KIN 188 – Prevention and Care of Athletic Injuries Pre-Participation Physical Examinations
PPE <ul><li>Goals of the PPE </li></ul><ul><li>Preparation for the PPE </li></ul><ul><li>Medical history </li></ul><ul><li...
Goals of the PPE <ul><li>Determine general health and current immunization status </li></ul><ul><li>Establish rapport with...
Goals of the PPE <ul><li>Establish baseline parameters for return to play decisions </li></ul><ul><li>Assess physical matu...
Goals of the PPE <ul><li>Specific focus of PPE varies amongst populations </li></ul><ul><ul><li>Pre-pubescent </li></ul></...
Preparation for the PPE <ul><li>No one best/right way to do PPE </li></ul><ul><li>Influenced by several factors </li></ul>...
Preparation for the PPE <ul><li>Format </li></ul><ul><li>Timing </li></ul><ul><li>Frequency </li></ul>
PPE Format <ul><li>Primary care physician model </li></ul><ul><ul><li>Enhanced knowledge of medical history, immunization ...
PPE Format <ul><li>Group/station model </li></ul><ul><ul><li>Good for large number of PPE in given period of time </li></u...
PPE Timing <ul><li>Ideally completed several weeks prior to initial practice </li></ul><ul><li>Allows ability to address a...
PPE Frequency <ul><li>Entry-level PPE (complete) at outset of participation for school/organization </li></ul><ul><li>Reco...
Medical History <ul><li>Generally accomplished ahead of time in yes/no format </li></ul><ul><ul><li>Often a supplemental f...
Components of the PPE <ul><li>Vital signs </li></ul><ul><li>General medical problems </li></ul><ul><li>Cardiovascular </li...
Vital Signs <ul><li>Establishes individual’s baseline parameters </li></ul><ul><ul><li>Height/weight </li></ul></ul><ul><u...
General Medical Problems <ul><li>Questions asked regarding </li></ul><ul><ul><li>Currently being treated for illness/injur...
Cardiovascular Examination <ul><li>Done in quiet area to maximize validity </li></ul><ul><li>Auscultation of heart sounds ...
Pulmonary Examination <ul><li>Done in quiet area to maximize validity </li></ul><ul><li>Auscultation of breath sounds in a...
Musculoskeletal Examination <ul><li>Basic exam consists of observation for symmetry, ROM, strength tests for major muscles...
Neurologic Examination <ul><li>Evaluation consists of cranial nerve tests including pupil function, sensory/motor tests of...
Eye Examination <ul><li>Visual acuity assessed via Snellen chart, both monocularly and binocularly (use corrective lenses)...
Dental Examination <ul><li>Typically done by dentist – not meant to perform preventative care but to establish pre-existin...
Gastrointestinal Examination <ul><li>Evaluation of digestive system, eating habits and nutrition </li></ul><ul><ul><li>Con...
Genitourinary Examination <ul><li>For males, questions asked regarding </li></ul><ul><ul><li>Hernias, testicular torsion, ...
Dermatologic Examination <ul><li>Skin evaluated for rashes, lesions, infections that can be contagious to others </li></ul...
Examination for Heat Disorders <ul><li>Especially important for activities taking place under conditions of high temperatu...
Laboratory Tests <ul><li>Not typical associated with PPE – usually due to cost of testing procedures </li></ul><ul><li>Oft...
Clearance for Participation <ul><li>Conditions to be met to allow clearance by ME at end of PPE </li></ul><ul><ul><li>Will...
Clearance for Participation <ul><li>Individuals have right to participate in any activity regardless of pre-existing medic...
Clearance for Participation <ul><li>Examples of recommended disqualifying conditions (American Academy of Pediatrics) </li...
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Kin 188 Pre Participation Physical Examinations

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Kin 188 Pre Participation Physical Examinations

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