Kin 188  Pre Participation Physical Examinations
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Kin 188 Pre Participation Physical Examinations






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    Kin 188  Pre Participation Physical Examinations Kin 188 Pre Participation Physical Examinations Presentation Transcript

    • KIN 188 – Prevention and Care of Athletic Injuries Pre-Participation Physical Examinations
    • PPE
      • Goals of the PPE
      • Preparation for the PPE
      • Medical history
      • Components of the PPE
      • Clearance for participation
    • Goals of the PPE
      • Determine general health and current immunization status
      • Establish rapport with participant
      • Detect medical conditions that can predispose one to injury/illness so treatment can be continued/initiated
      • Identify health risk behaviors that can be addressed with counseling
    • Goals of the PPE
      • Establish baseline parameters for return to play decisions
      • Assess physical maturity
      • Evaluate physical fitness
      • Make recommendations regarding participation/exercise
      • Meet legal requirements to athletic participation
    • Goals of the PPE
      • Specific focus of PPE varies amongst populations
        • Pre-pubescent
          • Undiagnosed congenital abnormalities
        • Pubescent
          • Maturation level, establishing healthy behaviors
        • Young adult
          • History of previous injury, sport-specific exam
        • Adult
          • Overuse conditions predominate
    • Preparation for the PPE
      • No one best/right way to do PPE
      • Influenced by several factors
        • Level of competition
        • Availability of personnel and facilities
        • Number of PPE being conducted
        • Personal preference/history
    • Preparation for the PPE
      • Format
      • Timing
      • Frequency
    • PPE Format
      • Primary care physician model
        • Enhanced knowledge of medical history, immunization status and prior injuries that could limit participation
        • Generally a more thorough exam
        • Affords best privacy and better environment for counseling
        • Cost is expensive – insurance?
    • PPE Format
      • Group/station model
        • Good for large number of PPE in given period of time
        • Allows better understanding of demands of activity
        • Individual personnel responsible for given element of PPE at “station”
        • Clearance verified by team MD at end of PPE
        • Typically free of charge
    • PPE Timing
      • Ideally completed several weeks prior to initial practice
      • Allows ability to address any problems identified on PPE (labs, tests, records) without impeding participation status
      • Typically done within 1 week prior to first scheduled activity – high schools often over summer
    • PPE Frequency
      • Entry-level PPE (complete) at outset of participation for school/organization
      • Recommended annual re-evaluation without complete PPE unless warranted
    • Medical History
      • Generally accomplished ahead of time in yes/no format
        • Often a supplemental form for females
      • For station model, qualified evaluator must review history and red flag potential concerns for further scrutiny/evaluation
    • Components of the PPE
      • Vital signs
      • General medical problems
      • Cardiovascular
      • Pulmonary
      • Musculoskeletal
      • Neurologic
      • Eyes
      • Dental
      • Gastrointestinal
      • Genitourinary
      • Dermatologic
      • Examination for heat disorders
      • Laboratory tests
    • Vital Signs
      • Establishes individual’s baseline parameters
        • Height/weight
          • Comparison to normative data
        • Pulse/respiratory rate (60-100/12-16)
          • Observe quantity and quality
        • Blood pressure (120/80)
          • Cuff size very important
        • Body temperature (98.6/37.0)
          • Oral vs. tympanic vs. axillary (rectal)
    • General Medical Problems
      • Questions asked regarding
        • Currently being treated for illness/injury
        • History of hospitalization or surgery
        • History of progressive disease (MS, MD, cancer)
        • Current use of OTC/Rx meds
        • Allergies to meds, food, environment
    • Cardiovascular Examination
      • Done in quiet area to maximize validity
      • Auscultation of heart sounds
      • Questions asked regarding
        • Fainting (syncope), dizziness, SOB, chest pain with exertion
        • Heart palpitations, tachycardia, dysrhythmia, known murmur
        • Family member with sudden, early cardiac death
      • Positive responses to any necessitate referral to cardiologist for further evaluation
    • Pulmonary Examination
      • Done in quiet area to maximize validity
      • Auscultation of breath sounds in all lung lobes – look for symmetrical movement of diaphragm
      • Questions asked regarding
        • Excessive coughing during/after activity
        • History of asthma, EIA, bronchitis, allergies
        • SOB, unusual breath sounds during/after activity
        • History of collapsed lung (pneumothorax)
    • Musculoskeletal Examination
      • Basic exam consists of observation for symmetry, ROM, strength tests for major muscles and specific tests for previously injured areas
      • Questions asked regarding
        • Focus on history of injury, time frame, evaluation, treatment and rehabilitation
        • Use of protective devices
    • Neurologic Examination
      • Evaluation consists of cranial nerve tests including pupil function, sensory/motor tests of UE/LE, deep tendon reflexes
      • Questions asked regarding
        • History of head injuries
        • Any previous loss of consciousness
        • Numbness/tingling, loss of motor function in body
        • History of seizures, burners/stingers
    • Eye Examination
      • Visual acuity assessed via Snellen chart, both monocularly and binocularly (use corrective lenses)
        • Emmetropia (20/20 vision)
        • Myopia (nearsightedness)
        • Hypermetropia (farsightedness)
      • Questions asked regarding
        • Use of corrective lenses/type
        • Blurring or double vision
        • Color blindness, peripheral vision loss
        • History of eye trauma, retinal detachment
    • Dental Examination
      • Typically done by dentist – not meant to perform preventative care but to establish pre-existing conditions for liability reasons in case of dental injury
      • Allows opportunity for dental molds to be made for crafting of custom mouthguard
    • Gastrointestinal Examination
      • Evaluation of digestive system, eating habits and nutrition
        • Concerns for athletes where image is important to activity
      • Evaluation done supine with palpation for masses or organomegaly
      • Questions regarding
        • History of heartburn, indigestion, diarrhea or constipation
        • Prior history of organ injury (spleen, liver, kidney)
    • Genitourinary Examination
      • For males, questions asked regarding
        • Hernias, testicular torsion, absent or undescended testicle
      • For females, questions asked regarding
        • Menstrual cycle, pregnancy
      • General questions asked regarding
        • History of bladder/urinary tract infections, STDs
        • Absence of one kidney
      • Can include urinalysis to look for proteins, blood, sugar and hemoglobin in urine
    • Dermatologic Examination
      • Skin evaluated for rashes, lesions, infections that can be contagious to others
        • Herpes, fungal infections (tinea), impetigo, STDs, acne/treatment
      • Also look at existing blemishes (warts, moles, etc.)
        • Change in appearance (size, color, border, etc.) in recent past
    • Examination for Heat Disorders
      • Especially important for activities taking place under conditions of high temperature, high humidity or a combination of the two
      • Questions asked regarding
        • History of heat illness (cramping, syncope, exhaustion, stroke)
        • Current meds (diuretics, antihistamines)
        • Use of caffeinated/alcoholic beverages
        • Nutritional and hydration habits
    • Laboratory Tests
      • Not typical associated with PPE – usually due to cost of testing procedures
      • Often used when/if red flags appear during PPE
        • Urinalysis
        • Blood work
        • ECG
    • Clearance for Participation
      • Conditions to be met to allow clearance by ME at end of PPE
        • Will condition increase risk of injury to individual or others?
        • Can participation be allowed if meds, rehab or protective bracing/padding is used? If so, can limited participation be allowed in interim?
        • If clearance is denied for particular activity, can other safe activities be identified and clearance be granted for them?
    • Clearance for Participation
      • Individuals have right to participate in any activity regardless of pre-existing medical condition/s
      • Physician’s cannot exclude individual from participation – can only recommend against participation
      • Often use exculpatory waiver to identify and acknowledge assumption of risk
    • Clearance for Participation
      • Examples of recommended disqualifying conditions (American Academy of Pediatrics)
        • Atlantoaxial instability
        • Aortic disorders
        • Convulsive disorders
        • Serious bleeding tendencies
        • Absence of paired organ for contact activities
        • Repeated concussions
        • Uncontrolled diabetes