Injury/Illness Prevention & Wellness Protection

Carbohydrates

- 4 cal. per gram -Simple carbs (sugars, fruits, & dairy products) are the fastest source of energy, requiring about 30 mins to metabolize -Complex carbs (whole grains, veggies) convert slowly to energy, taking about 2 hrs -Should comprise about 55% of diet -Provide more energy per unit of oxygen expended than other food components

Guidelines Related to the Need & Schedule of PPE's

-American Academy of Family Physicians, & other medical societies require examination be signed by medical doctor or doctor of osteopathy, but regulations vary from one state to another -Athletes must have PPE b4 participating in sports in middle school (junior high) & high school & when transferring to new school, w/ annual updates & comprehensive exams repeated every 2 yrs -National Collegiate Athletic Associations (NCAA) also requires that college athletes have PPE b4 participating in intercollegiate sports programs; also, annual updates are required -Federal regulations under Health Information Portability & Accountability Act (HIPPA) allow healthcare providers to share info about athlete's health condition after the patient or parent signs the permission wavier

Treatment After Warming & Debridement of Clear Blisters

-Aloe Vera cream every 6 hrs to blistered areas -Dressings, separation of digits - Tetanus prophylaxis

General Purpose & Common Criticisms

American Medical Association (AMA) & multi-organizational PPE Task force, have concluded that a PPE should perform following functions: -Athletes @ risk of injury or death (cardiac arrest) b/c of pre-existing med. conditions -Disqualify athletes from participation in sports only if there are compelling safety concerns or other reasons -Meet regulatory & insurance requirements in order to protect organization form liability

Amphetamine & Cocaine

Amphetamine toxicity: -May be caused by intravenous injection, inhalation, or sniffing of various substances (methamphetamines', methylphenidate), & ephedrine & phenylpropanolamine -Cocaine may be ingested orally, IV or by sniffing, while crack cocaine is smoked -Crack cocaine may cause pulmonary hemorrhage, asthma, pulmonary edema, barotrauma, & pneumothorax -CNS stimulate that cause multi-system abnormalities Symptoms: -Chest pain -Dysrhythmias -Myocardial ischemia -Seizures -Intracranial infarction -Hypertension -Dystonia -Repetitive movements -Unilateral blindness -Lethargy rhabdomyolysis w/ acute kidney failure -Perforated nasal septum (cocaine) -Paranoid psychosis (amphetamines)

Gonorrhea

Caused by Neisseria gonorrhoeae & should be suspected w/ urinary infections

Syphilis

Caused by spirochete Treponema pallidum & has increased in incidence over last 10 yrs, associated w/ risk-taking behavior like drug use.

Diagnosis & Treatment for Rohypnol

Diagnosis: -History -Clinical exam Treatment: -Assessment for rape & STD's -Gastric emptying (less than 1 hr) -Charcoal -Monitoring for CNS/respiratory depression -Supportive care -Counseling referral for rape

Symptoms of Chlamydia

Males: -Urethritis, epididymitis, proctitis, or Reiter's syndrome (urethritis, rash, conjunctivitis) Many cases are asymptomatic Females: -Mild cervicitis w/ vaginal discharge & dysuria, but complications can lead to infertility & pelvic inflammatory disease (PID)

Symptoms for Gonorrhea

Males: -Dysuria & purulent discharge from urethra, epididymitis, & prostatitis Females: -Many women are asymptomatic or may have lower abdominal pain, cystitis, or mucopurulent cervicitis; if untreated it can result in PID & chronic pain -Rectal infections common in women & gay men -Untreated can become a systemic infection= petechial or pustular skin lesions, arthralgias, tenosynovitis, fever & malaise, & septic arthritis -Should be referred for diagnosis & treatment

Near Drowning

Submersion asphyxiation caused by near drowning can cause profound damage to: -CNS -Pulmonary dysfunction related to aspiration -Cardiac hypoxia w/ life-threatening arrhythmia -Fluid & electrolyte imbalances -Multi-organ damage Hypothermia related to near drowning has some protective effect, b/c blood is shunted to brain/hear, but not likely to occur in heated swimming pool

Symptoms & Treatment For CA-MRSA

Symptoms: -Cellulitis (bacterial infection)/impetigo (bacterial infection for kids) -Folliculitis, especially on face, appearing like severe pustular acne -Furunculus's below hairline -Carbuncles involving hair follicles -Fascitis w/ abscess formation Treatment: -Should be isolated from team members until infection clears

High-Altitude Pulmonary Edema (HAPE)

- Lead to acute respiratory distress & death

Tinea Cruris Symptoms & Treatment

- Scaly, itching, erythematous rash that may contain papules or vesicle & is usually bilateral & symmetrical -Selenium sulfide shampoo wash of area b4 applying meds. Topical antifungal (clotrimazole, miconazole, tolnaftate, naftifine, terbinafine) 2 times daily for 4 wks

Rohypnol

-(flunitrazepam) type of benzodiazepine, commonly referred to as the "date rape drug" or "roofie" b/c it causes anterograde amnesia -Popular w/ teens & young adults & is often taken w/ alcohol, which potentiates its effects -A CNS depressant that cuases muscle relaxation, slurs speech & reduces inhibitions -Effects occurs w/in 20-30 mins of ingestion but may persist for 8 to 12 hrs -Repeated use= aggressiveness, & w/drawl may cause hallucinations & seizures -Overdoses causes hypotension, altered mental status, vomiting, hallucinations, dyspnea, & coma -Females are common victims, & may not remember event except for perception of lost time or physical discomfort

Protein

-4 cal. per gram -Includes meat & fish, metabolizes more slowly (3 hrs) but provides longer-lasting source of energy -Should comprise about 15% of diet

Ethanol

-A form of alcohol found in alcoholic drinks, flavoring, & some meds -A multisystem toxin & CNS depressant -Binge drinking can lead to serious morbidity/death -Has direct effects on CNS, myocardium, thyroid, & hepatic tissue -Absorbed through mucosa of mouth, stomach, & intestines, w/ concentrations peaking about 30-60 mins after ingestion -90% metabolized in liver, & rest excreted through pulmonary & renal systems -Overdose affects CNS & organs of the body -If person exhibits altered metal status, nausea & vomiting, or is semi-conscious/unconscious, EMS treatment should be initiated

Vulnerability to Heat-Related Illness

-About 65% of heat is lost through evaporation during exercise, but heat dissipates less readily in, hot humid enviro. & when athlete is wearing wet, sweaty clothes

Chlamydia

-STD caused by Chlamydia trachomatis & is often co-infected w/ gonorrhea -Maybe transmitted by oral, anal, & vaginal sex -Most common STD in US

ASTAM

-American Society for Testing and Materials -Sets standards for eye protection for racquet sports as well non-racquet sports (baseball, basketball, field hockey, & skiing) to reduce risk of eye injury -Dissipate force of impact from eye/face to skull w/out leading to intracranial injury & w/out interfering w/ playing of sport -Most eye protection is formed of polycarbonate plastic, which is very resistant to force -Lenses 2mm for low risk sports, & 3mm for high risk activities - Can be made w/ prescription lenses if necessary -Must include both frames & lenses, & frames must meet impact-resistant standards -Sports like hockey, a full-face cage of polycarbonate or wire is required -All athletes who have lost an eye should wear protective eye gear @ all times

Ankle Supports

-Ankle comprises 3 bones & 3 groups of lig. that stabilize jt. -Talus bone connects in a hinge jt. w/ distal tibia & fibula, stabilized by ant. & post. tibiofibular lig. -Medial aspect of Ankle stabilized by deltoid lig. -Most sprains are inversion injuries w/ tearing of lat. lig. -Sprains may weaken Ankle, taping helps to stabilize Ankle & prevent further injuries -Focus on strengthening exercises Program: -Taping using 1.5-2 inch porous athletic tape/moleskin -High-top shoes w/ inflatable support to protect ankle -Semi-rigid orthotic stabilizers that fit about ankle -Shoes w/ adjustable straps providing semi-rigid support to ankle

High-Altitude Sickness

-Ascending to high elevations, experience deg. of shortness of breath w/ change in altitude -Air is still 21% oxygen, atmospheric pressure is lower, O2 molecules further apart, people take less O2 w/ each breath -17% decreased in O2 @ 5000 ft. & 31% decrease @ 10,000 ft. -Athletes training in high altitudes must be aware of dangers of high altitude sickness & preventative measures 3 types of High Altitude Sickness: -Acute Mountain Sickness (AMS) -High-altitude Cerebral Edema (HACE) -High-altitude Pulmonary Edema (HAPE)

Tinea Pedis Symptoms & Treatment

-Athlete's foot, is a fungal infection of the feet/toes -It is rare b4 adolescence & more common in males Symptoms: -Severe itching w/ vesicles or erosion of instep & w/ peeling maceration & fissures b/w toes -Dry, scaly, mildly erythematous patches on plantar & lateral foot surfaces Treatment: -Same as tinea cruris. Keep feet dry w/ absorbent talc -Allow feel to air dry & use 100% cotton socks, changed twice daily

Keratoderma

-Athletes prone to development of (callus formation), caused by hypertrophy of stratum carenum layer of epidermis, on palms of hands/bottom of feet, depending upon sport -Calluses on feet are most problematic if they become very thick & interfere w/ elasticity of the skin, b/c cracks may form, that can be painful, & blisters may form beneath callus

Athletes Diet

-Athletes should expend 2200-4400 calories daily -To prevent dehydration, athletes must consume adequate amounts of water, approx. 2 1/2 liters per 2400- calories energy output

PPE: Cardiac Assessment Component

-Athletes should have a thorough cardiac assessment to determine if have cardiac abnormalities (like hypertrophic cardiomyopathy/coronary artery abnormalities) that might put risk of complications or sudden death -Should be referred to specialist for further testing. Tall athletes (males over 6 ft & females over 5'10) w/ two or more signs of Marfan's Syndrome should have further eval. Assessment includes: -BP to determine if there is elevation of BP -Pulse rate: Assessment of radial & pulmonary pulses for evidence of delay that may indicate coarctation of aorta. Check for evidence of tachycardia, bradycardia or other abnormalities. Pulse rates less than 60 (sometimes low as 48) are common in athletes who are physically fit & exercise reg. -Auscultation of heart for evidence of murmurs or abnormal beats

Standard Protective Equipment: Feet

-Athletic shoes made w/ proper cushioning & ankle support for specific types of sports activity, & guidelines about shoes -Should be advised to wear type of socks they will wear during sport when fitting shoes Supportive devices: Insoles: -May be aimed foam padding or ridged orthotics, which provide best support Arch supports: -Used to prevent pain in arch or forefoot Heel cups: -One type of heel cup is firm plastic & essentially compresses fat in heel to provide a cushion - Another type is padded & rubberized, compressing as heel pushes downward & preventing heel from contacting shoe -Padded heel cups have rubberized waffle-designs & other have cutouts (U-shapped) below heel Heel pads: -Provide less support than heel cups but may relieve discomfort

Overweight Athletes should be Advised to

-Avoid use of performance-enhancing supplements, steroids or stimulants in trying to lose weight or convert fat to muscle, b/c may result in hypertension, cardiac abnormalities, or other health problems -Avoid high-volume, high-intensity plyometric exercises, can result in jt. damage -Acclimatized to heat & to exercise by staying hydrated & staying alert for signs of heat-related illness -Maintain a nutritious diet

Prevention for Hight-Altitude Sickness

-Begins below 10,000 ft, but a gradual ascent w/ few days planned rest b4 exertion is optimal: -Immediately stop ascent w/ any signs of AMS until symptoms subside -Always descend immediately for emergency treatment when signs of HACE or HAPE emerge -Increase elevations above 10,000 ft @ rate of 1000 ft daily, w/ one day rest for each 1000 ft. -If flying/driving to high elevations, avoid exertion or more ascents for 24 hrs. -Drink a lot of water (4-6 liters/day) to keep urine clear/pale. -Avoid exercise & over-exertion until acclimatized, & sleep only @ night -Eat 70% carbs diet, avoid use of alcohol, tobacco, or depressant drugs

High-Altitude Cerebral Edema (HACE)

-Can lead to acute neuro damage, causing seizures, coma & death

Pollution

-Can pose a considerable risk to health of athletes -Especially urban/industrial, playing areas or fields are located in high traffic areas, increasing risk of exposure to particular matter (fumes & soot) from automobile exhaust Some areas ozone levels & pollen counts are of concern: -Practices/games should be held after rush hour, usually in late afternoon -Pollen counts & ozone levels should be checked daily & outdoor activities should be cancelled or delayed when appropriate -Exercises may be done in the early AM when it is cooler & ozone pollution levels ore lower, b/c heat combo w/ some compounds to produce ozone -Aerobic exercise, like jogging increases use of mouth breathing & intake of particulate matter & may require mods, movement to a less polluted area, or to indoor facility

Jet Lag

-Caused by disturbance in Circadian rhythm of waking & sleeping when traveling from one time zone to another -Traveling from west/east cause more problems then opp. -Takes 1 day to compensate for each time zone crossed Symptoms: -Lethargy -Dizziness -Insomnia -Dehydration -Drowsiness -Impaired athletic performance

Treatment for Gonorrhea

-Cefixime 400 mg orally in one dose OR -Ceftriaxone 125 mg in one dose OR -Ciprofloxacin 500 mg orally in one dose OR -Levofloxacin 250 mg orally in one dose

Lighting: Steps to Minimize Risk

-Check weather report daily -Use portable (SkyScan or Thorguard) detection system if possible to detect lightning, & use Internet to check weather changes. Safe shelters prior to sports activities, & gauge length of time needed to access shelter: Building grounded w/ electrical wiring/plumbing OR vehicles w/ hard metal roofs & windows closed. -Avoid sheds, which usually not secure or grounded -Utilize "flash-to-bang" method to estimate proximity of lightning: Count secs from flash to bang of thunder & divide by 5 to arrive @ the distance in miles -Stop all activity when "flash-to-bang" nears 30 secs or lightning detection system indicates increasing storm activity -Advise spectators to seek shelter & exit metal bleachers -Seek shelter away from lone objects, tall trees, standing water, or open fields, avoiding metal structures. Avoid locker room, showers, & indoor pools or tubs -Open area: Crouch low w/ only feet touching ground -Avoid use of telephone landlines, which can transmit electrical charges -Ensure CPR certified indiv. are available

CA-MERSA

-Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections common in sports like football/wrestling Risk Factors: -Crowding like locker rooms -Contact like occurs in contact sports -Compromised skin, like cuts/scrapes -Contaminated surfaces, like equipment, & shared items, like towels, clothing, razors, & bar soap -Cleanliness (lack of), like environmental & personal lack of hygiene

Frostbite

-Damage to tissue caused by exposure to freezing temp, most often affecting nose, ears, & distal ext. -Affected part feels numb & aches or throbs, becoming hard & insensate as tissue freezes, resulting in circulatory impairment, necrosis of tissue, & gangrene

PPE: Q angle Assessment Component

-Females more @ risk of injury than males -Females tend to have wider pelvis than males, resulting in an increased Q (quadriceps femoralis) angle -Measure from ASIS down ant. thigh (femur), through & past center point of patella -Second line drawn from center point of patella to tibial tubercle, then angle b/w two lines is measured @ point of tibial tubercle Normal angles: -Male 13 deg -Females 15 deg -An increased Q angle can result in increased knee stress -Female athletes experience 2-3 times # of injuries to ACL than male athletes -If increased Q angle, athlete may need flexible custom orthotic to prevent pronation of foot, knee support, & program of strength-building exercises for quads & HS

Prevention from Near Drowning

-Forbidding roughhousing in pool area -Never swimming or diving alone -Never swimming or diving while under the influ. of drugs/alcohol -Securing pool facilities to prevent unauthorized access

Maintenance of Clinical & Treatment Areas

-Depending upon size of organization or facility, clinical & treatment area may be shared by number of diff. staff & athletes -Includes office space, examining rooms, taping area, wound care area, rehab area, electrotherapy (ultrasound, diathermy) & hydrotherapy tubs & pools -Clinical/treatment areas are ideally located w/in close prox. to training areas, like adjacent to locker rooms or gymnasiums Equipment must be maintained w/ accepted standards: -A schedule for use should be maintained & updated weekly to avoid conflicts -ATC usually responsible for cleaning equipment & maintaining floors & environmental surfaces -Treatment tables should be cleaned daily & after each use -Hydrotherapy equipment should be disinfected daily following manufacturing guidelines & using EPA-approved disinfectants -Treatment areas should have access to a clean & functioning ice machine in case cold packs are needed -Hydrotherapy area should have elevated outlets (5 ft) to prevent splashing of outlets &/or electric shock -Should shower b4 non-emergency treatment -Cleats & other equip. should be left outside treatment area -Shoes should not touch treatment tables -Telephones must be accessible in case of emergency assistance required -Smoke detectors & fire safety info must be available -ATC should be sure @ all times to operate w/in scope of practice when supervising & providing treatment to athletes

Prognosis is poor for 3rd & 4th degree freeze injuries

-Difficult to determine degree of of injury b/c of thawing may have occurred prior to hospital admin. Treatment: -Rapid rewarming w/ warm water bath (104-107 deg F), 10-30 mins or until frostbitten area is erythematous (red) & pliable -For generalized hypothermia

Frontal (coronal)

-Divides body or parts into ant. (front) & post. (rear) sections (ex) Arm during backstroke in swimming

Median (mid-sagittal/lateral)

-Divides body or parts into right & left sections (ex) -Movement of criterion arm during serve in tennis -Pulling arms upward

Transverse (horizontal)

-Divides body or parts into superior (upper) & inferior (lower) sections (ex) -Bat swing in baseball -Movement of criterion arm in basketball jump shot -Movement of criterion arm in forehand drive in tennis

PPE: Vision Assessment Component

-Done to determine if there are any abnormalities or disorders of they eye -Refractive disorders may require referral of corrective lenses, like contact lenses, can be worn w/ protective goggles -Special sports contact lenses (both prescription & non-prescription) are now available & used increasingly by athletes to block certain wavelengths & remove glare -Specialized lenses intended primarily for outdoor use Examination Includes: -Test for visual acuity -Pupillary response to light & accommodation -Extraocular muscle motility assessment -Test of peripheral vision -Ophthalmoscope examination of inner eye Common refractive disorders of the eye include: -Myopia: nearsightedness -Hyperopia: Farsightedness -Astigmatism: Distortion of vision

Prognosis Very Good for 1st Degree & Good for 2nd Degree Frostbite

-Full-thickness & into sub-dermal tissue freezing w/ cyanosis, hemorrhage blisters, skin necrosis & "wooden" feeling, severe burning, throbbing, & shooting -Freezing extends into subcutaneous tissue, including muscles, tendons, & bones, w/ mottled appearance, non-blanching cyanosis & eventual deep black eschar

Treatment for Amphetamines & Cocaine

-Gastric emptying (1 hr or more) & charcoal admin. IV access & supplemental oxygen -Sedation for seizures. Haloperiodol for agitation -Hypertension: Nitroprusside, phentolamine2.5-5 mg IV -Cocaine quinidine-like effects : Sodium bicarbonate

PPE: Marfan's Syndrome Assessment

-Genetic disorder of connective tissue (CT) that may put athletes @ risk -(CT), like tendons, lig., heart valves, & blood vessels, are often defective & weak -Depending on severity of disorder, may be restricted from team sports, especially contact sports may result in chest trauma, or isometric exercises, like weightlifting -Symptoms noted on PPE and athlete referred to specialist

Typical changes that occur during acclimatization include

-Hyperventilation to increase oxygen uptake (hypoxic ventilatory response) -Increased urination & dehydration -Increased HR -Frequently wakening during the night & Cheyne-Strokes respirations -Increased BP

Heat Stress

-Increased temp causes dehydration -May develop swollen hands & feet, itchy skin, sunburn, heat syncope (pale moist skin, hypotension), & heat cramps Treatment: -Removing from heat, cooling, hydrating, & replacing sodium

Acute Mountain Sickness (AMS)

-Indicates failure to acclimatize; may be mild to severe & often presents w/ headache, lethargy, nausea, confusion, unsteady gait, & dyspnea -Occurs 6-24 hrs after ascent

Mononucleosis

-Infectious disorder caused by Epstein-Barr virus -Spread through saliva & airborne droplets & occurs most often in teens/young adults -Incubation period is 4-6 wks Symptoms: Similar to upper respiratory infection or flu, w/ adults affected more than children -Weakness -Headaches -Fever -Persistent sore throat -Enlarged lymph nodes in neck & axillae -Enlarged tonsils -Generalized red macular rash -Enlarged spleen (ruptured may occur in rare cases)

Pediculosis

-Infestation w/ lice, transmitted by direct contact w/ someone who is infest Includes: -Head lice (common in children) -Body lice (common in transient pop): Feed on body but live in clothing/bedding & spread by sharing bedding, clothes, or towels -Pubic lice: spread by sexual contact or, rarely, sharing clothes/bedding; may infest genital area, eyebrows, eyelids, lower abd., & bread

Fats

-Provide slowest but most efficient form of energy, requiring 5 hrs to metabolize -Should comprise 30% of diet -9 cals per gram

Exclusion from Sports includes

-Injuries -Latent conditions, like cardiac abnormalities, which may cause harm -Physical disabilities that pose a danger to person or others -Renal disease -Uncontrolled hypertension -Health conditions that pose a risk to others, like acute Staphylococcus aureus/MRSA infection &, in some cases, HIV & hepatitis infection -Disagreement among physicians regarding safety of allowing athlete to participate in sports activities -Failure of reasonable accommodations to eliminate risk -Contagious diseases that pose a risk to others -Athletes one eye should be excluded from boxing, wrestling & full-contact martial arts, b/c adequate eye protection gear is unavailable

Isotonic (concentric & eccentric) Contractions

-Involve movement of the muscle as when pushing or pulling Usually balance concentric & eccentric contractions: -Concentric contractions -Eccentric contractions

Heat Stroke

-Involves failure of the thermoregulatory system w/ temps that may be greater than 106 deg F; may result in seizures, neuro. damage, multiple organ failures & death -Exertional heat stroke often occurs in young athletes who engage in strenuous activities in high heat Treatment: -Evaporative cooling, rehydration, & immediate emergency transfer

Heat Exhaustion

-Involves water or sodium depletion; is common in children & teens who are not acclimated to heat -Can result in flue-like aching, nausea & vomiting, headaches, dizziness, & hypotension w/ cold clammy skin & diaphoresis -Temp may be normal or elevated but less than 106 deg Treatment: -To cool body & replace sodium & fluids must be prompt in order to prevent heat stroke -Careful monitoring is important, as reactions may be delayed

PPE: Medical History Component

-Is a critical component of PPE, can signal areas of concern or need for further eval. Includes: -Previous hospitalizations/surgeries -Current/chronic illnesses & med. conditions -Current meds & history of illicit/illegal drug use, like steroids. Allergies, as well as type of response (rash, anaphylaxis), & whether person carries Epi-pen -Any exercise-induced symptoms, like dizziness, fainting, dyspnea, cough, or chest pain -History of hypertension -History of neuro disorders, pinched n.. seizures, head injury. Cardiac abnormalities, like palpations/heart murmur. Vision abnormalities, like color-blindness, need for prescription glasses or contacts -History of menses, like onset, last period, & frequency -Orthopedic injuries, past/present. like fx, sprains, strains. History of renal disorder including loss of kidney. Loss of eye or testicle. Current vaccinations, like tetanus. Need for accommodations

Tinea Cruris

-Jock itch, is a fungal infection of perineal area, penis, inner thighs, & inguinal creases, but may also occur under breasts in women & beneath abdominal folds where skin is warm & moist -Rarely occurs b4 adolescence

Lightning

-Kills about 100 people a year in US & injures 400-500, poses serious safety hazard for athletes -Storms arise & become dangerous in very short time, less than 30 mins, especially in areas of country w/ frequent thunderstorms -Often accompanies rainstorms, can occur w/out rain as well -ATC usually monitors weather conditions & advises coaches & other staff when hazardous conditions arise, or when changes in weather conditions suggest potential hazard may occur

Anabolic Steroids Side Effects

-Liver disorders (especially oral anabolic steroids) -Cardiovascular disorders -Increased aggressiveness & libido Males: -Decreased sperm count, atrophy of testes, & erectile disfunction -Gynecomastia (breast development) in males Females: -Inhibition of formation of follicles & irregularities of menstrual cycle, including amenorrhea -Hypertrophy of clitoris -Acne -Hair loss & male pattern balding w/ increased facial hair -Breast atrophy -Masculinization of body, features, & lowering of voice

Supportive Treatment for Mononucleosis

-Rest & restricted activity to avoid spleen rupture -Acetaminophen/ibuprofen -Adequate fluid intake

Male Genital Protective Devices

-Males don't report painless testicular swelling, so edu. athletes about danger of injury to genitals is necessary to ensure compliance w/ safety guidelines, since about 20% of genital injuries result in permanent damage -Injuries include hematoma of testis or of scrotum; & hernia Genital protection devices include: -Genital cups, held by jock strap: There is wide variety of cups, from flat to contoured, designed to absorb impact. Must be large enough to comfortably fit over genitals & minimize movement, or else they can be uncomfortable -Compression shorts made of nylon & spandex to limit movement & provide support -Running shorts combine shorts & briefs, but don't provide sufficient protection from cold

Safety Hazards: Field Conditions

-Many sports injuries caused by poor field conditions, like holes in field from poor maintenance, gophers, or other burrowing animals, or damage caused by sports activities -There may be pooled water, broken glass, rocks, raised sprinkler heads, or items that have been thrown onto the field, all which pose potential hazard -Referees maybe responsible @ some institutions, but reality is that they rarely walk entire field & often arrive shortly b4 game time -ATC should ensure that procedure is in place to check field b4 use. -Includes groups of athletes walking the field b4 play/volunteers, like athletic supporters or parents

Anabolic Steroids

-Must take firm no-use stand on these as they have been widely used among athletes -Athletes must be edu. about dangers of drugs -Steroids like cypionate & testosterone enanthate, used to increase muscle mass & improve athletic performance, but have serious side effects

NOCSAE

-National Operating Committee on Standards of Athletic Equipment -Researches & est. standards regarding protective equipment. Prevent serious injuries of head/face: -Batting, face guards rarely used, can prevent many facial injuries & should be recommended, especially for younger athletes -Mouth guards should be made of flexible material by dentist to fit indiv. jaw & upper teeth, or fit-checked to make sure they provide max. protection & comfort -Helmets should fit snugly, so they don't move if they are rotated, turned or tilted. should be pressed down @ crown to check for fitting of jaw pads & chin straps. Helmets may be air/fluid-filled or padded -Flack jackets (padded vest-like snug protective gear) are intended to protect thoracic area after rib injuries

Athletic Equipment

-Number of safety hazards ranging from electric shock & infection to injury from incorrect use or damaged equipment Measures can Minimize Risks: -Electrical equipment should be checked reg. to ensure that cords are not frayed & that plugs are intact. Multiple adaptors & cords should be avoided -Electrical equipment should be shut off when not in use, & portable equipment, like pitching machines, should be unplugged -Signs should be posed indicating that electrical equipment should not be used w/ wet hands or if floor is wet -All environmental surfaces in contact w/ body fluids, including perspiration, should be cleaned daily or b/w uses w/ EPA-approved disinfectant -Athletes should wash hands b4 & after use of equipment -Prevent clutter or cords from blocking passageways, like as around equipment

Hypothermia

-Occurs w/ exposure to low temps that cause core body temp to all below 95 deg F -Associated w/ immersion in cold water, exposure to cold temps, metabolic disorders (hypothyroidism, hypoglycemia, hypoadrenalism), or CNS abnormalities (head trauma, Wernicke disease) -Those intoxicated w/ alcohol/drugs Symptoms: -Pallor -Cold skin -Drowsiness -Alteration in mental status -Confusion -Severe shivering -Any numbness requires immediate attention Could Progress to: -Shock -Coma -Cardiac abnormalities, & cardiac arrest -Usually begins w/ shivering as the body's core temp drops

Concerns for Female Athletes Diet

-Often believe that they should lose weight to compete better, but run risk of inadequate nutrition, which can impair performance instead -@ least 1200-1500 calories/day usually required for most girls & women, but female athletes require many more calories -Often require increased iron in diets b/c they lose iron through menses -Many develop amenorrhea as their bodies attempt to conserve stores of iron -Amenorrhea/excessive exercise can lead to bone loss & osteoporosis, so diet w/ sufficient iron, from sources like red meat/pork -Adequate calcium intake may counteract bone less, but calcium supplements of 1500 mg/day may required to avoid stress fx, especially for participants in activities that require running/jumping -Vit. C , which helps w/ absorption of iron is necessary

Overweight Athletes

-Often engaged in sports that require large size & mass, like football, basketball, & wrestling -Athletes should be carefully assessed for risks -Athletes should have their body masses double-checked, since indiv. w/ extreme muscle mass are often inaccurately categorized as overweight -More likely to suffer from injury

Buffer Zones

-Open spaces surrounding areas of sports activity w/in a sports facility -Needed b/c athletes often leave playing area @ a high speed (sports like basketball) or may not be looking where they are going -Standards for buffer zones for all sports, like distance from windows to prevent breaking glass from injuring athletes -Sometimes danger arises when coaches or trainers use "found" space for practice activities rather than gymnasium -Should always be adequate, & should not be used for any other purpose, like equipment storage or scoring tables -Only spaces intended for athletic activities should be used for practice, & these areas should always be supervised

Concentric Contractions

-Part of Isotonic contractions -Cause the muscle to shorten, as occurs when the muscle is used to lift a weight, as w/ a bicep curl

Eccentric Contractions

-Part of Isotonic contractions -Cause muscle to lengthen, as occurs when lowering weight

Symptoms Vary According to the Degree of Freezing

-Partial freezing w/ erythema & mild edema, stinging, burning, throbbing pain -Full thickness freezing w/ elevated edema in 3-4 hrs; edema & clear blisters in 6-24 hrs; desquamation w/ eschar formation & numbness; & when aching & throbbing pain

Warm-Up Exercises

-Performed for 15-30 mins, should be 1st part of training exercise/participation in sports to increase circulation & muscle elasticity & prevent injury -Should begin slowly & the proceed systematically to involve all parts of body -Should include combo. of exercise activities, like slow running for 3-5 mins to increase muscle circulation, 10 mins of gen. stretching to improve muscle elasticity, & 10 mins of specific pre-conditioning exercises for particular sport -Should wear proper clothing & footwear during exercises 3 Types of Warm-up Activities: 1)Passive: -Massage & warm showers 2)General body-wide: -Jogging 3)Specific stretching motions: -Special attention should be paid to muscles most used in sports activity, like swinging arm & throwing a ball in prep. for pitching -Stretching should be bilateral, held 10-30 secs, & static rather than ballistic

Treatment for Pediculosis

-Permethrin 1% (Nix): Cream finse applied after body/hair washed w/ non-conditioning shampoo & towel dried -Left on for 10 mins & rinsed off, leaving residue designed to kill nymphs emerging from eggs not killed w/ first app -Repeated 7-10 days, nits should be removed manually

Symptoms of Pediculosis

-Persistent itch (worse @ night) -Irritation -Excoriation -Secondary infection

Breast Protective Devices to Support Copper's Ligament

-Polyurethane nipple & breast cups (worn under a sports bra) -Seamless sports bras made of non-abrasive, hypoallergenic material. -Compression sports bras are usually used for females w/ breast cup sized of A/B. -Encompassing sports bras are more appropriate for females w/ larger breasts, as they support each breast separately. Careful measuring should be done to ensure correct fitting -Polyurethane chest shields, usually placed over a sports bra & fitted snugly to indiv.

Shower Facilities

-Pose a number of safety hazards resulting in falls, burns, & infections Separate shower facilities should available for males & females: -Shower facilities, adjacent locker rooms, & environmental surfaces should be cleaned daily to prevent spread of infection -Water temp. should be monitored & should not exceed 110 deg F to prevent burns -Shower areas should have non-slip floor surfaces -Liquid soap dispensers should be available @ each shower & filled daily -Bar soap should not be used b/c it may harbor bacteria -Towels should not be shared, & should be washed w/ soap & water @ 106 deg F & dried w/ hot air -Athletes should wear foot protection, like as flip-flops or shower sandals, to prevent spread of fungus infections

Floor Mats

-Pose a potential hazard to athletes, like wrestlers, who come in skin contact w/ the mat -Meet the standards & specifications of particular sport so they provide adequate cushioning to prevent injury Mats should be: -Examined reg. & replaced if cushioning deteriorates -Checked to ensure they are smooth, w/out surface cracks, prior to each event -Cleaned thoroughly, following manufacturer's guidelines, & disinfected b4 each session -Protected from people walking on them w/out proper footwear, as this may damage cushioning & surface of the mat -Installed away from walls or protrusions that might injure athlete during activities -If not left in place, stored according to manufacturer's guidelines to prevent damage to mat

PPE

-Pre-participation examination (PPE) is a procedure that allows examiner to identify potential health problems related to an athlete's participation in sports -National standards helps protect an organization against litigation

Treatment for Syphilis

-Primary, secondary, early tertiary: Benzathine penicillin G 104 million units IM in one dose -Tertiary: Benzathine penicillin G 2.4 million units IM weekly for 3 weeks

PPE: Maturity Assessment Component

-Should be part of PPE for children & adolescents to determine level of sexual, dental, & skeletal maturity -Only physician/physician's assistant may assess an athlete for sexual maturity Skeletal Maturity: -Assessed by measurements of hand/wrist as well as weight/height for age. (ex) age is 14.3 & skeletal age is 15.5, expressed as 15.5-14.3=SA + 1.2 OR Chronological age: Divide Skeletal age by chrono. age -Score greater than indicates adv. skeletal maturity & score less than one indicates delay in skeletal maturity -Most common assessment tool for sexual maturity is Tanner's 5 stages of assessment, assess maturity both males/females based on direct obs. of breasts/genitals: Females: -Breast development, onset of menses, & pubic hair distribution Males: -Penis & testes development & pubic hair distribution

Treatment Chlamydia

-Should be referred for diagnostic testing & treatment -Azithromycin 1 g orally in one dose OR -Doxycycline 100 mg orally twice daily for 1 wk -Avoidance of sexual contact for 1 wk -Very important to avoid reinfection after treatment

Initial Treatment from Near Drowning

-Should be removed from water & CPR immediately while awaiting emergency transfer -Those who recover promptly & are breathing indep. should be taken to ED for eval, as physiological responses may be delayed Treatment: -Estab. ABC's -Hight flow 100% O2 w/ facemasks -Monitoring for @ least 72 hrs for respiratory, cardiac, or neuro deterioration

Minimize Effects of Travel and Jet Lag

-Sleep well night before -Hydrate prior to boarding plane, avoiding alcohol -Avoid drinking juices, sodas, caffeinated beverages, & alcohol during flight -Try to eat/sleep on schedule that coincides w/ home time , when ext. period of adjustment is not possible -Remove shoes, stretch, & walk about periodically to improve circulation -Schedule rest time during day if necessary

Prevention of Keratoderma

-Soaking feet & using callus files to reduce thickness of existing calluses -Wearing double socks to cushion sole of foot -Wearing properly fitted shoes -Applying emollients to feet/hands to prevent friction & keep skin supple -Wearing protective gloves, tape, or moleskin to protect palms from friction

Frostnip

-Superficial freeze injury that is reversible

Marfan Syndrome Traits

-Tall, thin stature w/ loose jts., w/ long bones disproportionately long -Scoliosis -Flat feet -Pectus carinatum (pigeon chest) or Pectus excavatum (funnel chest) -Long, narrow face w/ high-arched roof of mouth & crowding of teeth -Dislocation of lenses of eyes & sometimes retinal detachment, myopia -Aortic dilation (w/ risk of dissection) -Cardiac valve disorders w/ hear murmurs -Stretch marks -Abdominal/inguinal hernia -Sleep apnea (rare)

PPE: Skinfold Measurement Component

-Using special calipers is way to est. body fat & may be performed on triceps (TST), biceps, suprailiac, & subscapular areas -Actual measurement divided by standard measurement & multiplied by 100. -Males (TST) measured 11.8: 11.8/12.5=0.944 x 100= 94.4% Males (adults): -TST 12.5 mm Females (adults): -TST 16.5 mm

Strength Training & Weightlifting

-Utilize same equipment, like free weights & weight machines, but goals are diff. -Strength training aims to improve physical conditioning, while weightlifting (not recommended for children or adolescents) is a competitive sport that involves lifting max. amounts of weight There is a number of steps that should be taken to reduce safety hazards: -Exercise equipment should be checked daily & cleaned to ensure it is safe -Instruction in lifting techniques & supervision should be provided -Athletes should be advised to do warm-up & stretching exercises b4 using equipment -Use of weights & equipment should be based on age-& size-appropriate standards to prevent injury -Weightlifting requires a spotter@ all times -One or more spotters must assist w/ free-weight exercises in which the bar passes over face or head, the athlete is positioned on back, or bar is racked in front of the shoulders

Steps to Prevent Heat Loss

-Utilize wet bulb temp index, which monitors effects of humidity, temp, & solar energy to determine risks. High risk are diabetes mellitus or overweight -Provide adequate hydration: 16 oz of fluid (sports drink, not sodas) b4 activity & 8 oz every 20 mins during activity to percent thirst. Pre- and Post-activity weight measurement, w/ 16 oz for every 1 lb loss of weight -Allow time for acclimatization (7-10 days) -Monitor for signs of hyperthermia -Provide 10 min breaks @ least every hr. -Promote evaporation, change wet shirt -Provide shelter

Breast Support

-Vulnerable to breast injuries, w/ nipple the most commonly injured b/c of sensory stimuli causing erection of the nipple tissue & subsequent friction from clothing, resulting in pain & bleeding -Breasts may have contusions, abrasion, & lacerations from impact, especially in contact sports & sports where balls or other things are hurrled @ high speeds -Breast injuries have shown to increase risk of cancer -Breast supportive devices should support Cooper's lig., which suspends breasts

Safety Measures that can be Taken Against Hypothermia

-Wearing clothes appropriate for enviro., temp, & chill index, as wind & humidity increase heat loss -Doing warm-up exercises to increase circulation -Begin exercises slowly & avoid slippery surfaces -Removing wet clothes & replacing w/ dry clothes -Avoid a lot of moisture in clothing by overheating -Wearing layers that allow for ventilation -Ensuring head & neck covered, 50% heat loss is from these areas -Wearing mittens/gloves approp. for temp & conditions -Wearing moisture-wicking socks, like those made of wool or polypropylene, to keep feet dry -Avoiding alcohol, results in vasodilation, increased heat loss & impaired reasoning

Minimizing Injury: Running shoes

-Wearing improper fitted/worn out shoes is major cause of foot injuries -Should be constructed of breathable material w/ soft but sturdy midsole, good forefoot flexibility, a strong heel -Shoes should be able to support 350 to 550 miles of running, but shock absorption weakens w/ time may need to be replaced by obvious wear occurs -Shoes should be worn for @ least 10 mins to ensure comfort -New shoes should be broken in slowly (3 mile runs) & never be worn in a marathon or other race immediately after purchase

3 Zones of Injury

1) Coagulation: Usually distal, is severe irreversible cellular damage 2) Hyperemia: Usually prox, is minimal cellular damage 3) Stasis: Between two zones, is severe, but damage is sometimes reversible

PPE: BMI Assessment

BMI formula: BMI= (weight (lbs) X 703)/ Height (inch2) OR BMI= weight (kg)/Height (m2) -Indicator of obesity/malnutrition -Cannot be used alone to diagnose obesity, as types differ considerably -Women have more body fat than men Resulting scores for adults age 20 & over are by chart: -Below 18.5 Underweight -18.5-24.9 Normal weight -25.0-29.9 Overweight -30 & above Obese BMI under age 20 uses age- & gender-specific -< 5th% Underweight -85th-<95% @ risk for overweight ->95th% Overweight

Standard Protective Equipment: Sport-Specific

Baseball: -Batting helmets w/ mouth guards -Catchers: Mouth guard, shin guards, chest protector, & protective mitt Football: -Football, helmet & mouth guard; shoulder, hip, & tailbone padding; & thigh guards Basketball: -Basketball shoes (med. tops providing ankle support) & mouth guards Gymnastics: -Wrist guards, handgrips, & soft gymnastic footwear; floor pads should be in use & equipment properly padded Skateboarding: -Helmet, knee & elbow pads, & slip-resistant shoes w/ closed toes Soccer: -Shin guards & special molded cleats or ribbed0sole shoes; goal posts should be padded to prevent head injuries Volleyball: -Kneepads, protective pants, & shoes w/ ankle/arch support

Diet Modifications for Exercise

Carbo loading & protein diet mods are often used to increase storage of glycogen be4 endurance sports, & to prevent energy loss & anemia: -Intake simple carbs immediately be4 an event may increase dehydration & cause increase in insulin, thus lowering blood sugar. If activity lasts longer than 90 mins, then stored glycogen is adequate. Lasting for more than 2 hrs, then sports drinks that are 6-8% glucose may be used during event -While high carb diet (70%) should not be used to for prolonged periods, carbo loading diets often used for 3 days b4 endurance events. Shorter durations (1 day) may cause water retention & muscular stiffness -Exercise increases need for protein, & insufficient intake may result in anemia. Endurance activities require 1.2-1.4 g protein/kg of body weight. Resistance & strength activities require 1.6-1.7 g protein/kg. Protein supplements should be avoided -Pre-event meals should be0500-1000 cal. 3-4 hrs be4 event

Syphilis: 3 Phases to Disease, w/ incubation period of about 3 weeks

Primary: -Chancre (painless) in areas of sexual contact, persisting 3-6 wks Secondary: -General flu-like symptoms (sore throat, fever, & headaches) & red popular rash on trunk, flexor surfaces, palms, & soles; lymphadenopathy occurs about 3-6 wks after end of primary phase & eventually resolves Tertiary (latent): -Affects about 30% & includes CNS & cardiovascular symptoms 3-20 yrs. after initial infection