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Overview of the Sports Preparticipation Physical

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Overview of the Sports Preparticipation Physical Jose Yasul, MD CCRMC Martinez, CA * AHA differences vs AAFP Family history of heart disease Marfan s family history ... – PowerPoint PPT presentation

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Title: Overview of the Sports Preparticipation Physical


1
Overview of the Sports Preparticipation Physical
  • Jose Yasul, MD
  • CCRMC
  • Martinez, CA

2
Objectives
  • Review why we do a PPE
  • Determine your responsibility
  • Describe the major features of the PPE
  • Familiarize you with the comprehensive
    musculoskeletal exam

3
Preparticipation Physical EvaluationThird
Edition (2005)
  • Editorial Board American Academy of Family
    Physicians American Academy of Pediatrics
    American College of Sports Medicine American
    Medical Society for Sports Medicine American
    Orthopaedic Society for Sports Medicine American
    Osteopathic Academy of Sports Medicine

4
Perception
  • Viewed in different ways amongAthletesCoachesP
    arentsAthletic TrainersAdministratorsPhysicians

5
My Goal
  • is to ensure the student-athlete is healthy to
    participate in sports
  • If a problem is identified, then it can be
    addressed
  • Im not looking for a reason to disqualify or
    exclude students from participating

6
Objectives of the PPE
  • Primary
  • Screen for conditions that may be
    life-threatening or disabling
  • Screen for conditions that may predispose to
    injury or illness
  • Meet administrative requirements

7
Objectives of the PPE
  • Secondary
  • Determine general health
  • Serve as an entry point to the healthcare system
    for adolescents
  • Provide an opportunity to initiate discussion on
    health-related topics

8
Timing of evaluation
  • To allow time to treat or rehabilitate any
    identified problem (gt6 weeks prior)
  • Preferably with their PERSONAL PHYSICIAN with
    access to medical records
  • Good option is midsummer or the end of the
    previous school year

9
Setting of evaluation
  • Physicians office versus coordinated team
    approach
  • In either setting it is preferred that the
    history and PE be done by the same physician

10
Setting of Evaluation
  • Stage Purpose
  • Waiting Area Sign in and review instructions
    about filling out forms
  • Vitals station Height, weight, BP, vision
  • Exam Area Review history, perform
    physical, sign out to preceptor
  • Optional Educational/Rehab areas

11
Tips for coordinated approach
  • Inform athletes in advance about the detailed
    nature of the exam and the appropriate attire
  • -Sports bras for girls
  • -Shorts for boys
  • Separate areas for examining boys and girls
  • Private counseling room for sensitive issues

12
Tips for coordinated approach
  • Clear protocols for referrals
  • Team physicians or athletic trainers should have
    a list of disqualified athletes or those who
    require further evaluation before final clearance
  • If the athlete is not cleared for their desired
    sport, the evaluating physician should be
    prepared to counsel on alternative activities

13
PPE Medical History
  • The most crucial component
  • Will identify approximately 75 of problems
    affecting athletes

14
PPE Medical History
  • Medical History (1-4)
  • Meds supplements (5-6)
  • Allergies (7)
  • Cardiovascular problems (8-18)
  • Viral illness (17)
  • Dermatological conditions (19)
  • Neurological conditions (20-25)
  • Heat Illness (26)
  • Asthma/allergic rhinitis (27-29)
  • Eyes Vision (31-32)
  • Anaphylaxis (33)
  • Musculoskeletal injury (34-35)
  • Nutritional concerns (36-37)
  • General concerns (38-39)
  • Menstrual history (4-44)

15
Questions I ask
  • Did you have any injuries last season did you
    miss any games or practices because of an injury?
  • Have you ever passed out while exercising?
  • Has anyone in your family died unexpectedly under
    the age of 50?
  • Do you find it hard to catch your breath when you
    exercise?
  • When exercising, do you get tired more quickly
    than your friends?
  • Do you cramp up easily?
  • Are you taking any supplements?

16
PPE Medical History
  • YOUTH RISK BEHAVIOR
  • Questions to be asked in the exam room
  • Do you feel stressed out or under a lot of
    pressure?
  • Do you feel so sad or hopeless that you stop your
    usual routine for more than a few days?
  • Do you feel safe?
  • Have you ever tried cigarette smoking, even 1 or
    2 puffs?
  • During the past 30 days have you used smokeless
    tobacco?
  • During the past 30 days have you had at least 1
    drink of alcohol?
  • Have you ever taken steroid pills or shots
    without a doctors rx?
  • Are you taking anything to lose weight or improve
    your performance?
  • Questions about guns, seatbelts, unprotected sex,
    D. V., drugs, etc.
  • (Youth Risk Behavior Survey)

17
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18
Physical Examination
  • Vitals, height, weight
  • EyesVisual acuity (Snellen)Pupils
  • Oral cavity/Ears/Nose
  • Cardiovascular examgtBlood PressuregtPulses
    (radial, femoral)gtHeart (rate, rhythm, murmur)
  • Lungs
  • Abdomen
  • Genitalia (males only)CryptorchidismTesticular
    masses
  • Skin
  • Musculoskeletal exam

19
Blood Pressure
  • NORMAL VALUES FOR KIDS DIFFER FROM ADULTS
  • SBP DBP are compared by sex, age and height
  • BP is lt90th percentile, child is normotensive
  • BP between 90th and 95th percentiles, child is
    high-normalobserve and consider other risk
    factors
  • BP gt 95th percentile, child may be
    hypertensiverepeated measurements are indicated
  • http//www.cc.nih.gov/ccc/pedweb/pedsstaff/bp.html

20
AHA Recommended Elements of Preparticipation
Cardiovascular Screening in Young Athletes
  • Medical history
  • Family
  • Death from heart disease in one or more relatives
    younger than 50 years
  • Disability from heart disease in a close relative
    younger than 50 years
  • Hypertrophic or dilated cardiomyopathy, long QT
    syndrome or other ion channelopathies, Marfan
    syndrome, or clinically important arrhythmias in
    any family member
  • Personal
  • Elevated systemic blood pressure
  • Excessive exertional and unexplained dyspnea or
    fatigue associated with exercise
  • Exertional chest pain or discomfort
  • History of heart murmur
  • Unexplained syncope or near-syncope
  • Physical examination
  • Brachial artery blood pressure (measured while
    seated)
  • Femoral pulses to exclude coarctation of the
    aorta
  • Heart murmur
  • Physical stigmata of Marfan syndrome

21
Incidence of sudden death in athletes
  • Auto accidents 30/100,000
  • Homicide 12/100,000
  • Suicide 10/100,000
  • Sports 0.5/100,000

22
Cause of sudden death in young athletes
23
Hypertrophic cardiomyopathy
  • Usually AD, variable penetrance and
    expressionMurmur systolic and increases with
    standing and valsalva and decreases with
    squatting and isometric handgrip

24
Marfans syndrome - stigmata
  • Arachnodactyly
  • Tall stature
  • pectus excavatum
  • Kyphoscoliosis
  • Lenticular dislocation
  • Murmur of mitral valve prolapse and/or aortic
    regurgitation

25
Musculoskeletal System
26
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27
Determining Clearance
  • Important occasionally difficult decision
  • 3.1 to 13.9 of student athletes require further
    evaluation before a final clearance status can be
    given

28
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29
Determining Clearance
  • Initial Clearance has 4 categories
  • Cleared without restriction
  • Cleared, with recommendations for further
    evaluation or treatment (i. e. check BP in 1
    month)
  • Not cleared, reconsideration after completion of
    further evaluation, treatment, or rehabilitation
  • Not cleared for certain types of sports or all
    sports

30
Determining Clearance
  • AMERICAN ACADEMY OF PEDIATRICSMedical
    Conditions Affecting Sports ParticipationPEDIATRI
    CS Vol. 121 No. 4 April 2008, pp. 841-848
    (doi10.1542/peds.2008-0080)
  • Classification of Sports by Contact
  • Classification of Sports by Strenuousness
  • Medical Conditions and Sports Participation
    http//www.pediatrics.org/cgi/content/full/107/5/1
    205

31
Summary
  • Single examiner
  • In addition to reviewing the history, ask
    pertinent questions to the athlete directly
  • Goal is to assure safe student-athlete
    participation in a sport

32
  • My doctor told me I shouldnt work out until Im
    in better shape.
  • I told him, All right, dont send me a bill
    until I pay you.
  • Steven Wright
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