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PED Sports Exam
PED pre-participation evaluation
| Question | Answer |
|---|---|
| PPE Timing | at least 6 weeks prior to practice to allow time fro referrals and rehab. Highschool is PPE before sports and q2yrs |
| Labs | No routine lab is recommended unless indicated by medical condition |
| Coxsackie B virus associated with | 50% of myocarditis |
| HCM | hypertrophic cardiomyopathy |
| Causes of Sudden death | HCM (36%), Congenital coronary artery abnl (19%), Marfan's syndrome (5%), Myocarditis (3%), >35 yo athlete (CAD). Non-cardiac causes: hyperthermia, asthma, anaphylaxis, trauma |
| First indication of hypertrophic cardiomyopathy | sudden death. May present: SOB, chest pain, palpitations, syncope. EKG nl in 15%. CXR may show LVH |
| must wear protective eye wear if | vision <20/40 or loss of one eye |
| EIA | exercise induced asthma. sx should be referred to PCP |
| Femoral pulse abnormality may suggest | coarctation of the aorta |
| Heart auscultation required in | 2 positions. Standing and supine, valsalva and/or squat (deep breath and bear down) |
| Murmur of HCM ____ with valsalva | increased. Decreases with squatting, and increases when patient stands |
| Cardiology Evaluation of | all murmurs >3/6, diastolic murmurs, murmurs that increase with valsalva, evaluate with clearance |
| Murmur of HCM includes: hypertrophy and stiffness of left ventricle, murmur increases wtih valsalva, decreases with squatting and increases with standing, plus | systolic crescendo-decrescendo murmur, heard best between apex and LSB, well after 1st sound, radiates to axilla but not neck |
| Marfan's Syndrome | Affects MS, CV and ocular systems. Mortality: rupture of thoracic aortic aneurysm. arm span>height |
| Stingers | stretch or compression injury of brachial plexus (C5-T1). 1st episode: okay to play if there are no neuro sx. Recurrent sx: need MRI to r/o spinal stenosis. |
| Post concussion syndrome | H/A, dizziness, N/V, memory, attention deficit, may not play until resolved (up to 6 months) |
| Second impact syndrome | seen in players not fully recovered from initial concussion. Second minor head injury results in significant brain edema. |
| Grade 1 | no LOC, just confusion <15 min |
| Grade 2 | no LOC, confusion >15 min. |
| Grade 3 | any LOC |
| Male Genitalia | Look for absence, masses of testes, hernia, teach TSE, Mandate cup support in contact pts for pts with solitrary testes |
| Tanner staging | no longer recommended |
| Female Genitalia | exam only if indicated by history |
| Specific Cardiac exam including | BP, Radial & Femoral Pulses, Auscultation: standing, supine, Valsalva. Refer frade 3/6 murmurs, positive cardiac hx. Conditional disqualification pending cardiac assessment |
| Two minute ortho exam includes: inspection for symmetry, neck ROM, resisted shoulder strug (C4), Resisted Shoulder abduction (C5), Int/Ext shoulder rotation, Elbow flexion/extension, elbrow pro/supination, clench and spread fingers, plus | back extension, forward flexion, contract quads, duck walk (squat and walk down hall), heel and toe standing |
Created by:
ltm12