Final Flashcards

Question

Bacteria Infection

Answer 1

- can infect any area of the body - Vaccination (e.g., tetanus, tuberculosis) - Treatment: usually goes away on its own, antibiotics - targeted to specific bacteria type and locatino of infection, oral;tropical;injections, finish entire course even if feeling well

Answer 2

- Yeast & Mold & Mushrooms - A few hundred species can infect human - No licensed vaccines available - e.g. skin, nails, lungs, organs - antifungals (topical;oral;injections)

Answer 3

- Three main types of parasites cause disease in humans (Protozoa (e.g., Giardia) Helminths (e.g., Roundworm) Ectoparasites (e.g., Ticks, Lices, Mites) - Vaccines for domestic animals - WHO approved malaria vaccine in Oct 2021 - Treatment - Antiparasitics (oral,topical,injections)

Answer 4

**1. Direct Contact** - *Requirements*: direct physical contact - *Example transmissions*: shaking hands, kissing - *Example infections*: Common cold & Mononucleosis **2. Indirect Contact** - *Requirements*: infectious agent deposited onto surface - *Example Transmissions*: Door handles, Training euipment - *Example Infections*: Norovirus **3. Droplet** - *Requirements*: Large droplets through the air - *Example transmissions*: coughing & sneezing - *Example infections*: influenza **4. Airbone** - *Requirements*: small particles that are inhaled - *Example Transmissions*: Ventilation systems - *Example Infections*: Tuberculosis, Measles **5. Vehicle** - *Requirements*: Single contaminated sources - *Example Transmissions*: contaminated food or water - *Example Infections*: E Coli, Norovirus **6. Vector-Borne** - *Requirements*: Insect or animals - *Example Transmissions*: Mosquitoes, ticks - *Example Infections*:

Answer 5

- Relationship has been described as J curve - excessive exercise may impair immune function (depressive effect lasts up to 24h after exercise) - Strenuous Exercise --> Leukocyte depression - Higher rate of breathing --> Exposure to bacteria and virus

Answer 6

**Most common infection in athletes** **incidence: ** average adult 1-6 infections per year (athlete and non-athlete) **pathogens**: majority are VIRAL (Rhinovirus), direct & indirect contact;droplets **diagnosis & treatment**: runny nose, sore throat, fatigue, low grade fever, cough. COURSE: 4-10 days, symptom management: fluids, pain control, rest

Answer 7

**symptoms above the neck**: - nasal congestion, runny nose, sore throat - can play --> proceed cautiously **symptoms below the neck**: - vomiting, diarrhea, fever, myalgia - stop activity ---> rest **bacterial infection (sinusitis, pharyngitis)** - athlete should be aferbrile and on antibiotics for at least 24 hrs before RTS

Answer 8

- Common (95% of adults exposed) - viral illnesses of the lymphoreticular system (Epstein-Barr virus) - Spreadd through saliva (kissing disease) - 30 to 50 day incubation period - Athletes at same risk as non athletes - symptoms: fever, fatigue, sore throat, swollen lymph glands **diagnosis**: - Clinical findings - Laboratory data **Treatment**: - Rest, eat healthy, fluids - Tylenol/Advil for sore throat and headaches - No antivirals **Complications**: - Spleen enlargement (splenomegaly) occur in >50% of casses - Splenic rupture occur in 0.1-0.2% of those with Mono **RTS** - Recovery 4 to 6 weeks from diagnosis (can take .12 weeks) - when aferbrile, fatigue resolved and 3 weeks from onset of symptoms --> return to light and noncontact activity - No worsening symptoms --> Progress to mroe strenuous activity - RTA should be individualized

Answer 9

**symptoms** - Headache - Fever - Extreme tiredness - Aches - Runny or stuff nose - sore throat - coughing - vomiting - Not the common cold - Influenza A or B viruses - Highly contagious - Winter season (Oct-March) **SYmptoms and Complications**: - Days 1-3: Sudden appearance of fever, headache, muscle pain, weakness, dry cough, sore throat and sometimes a stuffy nose - Day 4: Fever and muscle aches decrease. Hoarse, dry or sore throat, cough and possible mild chest discomfort become more noticeable - Day 8: Symptoms decrease. Cough and tiredness may last 1-2 weeks or mroe - Complications: dehydration, pneumonia, bronchitis, myositis, death **Treatment**: - Supportive care, maintain hydration - Tylenol/NSAIDs - Antivirals (e.g., Tamiflu) - within 48h of symptom onset - Isolate athlete for 5 days - RTS when all symptoms resolved

Answer 10

- Vaccinations - Avoid contacts with infected people and contagious objects (keep distance) - wash hands - cough and sneeze into sleeve - avoid touching face - isolate a team member with symptomsd - wear a face mask - don't share wateer bottles/sport equipment - avoid getting wet and cold after exercise - heat and moisture exchanging mask at temperatures below -15 degrees (e.g., Cross-country skiing) - Good recovery routines

Answer 11

- Usually, bacterial - Itching, redness, pain, hearing loss - Risk factors: chronic moisture trauma from foreign bodies (e.g. ear plugs) - prevention: keep ears dry, don't damage the skin - treatmentL antibiotic/steroid combination drops,& NSAIDs- pain control

Answer 12

**Cellulitis**: - acute spreading infection of dermal & subcutaneous tissues - Group A streptococcus; staphylococcus aureus - occurs via bacterial invasion into damaged skin tissue - pain, redness, swelling, warm tense skin with or without fever - **treatment**: skin hygeine, antibiotics (5-10 days oral, severe cases can be up to 14 days) **Impetigo** - Superficial skin infection - Staphylococcus or streptococcus - direct skin to skin contact - broken or unbroken skin - **symptoms/signs**: early - tender red papules, later - non tender vesicles with surrounding redness, late - honey coloured crust - **treatment**: skin hygiene, antibiotics for 7-10 days (topical in mild cases and oral in more diffuse), return to contact sport after 72 hours of antibiotics completed, no new lesions in 72 hours and no moist lesions **Herpes SImplex** - HSV-1, herpes gladiatorum - common in wrestlers: up to 80% of wrestlers will get it (head, face, neck), *skin to skin contact* - Highly contagious - **symptoms**: - first mild glu-like symptoms --> rash appears 1 to 2 days later - burn/tingle - lesions last 10-14 days - Re-activation (latent herpes: which lives in neural ganglia, tingling and burning before appearancce of skin lesions, triggered by physical or emotional stress and fever) - **Treatment & RTS**: - pain relief, keep dry - oral antivirus --> 10 days for initital infection - RTS: free of systemic symptoms for 72 hours, no new lesions for 72 hours, no moist or activee lesions, treated with antivirals **Tinea** - Fungal skin infection - Highly contagious - Heat and moisture help fungi grow where sweat - Athletes Pedis: athletes foot, superficial skin infection of the feet, trichophyton, epidermophyton, itching, scaling, vesicles. **treatment**"\: topical (e.g. Lamisil) or oral antifungals 2-4 weeks

Answer 13

clean and cover up cuts and scrapes, prevent blisters with pad, gel or spray to areas that routine blitster (for feet, footwear is important) - wear moisture wicking clothes (premium moisture management) - wear sandals in locker room - shower after practices and game s+ use antimicrobial soap - use their own personal care items + clean towels - wash clothes and towels after each use (an sports bag) - disinfect equipment daily - perform regular skin checks (esp in high risk sports), look for any changes and report to athletic trainer or doctor - make sure athletes don't use sandpaper or bleach to pass skin check

Answer 14

- Study of the time course of a drug and its metabolites in the body after administration by any route - absorption - distribution - metabolism (biotransformation) - excretion

Answer 15

- genetic - environmental (enzyme induction or inhibition) plus drug interactions - physiological (age, liver disease, renal disease, nutrition, alcohol, smoking)

Answer 16

physiological effects of drug on the body 1. activation or blockage of cellular receptions 2. signal messaging

Answer 17

- lower limit: concentration that produces half the greatest possible effect - upper limit: no more than 5-10% of patients experinece a harmful side effect - **diagram**

Answer 18

- tylenol - aka paracetamol (para-acetylaminophenol) - possible action through COX centrally (temp effects), serotonin (5-HT), modulation of endogenous cannabinoid system - effects: analgesic and anti-pyretic - ceiling effect at 1000mg per dose - high absorption in small intestine - metabolism in liver - **time to peak**: 10-60 minutes - **half life**: 2-3 hours - elimination through urine mostly as metabolites - overdose - depletes liver of glutathione which detoxifies metabolic intermediaries

Answer 19

- salicylates and related compounds - anti-inflammatory, anti-pyretic, anti-platelet and analgesic - act by inhibiting cyclo-oxygenase (COX) - absorbed rapidly from the stomach and upper small intestine - time to peak: 1-2 hrs - distribution throughout most body tissues - metabolized in liver - excreted through urine - half life 2 hrs

Answer 20

- stomach (nausea, pain, gastritis, ulcer/bleeding) * Kidneys – hypertension, fluid retention, renal failure * Platelets – dysfunction (inhibit clotting) * Vessels – vasoconstriction (hypertension) * Other (tinnitus)

Answer 21

NSAIDs can * Inhibit of protein synthesis and muscle repair/regeneration * Inhibit of tenocyte proliferation and collagen formation (but may be useful in acute/reactive tendinopathy) * ?impair bone healing

Answer 22

-Diclofenac (Voltaren), indomethacin, ketoprofen * Avoids systemic effects (<5% plasma concentration of oral form)

Answer 23

* Produced endogenously within the adrenal cortex from cholesterol * Main form is cortisol (hydrocortisone) * Reduce pain and inflammation * Inhibit collagen synthesis * Toxic to chondrocytes * Exogenous routes: inhaled, topical, oral, injectable, rectal * E.g. prednisone, triamcinolone, dexamethasone

Answer 24

* Indications: bursitis, tenosynovitis, osteoarthritis * Contraindications: infection, prosthetic joint, fracture * Achilles or patellar tendinopathies * Relative C/I: anticoagulant, IDDM, TB, hemarthrosis, immunosuppression * Possible ADRs: damage to cartilage/tendon, infection, post- injection flare 10%, skin atrophy, tendon rupture, bleeding * No superiority of specific forms (hydrocortisone, methylprednisolone, triamcinolone, etc.)

Answer 25

* μ-opioid receptor agonists * Oral, IM, IV, epidural, intrathecal, transdermal (fentanyl patch), intranasal *** Medical uses:** * Pain relief (acute, chronic) * Sedation * Anesthesia (spinal, epidural, intrathecal) * Cough * Diarrhea * Dyspnea * Side effects – nausea, dizziness, constipation, sedation, confusion * High risk of physical and psychological dependency (tolerance/withdrawal and addiction, respectively) * Overdose * Respiratory depression * NALOXONE (Narcan) kits

Answer 26

* **Two main compounds:** CBD (non-psychoactive) and THC (psychoactive) * Oral nabilone (Cesamet), nabiximol sprays, oils, inhaled * **Absorption** * Oral = lower peak concentration, slower onset * **Distribution extensively into fatty tissues** * Can be detected in blood up to 33 days after last use - **Metabolized in liver** - **Elimination mainly through feces** * Indications: chemotherapy-induced N/V, spasticity, neuropathic/cancer pain, seizures, wasting syndromes (HIV/AIDS, cancer) * ?PTSD * No supportive evidence: acute pain, headache, fibromyalgia, arthritis * Acute effects: sedation, dizziness, sensory disturbance, hallucination/paranoia, euphoria, dysphoria, anxiety, cognitive impairment, hypotension, tachycardia, hyperemesis * Chronic adverse effects*: anxiety, depression, psychosis/schizophrenia, cognitive impairment, lung disease, carcinogenicity (smoked) *correlation, not necessarily causation ꭞNo evidence of death secondary to overdose

Answer 27

**Bronchitis** * Acute – viral vs bacterial * *Chronic – airway changes associated with COPD (chronic obstructive pulmonary disease)* * Smoking * Genetic * *Treatment* * Asthma – inhalers * Anti-biotics **Pneumonia** * Lobe infection * Viral vs bacterial (fungal) * Treat – antibiotics vs anti-virals

Answer 28

* Commonly spontaneous * Trauma – broken rib * Short of breath, possible pain ** Treat** * Small – watch * Large – commonly chest tube **Tension** * Shift mediastinum - vena cava kink * Decrease oxygenation, decrease venous return * Emergency

Answer 29

* Blood in the chest cavity (Broken rib, bleeding vessels in thorax, sharp trauma) * Short of breath and pain * Sport – broken rib(s), Marfan syndrome – aortic aneurysm * Decrease oxygenation, blood loss * Hospital – chest tube

Answer 30

* Reversible airway disease characterized by airway narrowing and inflammation **symptoms** * Wheezing (expiratory) * Cough * Cough, wheeze, chest tightness with exercise **pathology** * Characterized by inflammation, increase mucous production and airway narrowing * Net effect is expiratory resistance and air trapping * Long term results include denudation of epithelium, collagen deposition and airway remodeling

Answer 31

* PFTs the usual standard for diagnosis * >= 12% improvement from baseline or >= 10% predicted in FEV1 after bronchodilator * FEV1% (FEV1/FVC %) <=65% * Increase Residual Volume (air trapping) – can’t measure with simple PFTs * Methacholine challenge test (eucapnic hyperventilation, exercise challenge, cold air, histamine challenge)

Answer 32

**ANTI-INFLAMMATORIES** * Mast cell stabilizers (Intal , Tilade ) – both discontinued but still in Europe * Anti-leukotrienes (Accolade , Singulair ) - pills * Corticosteroids (Pulmicort , Flovent )- puffers * Oral Corticosteroids if severe symptoms **SMOOTH MUSCLE RELAXANTS** **B2 agonists* * ALL are banned – except salbutamol, formoterol, salmeterol and vilanterol - short acting (SABA) (Ventolin , Bricanyl ) * Terubutaline (Bricanyl) - long acting (LABA) (Serevent (Advair); Symbicort ) * *Clenbuterol* *Anticholinergic* (Atrovent , Spiriva **Traditionally mild asthma – SABA before exercise** * Current recommendation is for a combined inhaler (GCS/LABA) * As good short term control * Prevents exacerbation of asthma .. **Severe asthma, allergy related asthma** * Referral to respirologist for advanced investigations * New treatments include ‘biologics’ (often seen in rheumatology disease, cancer treatments) that attack enzymatic/inflammatory pathways

Answer 33

* Anatomy, electrophysiology * Rhythm Disturbance * Sudden Cardiac Death * Cardiomyopathy * Commotio cordis * Coronary Artery Anomalies * Myocarditis and Pericarditis( COVID-19) * Atherosclerosis

Answer 34

* TRAGIC – receive disproportionate degree of public scrutiny * RARE event * Commonly death is the first indication of a problem * -- Male to female 2:1 * -- High school age and a little older * -- 0.75 in 100,000 athletes per year (3X higher than non athletes)

Answer 35

* The prevalence of HOCM - About 1 in 500 * HOCM is usually genetically transmitted (Histologically, there is myocyte hypertrophy, myocyte disorganization and disarray, and myocardial fibrosis) * Mutations may have a malignant or benign course * Competitive athletes dying suddenly (Usually are of 13 - 30 yrs of age) * LV wall thickening (Asymmetric, Distorted cellular architecture, Abnormal intramural coronary arteries) * Death may occur (Without any premonitory symptoms or During moderate to severe exertion) MECHANISMS OF SUDDEN DEATH * Malignant ventricular dysrhythmias * Sudden hemodynamic instability * -- Increase in LVOT obstruction * -- Exercise induced systemic hypotension * -- Brady dysrhythmias

Answer 36

**Blunt chest trauma over heart (sternum)** * Hits just before T wave – VF (Ventricular fibrillation) * Potential prevention by wearing padding to attenuate impact

Answer 37

* Heart disease the greatest cause of morbidity and mortality Related to: * Genetics * LDL cholesterol * Triglycerides * Tobacco * Lack of exercise and obesity * Diabetes * Hypertension * Older age

Answer 38

digram/google

Answer 39

* Address co-morbidities (diabetes, high LDL/triglyceride, smoking, obesity etc.) * Maintain low heart rate (beta blocker) – decrease energy requirements by decreasing work * Prevent clotting (Aspirin, other clot preventers) * Exercise * Angioplasty and Stent * Coronary bypass surgery Treatment * BCLS and Automatic External Defibrillator (AED) **In Sport** * 89% survival high school * 93% survival Italian sports facilities with an AED * Canada (Toronto) – 43.8% competitive athlete, 44.8% recreations athletes without optimal resuscitation available

Answer 40

* PAR-Q+ (for those wanting to be active), PARMED-X+ (for physicians) **History and physical examination** * Any ‘syncope’ symptoms need to be investigated, faint, SOB unexpected * Exercise related ‘chest pain’ * Family History <60 y/o cardiac disease * Heart rate irregularity, murmurs and blood pressure * Marfan Syndrome (connective tissue disorder) stigmata ** Tall and slender * Long arms, legs and fingers (Arm Span > Height) * High arched palate * Nearsightedness * Sternum protrudes or dips inward * Genetic testing* **heart tests** - not normally required in screening (ECG and ECHO)

Answer 41

Physiologic changes when the body shifts into a new time zone * Symptoms are episodic * Poor sleep, day-time fatigue, trouble concentrating, poor performance Direction of travel: West → East MOST JETLAG East → West 30-50% less jet lag N → S or S → N No desynchronization - number of time zones travelled = one day per time zone travelled of recovery

Answer 42

Physiologic, psychologic, and environmental effects of a long journey, or accumulated travel over a season * Symptoms can be the acute from a long journey. * Most typically, are cumulative & chronic * Persistent fatigue, recurrent illness, mood changes, loss of motivation

Answer 43

- Get enough sleep - Don’t stay up late packing - Reduce training volume and intensity - Choose evening departures for long eastbound flights

Answer 44

- Sleep and eat on destination schedule - Keep well hydrated – no caffeine or alcohol! - Minimal use of electronic devices - Short acting sedatives / melatonin

Answer 45

- Move to ‘new’ time - Reduce volume, intensity and frequency of training during the first few days - Fatigue countermeasures (if needed) - light therapy (3000 Lux) - Caffeine (50-200mg)

Answer 46

**1. before travel** - Travel Destination & Accommodation - Travel Insurance - Vaccinations - EAP - Fitness to Travel Assessments - Nutrition & Hydration Plan - Mitigate Jetlag - Injury and Illness Prevention **2. During Travel** - medical travel bag - compression stockings, ear plugs, eye masks - exercise - nutrition and hydration **3. On arrival** - establish medical room - specify treatment hours - contact information - local EAP **4. Journey Home** - medical travel bag - compression stockings, ear plugs, eye masks - exercise - nutrition and hydration - injuries and illnesses

Answer 47

- Digestive tract disorder - Classically E.coli - Other pathogens: Campylobacter, Salmonella, Shigella, Rotavirus, Giardia - Common in developing countries - Diagnosis is usually made by clinical presentation. - More severe cases → stool cultures **symptoms and treatment** - Malaise, vomiting, abdominal cramps, diarrhea, fever - Generally self-limited with symptoms lasting 1-5 days - Dehydration is major concern! - Stay hydrated (fluid and electrolytes); Rest; Antibiotics (if severe symptoms) **Prevention** *Watch what you eat and drink:* * Eat food that is well cooked and served hot * Stay away from salads, grapes and berries * Stick to fruits and vegetables that you can peel yourself * Avoid unpasteurized milk and dairy products * Don’t consume food from street vendors * Avoid unsterilized water – drink bottled water! * Avoid locally made ice-cubes, mixed juices made with tab water * Be aware that alcohol in a drink won't keep you safe from contaminated water Don’t swim in water that may be contaminated Keep your mouth closed while showering Use bottled water to brush your teeth Dukoral – vaccine that helps prevent E coli & Cholera

Answer 48

* Inflammation of the liver – most often caused by a virus * -- Hepatitis A virus (HAV) * -- Hepatitis B virus (HBV) * -- Hepatitis C virus (HCV) * -- (Hepatitis D, E, and G) * Symptoms: fever, fatigue, joint and abdominal, pain, nausea, vomiting, dark urine, loss of appetite * Vaccines for HAV and HBV

Answer 49

* Occurs when a blood clot (thrombus) forms in one or more of the deep veins * Can be caused by anything that prevents blood from circulating normally * Can be a life-threatening condition **signs and symptoms** - swelling - pain - red or bluish skin - feeling of warmth in the affected leg - can also occur without noticeable symptoms **diagnosis** - history - physical examination - ultrasound imaging - venography - magnetic resonance venography (MRV) - blood test (d dimer) **treatment** * Blood thinners * Clot busters * Filters * Compression stockings * Recovery: weeks to months

Answer 50

* Severe and life-threating complication of DVT **Signs and symptoms** * Sudden shortness of breath * Chest pain or discomfort * Feeling lightheaded, dizziness, fainting * Rapid pulse * Coughing up blood * Low blood pressure * Sweating * Fever * Leg pain/swelling **Diagnosis** * History & physical exam * Blood tests; chest X-ray; CT scan; MRI; US (legs); pulmonary angiography **Treatment** * Blood thinners for at least 3 months; clot busters; filters; surgery * Usually, hospitalization for a few days **recovery time** weeks to months

Answer 51

**Risk Factors** * Trauma * Slow blood flow * Birth control pills * Pregnancy * Chronic illnesses * Inherited blood-clotting disorder * History or Family history * Age * Obesity **Prevention** * Avoid long periods of staying still * Stay hydrated * Wear loose-fitting clothing when you travel * Talk to your doctor about risk of clotting * Stay active & exercise regularly

Answer 52

* Process of maintaining a normothermic body temperature - if body needs to warm up: vasoconstriction, thermogenesis - if body needs to cool down: vasodilation and sweating

Answer 53

**Radiation:** objects exchange radiation with each other and with the sky. Warmer objects lose heat to cooler objects **convection**: heat is lost by convection wehn a stream of air (wind) is cooler than body surface temperature **conduction**: direct transfer of heat when objects of different temperatures come into contact **evaporation**: of water from body surfaces or breathing passage cools body

Answer 54

* Exertional heat illness is the result of increased heat production and impaired dissipation of heat * MILD FORMS: Heat edema; Heat rash; Heat syncope; Heat cramps * MAJOR FORMS: Heat exhaustion; Heat stroke

Answer 55

* Normal core temperature * Peripheral vasodilation to produce heat loss leads to pooling of fluid in the distal body parts (extremities) (*soft tissue swelling - feet, hands*) **treatment** - elevation of hands/feet - compressive stockings - hydration and salt intake - no diuretics - 7 to 14 days

Answer 56

"sweat rash, malaria rubra, prickly heat" * Normal core temperature * Sweating saturates the skin and clogs the sweat glands – obstruction results in leakage of sweat into the epidermis or dermis * Blister-like rash on the skin * Risk of secondary infection **treatment**: - cool the skin and prevent sweating - loose and light clothing - shower in cool water - let your skin air dry - mild anti-inflammatory lotion - weeks

Answer 57

* Normal core temperature * Occurs with orthostatic hypotension resulting from peripheral vasodilation and venous pooling ( Low blood pressure → fainting) * Quick recovery once supine **Treatment** * Supine position (in a cool location if possible) * Elevate legs * Hydration * Check injuries! * Evaluation of the cardiovascular and central nervous systems for serious causes of syncope

Answer 58

* Normal or elevated core temperature * Etiology poorly understood * Electrolyte depletion (Magnesium, potassium & calcium) ? (*Evidence is not clear)* * Sodium loss is thought to play a significant role in heat cramps *(Evidence is not clear)* - prolonged exercise >2 hours --> often occur in active muscle groups (thigh, calf, abdmoinal, back, shoulder) **treatment** - removal from activation - hydration (e.g., sport drinks) - light stretching or massage - cooling with ice - if cramps don't subside in one hour --> seek medical help

Answer 59

* Elevated core temperature: 37°C-40°C * Malaise, fatigue, dizziness, heavy sweating, headache, vomiting, weakness, cold or clammy skin * Normal mental and neurologic status * Sometimes tachycardia or hypotension * Avoid progression to heat stroke! *----> Check core temperature **(rectal thermometer)** **treatment:** in order - removal from the heat - supine position and elevate legs - cool the body (armpits, neck and groin) - hydration with cool fluids (e.g., sports drinks) - monitor core temperature - if not feeling better within an hour then seek medical help

Answer 60

* Elevated core temperature of 40°C or greater * Central nervous system disturbance: irritability, ataxia, confusion, coma, seizures * May or may not be preceded by mild symptoms - 2 tpyes: classical (environmental heat waves) and exertional (intrinsic heat production) **treatment** * Assessment of ABC (airway, breathing, and circulation) **Reduce heat as quickly as possible!** * Goal: to lower core body temperature to less than 38.9°C within 30minutes * Cold water immersion (CWI) – the water should be 1.7°C–15°C * Monitor core body temperature (repeat every 3-5 min) and other vital signs during cooling * Remove patient when core body temperature reaches 38.9°C to prevent overcooling **Call for medical assistance as soon as possible** **immediate and rapid cooling** - cool first and transport second - continuous monitoring **complications** *Heat stroke may be complicated by* * Seizure * Hypotension * Arrhythmias * Damage of vital organs * Rhabdomyolysis

Answer 61

* Education * Screening * Monitor those at high risk * No exercising when sick * RTS after febrile illness → observe carefully * Check weather conditions * Schedule outdoor activities * Wear sunscreen * Sleep, diet & hydration * EAP → Appropriate medical care, first aid kit and onsite facilities * Ensure acclimatization * Responsibilities of event organizations

Answer 62

**Hypothermia develops when heat losses exceed heat production** * Core Body temperature <35°C (95 °F) **Body response** * Shivering to increase metabolism and heat * Superficial blood vessels constrict reducing skin heat loss **Signs and symptoms** - **mild 35-36**L feeling cold, sshivering, incoordination, apathy - **moderate 32-34**: Loss of shivering, confusion or sleepiness, slurred speech, decreased physiologic functioning, cardiac arrythmias may occur; Changes of behavior or appearance - **Severe < 32 degrees**: major metabolic and physiological abnormalities, asystole (cardiac arrest) by 18 degrees **treatment** - passive core rewarming - move to warm and dry place - remove wet clothing - cover with dry blankets - warm fluids - apply heat to trunk, axilla and groin - don't apply heat to extremities - monitor closely

Answer 63

freezing of body tissues - progresses from distal to proximal and superficial to deep **1. Frostnip**: superficial skin is frozen **2. Mild frostbite (superficial)**: freezing of the skin and subcutaneous tissue - involves dermis and/or shallow subcutaneous tissue - skin is red or white, cold, painful, blistering - usually will recover with no permanent damage - increased furutre susceptibility to cold injury **3. severe frostbite (deep)**: freezing of tissues below skin and adjacent tissues (e.g., muscle, tendon, bone) - involves subdermal tissue - skin is white/gray. hard. insensitive and becomes black - loss of tissue, loss of body part **treatment**: - rewarming with warm water immersion (39-42C) - pain medication and antibiotics - important to check for other injuries (e.g., hypothermia)

Answer 64

**External risk factors**: cold weahter, rain and wind, wet clothing **internal risk factors**: previous cold injury, body size and composition, sex, medical conditions **prevention:** screening, education, hydration and nutrition, monitor environmental conditions, proper clothing, training/competition environment, EAP

Answer 65

- sport related sstrain - performance culture - lack of health yrelationships - substances - type of sport - performance failure - sport related injuries - maltreatment in psort - extended travel - retirement/identity - stigma - mental health literacy

Answer 66

**1. screening tools**: * Counselling Center Assessment of Psychological Symptoms (CCAPS-34) → NCAA * Sport Mental Health Assessment Tool (SMHAT-1) * Athletic Coping Skills Inventory (ACSI-28) * Ottawa Mental Skills Assessment Tool (OMSAT-3) **2. Mental Health Literacy** “One of the major barriers around help-seeking is that people would use the word ‘stigma’ as a catch-all. The one thing most participants expressed was that there was a lot of talk in the industry but not much changing systemically at the base level” * Minimizing or dismissing personal problems * Fear of being selfish * Fear of drawing attention to themselves * “wasting” resources * Suspicion of team personnel * Job/position security “Knowledge and beliefs about mental disorders which aid their recognition, management, or prevention” * Who is most at risk? * Recognizing the signs/ tells of most common afflictions * Encourage help-seeking and help provision (when appropriate) * Understand self-help behaviour **3. Mental Performance**: "the development of mental and emotional skills, techniques, attitudes, perspectives, and processes that lead to performance enhancement and positive personal development” ✓ Emotional regulation ✓ Stress/pressure management ✓ Self-confidence & self-reflection ✓ Team cohesion & communication ✓ Injury recovery support ✓ Imagery ✓ Etc. - gold medal profile for sport psychology (LOOK AT BOTH DIAGRAMS)

Answer 67

* Psychotherapy * Medication → Be careful! * Support Groups * Complimentary/ Recreational therapies * Alternative medicine * Peer Support * Mental Performance training (in tandem)

Answer 68

- PO2 decreases with ascent because barometric pressure drops (O2 concentration remains unchanged) - A reduced PaO2 leads to reductions in SaO2 and CaO2 Ve --> PAO2---> PaO2 ---> SaO2 --> CaO2 * Decreased PaO2 triggers an increase in VE, which can partially counteract the decline in PaO2

Answer 69

- oxygen moves from high to low pressures (lungs --> blood --> muscle) - at altitdue P)2 is lower at all steps of oxygen cascade (less O2 available to tissues)

Answer 70

* Sigmoidal relationship between PaO2 and SaO2 (Hemoglobin binds O 2 cooperatively) * A lower PaO2 leads to a lower SaO2 * Shape of curve is protective against drops in PaO2

Answer 71

Arterial oxygen content is the quantity (volume) of oxygen in arterial blood **Depends on three factors:** 1. Hemoglobin concentra8on 2. Saturation of hemoglobin with oxygen 3. PO2 of blood

Answer 72

- oxygen cost of exercise not affected by acute hypoxia * For submaximal exercise, Q (CO) must increase (via HR) to provide adequate O2 to muscle (But thresholds decrease, and exercise “feels” harder) * The maximal Q and a-vO2 difference cannot increase so VO2max declines * Unless offset by a decrease in air density, endurance performance declines in hypoxia, but it is improved with acclimatization - - VO2max decline in hypoxia (CO and leg blood flow are still maximal but tissue O2 extraction cannot compensate for reduced oxygen transport) - maximal exercise performance declines at altitude - exercise at the same abs intesnity: Ve BLa and HR were exacerbated in moderate PO - at the same relative intensity: VO2 was different across different POs - performance improves with acclimatization (IOC recommends arriving at moderate altitiude at least 14 days prior to competition, intitial decrement in performance is ameliorated)

Answer 73

" Train High": Train at moderate altitiude, increase RBVC/CAO2, but there is training stress "Live High": Live at moderature altitidue, greater Increase in RBCV/CaO2 with no training stress "Train low": training near SL with normal increase RBCV/Ca2 and normal training stress “Altitude training does not convincingly increase exercise performance and should not be recommended to elite athletes..." * The rationale for altitude training is to increase hemoglobin mass, red blood cell volume, and maybe [Hb] * As training in hypoxia may decrease performance, some have tried a live-high, train-low approach * Altitude training in general is still not well supported from a scientific perspective, but it is commonly used for endurance athletes.

Answer 74

- affect travelers to altitidue - incidence depends on many factors - range in severity from self limiting to life threatening **acute mountain sickness (AMS)** **high altitude pulmonary edema (HAPE)** **High altitidue cerebral edema (HACE)**

Answer 75

- generally above 2500 m and within first 24h - 4 recognized non specific symptoms (Lake louise score - headache, dizziness, fatigue, nausea) - self limiting - physiological basis is unclear (insufficient acclimatization) - primary risk factors: ascent rate and altitidue attained - previous history not a strong risk factor - treatment: descent, oxygen and pharmacueticals

Answer 76

- rare but generally above 3000m, 2d after arrival - many signs: fatigue, breathlessness, coughing, frothy sputum, inspiratory crackles, cyanosis, tachypnea, tachycardia, chest x-ray for diagnosis - noncaridiogeneic pulmonary edema (secondary to exaggerated pulmonary artery pressure and hypoxic pulmonary vasoconstriction) - primary risk factors: ascent rate and altitude attained - previous history IS a strong risk factor - treatment: descent, oxygen, pharmacueticals

Answer 77

- rare but generally above 3000m, 2d after arrival - signs: some overlap with AMS, confusion, severe lassitude, loss of consciousness - brain MRI demostrates vasogenic edema (distruptions to blood brain barrier) - parimry risk factors: ascent rate and altitiude attained - role of previous history is unclear - treatment: descent, oxygen, pharmacueticals

Answer 78

- majority do not result in structural injuries but rather Rather, mild TBI is a rapid-onset neuronal dysfunction that often resolves in a spontaneous manner over a few days to weeks - most impacts are combination of linear and rotational accelerations with blows at an angle to the individuals resulting both impact forces being transmitted to the brain - diffuse axonal injury: tensional forces, rotational forces and shearing forces

Answer 79

neurons in the brain are stretched which promotes a cascade of events to occur: * Potassium leaks out of the neurons leading to an increased demand for glucose * Calcium leaks promote vasoconstriction in the cerebrovasculature * Overall cause a decreased efficiency in brain function and is recognized as clinical symptoms (headaches, concentration problems, dizziness, blurred vision…) - ionic influx of K cause indiscriminate release of glutamate - if too much glutamate then increased risk of seizure - excess glutamate can trigger voltage + ligand gated channels in brain to depolarize and disrupt normal process - thought to influence some very acut post-concussive impairments

Answer 80

- decrease Participation in sport and recreation - decreased School attendance and academic performance - decreased Physical activity = increased overweight/obesity - Psychosocial consequences → child and family - Health care and indirect costs are high - Rare but serious outcomes

Answer 81

Primary (prevent or reduce risk), secondary prevention (susceptible - early diagnosis/prevention of injury reoccurance), tertiary prevention (rehabilitation - preventing long term consequences of injury)

Answer 82

Body checking single most consistent risk for injury in youth ice hockey other risk factors: - psychological - weight - sex - position - age - level of play - session type - relative age - equipment extrinsic: sport, sesstion type, equipment, rules of game intrinsic: previous concussion, pre-esting symptoms, player weight

Answer 83

- ALzheimers disease, MCI, parkinsons, ALS, any neurodegenerative disease, also suicide - aggresion..mood chances, depression and anxiety

Answer 84

- headache - pressure in head - neck pain - nausea/vomiting - dizziness - blurred vision - balance problems - sensitivity to light or nose - feeling slowed down - feeling like in a fod - don't feel right - difficulty concentrating or remembering - fatigue or low energy - confusion - drowsiness - more emotional - irritability - sadness - nervous or anxious - trouble falling asleep

Answer 85

Sport concussion Assesment Tool - asks to rate symptoms on 0-6 - then add total number present and symptom severity score - Do symptoms get worse with physical actiivty or mental activity? - If not feelings 100% normal what percent is felt.

Answer 86

- Removed from play (current game or practice) – Not left alone, regular monitoring is essential – Medically evaluated following the injury – Return to play should be a medically advised, step-wise process – Players should not return to play while symptomatic When in doubt sit them out

Answer 87

- falls - unkown/other - struck by/against - motor vehicle - assaults

Answer 88

- impairs judgement * Increased risk of depression + anxiety * ---Each hour of lost sleep had a... * -----------38% increase risk of feeling sad or hopeless * -----------58% increase risk in suicide attempts * Poorer grades * Those with C,D,Fs averaged ~30 min less than those who got good grades (As and Bs) **athletic performance** reduced in the basketball trial

Answer 89

- athletes typically have poorer sleep quality **reasons** * Hyperarousal (bright lights, music, adrenalin) * Hydration + fueling pre-sleep * Temperature increases from exercise * Irregular schedules * Chronic sleep deprivation from schedule overload * Travel/jet lag * Pain, muscle soreness, injury * Substances: caffeine, sleep meds, alcohol

Answer 90

- mood impacted more than any other performance factor - prefrontal and insular cortex activity de-activated during sleep loss - increased risk for depression - increased hunger and appetitie - sleep helps increase testosterone and decrease cortisol - with sleep optimization and RT decreased fat mass and increase lean mass with sleep - with sleep deprivation increase in kcals consumed - with more sleep, decrease chance of catching a cold - with more sleep (<8h) decreased risk of injury - more sleep may reduce concussion risk -

Answer 91

**1. Educate** - sleep information sessions - emphasize sleep and check-in frequently **2. Screen** **3. Be wary of wearables** - cons: don't measure sleep directly, difficulty detecting motionless wake and accuracy of sleep stages limited - pros: generates big data, relatively low cost, increased awareness of sleep - understand limitations **4. Bank sleep** - **5. Pre-sleep routine** - techniques to help fall asleep at the beginining or middle of night (breathin 4-2-8, snake breathing), cognitive technique (cognitive shuffle, color shuffle), get up out of bed and do relazing activity **6. Nap** - naps taken during post lunch dip in circadian alertness are more recuperative for 20-90 minutes (1-4 pm) - provide at least 30 min for sleep inertia to disappear after a nap before training or competing - naps outperform caffeine **7. Sleep in a cave** - keep the room like a cave - cool temperature, dark environment and quiet **8. Prepare for Travel** - select right flight (if heading eat then select morning flights, if west select afternoon flights) - 3 days before the trip go to bed at right time and wake up at right time (if going east go to bed earlier and wake up earlier, if going west go to bed later and wake up later) - 3 days before trip get light at the right time (if going east then get light in the morning, block light at night. if going west get light in evening block light in the morning)

Answer 92

Pull Method: 90 Degrees at elbow and shoulder - pull behind knee and neck - pull over to their side - monitor breathing Push: pushing instead

Answer 93

**anterior stabilization**: - four points of contact (2 elbows, 2 hands) **MILS stabilization** - grasp head as a whole - ground yourself to soemthing **when to stop stabilalizing** - if EMS gets there - if person stops breathing, give CPR - if you need to swtich with somebody (hand for hand)

Answer 94

**cervical collar**: neck **malleable finger splint:** finger fracture/sprain **vaccum splint**: ankle **speed/box splint**: lower leg fracture **SAM splint**: forearm | look them up to understand them

Answer 95

Reaction to immune system danger (accumulation of histamines) **1. Assess** - clutching, wheezing, hives, can't breathe **2. Approach** - consent and introduce, ask if they have an epipen **3. Check 5 Rs** - Right person, right dose, right time (expiration is discoloured but can still administer and can administer 2), rigth medication, right method (administer correctly) **4. Blue to sky orange to thigh** **5. remove blue cap** **6. apply EpiPen** - sitting correctly, anterior lateral aspect of high, recommended to reach across to leg - hold for 30 seconds to make sure it's administered fully - cant go through thick clothing

Final Flashcards

(119 cards)