KIN 191B Advanced Assessment of Upper Extremity Injuries

1. KIN 191B – Advanced Assessment of Upper Extremity Injuries General Medical Conditions

2. Cardiopulmonary Conditions

3. Cardiopulmonary Conditions • Clinical anatomy • Evaluation of cardiopulmonary conditions • Pathologies

4. Anatomy • Pericardium – within mediastinum • Fibrous – dense outer layer • Serous – parietal layer lining fibrous layer and visceral layer attaching to heart • Heart chambers and great vessels • Valves – one way, prevent backflow • Tricuspid valve: R atrium and ventricle • Semilunar valve (pulmonary): R ventricle and pulmonary arteries • Mitral valve: L atrium and ventricle • Semilunar valve (aortic): L ventricle and aorta

5. Pericardium

6. Heart Valves

7. Evaluation • History • Location of pain • Current symptoms • Previous history/symptoms • Onset of symptoms • Etiology • Inspection/Palpation • Conscious vs. unconscious individual • Special tests

8. History

9. Location of Pain • Cardiac conditions generally present with pain, tightness and/or squeezing to chest • May experience referred pain to left shoulder/arm, jaw or epigastric area • Pulmonary conditions generally present with dyspnea and/or pain with respirations

10. Current Symptoms • Cardiac conditions • Dizziness, nausea, vomiting, dyspnea, lightheadedness, fatigue • Abnormal heart rhythms, syncope • Pulmonary conditions • Chest congestion, fatigue

11. Prior Symptoms • Prior cardiopulmonary condition symptoms must be evaluated and cleared by a physician prior to engaging in strenuous physical activity • Individuals often hesitate to communicate episodes for fear of the unknown and/or affect on participation

12. Onset of Symptoms/Etiology • Cariopulmonary conditions are typically either congenital or acquired over significant periods of time – manifest in acute onset of symptoms/distress • Some arrhythmias may be associated with trauma to anterior chest

13. Inspection and Palpation

14. Inspection/Palpation – Unconscious Individual • Primary survey • A: airway • Look, listen and feel • B: breathing • Rate (tachypnea vs. bradypnea) and quality (dyspnea) • C: circulation • Carotid pulse

15. Inspection/Palpation – Conscious Individual • Posture/positioning • May clutch chest, bend over to use secondary inspiratory muscles (SM, pecs) • Skin color • Pale or cyanotic when should be flushed • Airway • Verify patency • Breathing • Rate and quality of respirations assessed

16. Inspection/Palpation – Conscious Individual • Circulation • Rate and quality of pulse assessed • Sweating • Diaphoresis is common symptoms, must differentiate from athletic activity • Responsiveness • Decreased oxygen to tissues • Nausea/vomiting • Often accompanies heart attack

17. Special Tests • Activation of EMS • CPR or rescue breathing as necessary • Assessment of vital signs

18. Syncope Hypertrophic cardiomyopathy Myocardial infarction Arrythmias Bradycardia Tachycardia Mitral valve prolapse Hypertension Asthma Hyperventilation Pathologies

19. Cardiac Conditions

20. Syncope • Five underlying causes of fainting (transient loss of blood flow/oxygen to brain) • Vasovagal reactions • Venous dilation secondary to anxiety • Decreased blood volume • Dehydration (vomiting, diarrhea), bleeding • Metabolic conditions • Hypoglycemia, especially in diabetics • Cardiac disorders • Arrhythmias • Drug reactions • Stimulant use or abuse

21. Hypertrophic Cardiomyopathy • Most common cause of sudden death in young athletes • Enlargement of heart muscles without enlargement of heart chambers • Most significant risk factor is family history • May also present with significant heart murmur, Marfans syndrome characteristics and documented history of arrhythmia • Symptoms include fatigue, exertional syncope, dizziness, dyspnea, chest pain, arrhythmia while exercising • Difficult to evaluate and treat – must be referred for physician evaluation and clearance

22. Hypertrophic Cardiomyopathy

23. Myocardial Infarction • Caused by blockage of coronary arteries • Decreased oxygen and ultimate necrosis • Risk factors • Family history, hypertension, high cholesterol, smoking, obesity • Symptoms • Chest pain, referred pain, diaphoresis, cyanosis, nausea/vomiting, altered vital signs • Must recognize acute symptoms and refer immediately – increased risk of survival

24. Myocardial Infarction

25. Arrhythmias • Relatively common in athletic population • Most cases are benign, occasionally require medication for control • Potentially can be fatal • Must be thoroughly evaluated to screen for associated conditions and to determine safety of participation in physical activity

26. Bradycardia • Defined as heart rate less than 60 bpm • Often present in conditioned athletes and is indicative of cardiopulmonary fitness and efficiency • If unable to relate to conditioning, must be evaluated by physician to rule out cardiopulmonary conditions

27. Tachycardia • Increase in heart rate (no defined parameter) • Associated with anxiety and/or participation in physical activity • If heart rate abnormally high at inappropriate times, must refer for evaluation by physician • Heart becomes inefficient at sustained high pulse rates and can lead to fibrillation and death

28. Mitral Valve Prolapse • Present in approximately 5% of population • Pressure from backflow of blood causes valve to collapse and blood can take reverse path through valve • Most individuals able to participate in vigorous physical activity with MVP, but some are limited to low-intensity activities

29. Mitral Valve Prolapse

30. Hypertension • Most common cardiac abnormality affecting athletes, especially African-Americans • Clinically defined as greater than 140/90 • Control with diet, exercise, medications • If left untreated, can lead to MI, stroke, kidney failure, vision disturbances

31. Pulmonary Conditions

32. Asthma • Bronchoconstriction from bronchospasm and/or increased mucosal secretions • Extrinsic – caused by allergens • Attacks secondary to exposure to allergen/s • Intrinsic – commonly presents as EIA • Attacks secondary to exercise in cold, dry climate (triggers bronchospasm)

33. Asthma

34. Asthma • Characterized by dry wheezing with respirations, most difficulty with expiration • Most cases controlled via bronchodilator inhaler medications • Assessment and monitoring of condition via peak flow meter – measures maximal velocity of air forced from lungs after deep inhalation

35. Hyperventilation • Caused by oxygen-carbon dioxide imbalance caused by asthma, anxiety, etc. • Symptoms include dizziness, tracheal spasm, increased heart rate, syncope • Manage with breathing into paper bag or only through one nostril • Symptoms quickly resolve with appropriate management of condition

36. General Medical Conditions

37. Respiratory infections Viral syndromes Sexually transmitted diseases (STDs) Bloodborne pathogens Endocrine system disorders Systemic disorders Cancer Neurologic disorders Disordered eating Skin conditions General Medical Conditions

38. Respiratory Infections • Upper respiratory infections (URIs) • Influenza • Sinusitis • Laryngitis • Pharyngitis • Allergic rhinitis • Lower respiratory infections (LRIs) • Bronchitis • Pneumonia

39. Upper Respiratory Infections • Describe viral or bacterial infections of nasal pathways, pharynx or bronchi • Common cold – rhinovirus (adults) or corona virus (children) • Symptoms generally last 10-14 days and usually don’t impact participation • Less risk with moderate exercise, but risk increases with fatigue associated with intense physical activity

40. Influenza • Viral infection spread by water vapor and droplet transmission • Virus is constantly changing and produces annual outbreaks despite vaccination efforts • Typically only affects upper respiratory tract, but may also involve lower respiratory tract – usually has greater impact on participation than common cold

41. Sinusitis • Inflammation/infection of nasal sinuses • Interferes with normal airflow and fluid/mucous drainage • Bacterial infection often secondary to viral infection/illness • Changes in pressure (air travel) and environmental conditions can increase symptoms • Pain and/or swelling over sinuses defines

42. Sinusitis

43. Laryngitis • Inflammation of vocal cords – often secondary to URI • May also result from overuse (yelling, etc.) • Voice becomes hoarse, raspy, weak or may be unable to speak • Rest is definitive treatment

44. Pharyngitis • Commonly known as sore throat • In addition to pharynx pain, lymph node enlargement is classic symptom • Strep throat – pharyngitis from group A streptococcus bacteria • Tonsillitis – infection of large lymph nodes at back of throat

45. Allergic Rhinitis • Occurs secondary to exposure to allergens in the environment • Generally referred to as “hay fever” • Most prevalent in hot, dry environments • Typical symptoms limited to sneezing, nasal discharge (usually clear), coughing – some individuals react more severely

46. Lower Respiratory Infections • Less common than URIs • Generally more severe symptoms and increased morbidity • Affects bronchi of lungs, compromising exchange of gases and lung efficiency

47. Bronchitis • Acute – viral infection of lower respiratory tract which inflames bronchi • Often leads to secondary bacterial infection (from prolonged URI) • Chronic – COPD (chronic obstructive pulmonary disease) • Long term exposure to smoke, pollution • Generally presents with dyspnea, wheezing, coughing, swelling of LE if prolonged

48. Pneumonia • Inflammation of the lungs from bacteria, viruses and/or chemical irritants – may be primary infection or arise secondary to URI • Regardless of origin, condition is potentially lethal • Persistent coughing with pneumonia can lead to irritation of visceral pleura (pleurisy) • Chest radiograph amongst diagnostic tools

49. Pneumonia

50. Viral Syndromes • Mononucleosis • Measles • Rubeola • Rubella • Mumps