patho exam

Chapter 16: Therapeutic modalities

Modality options

-          Thermotherapy

-          Cryotherapy

-          Electrical stimulation

-          Short wave diathermy

-          Light therapy

-          Ultrasound

-          Phonophoresis

-          Traction

-          Intermittent compression

-          Massage

Energy

•      Can be reflected, refracted, absorbed or transmitted

•      Must be absorbed in tissue for physiological effects to take place

•      The mechanism of action depends on which form of energy is used during its application

Thermotherapy

Convection: the transfer of heat through a fluid (liquid or gas) caused by molecular motion (heating pad)

Conduction: The transfer of heat or electric current from one substance to another by direct contact. (Hot or cold tube with jets)

Radiation: Energy that is radiated or transmitted in the form of rays or waves or particles (light therapy)

Temperature & Tissue changes

Physiologic Response to Cold

•      Lower metabolic rate

•      Decreased damage due to hypoxia immediately after injury

•      Minimizes swelling

•      But do not get rid of swelling that is already present

•      Decrease free nerve ending excitability

•      More penetration and duration of effects than heat

CBAN

•      Cold

•      Burning

•      Aching

•      Numbness

Gate Control Theory (chapter 10)

•      Pain nerves = A-delta and C fibers

•      Sensory nerves = A-beta fibers (touch or pressure)

•      A-beta can overpower A-delta and C

•      Decreases pain sensation

Electric Stimulation (E-Stim)

•      Not Stem!

•      TENS = Transcutaneous electrical nerve stimulation

•      Includes neuromuscular electric stimulation (NMES)

•      When not NMES, it is used for pain modulation

Ultrasound

•      Can be thermal (continuous) or non-thermal (pulsed)

•      Can be superficial (3 MHz) or deep (1 MHz)

Massage

•      Mechanical responses

•      Venous and lymphatic drainage

•      Stretching of connective tissue

•      Physiological responses

•      Increased circulation à Increased metabolism

•      Reflex effects à relaxation

•      Psychological responses

•      Relaxation and bonding with practitioner

Cupping Therapy

•      Creates a suction effect

•      Used for swelling, pain, and scar tissue treatment

•      Mixed results from scientific research

Evidence-based practice

•      Clinical effectiveness yet to be determined for most modalities

•      Effectiveness vs. efficacy

•      Info from manufacturers

•      Need more research to be done

Chapter 17: Pharmacology, Drugs and sports (look at tables)

Vocabulary

Pharmacokinetics

•      Method by which drugs are absorbed, distributed, metabolized, and eliminated by the body

Inter-

·         Between

Intra-

·         Within: Intramuscular, intranasal

Pharmacodynamics

·         Effects of the drug on the body

In vitro

·         In the lab

·         “efficacy”

In Vivo

·         In the body

·         “effectiveness”

Effectiveness

A drug must reach the target tissue receptors to be effective

•      Dissolved, then absorbed into the blood

•      Distribution – transported in the blood to target tissue

•      Efficacy = Capability to produce desired effect

•      Potency = Dose needed to create the effect

•      Bioavailability – How completely a drug is absorbed and used

•      Metabolism – Transformed into water-soluble compound (liver)

•      Excretion – Filtered and excreted usually through urine (kidneys)

Pharmacokinetics & Physical Activity

•      Exercise increases absorption after intramuscular or subcutaneous administration

•      Exercise decreases absorption after oral administration

Drug Response

•      Influenced by:

•      Genetics, diet, alcohol consumption, physical activity, other drugs

•      Influences:

•      Hydration status, energy level, thermoregulation, other drugs

•      Every individual will react differently, even to the same drug and dosage

(thermoregulation: levels out your temperature in heat)

Body Responses to drugs

•      Antagonistic action – Two medications have adverse or counteracting effects on each other

•      Idiosyncrasy – Unusual or distinctive response to a drug (unique response to the individual)

•      Paradoxical reaction – Effect is the opposite of the therapeutic intention

•      Potentiating agent – Medication that increases the effect of another

•      Synergistic effect – Two drugs combined to have a greater effect than either drug alone

Drug Classification

•      Analgesics – Pain relief

•      Antibiotics – Kill or inhibit growth of bacteria (not viruses) (viruses: DNA/RNA needs a host)

•      Antihistamines – Fight allergic reactions

•      Antipruritic – Relieves itching

•      Antipyretics – Reduce body temperature

•      Antitussives – inhibit or prevent coughing (opposite of expectorants) (decrease coughing)

•      Anxiolytics – Inhibit anxiety

•      Bronchodilators – Relax or dilate the airways in the lungs (asthma)

Arachidonic Cascade

(COX) Cyclooxygenases

-          COX1 & COX2

NSAIDs

•      Anti-inflammatory, antipyretic (fever), and analgesic (Pain)

•      Inhibit prostaglandin synthesis (“COX-# inhibitors”)

•      WARNING: Associated with increased risk of cardiovascular events as well as gastrointestinal irritation.

•      Take the lowest effective dose for the shortest duration of time.

Performance Enhancing Drugs/Substance

PEDs are ergogenic aids (used to enhance athletic performance)

•      Stimulants = increase alertness, reduce fatigue

•      Amphetamines, caffeine

•      Beta Blockers = Relaxes blood vessels à Decreased HR and BP

•      Shooting and sailing (for high blood pressure)

•      Diuretics = Helps fluid elimination from tissues

•      Used for weight loss or to “flush” other drugs out of the body

•      HGH – Naturally occurring, but can be made synthetically

•      Blood Reinjection (Blood Doping) = Increases blood volume

Dependence

Psychological

•      Drive to use a drug in order to avoid discomfort or produce pleasure

Physiological

•      Tolerance of a drug leading to increased dosage and withdrawal symptoms

Some drugs that are abused are also PEDs (e.g., amphetamines or cocaine)

Drug Testing

•      Differences between US Anti-Doping Agency (USADA) and NCAA

•      Also, may not ban all the same substances

•      Both require urinalysis with two samples

•      Second sample would be used if a positive test is found

•      Banned substances could be illegal, PEDs, recreational, OTC, or prescription

Therapeutic Use Exemption (TUE)

•      Allows athlete to use a prescribed drug that would otherwise be banned

•      Requires paperwork and can only be used for a limited time

•      Still potential for cheating

Chapter 11 Psychological Considerations w/ Athletes

Pain (chapter 10)

●       Major indicator of injury

●       Pain is individual and subjective

●       Factors involved in pain

○       Anatomical structures

○       Physiological reactions

○       Psychological, social, cultural and cognitive factors

Pain Categories

●       Pain sources

○       Cutaneous pain is sharp, bright and burning with fast and slow onset (Acute injury)

○       Deep somatic pain originates in tendons, muscles, joints, periosteum and blood vessels

○       Visceral pain begins in organs and is diffused at first and may become localized

○       Psychogenic pain is felt by the individual but is emotional rather than physical

●       Fast versus Slow Pain

○       Fast pain localized and carried through A-delta axons (similar to Cutaneous pain)

○       Slow pain is perceived as aching, throbbing, or burning (transmitted through C fibers)

●       Acute versus Chronic Pain

●       Projected or referred pain

○       Pain which occurs away from actual site of injury/irritation

○       Three types of referred pain include: myofascial, scleronomic (nerve ends), and dermatomic (nerve ends)

Psychological Aspect of Pain

●       Pain thresholds vary per individual

●       Pain is often worse at night due to solitude and absence of external distractions

●       Personality differences can also have an impact

●       Patients, through conditioning, are often able to endure pain and block sensations of minor injuries

Why are psychological considerations important?

●       Athletic activity may result in a physical injury, however physical injury can elicit psychological reactions

○       Stress

○       Sadness

○       Anger

●       Psychological factors can be a precursor to injuries, play a role in rehabilitation, and play a role in successful return-to-play

Personality

Type A vs. Type B Personalities

●       Type A people tend to be more competitive, time urgent, and perceived as hostile or aggressive

●       Type B people tend to be more relaxed, patient, and easy going

●       Personality affects people's reactions to events, such as stress or injury and recovery

Model of stress & Injury

Coping

●       Healthy Coping:

○       Sports/Exercise

○       Meditation

○       Hobbies outside of sport

○       Thought replacement

○       Imagery

○       Positive self-talk

○       Goal setting

○       Progressive muscle relaxation

●       Unhealthy Coping

○       Substance Abuse

○       Anger

○       Self-Harm

Eating Disorders & Body Dysmorphia

Anorexia vs. bulimia

●       Body Dysmorphia = a mental health disorder where you can't stop thinking about one or more perceived defects or flaws in your appearance

Signs and Symptoms:

●       Obsession with food and exercise

●       Compulsive exercise beyond what is good for sport performance and health

●       Social withdrawal

●       Fear of eating in public

Relative Energy Deficiency in sport (RED-S)

·         Formerly “Female Athlete Triad”

·         Life-threatening

·         Not limited to elite athletes or certain ages

·         Especially harmful in youth

·         Men with disordered eating may also have bone loss

●     Disordered eating – inadequate food, energy intake that does not meet metabolic demands of exercise and normal physical functioning

●     Amenorrhea – more than 3 months

●     Osteoporosis

●     Begins with disordered eating (inadequate food for energy/metabolic demands), which results in amenorrhea and low estrogen, which eventually results in bone loss (estrogen drops to postmenopausal levels).  Bone mineralization is also inhibited due to dietary intakes and other hormonal changes

●     Critical time for amenorrhea is unknown but >3 months is widely considered dangerous

●     Risk for fractures; bone density can increase with return to normal estrogen and dietary intakes, but doesn’t recover completely

Exercise Addiction

•      Chronic loss of perspective on the role of exercise in a full life.

•      Do not see value in unrelated activities and pursue exercise against their own best interests.

Signs of Exercise Addition

·         Allows exercise to become overvalued

·         Emotional connections are passed up

·         All free time is consumed by exercise

·         Withdrawal symptoms occur

Reaction to injury- 3 phases

Three reactive phases of injury and rehabilitation

○       Reaction to injury (Acute inflammation)

○       Reaction to rehabilitation

○       Reaction to return to activity (remodeling)

Reaction to short-term (<4 wks) injury

○       Reaction to Injury: Shock, Relief

○       Reaction to Rehab: Impatience, Optimism

○       Reactions to Return to Activity: Eagerness, Anticipation

Reaction to Long-term (>4 wks) Injury

○       Reaction to injury: Fear, Anger

○       Reaction to Rehab: Loss of vigor, irrational thoughts, Alienation

○       Reaction to Return to Activity: Acknowledgement, Trust

Reaction to chronic Injury

○       Reaction to Injury: Anger, Frustration

○       Reaction to Rehab: Dependence, Independence, Apprehension

○       Reaction to Return to Activity: Skeptical, Confident

Reaction to Career ending injury

○       Reaction to Injury: Isolation, Grief

○       Reaction to Rehab: Loss of athletic identity,

○       Reaction to Recovery: Closure and renewal (what now & what’s next)

Psychological Issues with Rehabilitation

●       Athletes need to be able to voice their concerns

●       AT can help by answering questions and explaining the process of RTP

●       Goal setting, positive self-statement, cognitive restructuring, and imagery/visualization are strategies that are associated with faster recovery

●       Talk about the different types on injury

●       Cognitive restructuring: a psychotherapeutic process of learning to identify and dispute irrational or maladaptive thoughts

●       Ex: such as all-or-nothing thinking, magical thinking, over-generalization, magnification, and emotional reasoning

Psychological reactions to exercise and athletic injuries

●       Fear and anxiety

●       Identity loss

●       Lack of confidence

●       Performance decrements

●       Group processes

Signs of adjustment to athletic injuries

●       Obsession with the question of when one can return to play

●       Denial (e.g., “The injury is no big deal”)

●       Repeatedly coming back too soon and experiencing reinjury

●       Exaggerated bragging about accomplishments

●       Dwelling on minor physical complaints

●       Guilt about letting the team down

●       Withdrawal from significant others

●       Statements indicating that no matter what is done, recovery will not occur

●       Unreasonable fear of reinjury (Kinesiophobia)

Role of the AT

●       Understand and recognize the symptoms of substance use disorders and mental health disorders

●       Explain the adverse effects that substance use and mental health disorders

●       Work with campus partners to provide access to licensed mental health providers

●       Facilitate appropriate referrals for those seeking treatment, understand that you are not an expert on these conditions

●       Think about referrals this way, you would see an ortho for injuries to the body, a neurologist for the brain, it is the same when referring for SA or MH, send them to an expert

Supports Systems

●       Family

●       Friends

●       Teammates/Coaches

●       Counselors

Hit on how athletes must relearn to build support & How injury can affect team and coach support

Types of social support

Multidimensional:

○       Emotional Support (kiss the booboo)

○       Esteem Support (you’ll be ok)

○       Informational Support (factual information)

○       Tangible Support (physical help)

Key Points:

○       Recognize different types are provided by different agents

○       Need is greatest when the rehab process is slow, when set-backs occur, or when life demands add extra stress

Help to end the stigma

●       Too often mental health disorders are seen as weakness

●       Ways to end the stigma and create a safe space for your athletes: 

○       Use respectful language Challenge misconceptions

○       See the person, not the condition

○       Offer support if you think someone is having trouble

●       Labels to avoid:

○        Challenged    

○       Crazy

○       Demented

○       Lunatic

○       Normal/not normal

○       Psycho/psychopath

○       Schizo

○       Special

○       Sufferer/victim

○       Wacko

Injuries Supplement

Palpation = feeling with your hands

Palpitation = heart irregular rhythm

FOOSH/ FOOSA

Falling On Outstretched Hand/Arm

Just about any part of the upper extremity can be injured from this mechanism

           - Scaphoid

           - Thumb UCL sprain

           - SLAP Tear

           - AC Joint Sprain

           - Clavicle Fx

           - Shoulder dislocation

Rotator Cuff

1.      S: Supraspinatus

2.      I: Infraspinatus

3.      T: Tere minor

4.      S: Subscapularis

Many rotator cuff rehab programs must include strengthening of the “scapular stabilizers” (rhomboids, trapezius, etc.). If the scapula is not stabilized, the rotator cuff does not have a strong foundation to move from.

Achilles tendon rupture

·         Filling extended Achilles with a push off motion

Loud “Pop”

·         Achilles tear

·         ACL (Especially after a plant and twist)

·         Ulnar Collateral Ligament

·         Lateral Ankle Sprain (grade 2 or 3)

Patella Dislocation Reduction

·         Will slowing going back into place when knee goes from flexion to extension with guidance

·         Fingers, kneecaps and shoulder (an AT will put back in place)

Plantar Fasciitis Treatment

·         Use a lacrosse ball to roll out the calf muscles

Why?

Why can you walk (and sometimes even jog) with a torn ACL?

The muscles around support to area around the ACL

Why might patellar dislocation lead to pain in the hip?

Patellar dislocation, or a dislocated kneecap, can cause pain in the hip due to the "kinetic chain" effect

Proprioception

To Surgery or Not to surgery (Questions asked by ATs or physicians before moving from conservative)

·         Prioritize conservative treatment

·         What leads to best recovery?

·         Can it heal on its own (displaced vs. non-displaced; blood flow)?

·         Adverse effects?

·         Evidence-based?

Injuries To focus on

           Plantar Fasciitis

           Iliotibial Band

           Rotator Cuff

           Acetabular Labrum

           ACL

           Achilles Tendon

           Spondylolysis/Spondylolisthesis

Talus Shape & Inversion Sprain

·         Because the posterior portion is narrower, going into plantarflexion creates more space in the joint à higher risk of injury. This is why basketball players may come down from a jump, land on someone else’s foot, and sprain their ankle.

Locking/clicking

           -Meniscus

           - Acetabular labrum

           The “bucket handle” tear is when a part of the meniscus lifts up from the tibial plateau. The piece of the meniscus is then vertical in the joint space, which will lead to locking/clicking of the knee.

Chapter 26: Head, Face, Eyes, Ears, Nose, Throat

Dental Injuries

Avulsion: dislocation

VS

·         Allergens don’t cause damage (is not contagious)

·         Pathogen is usually a viruses / bacterium ( body is trying to get it out of its body)

·         Viruses needs a host cell

·         Viruses will spread

·         Bacteria will stay local

Nasal Injuries

¡  Epistaxis = Nose Bleed

Ear Injuries

¡  Auricular (Pinna) Hematoma a.k.a. “Cauliflower Ear”

¡  Prevent by reducing friction or application of cold pack

¡  May need draining (IND), but easy to re-injure

¡  Otitis Externa a.k.a. “Swimmer’s Ear”

¡  Caused by bacteria, especially when water is caught in the ear

¡  Prevent by drying ears thoroughly

¡  Requires referral to a physician

¡  Otitis Media (Middle Ear Infection)

¡  Buildup of fluid in middle ear

Eye Definition & assessment

¡  Optometrist vs. Opthalmologist

¡  Diplopia = Double vision

¡  Nystagmus = Uncontrolled shaking

¡  PERRLA = Pupils Equal Round Reactive Light Adaptation

Eye injuries

¡  Orbital Hematoma a.k.a. “Black Eye”

¡  Orbital Fracture or “Blowout Fracture”

¡  Surgical repair within 6-15 days

¡  Corneal Abrasions/Foreign Bodies

¡  Hyphemia

¡  Blood in anterior eye chamber

¡  Immediately refer to eye specialist!

¡  Retinal Detachment

¡  Floating specs, flashes of light, blurred vision. “Curtain” falling over field of vision

¡  Refer to ophthalmologist

¡  Conjunctivitis (Pink Eye)

¡  If whitish yellow discharge, associated with bacteria. Highly contagious.

¡  There are specialists and physicians for these conditions

¡  Refer when necessary

Chapter 29: Additional General Medical Conditions

Rhinovirus (Common cold)

◦         Etiology

◦         Over 100 different rhinoviruses

◦         Transmitted by either direct or indirect contact (cough, sneeze, speaking, touching contaminated article)

◦         Sign and Symptoms

◦         Begins w/ scratchy, sore throat, stopped-up nose, watery discharge and sneezing

◦         The second batch may produce thick yellow nasal discharge, watering eyes, mild fever, sore throat, headache, malaise (feeling tired), myalgia (muscle soreness), dry cough

◦         Secondary - laryngitis, tracheitis, acute bronchitis, sinusitis, and otitis media

◦         Management

◦         Symptomatic treatment (may last 5-10 days)

◦         Non-prescription cold medications

◦         Eat a balanced diet, consume 64 oz. of water

◦         Avoid emotional stress and extreme fatigue

Influenza (Flu)

◦         Etiology

◦         Virus enters through membrane, then controls cell genetic material

◦         Sign and Symptoms

◦         Fever (102-103 degrees F), chills, cough, headache, malaise, and inflamed respiratory mucous membrane w/ coryza

◦         General aches and pains, headaches become worse

◦         Weakness, sweating, fatigue may persist for many days

◦         Management

◦         Bed rest and supportive care, usually resolved in 3-7 days

◦         Symptomatic care

◦         Aspirin should be avoided by those under 18

◦         Steam inhalation, cough medicines, and gargles

Infectious Mononucleosis (Mono)

◦         Etiology

◦         Epstein-Barr virus (member of herpes group) that has an incubation period of 4-6 weeks

◦         Transmitted through saliva

◦         Sign and Symptoms

◦         First 3-5 days -severe fatigue, headache, loss of appetite and myalgia

◦         Days 5-15 - fever, swollen lymph nodes and sore throat (50% will experience enlarged spleen)

◦         Possible jaundice, skin rash, puffy eyelids

◦         Management

◦         Supportive symptomatic treatment

◦         Acetaminophen for headache, fever and malaise

◦         Resume training after 3 weeks after onset if spleen not markedly enlarged/painful, patient is afebrile, liver function is normal, and pharyngitis is resolved

Varicella (Chicken Pox)

◦         Etiology

◦         Caused by the varicella-zoster virus (herpes zoster)

◦         May occur at any age (more common in children)

◦         Incubation time is 13-17 days following exposure

◦         Contagious for 11 days, including 5 days prior to rash

◦         Signs and Symptoms

◦         Slight elevation in temperature followed by eruption of rash

◦         Rash progresses (macule, papule, vesicles, and crusts over for 2-3 days)

◦         Rash begins on back and chest

◦         May last 2-3 weeks

◦         Management

◦         Varicella-zoster immune globulin within 3 days of exposure will prevent clinical symptoms in normal healthy children

◦         Acyclovir meds should be administered to adolescents and adults w/ in 24 hours of exposure

◦         Anti-itching medications to prevent scratching

◦         To prevent, children 12-18 months can be vaccinated

◦         Results in significantly lowering the chance of getting chickenpox later in life

◦         Later in life = shingles

◦         Vaccine

◦         One dose for children under 4 years

◦         2 dose sequence for those older than 4 years

Respiratory Condition

Sinusitis

◦         Etiology

◦         Stems from upper respiratory infection caused by a variety of bacteria

◦         Sign and Symptoms

◦         Painful pressure occurring from accumulation of mucus

◦         Skin over sinus may be swollen and painful to the touch

◦         Headache and malaise; purulent nasal discharge (Clear)

◦         Management

◦         If infection is purulent (pus), antibiotics may be warranted

◦         Steam inhalation and other nasal topical sprays w/ Afrin

Seasonal Atopic (Allergic) Rhinitis

◦         Etiology

◦         Reaction to pollen , dust, dander, or mold

◦         Airborne fungal spores (allergens) resulting in allergic antibodies causing the release of histamine

◦         Sign and Symptoms

◦         Eyes, throat, mouth and nose begin to itch, followed by watering eyes, sneezing and clear watery discharge

◦         Management

◦         Oral antihistamines and decongestants

Pharyngitis (Sore throat)

◦         Etiology

◦         Caused by virus or streptococcus bacteria

◦         Transmitted by direct contact of infected person or one who is a carrier

◦         Sign and Symptoms

◦         Pain w/ swallowing, fever, inflamed and swollen glands, malaise, weakness

◦         Mucus membrane may be inflamed and covered w/ purulent matter

◦         Management

◦         Throat culture

◦         Topical gargles and rest

◦         Antibiotic therapy for streptococcal infection

Bronchial Asthma

◦         Etiology

◦         The exact cause is unclear

◦         Can be triggered by viral respiratory tract infection, emotional upset, changes in barometric pressure or temperature, exercise, inhalation of noxious odor or exposure to specific allergen

◦         Exercise-Induced Asthma

◦         Bronchial asthma triggered by exercise

◦         Brought on by exercise w/ exact cause unknown

◦         Loss of heat and water, sinusitis can also trigger

◦         Management

◦         Regular exercise program

◦         Inhaled bronchodilators

◦         Prevention (scarf in cold air, slowly building intensity, avoiding polluted air)

Blood & Lymph Disorders

Anemia

◦         Iron Deficiency Anemia

◦         Prevalent in menstruating women and males age 7-14

◦         Menstruation accounts for most iron lost in women

◦         Three things occur during anemia

◦         Small erythrocytes

◦         Decreased hemoglobin

◦         Low ferritin concentration (compound that contains 23% iron)

◦         Sickle Cell Anemia

◦         Hereditary hemolytic anemia - RBC’s are sickle or crescent shaped (irregular hemoglobin)

◦         Less ability to carry oxygen, limited ability to pass through vessels, causing clustering and clogging of vessels (thrombi)

Cytes: cells

Hemophilia

◦         Etiology

◦         Hereditary disease caused by absence of clotting factors

◦         Prolonged coagulation time, failure of blood to clot and abnormal bleeding

◦         Sign and Symptoms

◦         Physical exertion can cause bleeding into muscles and joints -- may be extremely painful

◦         Joints may become immobilized

◦         Management

◦         If bleeding occurs, athletes should be taken to a medical care facility

◦         No cure

◦         Clotting factors have been developed to control bleeding for several days

◦         Avoid trauma and wear medical alert bracelet

Diabetes Mellitus

◦         Etiology

◦         Involve a complete or partial decrease in insulin secretion

◦         Type I (insulin-dependent, or IDDM)

◦         Pancreas produces little to no insulin

◦         Typically occurs in individuals under age 35

◦         More genetic

◦         Type II (non-insulin-dependent)

◦         Body has developed resistance to insulin

◦         More often in people older than 40

◦         Sign and Symptoms

◦         Type I - sudden symptoms of frequent urination, constant thirst, weight loss, constant hunger, and tiredness

◦         Type II – same as above but slower onset and also itchy dry skin and blurred vision

◦         Diagnosed through measurements of blood glucose levels

◦         Both forms can be a threat to heart, kidney, blood vessel and eye function

◦         Management

◦         Monitor and control glucose levels through diet or insulin injections

◦         Vigorous exercise increases peripheral insulin action and enhances glucose tolerance

◦         Extreme temperatures and unpredictable activity levels may require the administration of rapid-acting carbohydrates

Diabetic Coma

◦         Too little insulin

◦         Etiology

◦         Loss of sodium, potassium and ketone bodies through excessive urination (ketoacidosis)

◦         Sign and Symptoms

◦         Labored breathing, fruity smelling breath (due to acetone), nausea, vomiting, thirst, dry mucous membranes, flushed skin, mental confusion or unconsciousness followed by coma.

◦         Management

◦         Early detection is critical as this is a life-threatening condition

◦         Monitor blood glucose levels

◦         Insulin injections may help to prevent coma

Insulin Shock

◦         Etiology

◦         Occurs when the body has too much insulin and too little blood sugar

◦         Sign and Symptoms

◦         Tingling in mouth, hands, or other parts of the body, physical weakness, headaches, abdominal pain

◦         Normal or shallow respiration, rapid heart rate, tremors along with irritability and drowsiness

◦         Management

◦         Adhere to a carefully planned diet including snacks before exercise

Seizure Disorders: Epilepsy

◦         Defined as recurrent paroxysmal disorder of cerebral function characterized by periods of altered consciousness, motor activity, sensory phenomena or inappropriate behavior caused by abnormal cerebral neuron discharge

◦         Etiology

◦         For some forms of epilepsy there is genetic predisposition

◦         Brain injury or altered brain metabolism

◦         Sign and Symptoms

◦         Periods of altered consciousness, motor activity, sensory phenomena or inappropriate behavior caused

◦         May last 5-15 seconds (petit mal seizure) or longer (grand mal seizure)

◦         Includes unconsciousness and uncontrolled tonic-clonic muscle contractions

◦         Management

◦         Individuals that experience daily or weekly seizures should be prohibited from participating in collision sports (blow resulting in unconsciousness could result in serious injury)

◦         Must be careful with activities involving changes in pressure

◦         Can be managed with medication

Hypertension (High Blood Pressure)

◦         Etiology

◦         Primary hypertension accounts for 90% of all cases with no other disease association

◦         Secondary hypertension is associated with kidney disorder, overactive adrenal glands, hormone-producing tumor, narrowing of aorta, pregnancy and medications

◦         Long term cases increase the chances of premature mortality and morbidity due to coronary artery disease, congestive heart failure and stroke

◦         Sign and Symptoms

◦         Primary hypertension is generally asymptomatic until complications arise

◦         May cause dizziness, flushed appearance, headache, fatigue, epistaxis (nose bleeds) and nervousness

◦         Management

◦         Thorough examination must be performed to determine the type of hypertension and extent of hypertension

◦         Medication is not recommended for those with pre-hypertension (120-139/80-89) unless linked with other conditions

◦         If pre-hypertension is an issue - lifestyle changes should be made

◦         Individuals with stage 1 and 2 hypertensions should be medicated

                      Cancer

◦         Etiology

◦         Condition where cellular activity becomes abnormal and cells no longer perform normal function

◦         Cells do not multiply at increased rate but continue to develop ultimately taking over normal tissue

◦         Tumors may be benign or malignant

◦         Malignancies are classified based on the types of tissue they invade

◦         Variety of causes including, ultraviolet radiation, chemicals (tobacco), alcohol, fatty diet, combination of heredity and environmental factors

Cancer Management

◦         Sign and Symptoms

◦         Vary tremendously depending on type of cancer

◦         Warning signs include change in bowel and bladder habits, sore throat that does not heal, unusual bleeding or discharge, development of lump in breast or elsewhere, indigestion, change in wart or mole

◦         Management

◦         Early detection is critical

◦         Effective forms of treatment include surgery, radiation and chemotherapy

Chapter 6: Environmental Considerations

Types of environmental health issues

•      Hyperthermia

•      Hypothermia

•      Altitude

•      Sunburn

•      Lightning

•      Air Pollution

Heat

•      Heat illness is a serious threat to health, but it is preventable

Physiology

•      Metabolic Heat Production

–     Normal metabolic function results in heat production (“burning” of calories)

•      Therefore, we need to find a way to dissipate the heat in order to maintain normal body temperature (98f/37c body temp)

Body heat exchange

•      Conduction – direct contact (loss or gain)

•      Convection – circulation (loss or gain)

•      Radiation –  loss or gain (from sun)

•      Evaporation (heat loss only)

–     When radiant heat and environmental temperature is greater than body temperature, the body must cool via sweat evaporation

•      Cannot evaporate sweat in relative humidity of 75% or more

WBGT

•      Wet Bulb Globe Temperature Index

–     WBT and DBT are measured using a sling psychrometer (manual or digital)

–     Incorporates

•      Dry bulb – standard air temperature

•      Wet bulb – heat with humidity

•      Black bulb – radiant heat

–     These readings together provide a heat index reading

Heat Illness

•      Heat Rash (prickly heat)

–     Red, raised rash that stings from sweat

•      Heat Syncope (fainting)

–     Associated with rapid fatigue, overexposure to heat, and long periods of standing

•      Heat Cramps

–     Due to dehydration and electrolyte imbalance

Hot Exhaustion

–     Result of dehydration and overexertion

–     Cardiac output drops

–     S&S

•      Profuse sweating

•      Pale skin

•      Mild elevation in temperature

•      Dizziness

•      Nausea

•      Vomiting/diarrhea

•      Hyperventilation

•      Muscle cramps

•      Loss of coordination

–     Must be hydrated and cleared by a physician to return to play

Heat Stroke

–     Life – threatening condition (body is giving up)

–     Sudden onset

•      Collapse

•      Loss of consciousness

•      Dysfunction of the central nervous system

•      Flushed, hot, dry skin (minimal sweating)

•      Shallow breathing

•      Strong rapid pulse

•      High core body temperature

–     Drastic cooling measures must be implemented

–     Constant Core Temperature Evaluation

–     Remove from cold tub when core temp reaches 102°F

Prevention of Heat Illness

•      Stay cool and ingest fluids

•      Drink before thirst

–     1-2% drop in body weight indicated dehydration

•      Modify exercise in hot humid climates

•      Allow athletes unlimited access to water

•      Sports drinks

–     Replaces electrolytes

–     Flavor enhances desire to drink

•      Acclimatization

–     Preseason conditioning – graded conditioning over 7-10 days

–     80% acclimatization can occur in the first 5-6 days of double practices

•      Identify those who are at risk

–     Athletes with large muscle mass

–     Overweight athletes

–     Individuals with

•      Poor fitness

•      History of heat illness

•      Heart conditions

•      Wear light clothing that is breathable

•      Weight records

•      Temperature and humidity readings

Hypothermia

•      Most activities in sport allow for adequate heat production (watch warm up and down times)

•      Temperature in combination with wind chill, and wetness increases the chance of hypothermia

Prevention of hypothermia

•      Wear gear that wicks moisture away from skin

•      Windproof and waterproof fabrics

•      Dress in layers

•      Hydration assists with heat maintenance

•      Associated cold injuries

–     Frost nip (mild), frost bite (more severe)

–     Raynaud’s Syndrome (reducing blood flow)

Cell death: Necrosis 

Altitude

•      Natives

–     Larger chest capacity, more alveoli, capillaries, and red blood cells

•      Residents

–     Partial adaptations include

•      Increased mitochondria, hemoglobin and glycogen conservation

•      Visitor

–     Increased breathing and heart rates

–     Changes in blood flow and enzyme activity

–     Takes 2-3 weeks to adjust

Altitude Illness

•      Acute mountain sickness

–     Due to disruption in fluid balances in the brain

–     Headache, nausea, vomiting, sleep disturbance, dyspnea (Shortness of breath)

•      Pulmonary edema

–     Lungs accumulate fluid

–     Dyspnea, cough, headache, weakness, LOC

•      Sickle Cell Trait

–     8-10% of African Americans have this trait

•      High red blood cell hemoglobin

–     In high altitudes, the blood is deoxygenated, and the RBC’s clump together, causing deoxygenation of the tissues and tissue death.

–     Results in enlarges spleen and possibly rupture

Lightning Safety

•      #2 Cause of death by weather phenomena

•      For safety of athletes and spectators, there must be a plan of action

•      Safety

–     Avoid large trees, flag/light poles, standing water, telephones, bleachers, pools, showers, umbrellas, other metal objects

–     If hair stands up on your hand, you are in imminent danger and should minimize the surface area for the lightning to strike

Flash-to-Bang

•      Flash to bang method

–     Estimates the distance of the storm from your location

•      Count the time from the flash of lightning to the sound of the thunder

–     5 seconds = 1 mile

–     < 30 seconds indicated inherent danger (too close) (6 miles)

–     < 15 seconds - should evacuate the field

–     May return to the field 30 minutes following the last sound of thunder

Air Pollution

•      Problem in urban areas

•      Types

–     Smog – carbon monoxide (effects lungs and cognitive performance) and sulfur dioxide (effects lung capacity and efficiency)

–     Photochemical haze – nitrogen dioxide and stagnant air

•      When mixed with sun, creates and ozone

•      Ozone

–     Athletes may experience shortness of breath, coughing, chest tightness, pain with deep breathing, nausea, eye irritation, fatigue, lung irritation, etc

–     Asthmatics are at greater risk of symptoms

–     May become desensitized over time

Managing Environmental Risks

•      Know who is susceptible

•      Prepare ahead of time

–     Hydration, sleep, acclimatization

•      Communication is key