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Sports Physical

8/28/2020

1 Comment

 
Sports physicals? In Urgent care? When I first began practicing, I didn’t think I would be doing a physical exam in urgent care. That’s what Family Med is for, right? Boy was I wrong! Sports physicals are actually very common in urgent care—some urgent care clinics have set up a partnership with local high schools. Also—cue those procrastinators who come in 5 min before closing because the form is due tomorrow!
 
Below you’ll find some few tips and tricks from Urgent Care Boot Camp by HippoEd. I’ve learned a ton about what I can improve on my own sports physicals to ensure the safety of my student athletes. *FYI—I’ve stayed away from mentioning Hypertrophic cardiomyopathy as this is often drilled into us & always the main topic of sports physical—rightfully so but thought I'd highlight other components!

As always, check out Urgent Care Boot Camp by HippoEd--they've been amazing partners in this blog series of tips/tricks and giving you insight into the course: here

Forms
Now, everyone knows student athletes bring in their own forms and requirements, however check out the "gold standard" pre-performance history and physical form by American Academy of Pediatrics (AAP). You cannot go wrong with these forms-links below:
  • History form by AAP
  • Physical form by AAP
 
Key medical history components: 
  • Pre-existing medical problems
  • Previous injuries
    • Musculoskeletal—the biggest predictor of a musculoskeletal injury is a previous injury
    • Concussion
    • Head and neck injuries
  • Medications and supplements—a great way to ask is “Do you take anything to affect your health or performance?”
  • Cardiac history—any chest pain, shortness of breath, palpitations, syncope/presyncope during or after exercise?
  • Weight perceptions & menstrual history—key information on eating disorders/ female triad
 
 
Common abnormalities:Vision & Blood Pressure
 
Vision
  • What is considered abnormal? When to restrict?
  • Less than half correct at 20/40 line in either eye OR
  • Two line difference between eyes even within the passing range (e.g. 20/20 and 20/30)
  • Consider restricting athletes with abnormal vision until further evaluation by Optometrist/Ophthalmologist
  • Functionally one-eyed—best corrected visual acuity in one eye is greater than 20/40
    • These athletes must wear mandatory protective eyewear & cannot participate in sports where goggles cannot be used (e.g. wrestling, boxing) & should not be cleared to play
Blood Pressure: 
  • Ensure correct cuff, repeat reading (manual if needed)
  • Mild Moderate HTN (Stage 1)—refer to PCP. No restriction—unless other concerning physical exam findings
  • Severe HTN (stage 2)—95th% + 12mm Hg OR ≥ 140/90. Restrict from high static sports until controlled
  • Check MDCalc for quick pediatric HTN guidelines & plug in numbers to determine which stage: here
 
 
Physical exam pearls
 
CV exam
  • Palpate upper and lower extremity pulses (check for coarctation of Aorta)
  • Auscultate—Must do in two positions! Seated and supine
  • Listen for rate, rhythm, murmur—restrict until cleared by Cardiology if abnormality or concern
 
 
Should I restrict these athletes?
  • Concussion: Ensure has followed return to play guidelines
  • Seizure disorder: if poorly controlled—no archery, water sports, gymnastics
  • Sickle cell trait: no limitation
  • Sickle cell disease: high exertion sports contraindicated
  • Solitary kidney: no limitation
  • Solitary ovary or testicle: no limitation. Solitary testicle must use protective cup for contact sports


Did you learn something new? Check out next week's installment for a summary on common infections & antibiotics!
1 Comment
Brittan
3/4/2021 04:19:07 pm

Me encanta tu Blog !

Reply



Leave a Reply.

    Author

    Melody, PA-C, MPH writes a weekly blog on the Urgent Care Boot Camp CME by HippoEd. Stay tuned for next week's installment

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  • Home
  • MEDICINE
    • Dermatology Rotation
    • Advice from New Grads
    • Family Medicine Rotation
    • Global Health Rotation
    • Pediatrics Rotation
    • Stethoscopes & Yoga...and Public Health
    • Emergency Medicine Rotation
    • Medicine, Finances, Loans
    • Surgery Rotation
    • How I passed the PANCE
    • Anatomy Study Tips
    • From Student to Clinician
    • Rotations-The Logistics
  • Lifestyle
    • Completing 100 miles
    • Running 100 miles
    • Mindfullness Program
    • #healthyinmedicine
  • Medical Spanish
    • Lesson 1: Introductions
    • Lesson 2: Basic Anatomy
    • Lesson 3: Medical Specialties
    • Lesson 4: Skeletal System Anatomy
    • Lesson 5: Describing Pain
    • Lesson 6: Medications
    • Lesson 7: Medication-History, Routes, & SE
    • Lesson 8: Medication Classes
    • Lesson 9: COVID-19 symptoms
    • Lesson 10: Preventing COVID-19
    • Lesson 11: Cranial nerves
    • Lesson 12: Diagnostic Tests
    • Lesson 13: History of Present Illness (HPI)
    • Lesson 14: Dermatology
  • Urgent Care lessons
    • Introduction
    • Charting
    • Sports Physical
    • Skin Infections & Antibiotics
    • Eye Chief Complaints
    • Wound/Laceration repairs
    • Approach to Trauma & Head Injuries
    • Approach to Trauma: Neck & Spine injuries
    • Urinary Tract Infecto\\ions
    • Telemedicine Tips
    • Approach to Fractures
    • Medica Legal Lessons: Headaches
    • COVID19 Triage
    • Shooter's Abscess
    • Pediatric Burns
  • Contact
  • About