HBIO441 midterm 2 set 2

implications for trainers dealing with disease and pathogens

1. maintain clean and sterile A.T. room

2. protect themselves when cleaning wounds

3. protect athlete when being treated

4. educate athletes, coaches, parents, and anyone else involved with athlete care

bacterial infection treatment

treat with antibiotics

fungal infection treatment

treat with anti-fungal agents

virus

can potentially cause disease and are present in human blood and other bodily Transmitted through human blood and other bodily fluids

3 most significant blood borne pathogens are…

1. HBV

2. HBC

3. HIV

what does hepatitis B (HBV) attack

attacks the liver

how does HBV spread

spreads through blood/fluid from 1 person to another

HBV signs & symptoms

flu-like symptoms, jaundice, dark urine

HBV prevention

good personal hygiene & thorough cleaning of surfaces and avoiding “high risk” activities

how long does HBV last?

may last at least 1 week in dried blood or contaminated surfaces

HBV vax possible?

yes- 3 doses, 6 mo., 95% effective

HBV immunization possible?

yes, post exposure it’s possible

is HBV or Hep C more common

hep c more common

what transplant does Hep C lead to?

leads to liver transplant

Hep C signs & symptoms

• jaundice

• abdominal pain

• flu-like symptoms

• dark urine

• 80% don’t have sex or symptoms

Hep C prevention?

blood transmission only

Hep C treatment?

yes- antiviral meds

Hep C vax?

no, there’s no vax for hep c

HIV

• same signs and symptoms as as HBV

• can progress to AIDS

• prevention: good personal hygiene; avoid “high risk” activities

• NOT active in air or water

AIDS (acquired immunodeficiency syndrome)

• Symptoms: infection

• No protection against the simplest infections (very vulnerable to illness)

• Most often transmitted through intimate sexual contact

• Death can occur 2 years after symptoms appear

• Some medications slow down virus reproduction

• Prevention: safe sex

what does OSHA stand for

occupational safety & health administration

OSHA definition

Designed to set standards for preventing spread of BBP in occupational settings

OSHA standards (name 8)

1. All instruments clean

2. Hands clean

3. Wear gloves when contact with bodily fluids 

4. Place non-medicated dressing on lesion if athlete to be sent for medical attention

5. Place medication directly on pad, not lesion

6. Secure with wrap or tape

7. Keep immunizations up to date

8. Follow OSHA rules for sending athlete with wound back to play for disposing or cleaning of tools and/or laundry that has been soiled 

   1. Clean all surfaces with disinfectants (1:10 parts bleach to water)

   2. Biohazard labels where there is blood/sharp containers

   3. Contaminated laundry washed in hot water (158.9℉ for 25 mins) with detergent that deactivated the virus. Wash hands frequently 

Is HIV transmission between athletes during an event common?

No, HIV transmission is not common between athletes during an event

Blood borne pathogens high-risk sports

• boxing

• martial arts

• wrestling

• rugby

blood borne pathogens moderate-risk sports

• football

• basketball

• soccer

If asymptomatic with HIV, is it legal to prohibit an athlete from participation?

No, you cannot prohibit an athlete from participation per ADA

how do you protect an there in sports?

by preventing over-exhaustion due to sports

how do you protect yourself when handling HIV and athletics?

by handling fluids and blood correctly

is mandatory testing allowed for HIV?

likely not allowed

what do state laws govern in regards to HIV results?

confidentiality of results

What are NCAA rules regarding wounds and other skin lesions?

Aggressive treatment, remove from activities, return when safe 

Disinfectants for contaminated surfaces must be cleaned with what type of solution?

1 part bleach to 10 parts water or disinfectant approved by DPA

How is contaminated laundry cared for?

Transported in red container or bags with warning labels

in tissue response, what is stress or injury caused by?

microtrauma or macrotrauma

what is a factor tissue healing depends on?

type and number of cells and their ability to regenerate (not in blood)

labile regeneration

good

• location: skin, blood, intestinal tract

stable regeneration

some

• location: bone

permanent regeneration

some, none

• PNS, muscle, CNS

when injury to body, the primary reaction is…

tissue destruction due to stress caused by injury

when injury to body, the secondary reaction is…

cell death due to decrease oxygen supply (can be prevented to some extent by treatment)

injury repair cycle

Primary Trauma —> Cell Death-->Inflammation --> Hemorrhage/Edema--> Clogging of blood flow associated with pain spasm and atrophy-->Ischemia--> more cell death

vascular changes

up to 1 hour of vasoconstriction (usually less only a few seconds to 10 minutes), followed by vasodilation (swelling)

inflammation

natural physiological reaction to injury, mobilizing body's defense system

hemorrhage

subcutaneous (bruising) =  ecchymosis (black and blue)

edema

excessive fluid (not blood)

ischemia

lack of blood flow, causing decrease in oxygen and healing agents to the area

hypoxia

decrease in oxygen causing increased cell death

muscle spasm

involuntary shortening of muscle fibers (to splint/protect the area), causing a decrease in blood flow/oxygen to the area

atrophy

disuse due to immobilization or non use, causing decreased blood flow to the area (can happen as early as 24 hours post-injury)

stages of healing: inflammatory response phase

injury to 4 days

stages of healing: fibroblastic repair phase

day 3-4 to 6 week

stages of healing: maturation-remodeling phase

4 weeks to 2-3 years

Wolff’s Law

states that bone adapts to stressed as well as lack of stress 

acute tissue healing phase

up to about 4 days--trauma to periostem/surrounding tissue with possible hematoma. Clotting may lead to dying of osteocytes

repair/regeneration tissue healing phase

granulation with soft callus (3-4 weeks), followed by hard callous (3-4 months)

remodeling tissue healing phase

bone lays down on areas of stress; may take several years

factors affecting healing

• poor blood supply

• poor immobilization

• infection

metadysplasia

transformation of tissue from one type to another (not normal for that area)

dysplasia

abnormal development of tissue

hyperplasia

excessive proliferation of normal cells in normal tissue arrangement

atrophy

decrease in size of tissue due to cell death and re-absorption or decreased cell proliferation

hypertrophy

increase in size of tissue w/o changing # of cells

factors impending healing

• Extent of injury

• Edema 

• Hemorrhage 

• Poor vascular supply 

• Atrophy 

• Corticosteroid (treatment)

• keloids/hypertrophic calcification

• Infection

• Patient characteristics including diet, age, general health 

cartilage

limited capacity to heal due to limited or direct blood supply 

ligaments

• Full healing may take 12 months

• Surgically repaired ligaments tend to be stronger due to decreased scar formation

• Exercised ligaments are stronger 

• Muscle strength can be important or loose joint protection 

treatment modalities

Any form of electrical or physical therapeutics

infrared modalities

•  treats to an about 1 cm deep and causes increase or decrease in temperature

• Includes cryotherapy and thermotherapy

what does thermotherapy include

warm whirlpool, hydrocollator (heat pack), paraffin bath, infrared lamps 

thermotherapy indications

• Increase blood flow/increase nutrition to cells 

• Stimulate analgesia

• Remove metabolites/stagnant inflammation

• Decrease muscle spasm 

2 contradictions to thermotherapy

• acute injury (where blood increase not wanted)

• anesthetized area

hydrocollator packs indications/advantages

anywhere heat wanted, general relaxation

hydrocollator packs limitations

doesn’t get very deep (e.g., past fat tissue)

hydrocollator packs concerns/contraindications

may burn skin if too hot

Advantage of using a warm water whirlpool over hydrocollator packs?

Can move joint and jets have massaging action. Buoyancy of water

whirlpool concerns

cost/maintenance, needs electric outlets that are safe near water, as well as water

paraffin bath indications/advantages

distal extremities

paraffin bath concerns

no open wounds; be sure area clean

what does cryotherapy include

ice packs, ice massage, cold hydrocollator, cold whirlpool, cold spray, contrast baths, cryokinetics 

cryotherapy indications

Acute injuries (when you want to stop inflammation), pain relief

cryotherapy concerns/contradictions

Cold allergies/reynauds phenomenon, anesthetized areas

ice massage indications/advantages

provides massage w/ ice on muscle belly (e.g., calves); myofascial trigger points

common injury sing ice massage

shin splints

cold or ice-water immersion indications/advantages

circumferential cooling (e.g., post workout)

cold or ice-water immersion contraindications/concerns

too cold/frostbite

ice packs indications/advantages

provides compression; good to “wrap and go”

vapocoolant sprays indications

Decrease muscle guarding/spasm to increase ROM; good for myofascial/trigger point pain; before injections?

electrical stimulation

applied to NERVE or MUSCLE tissue in order to provide tissue membrane

transcutaneous electric neuromuscular stimulator (TENS) indications

• Muscle re-education

• Muscle pump/contraction

• Pain relief 

• Bone healing 

transcutaneous electric neuromuscular stimulator (TENS) concerns

• pacemaker/heart disease

• Cancer

• 3rd degree muscle-tendon lesion

• Epilepsy

• Danger of hemorrhage 

• Thrombophlebitis

what is iontophoresis

Transferring medicine through EMS

is iontophoresis used often by A.T.’s? why or why not?

Not practical due to expense and medication dispensing 

What is the depth that this technique can reach?

3-5 cm

what does the application of high-frequency electrical energy generate in the body?

generates heat in body tissues

shortwave and microwave diathermy indications

depth of treatment

shortwave and microwave diathermy concerns

shouldn’t be used around metal objects (e.g., zippers, glasses, jewelry, metal table)

low-level laser therapy indications

increase collagen synthesis, decrease microorganisms; good for trigger points

low-level laser therapy concerns

shouldn’t be used over cancerous tissue, eyes, pregnant women during 1st trimester

ultrasound

Causes thermal and/or “mechanical” effects on cells at both the superficial and deep levels

ultrasound indications

• Same as heat if at right intensity

• Decrease matured calcification

• May help to modify inflammatory response when used acutely at right settings

• Phonophoresis