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Preparticipation Physical Examinations

Preparticipation Physical Examinations. Mass Chaos or Good Health Care?. Why Do we do PPEs?. 1. 2. 3. 4. Timing, Setting, Structure. Qualifications of examiners Timing Frequency. Types of Structures. Office Based PPE . Station Based PPE. Stations. REQUIRED. OPTIONAL.

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Preparticipation Physical Examinations

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  1. Preparticipation Physical Examinations Mass Chaos or Good Health Care?

  2. Why Do we do PPEs? • 1. • 2. • 3. • 4.

  3. Timing, Setting, Structure • Qualifications of examiners • Timing • Frequency

  4. Types of Structures • Office Based PPE • Station Based PPE

  5. Stations • REQUIRED • OPTIONAL

  6. Stations for EXAM: • Height • Weight • Blood-pressure • Heart rate • Body Composition • Limb girth & Length • Snellen Chart

  7. The PPE Medical History • Will identify ~ 75%-92% of problems affecting patients • Forms? • Include: 1. 2. 3.

  8. Physical Examination • Cardiovascular: • Murmurs are worrisome if:

  9. PE: Cardio conditions • 1. Hypertrophic Cardiomyopathy (HCM) • 25% is detected by Hx & PE alone • FHx of sudden death (syncope, palpitations, murmur) • Need ECHO • 2. Marfan’s Syndrome • Rarely picked up with Hx or PE • Physical Characteristics – height, MVP • Need ECHO • 3. Congenital Coronary Artery Disease • 0% from Hx & PE • Exertional chest pain, Syncope • Need stress EKG & radionuclide testing

  10. Physical Examination • Musculoskeletal • The 2 min orthopedic screening exam • Focused exam on sport specific areas or previous injury area

  11. Important Areas to cover • Concussions: • Female Patient Concerns:

  12. Clearance • Considerations: (Options for clearance) • Does the problem increase the risk of injury? • Is another participant at increased risk for injury? • What other sports may be safe for patient? • Specific Conditions: • Atlantoaxial instability • Cardiovascular • HIV • Functionally one-eyed patients • Obesity • Sickle cell trait • Missing a paired organ • Seizure disorder

  13. American Disabilities Act • How does this affect us? • Need to include family in decision making process from the start

  14. Is the PPE worth our time? • To identify 1000 patients at risk, only 1 of whom would die, you would need to screen 200,000! • Misconceptions of PPE • Need to acknowledge limitations associated with PPEs in order to inform the general public about misconceptions • There is inherent risk in playing ALL sports

  15. Summary • Station Based vs Office Based • Physical Examination • Clearance issues/ADA • PRACTICE the skills for Exam!!!

  16. Office-based PPE order • 1. General conversation – let them talk • Mood/mentality • HX • C/C • Pointed questions – FHx, syncope, seizures, concussions, palpitations • 2. PE: • Vitals – resp patterns, pulse, temp, BP, weight • Skin – perspiration, moles (borders, size, bleeding, check back) • Movement – gait, coordination • System Review • Head – CN, Facial drop (Bells Palsy), ears, eyes, mouth/teeth, lymph nodes • Lungs – posterior • Heart – murmurs • Abdomen – palpation, percussion • Hernia check – pain , pressure, bulge • Extremities – nails, arches etc

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