will the problem increase the athlete’s risk of morbidity or mortality?
  • will other participants be at risk of morbidity?
  • will further eval, tx or rehab allow full participation?
  • could athlete be allowed limited participation?
15
Q

What are medico-legal considerations you need to keep in mind?

A
  • the athlete may have legal right to participate against medical advise
  • recommend that a waiver be used
  • majority of medical liability coverages don’t include anything about PPEs
16
Q

What are specific medical condions that may restrict a pt’s ability to participate?

A
  • alantoaxial instability: reqr clearance, Down’s disease
  • bleeding disorders reqr specific clearance
  • heart murmurs: if non-specific may be released
  • diabetes: may participate if controlled, specific concern for activities that last longer than 30 min
17
Q

Why is sickle cell impt to screen for? Screening should be considered in what pop?

A
  • linked to increase risk for heat illness and sudden cardiac death
  • screening should be considered in athletes w/ a family hx of sickle cell trait or in athletes of African descent and a hx of exertional rhabdomyolysis
18
Q

Can pts w/ HIV, 1 kidney, and sickle cell be cleared?

A
  • HIV: cleared but health care personnel must use universal caution
  • absence of kidney: cleared but w/ counseling and protection for contact
  • sickle cell trait: unlikely that they have an increased risk of sudden death or other medical problems w/ exception of extreme conditions of heat, humidity, elevation
19
Q

What are red flags on PPE?

A
  • hx of exercise intolerance
  • syncope or near syncope
  • chest pain w/ exercise
  • a family hx of unexplained death b/f age of 50
  • family hx of hyperlipidemia