GENERAL MEDICAL CONDITIONS

1. GENERAL MEDICAL CONDITIONS Tracy R. Ray, MD SEATA Competencies in Athletic Training Workshop Feb. 15, 2003 Atlanta, GA

2. RESPIRATORYCONDITIONS • Colds • Flu • Pneumonia • Exercise-Induced Asthma

3. Upper Respiratory Infections • “common cold” or URIs is most common infection in athletes; caused by adeno- or rhinoviruses. • S/S include fever, chills, cough, myalgias, nasal congestion, sore throat and fatigue. • Rx is rest, fluids and OTC meds. • May return when no fever or body aches. May need reconditioning.

4. Influenza • “Flu” caused by many strains of influenza virus. • Abrupt and more severe “cold” symptoms for one week with malaise lingering. • Rest, hydration and antipyretics are mainstay of Rx. Newer “anti-flu” meds may reduce length of illness if started early. • Similar RTP criteria as “colds”. • Prevention: flu shots

5. Pneumonia • Viral, bacterial, and mycoplasma (walking) pneumonia are all possible etiologies. • S/S include abrupt, high fevers and chills, productive cough, SOB and abnormal crackles on auscultation of chest. • Diagnosed clinically with confirmation by infiltrates on CXR and elevated WBC. • RTP after resolution of fever, cough and SOB.

6. Exercise-Induced Asthma • Hypersensitivity and bronchoconstriction in large and small airways following 5-8 minutes of exercise. • Pathophysiology is multifactorial. Multiple triggers play a role. • S/S include cough, SOB, poor performance, wheezing, tightness and increased sputum. • Dx is often made on historical information that leads to over- and underdiagnosis. • Non-med techniques and meds can be helpful.

7. EIA Controversy • Many NGBs require written request by MD to allow use of bronchodialators • Over-diagnosis and overuse of bronchodialators has lead to more extensive documentation regarding diagnosis. • Current tests include Exercise Challenge test and Eucapnic Voluntary Hyperventilation (EVH) Challenge test.

8. EAR, NOSE AND THROAT (ENT) CONDITIONS • Swimmer’s ear • Otitis media • Cauliflower ear • Nasal fractures • Nose bleeds • Loose teeth

9. Otitis Externa (swimmer’s ear) • Inflammation of external canal secondary to excessive cleaning and exposure to water. • Painful movement of auricle, drainage, edema and erythema of canal. • Rx requires antibiotic drops. • Return-to-pool after 2-3 days of treatment. • Prevention with drying agent(s) after swimming.

10. Otitis Media (middle ear) • Bacterial infection often following viral URI. • S/S include fever, pain in ear, sensation of fullness, and diminished hearing. • Rx consists of oral abx and abx ear drops if TM is ruptured. • RTP allowed when afebrile. Ear plugs if TM ruptured. Air travel not recommended.

11. Auricular Hematoma (Cauliflower Ear) • Common in boxing, wrestling, rugby, and judo. • Secondary to trauma tearing perichondrium from cartilage. • S/S are edema and tenderness to palpation. • Aspiration within 24 hrs. or I & D by specialist if seen later. • RTP after Rx if wearing adequate headgear.

12. Nasal Fracture • Most common facial fracture. • S/S include deformity, epistaxis, tenderness, crepitation, and periorbital ecchymosis. • Rx includes ice, elevation, analgesia and stoppage of nosebleed. Serial inspection of septum for septal hematoma. • Reduction should be done in 12 days. • RTP as tolerated and with protective equipment.

13. Epistaxis (Nosebleeds) • Due to trauma with 90% anterior epistaxis. • Controlled with pressure with athlete sitting upright and head slightly forward. • Identify sight of bleeding when not easily controlled by pressure alone. • Secondary Rx may include pledget soaked in vasoconstrictor. • Transport to ER if Rx and identification of sight of bleeding are unsuccessful.

14. Dental Avulsions Partial Avulsion: • If depressed, loose, or if numbness or pain is felt upon pressure, reposition tooth in socket and stabilize with mouth guard. • Should be evaluated by dentist ASAP, but may RTP if asymptomatic. Tooth Fracture: • Fractures exposing pulp (sensitive to air) should see dentist within 2-3 hrs.

15. Dental Avulsions (cont.) Complete Avulsion: • Rinse tooth with milk, saline, or saliva. • Handle by crown, and do not brush. • Reimplant or transport in milk or in athlete’s mouth for immediate eval/Rx. • If reimplanted within 30 min., 90% success. If reimplanted >2 hrs., 95% failure.

16. Laryngeal Trauma • Caused by direct blow in “stick” sports. • S/S include throat pain, pain upon swallowing, swelling, crepitus, and respiratory distress. • Always evaluate for airway obstruction with serial exams. • Loss of cartilaginous landmarks is ominous. • May RTP if asymptomatic and monitored for airway compromise.

17. Ear/Nose/Tongue Piercing • If visible, jewelry must be removed for participation to avoid lacerations. • Infections, allergic dermatitis, keloids, and lacerations are common. Tooth trauma from tongue jewelry has been reported. • Educational material in training rooms may reduce complications.

18. Gastrointestinal (GI) Conditions • Acute Gastroenteritis (AGE) • Exercise-induced GI Bleeding • Mononucleosis

19. Acute Gastroenteritis • Caused by viruses, bacteria or protozoans. • S/S include vomiting, cramping, diarrhea and fever. • Dx by history and exam, but stool samples may assist in diagnosis. • Symptomatic Rx with fluid replacement, antiemetics, and antimotility meds. Rarely, Abx are used. • RTP once afebrile, well hydrated and diarrhea controlled.

20. Exercise Induced GI Bleeding • GI bleeding is common with strenuous training and after competitive events. • Cause is multifactorial. Theories include ischemia, trauma, and overuse of NSAIDs. • Mostly self-limited, but athletes should be worked up appropriately. • Rx includes a brief decrease in activity, medications, and/or change in diet.

21. Mononucleosis • Caused by Epstein-Barr virus, affecting ages 15-24 primarily. • S/S include fatigue, HA, anorexia, malaise, myalgias, lymphadenopathy, and fever. • Rx is supportive, but may include steroids. • RTP at 3 weeks for non-contact sports and 4 weeks for contact sports or strenuous training, provided that the patient is afebrile, labs are as “expected”, and the spleen is not enlarged.

22. Genitourinary (GU) Conditions • Kidney Trauma • Traumatic Urethritis • Exercise Induced Hematuria • Testicular Torsion

23. Kidney Trauma • Minor renal trauma includes contusion, subcapsular hematoma, and superficial lacerations. Major trauma includes deeper lacerations, large hematomas, and fractures. • Evaluation should include hx, PE, UA, and necessary imaging. • Minor trauma treated with rest, hydration, and analgesia. • Major injury may require immed. resuscitation. • RTP determined by severity of injury.

24. Traumatic Urethritis • Blood from urethra most commonly caused from straddle injuries or cycling. • S/S include pain, inability to void, and blood with voiding. May be associated with neuropathy (numbness/tingling) and ED. • Dx made by hx and urinalysis. • Rx includes proper saddle positioning, increased padding in seat or shorts, and decreased training time.

25. Exercise Induced Hematuria • Blood in urine common in multiple sports. • Hematuria increases with intensity and duration of activity (i.e. endurance sports). • Consider serious until other causes are R/O. • Hx, PE, and UA diagnose most causes. Repeat UA may be required after 2 days rest. • If exercise induced, short period of rest is only necessary treatment.

26. Testicular Torsion • Torsion of the spermatic cord may be assoc. with trauma, but often spontaneous. • S/S include pain and swelling in a single testicle, especially after minor trauma. • PE (even with special maneuvers) may require testicular scan as adjunct for dx. • Expedient referral is essential!

27. Thank You