Download - Kin 188 General Medical Conditions
KIN 188 – Prevention and Care of Athletic Injuries
General Medical Conditions
Introduction Cardiovascular disorders Neurological conditions Respiratory tract conditions Gastrointestinal conditions Endocrine conditions Infectious diseases Dermatological conditions Special population conditions
Cardiovascular Conditions Blood and lymph disorders
Syncope
Shock
Blood pressure disorders
Sudden cardiac death
Non-cardiac causes of sudden death
Blood and Lymph Disorders Anemia
Iron-deficiency anemia Sickle cell anemia
Hemophilia
Reye’s syndrome
Lymphangitis
Anemia Defined as reduction in either red blood cell volume or
hemoglobin (Hgb) concentration
Iron-deficiency anemia Iron-deficiency characterized by deficient Hgb synthesis Most common in adolescent girls and women of childbearing age
from menstrual blood loss and increased iron demand during pregnancy
Treat with dietary iron supplements and vitamin C for iron absorption Sickle-cell anemia
Most common in African-Americans Results from abnormalities in Hgb structure that produce a
characteristic sickle-shaped red blood cell that cannot transport oxygen
Sickle cells clump together and often block vessels causing organ failure
No known treatment, hydration and modified exercise considerations (environment, duration, etc.)
Blood and Lymph Disorders Hemophilia
Bleeding disorder associated with deficiency of body’s blood-clotting system
Presents with large/deep bruises, prolonged bleeding from minor wounds
Reye’s syndrome Disruption of urea cycle in body resulting in ammonia in blood,
hypoglycemia, severe brain edema and critically high intercranial pressure
Almost always follows URI of viral nature (varicella and flu most common, but also can be from common cold)
Rare condition which may result in coma or death if not recognized and treated appropriately
Lymphangitis Inflammation of lymphatic channel secondary to infection distal to channel Most common presentation is swollen lymph nodes (groin – LE, axilla – UE)
Syncope Sudden, transient loss of consciousness (“fainting”) occurring
in healthy individuals
Most frequent cause is neural mediated syncope (NMS) from sudden drop in blood pressure reducing circulation to brain leading to loss of consciousness
Other causes may be related to heat illness, dehydration, emotional stress, cardiac arrhythmias and changes in blood volume or distribution
Initial management includes lying the individual down safely and assessing vital signs – recovery usually occurs within minutes, activate EMS if not and recurrent episodes should be evaluated by MD
Shock Occurs if heart unable to exert adequate
pressure to circulate enough oxygenated blood to organs
May be from damaged heart that fails to pump properly, low blood volume from blood loss or dehydration or because blood vessels dilate causing blood to pool in large vessels away from vital areas
Shock Most prevalent symptoms are
associated with vital signs Rapid, weak pulse Rapid, shallow respirations Decreased blood pressure
Skin turns cool/pale/clammy – lips and nail beds may become cyanotic
Represents a medical emergency and is potentially life-threatening
Blood Pressure Disorders Hypertension
Defined as sustained blood pressure greater than 140/90 mm Hg
Risk factors include age, diabetes, heredity, high blood lipids (atherosclerosis), obesity, race (African-American), gender (men), smoking
Treat with lifestyle and diet modifications and medications of other efforts unsuccessful
Hypotension Characterized by fall of 20 mm Hg or more from
individual’s normal baseline pressure Can be caused by shock, orthostasis (change in body
position), overtreatment of hypertension (meds) Of no concern in conditioned individual - CV efficiency
Sudden Cardiac Death Hypertrophic cardiomyopathy
Abnormal thickening of left ventricular wall prior to age 20 Leading cause of sudden death in young, active individuals Produces impaired ventricular filling, blood flow obstruction
and/or arrhythmias Mitral valve prolapse
Regurgitation of blood from left ventricle to left atrium during ventricular contraction
Results in murmur – often present with chest pain, dyspnea and palpitations during exertion
Myocarditis Infection causing inflammation of muscular walls of heart Sudden death occurs when inflammatory changes in heart
muscle lead to death of adjacent muscle cells causing life-threatening arrhythmias
Sudden Cardiac Death Acquired valvular heart disease
Defect/insufficiency in heart valve (stenosis or regurgitation)
If mild, participation OK – if severe, not recommended Coronary artery disease (atherosclerosis)
Most common cause of sudden death in individuals over 30 Impairs blood flow to heart muscle resulting in myocardial
infarction (heart attack) Marfan’s syndrome
Genetic condition characterized by arm span exceeding height, hypermobile joints, eye defects and aortic defects
Sudden death usually from aortic rupture (short life span) Arrhythmias
Several rare conditions resulting in arrhythmias and/or ventricular fibrillation can cause sudden death
Non-Cardiac Causes of Sudden Death
Commotio cordis Cardiac arrest from low-impact blunt force trauma to
the chest in the absence of structural cardiovascular disease
Substance abuse Certain drugs can cause cardiac changes that
predispose individual to sudden death (amphetamines, cocaine)
Erythropoietin is hormone that stimulates red blood cell production – ergogenic aid used to aid performance for endurance athletes – causes increased blood volume/viscosity causing decreased circulation and MI
Non-Cardiac Causes of Sudden Death
Head injuries Sudden death from catastrophic brain injuries
(epidural/subdural hematoma, second-impact syndrome)
Present with altered vitals, dilated pupil, posturing
Heat illness Secondary to heat stroke, especially if not recognized
and treated quickly
Sickle cell trait Secondary to clumping of sickle cells Increased risk during exertion in hot/humid
environments and at increased altitudes
Neurological Conditions Headaches
Migraine headaches Post-traumatic headaches Treatment
Seizure disorders/epilepsy Types of seizures Management
Meningitis
Encephalitis
Headaches Migraine headaches
Defined as idiopathic, episodic HA disorder with attacks lasting 4-72 hours
Recurrent, moderate to severe, acute onset Thought to be associated with vascular
responses Often preceded by aura (flash of light, odor,
taste, feeling dizzy, etc.) Usually unilateral, nausea/vomiting,
photophobia, phonophobia, desire to lay in dark/quiet area
Headaches Post-traumatic headaches
Most common neurological symptom following head trauma
Occurs within 2 weeks of trauma and can last up to 8 weeks
Greater risk if Loss of consciousness and/or amnesia present with head trauma
Return to play considerations (second impact syndrome, tumors)
Headache management Most treated with medications (OTC vs. Rx)
Seizure Disorders Definitions
Seizure Abnormal discharge of electrical activity from the
brain Seizure disorder
Recurrent episodes of sudden, excessive discharges of electrical activity in the brain whether from known or unknown causes
Epilepsy Describes recurrent, idiopathic episodes of sudden,
excessive discharges of electrical activity in the brain
Types of Seizures Partial
Localized onset and presentation, no loss of consciousness Sensory/motor deficits, emotional experiences,
visual/olfactory/auditory hallucinations, deja vu Complex partial
Large area affected, consciousness impaired Purposeful actions in “trance-like” state, no memory
Generalized Grand mal (convulsive) – tonic/clonic, often have aura, may
lose bodily function (50-90 seconds, up to 5 minutes) Petit mal (non-convulsive) – blank stare (3-15 seconds)
Special epileptic syndromes Febrile seizures in infants/children (102˚F) Reflex epilepsy (flickering lights, specific sounds, etc.)
Seizure Management Note time of onset and resolution
Protect individual from injury Remove eyeglasses, nearby objects, etc. and protect head Do not restrain person or stop seizure Do not place anything in mouth
Loss of control of bodily function may occur – spectators/observers
Ensure adequate airway and wait until individual fully awakens – activate EMS if seizure is continuous or if another occurs in rapid succession
Respiratory Tract Conditions Upper respiratory
tract infections Common cold Sinusitis Pharyngitis Laryngitis Tonsillitis Allergic rhinitis
General respiratory conditions Bronchitis Asthma Exercise-induced
bronchospasm Influenza Pneumonia
Upper Respiratory Tract Conditions
Common cold Primarily accounted for by rhinoviruses, usually
1-6/year Sx vary dramatically, treat symptoms with OTC
Sinusitis Inflammation of perinasal sinuses from infection,
allergens or environment Most common sx are sinus pain and pressure, nasal
discharge (often colored if bacterial origin) Treat per onset, nasal sprays use OK if limited
Pharyngitis (sore throat) Often associated with other infections Treat per onset, gargles, lozenges/sprays
Upper Respiratory Tract Conditions Laryngitis
Inflammation of vocal chords from infection, environmental exposure and/or vocal overuse
Hoarse voice or loss of voice Treatment per onset but involves vocal rest to avoid
irritation Tonsillitis
Infection of tonsils (lymph nodes) at back of throat, often can see pus and/or redness over tonsils
Treat with antibiotics if bacterial, treat symptoms if viral, tonsillectomy considered if chronic
Allergic rhinitis (hay fever) Inflammation of nasal mucosa from exposure to allergens
(pollen, mold, dust, pets, etc.) Managed with limited exposure to allergen and
antihistamine medications
General Respiratory Conditions Bronchitis
Inflammation of mucosal lining of bronchii May be viral or bacterial, typically have
coughing, wheezing and/or large amount of purulent mucous, treat per onset
Asthma Bronchospasm leading to inadequate airflow
during respiration (esp. expiration) Most common symptom is dyspnea
(difficulty breathing), wheezing and anxiety often occur
Typically treat with bronchodilator inhalers
General Respiratory Conditions Exercise-induced bronchospasm (asthma)
Diagnosis via forced expiratory volume measure with peak flow meter (10% decrease post-exercise normal, >10% identified as EIB)
Symptoms are tightness in chest, dyspnea, burning sensation with breathing, cough within 8-10 minutes of exercise, treat per asthma
Influenza Specific viral bronchitis typically occurring in epidemics,
immunizations available “Flu-like” symptoms typically start after 1-2 days and last
up to 5 days Pneumonia
Infection of lungs, treated per onset (viral vs. bacterial) Symptoms vary per onset, but typically include high fever,
pleurisy (chest pain), phlegm producing cough
Gastrointestinal Conditions Upper GI
disorders Gastroesophageal
reflux Dyspepsia Gastric ulcer Gastritis Gastroenteritis
Lower GI disorders Irritable bowel
syndrome Crohn’s disease Ulcerative colitis Constipation Diarrhea Hemorrhoids
Upper GI Conditions Upper GI conditions at level of stomach
or above Gastroesophageal reflux
Regurgitation of gastric juices (acids) into esophagus (“heartburn”)
Treat with antacids and diet modification Dyspepsia (indigestion)
Upper GI pain without known cause Often feels overfull after eating, may have
nausea and vomiting, can mimic heartburn Treat with antacids and diet/activity
modification
Upper GI Conditions Gastric (peptic) ulcer
Caused by excessive gastric juice production, consumption of excessive alcohol/spicy foods/orange juice/coffee, use of tobacco products
Common symptom is pain in stomach region within 1-3 hours of irritation
Gastritis Inflammation of stomach lining and erosion of gastric mucosa
from anxiety, NSAID overuse, excessive caffeine/alcohol May present with GI bleeding, vomiting (hematemesis)
Gastroenteritis Acute inflammation of mucosal membrane of stomach or small
intestine from viral/bacterial infection, food poisoning, anxiety, etc.
Presents with indigestion, nausea/vomiting, gas, diarrhea Usually self-limiting in 2-3 days, anti-motility meds, hydration
issue
Lower GI Conditions Irritable bowel syndrome
Altered bowel functions (constipation, diarrhea or alternations of each) combined with abdominal pain with no known cause
Most common treatment is diet modification Crohn’s disease (regional enteritis)
Chronic, patchy and segmented inflammation of intestine through all layers of intestinal wall resulting in thickening/toughening of wall and narrowing of intestinal pathway
Ulcerative colitis Chronic inflammation of only mucosal lining of large
intestine Often presents with bloody stools/diarrhea
Lower GI Conditions Constipation
Infrequent or incomplete bowel movements Can occur with insufficient dietary fiber, improper
bowel habits, medication side effects Diarrhea
Abnormally loose, watery stools – multiple possible origins
Treat with anti-diarrhea meds (limited use), hydration concerns
Hemorrhoids (piles) Dilations of veins around rectum/anus Present with pain, itching and small amounts of
rectal bleeding Treat symptoms, typically resolve in 2-3 weeks
Endocrine Conditions Thyroid disorders
Hyperthyroidism Hypothyroidism
Pancreatitis Acute vs. chronic
Diabetes mellitus Types of diabetes Complications of diabetes Nutrition and exercise recommendations
Thyroid Disorders Thyroid gland produces hormones that
regulate rate of body’s use of fats and carbs, regulate body temperature, influence heart rate, regulate production of protein and regulate amount of calcium in blood
Rate of hormone release from thyroid gland controlled by pituitary gland and hypothalamus
Hyperthyroidism Caused by overproduction of thyroxine
hormone – accelerated metabolism More common in women ages 30-50 Symptoms include goiter (enlarged
thyroid), tachycardia, loss of sleep, heat intolerance, ophthalmopathy (bulging eyes)
Treated with meds that affect thyroid function, partial removal of thyroid or use of radioactive iodine which shrinks the thyroid
Hypothyroidism Caused by insufficient or loss of function
of thyroid – lower metabolism Most common in women over 40 Symptoms include unexplained weight
gain, hypertension, goiter, heavier than normal menses, increased sensitivity to cold
Treat with hormone replacement therapy to normalize levels of hormones
Pancreatitis Pancreas produces digestive juices and enzymes as
well as insulin and glucagon for regulation of blood sugar
Acute pancreatitis Primarily caused (90%) by gall stones which blocks ducts
and also by alcohol abuse Typically self-limiting and treated symptomatically
Chronic pancreatitis Permanent damage (slow, progressive limiting) to
pancreatic function primarily from alcohol abuse (high mortality rate)
Ultimately ceases insulin production causing diabetes Treated with pain management, diet modification or
surgery
Diabetes Mellitus Types of diabetes
Type I Juvenile onset/insulin dependent, onset before age 30,
lean body type, insulin injections required to control blood glucose, common in Whites, minor family history link
Type II (most common Adult onset/non-insulin dependent, onset after age 30,
obese body type, insulin injections needed in 20-30% of patients, diet alone often able to control blood glucose, common in Blacks, Native Americans and Hispanics, typically have family history
Gestational diabetes Development of type I diabetes usually during later half
of pregnancy Typically resolves once baby is delivered
Diabetes Mellitus Complications of diabetes
Circulatory complications Associated with early development and rapid
progression of atherosclerosis >80% of diabetics die from CV disease (heart
attacks) Also associated with impaired kidney function and
retinal degeneration (loss of vision) Nerve complications
Nerve deterioration results in loss of sensation Most prominent in hands/feet Unable to feel injuries – may lead to amputation
Diabetes Mellitus Complications of diabetes
Insulin shock Hypoglycemia results from exercise and
unbalanced efforts of diet and insulin Aggressive/belligerent behavior,
pale/cool/clammy skin, decreased performance, treat with sugar (conscious vs. unconscious considerations)
Diabetic coma In absence of insulin, hyperglycemia develops Development of diabetic ketoacidosis from
inability to metabolize carbohydrates Fruity breath, dry/red/warm skin, confusion
progressing to coma, treat with insulin
Diabetes Mellitus Nutritional and exercise recommendations
Type I diabetes nutrition Must correlate insulin injections with meals and
consider results of exercise (lower blood sugar) Ingestion of high carbohydrate foods for pre-activity
meals, snacks during activity and after activity meals Type II diabetes nutrition
Must also be aware of carbohydrate ingestion to balance blood sugar and avoid hyper-/hypoglycemia
Exercise recommendations Exercise essential to managing diabetes and also helps
minimize risk of cardiovascular disease and peripheral vascular disease complications
Infectious Diseases Common childhood diseases
Bacterial Diptheria, tetanus, whooping cough, Hib
Viral Polio, chicken pox, measles, mumps, German measles
Atypical presentations due to immunizations
Infectious mononucleosis
Viral meningitis
Sexually transmitted diseases
Bacterial Childhood Diseases Diptheria
Life-threatening infection of upper respiratory region Presents with thick, patchy, gray/blue/white membrane over
mucous membranes of throat/palates/nose Tetanus (lockjaw)
Enters through open wounds, puncture most common, often treat with booster shots
Presents with involuntary muscle spasms, first in jaw/neck Whooping cough (pertussis)
Extremely contagious respiratory infection – must recognize and treat early with antibiotics for effective treatment
If allowed to progress, presents with violent coughing episodes followed by exhalations with high pitched whoop
Hib (haemophilus influenzae type b) One of leading causes of bacterial disease in kids <5 and also
leading cause of meningitis in that group Treat aggressively with antibiotics x 2+ weeks
Viral Childhood Diseases Polio (poliomyelitis)
Inflammation of gray matter of spinal cord Results in spinal and muscle paralysis
Chicken pox (varicella) Very contagious but mild disease in children, can be
severe in adults Characteristic rash starts on trunk/scalp and
progresses to extremities Mumps (parotitis)
Most common in children 5-9 years old Most common symptom is swollen salivary (parotid)
glands with associated lack of desire to swallow (eat/drink)
Viral Childhood Diseases Measles (rubeola)
Short incubation period (7-18 days), high fever (103-105˚F), Koplik’s spots in mouth (blue/gray specks with red halo), rash starts on head/neck and progresses to body, longer resolution (3-5 days)
German measles (rubella) Mild disease in children and adults, severe
risk if to unborn child during pregnancy Long incubation period (14-23 days, low-
grade fever, rash starting on face and spreads to body, quick resolution (2-3 days)
Infectious Mononucleosis Caused by Epstein-Barr virus Commonly called “kissing disease” due
to transmission through saliva Symptoms include headache, malaise,
fatigue, severe sort throat Splenic enlargement occurs to fight
virus – risk of rupture (especially in contact sports) – usually screen with ultrasound before clearing for return to play
Viral Meningitis
Inflammation of lining of central nervous system – rare, but severe disease
Can be exposed from water bottles, water coolers, drink dispensing machines that aren’t kept clean
Severe symptoms and can be fatal
Sexually Transmitted Diseases Affect >12 million Americans annually
Greatest risk in 15-19 year olds Chlamydia is most common bacterial STD in US,
preventable with safe sex practices, treated with antibiotics
Gonorrhea is second most common STD In men, have yellow/green discharge and pain with
urination – in women, often no symptoms until progresses to PID
Herpes simplex II typically results in genital ulcers, once exposed = always present but usually dormant
Genital warts from human papilloma virus present with cauliflower like appearance on genetalia
Dermatological Conditions Bacterial conditions
Abcess, acne, paronychia, folliculitis, furuncles/carbuncles, cellulitis, impetigo
Fungal conditions (tinea) Pedis, cruris, corporis, capitis, versicolor, candidiasis
Viral conditions Herpes, warts
Other conditions Eczema, psoriasis, hyperhidrosis, contact dermatitis,
urticaria, bites and stings
Bacterial Dermatological Conditions Abcess
Circumscribed collection of pus in a localized infection, may be a cavity formed by liquefaction necrosis of solid tissue
Acne Blockage of sebaceous glands resulting in bacterial infection Presents as blackheads or whiteheads, most common to
face/neck/back regions Paronychia
Occurs at lateral borders of nails (“ingrown nails”) usually secondary to hangnail or trimming too close
Area becomes red/swollen/painful, typically treated with soaks and occasionally surgically removed
Folliculitis Inflammation of a hair follicle (“ingrown hair”) usually presenting
with pustule at site More common with short/coarse hair and subsequent to friction
from clothing, equipment and/or shaving
Bacterial Dermatological Conditions
Furuncles (boil)/carbuncles Furuncles is singular and carbuncles is cluster of
furuncles Complication of folliculitis that goes deeper than follicle
and develops into pustule of walled-off purlument material
Cellulitits Painful infection of dermis and subcutaneous tissues Often appears as tender, reddened and “tight” area of
skin over infected region Impetigo
Highly contagious via direct contact Presents with sores that rupture and form honey-colored
crust that then turns red Most common to face/neck region
Fungal Dermatological Conditions All tinea infections are “ringworm”
Preventable with personal hygiene and facility cleansing considerations
Tinea pedis (“athlete’s foot”) Most common, typically transferred in locker
rooms/showers, very itchy Tinea cruris (“jock itch”)
More common in men than women Tinea capitis
On scalp – starts small and enlarges – may see bald spots in areas of infection
Fungal Dermatological Conditions Tinea corporis
On body – presents with circular patches of scaly skin with raised borders – common on trunk and axillas in wrestlers
Tinea versicolor Most commonly identified after sun exposure –
infected area lighter in color Not contagious
Candidiasis Yeast fungal infection of skin or vagina from friction in
hot/moist/humid area All fungal infections treated with antifungal
medications and changing/avoidance of warm, most environments
Viral Dermatological Conditions Herpes
Gladiatorum Caused by herpes type I virus Presents with clusters of vesicles, itchy – treat
outbreaks with antiviral meds, limit participation when infection is active
Zoster (shingles) Presents as red rash with blisters, most common on
torso Can treat successfully with antivirals early
Warts (verrucae) Caused by human papilloma virus (HPV) Most common on hands (small, round, elevated) and
feet (plantar warts – dark dots) Burn, freeze or remove with scalpel
Other Dermatological Conditions Eczema
Inflammation of the skin characterized by redness, scaling and exudate, typically itches increasing risk of other infections
Psoriasis Characterized by rapid buildup of rough, dry, dead
skin cells forming thick scales Most common on elbows, knees, scalp and gluteal
cleft Hyperhidrosis
Excessive perspiration especially to palms and axillary regions
Can be especially problematic in activities that require holding objects (balls, racquets, oars, etc.)
Other Dermatological Conditions Contact dermatitis
Allergic – direct contact with substance (tape, soaps, etc.) causing local inflammatory reaction
Irritant – results when skin is damaged or ulcerated (friction burns from turf or equipment)
Urticaria (hives) Elevated, red, itchy wheal secondary to hypersensitivity to
foods, drugs, infections, heat, cold, chemicals Bites and stings
Typically relatively benign unless anaphylaxis occurs Symptoms include respiratory distress, rapid/weak pulse,
hypotension, numbness, seizures, unconsciousness, etc. – can be life-threatening
Treat with administration of epinephrine via Epi-Pen device which typically isn’t definitive care, but buys time for that to occur
Special Population Conditions Female athletes
Menstrual disorders Eating disorders Osteoporosis
Athletes with disabilities Wheelchair athletes Amputees Cerebral palsy Visual impairment
Senior athlete considerations
Female Athlete Conditions Menstrual disorders
Dysmenorrhea Menstrual cramps from overproduction of prostaglandins that
cause uterine muscle to contract, most problematic during first few days of menstrual cycle
Often treated with OTC meds to relieve pain and cramping Exercise-induced amenorrhea
Primary amenorrhea is absence of menstruation by age 16 Secondary amenorrhea is absence of menstruation for 3+
cycles after menarche Often associated with weight loss, low body fat and excessive
exercise, especially in women endurance athletes Reduced bone density and increased risk of stress fracture
Female Athlete Conditions Eating disorders
Bulemia nervosa Characterized by binge/purge behavior, typically have normal
body weight for age/height Use vomiting, laxatives, diuretics to purge
Anorexia nervosa Characterized by distorted body image, excessive exercise,
controlled eating habits and body weight 15% below normal for age/height
Osteoporosis Decreased bone mass/strength and associated increased risk
of bony injury Component of “Female Triad” with amenorrhea (inadequate
estrogen for bone health) and disordered eating habits (improper nutrition and mineral levels
Most common in activities with “appearance” characteristics associated with achievement (gymnastics, swimming/diving, figure skating, etc.)
Athletes With Disabilities Wheelchair athletes
Upper extremity strains/sprains, blisters and neurological injuries common due to propulsion efforts
Higher risk of heat illness due to decreased ability to sweat and regulate body temperature
Amputees Most common problem is irritation at junction of limb and
prosthetic device, especially in LE due to weight-bearing Cerebral palsy
Muscle strains are common due to increased load on muscle/tendon units due to constant spasticity and decreased joint range of motion
Visual impairment Increased risk from collision with obstacles and decreased
ability to respond to surface changes
Senior Athlete Considerations Growing concern with aging and more
active population Decreased bone mass, decreased tissue
elasticity, muscle fiber atrophy, cartilage degeneration all associated with aging Adhesive capsulitis in shoulder, Achilles
tendon rupture, plantar fascia tears, etc. are common
Physical activity generally delays onset of these changes