This document discusses various medical issues related to athletes and sports. It covers topics like sports nutrition, hydration, supplements, injuries such as concussions and stingers, infectious diseases, environmental factors, and altitude medicine. For injuries, it provides details on diagnosing and treating conditions like concussions, stingers, and cardiac issues. For medical conditions, it outlines risks, symptoms and treatment approaches for things like rhabdomyolysis, sickle cell disease, and infectious diseases. Guidelines are presented for safely ascending to higher altitudes to prevent issues like acute mountain sickness and high altitude cerebral edema.

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Presenter: CHUN TSENG
OKU 11 READING
CH10 Polytrauma Care

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4. INITIAL ASSESSMENT AND RESUSCITATION
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• ABC care
• Tourniquet for massive bleeding from open extremity
wounds.
• Transfusion of high ratios of Fresh frozen plasma (FFP)
and platelets to packed red blood cells (PRBCs)
decreases mortality in patients requiring massive
transfusions.

5. TRAUMA-INDUCED COAGULOPATHY
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• 25% of trauma patients
• Shock and tissue injury are the initial triggers
• Independent predictor of mortality in trauma.

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• Treatment
• Recombinant factor VIIa
對Blunt trauma CASE 可以減輕輸血量
對Mortality rate 沒差
戰爭受傷O
 FDA X
• Tranexamic acid ~ inhibitor of fibrinolysis
<CRASH-2>
4 week mortality 會減少
within 3 hrs of injury
< MATTERs >
減少Mortality

7. TREATMENT PATTERNS DRIVEN
BY MILITARY EXPERIENCE
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• Tourniquet application and wound packing with hemostatic
dressings are the most useful interventions
• Preoperative or intraoperative CT is usually of little value
• Priority must be given to treating intraabdominal injuries and
unstable or open pelvic fractures.

8. EXTREMITY TRAUMA AND INDICATIONS
FOR DAMAGE-CONTROL ORTHOPAEDICS
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• Hyperinflammatory phase
• Hypoinflammatory phase
• Secondary endogenous and exogenous factors
• Applying the strategy of damage control surgery resulted in
better survival rates in polytraumatized patients with abdominal
injuries

9. DAMAGE CONTROL ORTHOPAEDICS (DCO)
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lessen blood loss, sepsis, and ischemia.
Early total care
SBP< 90mmHg
Nonorthopadeic sugery
acutely life-threatening injuries
acute nonorthopaedic care
in the trauma room with the
resuscitation protocol.
External fixator

10. OP TIMING
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• High levels of inflammatory markers (IL-6 )at the time of surgery
are indicators of complicated patient care and poor outcome
• Femoral shaft fractures in polytraumatized patients~~~
Definitive fixation within 12 hours of hospital admission was
associated with a higher mortality rate.
• Lung injuries and femoral fractures treated with intramedullary
nailing~~~~>24 HR 之後再開
• 六天之後再開 比較安全

11. PELVIC RING INJURIES
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• ATLS FIRST
• Image~~~CT
• APC injuries  associated with solid and hollow
abdominal organ injury, more profound shock, sepsis,
and delayed respiratory distress syndrome
• LC injuries  traumatic brain injury
• Transfusion volume and mortality
APC>>> CM >>> LC/VS mechanisms.

12. TEMPORARY MECHANICAL STABILIZATION
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• Immediate external fixation 
Reducing the volume available and inducing
tamponade
Around the greater
trochanters.

13. C-CLAMP
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SUPRA-ACETABULAR
EXTERNAL FIXATION

14. CONTROLLING BLEEDING
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• arterial, venous, and fracture surfaces
• Angioembolization
• Preperitoneal packing
• Then, C-clamp used

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Presenter: R2 曾準
OKU 11 READING
CH10 Medical Issues for
the Athlete

16. SPORTS NUTRITION
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• Normal Caloric intact 2,000 calories per day
(a minimum of 1,200 cal/day for women and 1,800
cal/day for men).
• For athletes, the caloric intake is much higher
• The recommended protein intake for vegetarian diets
should be approximately 10% higher.

17. MACRONUTRIENTS~ PROTEIN , CARBOHYDRATE, AND FAT
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• Fructose-based carbohydrates  increased visceral
adiposity
• Fat is also the primary source of reserve energy in the
body: plasma triglycerides can supply 30% to 80% of
the energy necessary for sustained physical activity

18. MICRONUTRIENTS AND OTHER FACTORS
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19. HYDRATION
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• >2% of body weight loss  decreased athletic
performance.
• American College of Sports Medicine Guideline
4 hours before training
Drinking 5 to 7 mL / kg of either water or a sports
beverage.
• Water or a sports beverage??
No clearly support for improving athletic performance
May maintain performance during endurance exercises

20. CAFFEINE AND OTHER SUPPLEMENTS
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• Caffeine On the World Anti-Doping
Agency monitoring program
• NCAA will ban any athlete with a caffeine
level in urine higher than 15 μg/mL
• Creatine improves performance in
high-intensity activities, such as
sprinting and weight lifting few
Kidney and liver dysfunction still
safe for healthy adults.

21. EATING DISORDERS AND
THE FEMALE ATHLETE TRIAD
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• Female Athlete Triad
• Disordered eating
• Amenorrhea
• Osteoporosis

22. CONCUSSION
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• A concussion is defined as a complex pathophysiologic process
induced by traumatic biomechanical forces that affect the brain
• In high-school sports, concussions account
for almost 15% of all sports-related injuries.
• football (47%), girls’ soccer (8%), and
boys’wrestling (6%).

23. CONCUSSION
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• Diagnosis made based on the mechanism of
impact and the associated symptoms.
• Emphasize physical and cognitive rest

24. STINGERS/ BURNERS
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• The C5 nerve root is most vulnerable because it is
directly aligned with the upper trunk of the brachial
plexus.
• ”dead arm” sensation
• The pain from a stinger is
usually experienced in a
dermatomal pattern and often
lasts only seconds or minutes.
• DDX with shoulder dislocation.

25. STINGERS/ BURNERS
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• Torg ratio helps determine the presence of central
cervical spinal stenosis, which correlates with an
increase
• A/B < 0.85 indicates stenosis risk of complications
after a stinger
• MRI survey

26. STINGERS/ BURNERS TREATMENT
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• Rest and NSAIDs
• Athletes with brief symptoms (lasting less than 15
minutes) and complete resolution of the stinger are
usually allowed to return to play unless the condition is
recurrent.

27. CARDIAC CONDITIONS IN ATHLETES
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• A left ventricular wall thickness greater than 13 mm
suggests hypertrophic cardiomyopathy (HCM)
• Left ventricular wall thickness can range from 13 to 16
mm because of physiologic causes.
• Cessation of training also can help make the distinction
between athlete’s heart syndrome (the hypertrophy
resolves) and HCM (the hypertrophy persists).

28. SUDDEN CARDIAC DEATH
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• HCM is the most common
cause of sudden cardiac death
in competitive athletes younger
than 35 years.
• Coronary artery disease is the
most common cause of
sudden cardiac death in
competitive athletes older than
35 years

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30. INFECTIOUS DISEASES IN ATHLETES
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• Skin Infections
• Cellulitis
• The increase in rates of community-acquired MRSA is an
ongoing concern.
• In elbows and the knees
• TX oral trimethoprim/sulfamethoxazole or clindamycin for
10 days
• Streptococcus Cephalexin or azithromycin
• small, benign-appearing lesion warm compresses can be used
four times per day
• Impetigo

31. INFECTIOUS DISEASES IN ATHLETES
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• Mononucleosis~~
• Epstein-Barr virus
• “the kissing disease ”
• The patient should avoid all forms of exercise for the first 21 days after the onset of
symptoms. Most splenic ruptures occur within the first
21 days.
• 30% of cases can also have a co-infection of group A Streptococcus
pharyngitis.
• Treated with penicillin because 80% to 90% of individuals treated with
amoxicillin develop a rash

32. METABOLIC DISEASES
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• Hyponatremia
• Rhabdomyolysis Early treatment should
include aggressive oral or intravenous
rehydration
• Sickle Cell Disease

33. ENVIRONMENTAL ISSUES FOR THE ATHLETE
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• Environmental Issues for the Athlete

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35. ALTITUDE MEDICINE ~
ACUTE MOUNTAIN SICKNESS
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• Acute mountain sickness is typically seen within
the first 6 to 12 hours at an altitude higher than
8,000 ft (2.4k meters).
• Gastrointestinal disturbance(nausea, vomiting,
anorexia), dizziness, fatigue, or sleep
disturbance.
• Acetazolamide can be taken before ascent as a
preventive measure.

36. ALTITUDE MEDICINE ~
HIGH-ALTITUDE CEREBRAL EDEMA
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• higher than 20,000 feet (also known as the
death zone
• Treatment involves immediate descent to a
lower altitude.
• If descent is not possible, the patient should be
treated with supplemental oxygen and
dexamethasone

37. ALTITUDE MEDICINE ~
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• increases in altitude should be limited to 300 m per day,
with rest days every 2 to 3 days.

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Thanks for Your
Listening
2015/04/16