Preparticipation PE

Question 1

Purpose of PPE?

Answer 1

• impt 1st step in assisting athletes in maintaining health and ensuring safe participation in training and competition

Question 2

Objectives of a PPE?

Answer 2

primary or essential:

• detect conditions that may limit participation
• detect conditions that may predispose to injury
• meet legal and insurance requirements
• f/u previous injuries conditions, surgeries

secondary or ideal:

• assess general health and ID health-risk behaviors: potential for discovering previously undetected condition
• assess physical maturity
• determine fitness and performance level

Question 3

When should PPEs be done?

Answer 3

• should be performed at least 6 wks beginning of sports to allow adequate time to address any issues
• must be done annually for high school athletes by montana regulations
• comprehensve baseline PPE before initiating sports season
• subsequent annual PPes may be limited to recent injuries but also include review of cardiopulm system

Question 4

Diff formats of PPE?

Answer 4

office based:

• advantages of physician-pt familiarity, privacy, and continuity of care
• disadvantages: cost, limited appt time and lack of communication back to school athletic staff

group screening:

• specialized personnel, time, and cost efficiency
• disadvantages: rushed, lack of privacy, potential for poor f/u of ID problems

Question 5

Diff stations for a PPE?

Answer 5

• sign in
• ht/wt
• vitals
• vision
• hx review
• PE

Question 6

What are impt questions to ask in medical hx?

Answer 6

- CV questions are key:
ID hypertrophic cardiomyopathy
marfans
premature atherosclerosis 
- health: risk behaviors, femal athletic triad

Question 7

What are CV causes of sudden death?

Answer 7

• hypertrophic cardiomyopathy
• anomalies of coronary arteries
• atherosclerotic heart disease
• marfans syndrome (Aortic rupture)
• aortic stenosis
• mitral valve prolapse
• myocarditis

Question 8

What is hypertrophic cardiomyopathy?

Answer 8

• primarily a disease of myocardium w/ hypertrophy w/o any obvious cause
• frequently asx until sudden cardiac death
• 0.2% of general pop

Question 9

Specific ?s to ask that focus on CV health?

Answer 9

• have you ever passed out during or after exercise?

- has anyone in your family died of heart problems or sudden death b/f age of 50? - if yes, need very thorough w/u

Question 10

HEENT part of PE?

Answer 10

• pupils (for anisocoria - unequal pupil size) and visual acuity
• swimmer, scuba divers, and wrestlers may reqr special evals
• smokeless tobacco users reqr oropharynx eval

Question 11

CV part of PE?

Answer 11

• BP measurements w/ appropriate cuff size:
  Younger than 10: greater than 125/75
  older than 10: over 135/85
• palpation of upper and lower extremity pulses: brachial-femoral delay may mean coarctation of aorta
• heart auscultation in 2 positions and w/ provocative maneuvers (valsava, deep inspiration, squatting) may help detect murmurs
• isolated premature ventricular contractions (PVCs) most commonly found - rarely of consequence
• benign arrhythmias:
  unifocal in origin
  disappear w/ exercise
  no hx of syncope w/ exercise
• coupling w/ PVCs may indicate myocarditis

Question 12

MSK part of PPE?

Answer 12

• impt to ID musculotendinous, bone or jt probs that may limit participation or predispose to injury:
  shoulder instability, ACL deficiency, unrehabbed ankle instability
• any positive responses in hx reqr thorough eval
• screening for flexibility
• screening for general neuro exam, soliosis

Question 13

Are routine screening tests recommended?

Answer 13

• not recommended and remains unproven:
• CBC, UA, chem profikes, sickle cell trait
• EKG, echo
• radiographs

Question 14

What questions should you consider b/f you clear an athlete to play?

Answer 14

• must be familiar w/ demands of specific sports
• will the problem increase the athlete’s risk of morbidity or mortality?
• will other participants be at risk of morbidity?
• will further eval, tx or rehab allow full participation?
• could athlete be allowed limited participation?

Question 15

What are medico-legal considerations you need to keep in mind?

Answer 15

• the athlete may have legal right to participate against medical advise
• recommend that a waiver be used
• majority of medical liability coverages don’t include anything about PPEs

Question 16

What are specific medical condions that may restrict a pt’s ability to participate?

Answer 16

• alantoaxial instability: reqr clearance, Down’s disease
• bleeding disorders reqr specific clearance
• heart murmurs: if non-specific may be released
• diabetes: may participate if controlled, specific concern for activities that last longer than 30 min

Question 17

Why is sickle cell impt to screen for? Screening should be considered in what pop?

Answer 17

• linked to increase risk for heat illness and sudden cardiac death
• screening should be considered in athletes w/ a family hx of sickle cell trait or in athletes of African descent and a hx of exertional rhabdomyolysis

Question 18

Can pts w/ HIV, 1 kidney, and sickle cell be cleared?

Answer 18

• HIV: cleared but health care personnel must use universal caution
• absence of kidney: cleared but w/ counseling and protection for contact
• sickle cell trait: unlikely that they have an increased risk of sudden death or other medical problems w/ exception of extreme conditions of heat, humidity, elevation

Question 19

What are red flags on PPE?

Answer 19

• hx of exercise intolerance
• syncope or near syncope
• chest pain w/ exercise
• a family hx of unexplained death b/f age of 50
• family hx of hyperlipidemia