What is a PPE?
Screening tool to assess safety/risk associated with athlete's participation in sports activity
How often should a cardiovascular risk be assessed?
What are the 5 sports classifications?
- 1. Contact
- 2. Collison
- 3. Noncontact
- 4. Dynamic
- 5. Static
What does a "dynamic" classification mean?
- -Exerts a volume load on the heart & may incrase systolic and MAP
- -Percent of Max O2 uptake--> increase cardiac output
What are some examples of dynamic sports?
What does a "static" classification mean?
- -Places pressure load on heart
- -⇑ systolic, diastolic, & MAP
- -Enlargement of heart mass but not chamber
Which has a "decrease" in diastolic pressure? sStatic or dynamic?
Dynamic has DECREASE in systolic (while static has increase)
Which is considered "sustained cardiac output"? Dynamic or static?
Which is considered (bursts of effort)? dynamic or static?
What are some examples of HIGH cardiac output and LOW BP?
Soccer, tennis, running
What are some sports examples of LOW CO & HIGH BP?
Gymnastics, water skiing, weight lifting (bursts)
What are some examples of HIGH dynamic (CO) and HIGH static (BP)?
- Rowing, cycling, triathlon
- **sustained muscular/cardiac effort
What are some sports examples of LOW dynamic (CO) and LOW static (BP)?
bowling, billards, golf
What lab may be considered for runners?
KNOW: Should kids with pre-HTN or Stage 1 HTN be limited from activities?
NO--. find etiology but don't limit
What is considered HTN in kids?
BP > 95th percentile for age/gender/ht
What is considered Pre-HTN in kids?
What is considered stage 2 HTN in kids?
KNOW: Should kids with Stage 2 HTN be limited in sports activities?
Only limit until controlled and find etiology
What percentage of Sudden Cardiac Death (SCD) occur from hypertrophic cardiomyopathy?
33% or 1/3
How long must a kid with Carditis or myocarditis wait before returning to sports?
If history suggests of attributes for SCD, what tests should be performed? (4)
According the AHA 12 step screening, what 5 things should be evaluated in PMH?
- 1. Excertional chest pain
- 2. Unexplained syncope
- 3. Unexplained dypsnea
- 4. heart murmer
- 5. Elevated BP
According to the AHA 12 step screening, what FMH should be assessed?
- 1. premature death (<50) from cardio
- 2. Disability from cardio
- 3. hypertrophic cardiomegaly
- 4. ion channelopathies (long QT)
- 5. Clinically important arrhythmias
According to the 12 step screening, what are 4 parts to excess in a PE?
- 1. heart murmer
- 2. femoral to radial pulse to exclude aortic coarctation
- 3. physical stigmata of Marfan's
- 4. Brachial artery BP in sitting position
What murmers must be evaluated before screening approval according to the Bethesda Conference?
- 1. All diastolic
- 2. systolic murmer 3/6 or greater
- 3. Murmers that increase w/ valsalva or standing
- 4. Any questionable murmers
What 4 MSK problems should be evaluated to clear for activity?
- 1. Joint inflammation
- 2. Changes in strength
- 3. ROM
- 4. instability
T or F. Kids with epilepsy can participate in most sports.
True, if managed. Provide safety guidance
What are the 3 most common causes of TBI?
bicycling, football, and baseball
What are physical (4) and cognitive (3) signs of mild TBI?
- -Physical- N/V, H/A, dizziness, visual problems
- -Cognifitive- altered memory, altered concentration, confusion
What are some emotional symptoms of mild TBI?
-irritability, sadness, anxiety, sleep disturbances, personality changes
How does a "second impact syndrome" occur?
- -A second head injury occurs after a first TBI hasn't completely healed
- -can cause pancerebral edema
When can kids be clears after TBI?
When no symptoms or neuro deficits present, recheck q 2-3 days
What is the cause of a "burner or stinger"?
Compression or stretching of cervical nerve root or brachial plexus
What are some non-cardio causes of sudden death with activity? (5)
- -heat injuries
- -sickle cell trait
- -nutritional supplements
- -sports enhancing or illicit drugs
What should be ruled out with kids who present with "asthma" with exercising?
What are the "safe" caffeine levels in a 4yo, 12yo, adult?
- 4yo--> 45mg
- 12yo--> 85mg
- Adult--> 400mg
How does caffeine contribute to SCD and heat injuries?
- -Increased HR
- -Increased BP
- -Arterial walls stiffen temporarily
- -Binds w/ Beta receptors (mimick epi)
When should activity be limited in kids with Sickle Cell Trait?
- -If concerned about hematuria, splenic infarction, exertional rhabdo
- -high altitudes, intense exertion, hypoemia, heat, dehydration
Which sports should be avoided in kids with single kidneys?
Collison or contact sports, refer to specialist for clearance
T or F. Kids with single functioning testicle, gross hematuria, or hernia should be referred for evaluation.
What are 4 MSK exam alternatives that can help evaluate?
- 1. scoliosis (maybe)
- 2. Duck walk
- 3. pushups
- 4. jumping jacks