primary care

primary care

• normal check up

• examine all systems

• refer to specialists as needed

liver

• cleans blood

• digests food

• stores energy

• secretes bile

gallbladder

stores bile

pancreas

• digestion of fats, carbs, proteins

• produces insulin and glucagon

stomach

• storage/mixing of food

• partial digestion

small intestine

primary site for digestion and absorption of food (chyme)

large intestine

• chyme converted to feces

• reabsorption of water

spleen

• storage and regulation of RBC

• produces antibodies and lymphocytes

adrenal glands

• secrete epinephrine, norepineprhine, cortisol, estrogen, aldosterone, and androgen

kidnyes

filter waste, ions, and drugs in blood

ureters/bladder

transport urine to bladder/storage of urine

palpitation

physical assessment

abdominal musculature

• rectus abdominus: stabilization/lumbar flexion; most superficial layer

• internal oblique: stabilization/ipsilateral rotation

• external oblique: stabilization/contralateral rotation

• transverse abdominus: protect organs/spinal stabilization/forced expiration; deepest layer

quadrants of abdomen

• midline extends from center of sternum through pubic bone

• horizontal line extends through umbilicus

• right upper, right lower, left upper, left lower

acute appendicitis

• mild to severe pain in lower right quadrant w nausea, vomiting, low grade fever

• inflammation of appendix does not mean burst but still medical emergency

mononucleosis

• viral disease (epstein-barr virus) severe fatigue, sore throat, headache, swelling of spleen

  • athlete out for 4-6 wks bc of spleen

blow to solar plexus

• paralysis diaphragm, stopping respiration, getting wind knocked out of you

type 1 diabetes

• pancreas produces little to no insulin

• difficult to manage —> need to keep blood sugar regulated w sugar and glucagon

type 2 diabetes

• developed resistance to insulin due to prolonged high levels

• specific to type 2: numbness/tingling of hand and/or feet (lose sensation w age), freq infections, slow healing wounds

general diabetes symptoms

increased thirst, freq urination, and unexplained weight loss

assessment

1. auscultation 1st: use stethoscope; need to do before touching bc touching creates artificial sounds (normal: gurgling, rumbling, clicking; abnormal: loud, reduced, absent)

2. palpitation: stand on left side, 4 regions start away from pain, feel for pain/rigidity/masses

3. percussion: dull- over solid organs; tympanic- over air filled structures

assessments

looking at pee color and stool consistency (watery is fatty diet or stomach issues)

lungs flow

nose/mouth > throat > trachea > bronchi > bronchioles

pneumothorax

• collapsed lung

• pleural cavity becomes filled w air

hemothorax

• punctured lung

• presence of blood w/in pleural cavity

asthma

• spasm of smooth muscle in bronchioles, causing narrowing of airway

• exercise induced bronchospasm (asthma)

• difficulty getting air OUT

pneumonia

infection of lung and bronchioles cause by virus bacteria or fungus

vocal cord dysfunction

difficulty getting air IN (inhalers would not work)

assessing and reporting respiration

• rate: breaths per min (BPM), count # of breaths in 60s

• rhythm: regularity

• depth: shallow, normal, deep

• effort: labored vs quiet breathing (accessory musculature)

• color: pallor (pale) and cyanosis (blue lips- cold or not getting enough o2)

• posture: hands on knees, holding ch

respiration abnormalities

• panic attack: increase rate, normal rhythm, shallow

• hyperventilation: involves shoulders and rib flares

tachypnea

• rapid breathing: > 24 breaths/min

hyperpnea

tachypnea w very large breaths

bradypnea

slow breathing <12 breaths/min

dyspnea

• difficulty breathing: at rest, w/ activity, changes w position, temp?

• can be w/ asthma when lying down

hypopnea

shallow, slow breaths

orthopnea

shortness of breath when lying down

cough

• characteristics: dry, barking, productive

• timing: worse at night (asthma/acid reflux), after exercise

phlegm colors

• white: allergies/viral infection

• green: bacterial infection (pneumonia)

• red: mean lung injury or malignancy

• brown: lung disease (smoking)

lung ausculatation

posterior

• r/l upper lobes b/w C7 (moves)-T3

• r/l lower lobes b/w t4-t10

pre participation physical evaluations

• purpose of PPE: facilitate and encourage safe participation not to exclude athletes (recommended by AAFP)

• identify any potential or correctable conditions that may impair athlete’s ability to full perform

• student-athletes required to have comprehensive PPE upon entry into middle of highschool or transfer

• annual updates on comprehensive health history, problem focused areas, vital signs

• PPE required for student entrance into intercollegiate athletics

history

• PPE started as a way to screen soliders

• NCAA recommends PPE but details up to institution

• PPE could be only contact adolescents have w medical provider in a year

goals of PPE

• determine general physical and psychological health (new)

• eval for conditions that may be life threatening or disabling (scoliosis, heart disease, sickle cell)

• eval for conditions that predispose injury or illness

• provide opportunity for dicussion of health and lifestyle issues

• serve as entry point into healthcare system

key concepts of PPE

• medical history effective at identifying 75% of problems affecting sport participation

• PPE serves as sole source of med eval for 30-88% of adolescents annually

• 0.3-1.3% denied participation (heart-related and c-spine instability)

• 3.2-13.9% requiring further eval

PPE vs well-child

• ppe: things that predispose to injury

• well-child exam: normal check up of overall health

family and personal health history PPE

• med history detects majority of gen and musculoskeletal conditions

• barriers: health literacy and limited english so difficult to interpret ?s

• scared to tell truth

physical exam of PPE

• height, weight

• vitals

• ENT

• auscultation

• abdominal

• genitalia

• skin

• female athletes

other PPE sections

• mental health portion

• physical fitness testing

• medications

special medical tests PPE

• optional

• dental, vision, cardiac, neurologic, gen med (ferritin, urinalysis, sickle cell, diabetes)

sudden cardiac death

• PPE prevents

• males higher than females, black higher than white, basketball highest incidence

• etiology: most common finding in athletes w SCD was structurally normal heart w no signs of disease

athletic PPE

• both AHA and ESC recommend screening all athletes w a comprehensive history and physical

• controversy exists abt whether or not to perform ECGs (electrical actvity in heart) on all athletes

hypertrophic cardiomyopathy

thickened cardiac muscle causes decreased cardiac output

heart murmur

abnormal, periodic sound due to changes in anatomy of heart valves

commotio cordis

• traumatic blow to chest during heart repolarization—> stops heart

• 15-30msec before twave

heart cycle

1. r atria

2. r ventricles

3. lungs (oxygenate)

4. l atria

5. l ventricles

6. body

continuous cycle w each beat

sinus node (SA)

loc in r atria and generates electrical stimulus

atrioventricular node (AV)

impulses slowed down for very short pd

bundle of his

• bundle of his pathway leading to ventricles

• divides into right and left pathways called bundle branches

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purkinje fibers

stimulate l and r ventricles

electrocardiogram

• graphic record of direction and magnitude of electrical activity generated by depolarization and repolarization of atria and ventricles

• can suggest or detect cardiomyopathies, ion channelopathies, myocarditis, and ventricular pre-excitation

  • other causes of SCD in young athletes (ex: anomalous coronary arteries, premature coronary artherosclerosis and aortopathies) not readily detected

electrical activity of heart

• p wave: depolarization of atrial myocardium

• QRS complex: depolarization of ventricular myocardium

• t wave: repolarization of ventricular myocardium

cardiac auscultation

A- aortic valve (semilunar); r sternal border, 2nd intercostal space

P- pulmonary valve (semilunar); l sternal border, 2nd intercostal space

E- erbs point; l sternal border; 3rd intercostal space

To- tricuspid valve (AV); l sternal border, 4th intercostal space

Man- mitral valve (AV); midclavicular line, 5th intercostal space