DIABETES

1
DIABETES

• Diabetes Mellitus
• Insulin-Dependent
• Non-insulin Dependent

2
Etiology

• Interaction of physical/environmental factors
• Complete or partial decrease in secretion of
  insulin by pancreas
• No distinct etiology

3
Sign SymptomsInsulin Dependent

• Commonly seen in childhood
• Frequent urination
• Constant thirst
• Weight loss
• Constant Hunger
• Tiredness/Weakness
• Itchy/Dry skin
• Blurred vision

4
Signs SymptomsNon-insulin dependent

• Occurs later in life
• Usually associated with overweight

5
Treatment

• Balanced Diet
• Insulin
• Exercise

6
Diabetic Athlete

• Eat before exercise
• Hourly Glucose Supplementation
• Insulin remains same
• Food intake increases
• Monitor
• Develop a treatment plan

7
Diabetic Coma

• Improper diet
• Improper intake of insulin
• Leads to development of acidosis

8
What happens?

• Loss of sodium, potassium, ketone bodies thru
  excessive urination
• Leads to ketoacidosis
• Leads to coma

9
Signs Symptoms

• Labored breathing/gasping for air
• Fruity-smelling breath(due to acetone)
• Nausea/vomiting
• Thirst
• Dry mucous membrane of mouth

10
Treatment

• Life-Threatening
• Medical Emergency 911
• Early detection is the key
• Insulin injection may prevent coma

11
Insulin Shock

• Too much insulin is taken into the body
• Results in hypoglycemia

12
Signs and Symptoms

• Tingling in mouth, hands
• Physical weakness
• Headaches
• Abdominal pain
• Normal or shallow respirations
• Rapid heart beat
• Tremors with irritability and drowsiness

13
Prevention

• Adhere to planed diet with snack before exercise
• Snack every 30/40 minutes

14
Treatment

• Discuss with physician
• Snack
• Prevention is key
• Can lead to an emergency
• Glucose gel

15
SEIZURES

• Epilepsy-recurrent seizures
• Disorder of cerebral function
• Brief attacks of altered consciousness/ motor
  activity/ inappropriate behavior

16
Etiology

• Altered brain metabolism
• History of injury

17
Types

• Petit mal
• Grand mal

18
Signs Symptoms

• Examine each case individually to determine
  whether to allow participation in sports
• Daily/weekly seizures should disqualify an
  individual from collision sports

19
Treatment

• Anticonvulsant medication
• Management during seizure

20
Management

• Stay calm
• If possible cushion fall
• Keep athlete away from injury-producing objects
• Loosen restrictive clothing
• Soft cloth between teeth
• Allow athlete to awaken normally
• Do not restrain athlete
• Physician

21
ASTHMA

• Chronic inflammatory lung disorder
• Obstruction of airways

22
Asthma triggers

• Exercise
• Viral infections
• Animal exposure
• Mold
• Air pollutants
• Weather
• NSAIDS

23
Signs Symptoms

• Coughing/ wheezing
• Shortness of breath
• Rapid breathing
• Inability to speak
• Bending over
• Chest tightness
• Lips/nailbeds turn blue(lack of oxygen)

24
Goals

• Prevent chronic symptoms
• Maintain normal lung function
• Maintain normal activity levels
• Prevent asthma attacks
• Provide meds with minimal side effects

25
Exercise-induced bronchospasm

• May occur minutes after exercise
• Peak 5-10 minutes after exercise
• Resolves in 20-30 minutes

26
Monitoring Asthma

• Monitor Signs Symptoms
• Pulmonary Function
• Quality life
• Status
• History of asthma attacks
• Pharmacotherapy

27
Treatment for Asthma Attack

• Plan of action
• Medication
• Be prepared to call 911

28
Call 911

• Symptoms worse than normal
• Asthma does not respond quickly to normal
  treatment
• Severe chest pain

29
Inhaler Use

• Shake inhaler
• Breathe out fully
• Breathe in deep and slow through mouth and
  depress canister
• Hold breath as long as possible
• Breath out
• Wait 1 minute between each use
• Follow dosage as instructed by physician

30
SHOCK

• Diminished amount of blood available to
  circulatory system
• Therefore, decreased O2 to organs
• Leads to tissue death
• In extreme cases, can result in death

31
Predisposing Conditions

• Extreme fatigue
• Extreme exposure to heat or cold
• Extreme dehydration
• Severe injury

32
Types of Shock

• Hypovolemic
• Respiratory
• Neurogenic
• Psychogenic
• Cardiogenic
• Septic
• Anaphylactic
• Metabolic

33
Anaphylactic Shock

• Result of severe allergic reaction
• Know athletes allergies and treatment plan
• Epi-pen injection (per physicians order)
• Medical emergency

34
Signs of Shock

• Moist, pale, cool, clammy skin
• Ashen, then cyanotic
• Weak and rapid pulse
• Shallow and increased respiratory rate
• Dilated pupils
• Decreased BP
• Systolic below 90mmHg

35
Management of Shock

• Maintain body temperature(keep warm)
• Elevate LE 8-12 inches unless suspected spinal
  injury
• May be compounded by psychological aspect (dont
  allow athlete to view inj.)
• Reassure athlete be confident
• Loosen clothing, refer to physician

36
INTERNAL HEMORRHAGE

• May be due to internal injuries
• Palpate for abdominal rigidity, guarding, rebound
  tenderness
• May be due to intracranial bleeding
• HA, vomit, unequal pupils, increased BP,
  decreased pulse, change in LOC
• Will result in shock
• All are emergencies!!

37
HYPERTENSION

• Excessive pressure applied against arterial wall
  while blood circulates
• May exclude sport participation
• Normal 120/80mmHg
• Upper limit 140/90mmHg
• Diagnosed after several high readings at
  different times

38
Primary Hypertension

• 90 of all cases
• No disease associated
• May not present with any other sxs
• Possible Sxs dizzy, HA fatigue, epistaxis,
  flushed skin, nervousness
• Rx weight loss, aerobic exercise, salt
  restriction

39
Secondary Hypertension

• Related to an underlying cause
• Tumor, BCP, medication, pregnancy
• May experience same sxs as in primary
  hypertension
• Rx when underlying condition improves, BP
  returns to N

40
SUDDEN CARDIAC DEATH

• Athlete dies suddenly, non-traumatic,
  non-violent, usually without any precipitating
  sxs
• More common in males
• Most commonly congenital
• Hx and PPE best screening
• Diagnostic testing less effective

41
3 Most Common Congential Causes

• Hypertrophic Cardiomyopathy (HCM)
• Anomalous origin of coronary artery
• Originates from a site different than N which
  compromises artery because of unusual course
• Marfans syndrome

42
Signs Symptoms

• Chest pain or discomfort (angina)
• Heart palpitations or flutters
• Syncope
• Nausea
• Profuse sweating
• Heart murmurs
• SOB
• Fever

43
Additional Causes

• Commotio Cordis
• Coronary Artery Disease
• Right ventricular dysplasia
• NonCardiac Sudden Death
• Drug use, head trauma, airway obstruction

44
Prevention History and PPE

• Chest pain during exercise?
• Diagnosed with a heart murmur?
• Syncope/dizziness during exercise?
• Accurate family history (parental involvement if
  lt 18 yo?)
• Sudden death under 35 yo?
• Diagnosed with thickened heart?
• Diagnosed with Marfans syndrome?

45
Terry et al

• Chain of Survival
• Activate EMS
• Early CPR (QUALITY!!)
• Early defibrillation (2-4 response time)
• Early ALS (within 8)
• Advanced life support measures

46
Koester

• N physiological response to exercise
• HCM
• Abnormal L ventricular thickening
• Family history
• Commotio Cordis
• ECG ? significant false-positive rate
• Italys program? Pros/cons?
• Minimum screening standards from AHA

47
Koester, HCM
48
Braverman

• Definition of Marfans Syndrome
• Initial Dx hx, physical exam, ECG, slit lamp eye
  exam
• CV system ABNleading cause of death
• Participation in competitive and
  collision/contact sports???
• As ATC, what to look for on exam?

49
Braverman ATC Assessment Sxs

• scoliosis, kyphosis
• pectus excatavum/carinatum
• Arm spanheight
• Upper segmentlower segment
• Facial features
• Joint laxity
• Pes planus
• thumb sign
• wrist sign
• Excessive height with incongruently low wt.