PED pre-participation evaluation

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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

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Labs

No routine lab is recommended unless indicated by medical condition

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Coxsackie B virus associated with

50% of myocarditis

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HCM

hypertrophic cardiomyopathy

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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

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First indication of hypertrophic cardiomyopathy

sudden death. May present: SOB, chest pain, palpitations, syncope. EKG nl in 15%. CXR may show LVH

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must wear protective eye wear if

vision <20/40 or loss of one eye

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EIA

exercise induced asthma. sx should be referred to PCP

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Femoral pulse abnormality may suggest

coarctation of the aorta

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Heart auscultation required in

2 positions. Standing and supine, valsalva and/or squat (deep breath and bear down)

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Murmur of HCM ____ with valsalva

increased. Decreases with squatting, and increases when patient stands

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Cardiology Evaluation of

all murmurs >3/6, diastolic murmurs, murmurs that increase with valsalva, evaluate with clearance

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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

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Marfan's Syndrome

Affects MS, CV and ocular systems. Mortality: rupture of thoracic aortic aneurysm. arm span>height

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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.

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Post concussion syndrome

H/A, dizziness, N/V, memory, attention deficit, may not play until resolved (up to 6 months)

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Second impact syndrome

seen in players not fully recovered from initial concussion. Second minor head injury results in significant brain edema.

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Grade 1

no LOC, just confusion <15 min

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Grade 2

no LOC, confusion >15 min.

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Grade 3

any LOC

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Male Genitalia

Look for absence, masses of testes, hernia, teach TSE, Mandate cup support in contact pts for pts with solitrary testes

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Tanner staging

no longer recommended

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Female Genitalia

exam only if indicated by history

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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

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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

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Created by: ltm12