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Cohn RM, Neufeld EV, Goodwillie AD, Sgaglione NA. Management of Sideline Medical Emergencies. J Am Acad Orthop Surg 2024; 32:e839-e849. [PMID: 39150745 DOI: 10.5435/jaaos-d-24-00173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/27/2024] [Indexed: 08/17/2024] Open
Abstract
Sideline medical care is typically provided by musculoskeletal specialists and orthopaedic surgeons with varying levels of training and experience. While the most common sports injuries are often benign, the potential for catastrophic injury is omnipresent. Prompt recognition of sideline emergencies and expeditious medical management are necessary to minimize the risk of calamitous events. Paramount to successful sideline coverage are both preseason and game-day preparations. Because the skillset needed for the sideline physician may involve management of injuries not commonly seen in everyday clinical practice, sideline providers should review basic life support protocols, spine boarding, and equipment removal related to their sport(s) before the season begins. Before every game, the medical bag should be adequately stocked, location of the automatic external defibrillator/emergency medical services identified, and introductions to the trainers, coaches, and referees made. In addition to musculoskeletal injuries, the sideline orthopaedic surgeon must also be acquainted with the full spectrum of nonmusculoskeletal emergencies spanning the cardiopulmonary, central nervous, and integumentary systems. Familiarity with anaphylaxis as well as abdominal and neck trauma is also critical. Prompt identification of potential life-threatening conditions, carefully orchestrated treatment, and the athlete's subsequent disposition are essential for the team physician to provide quality care.
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Affiliation(s)
- Randy M Cohn
- From the Northwell, New Hyde Park, NY (Dr. Cohn, Dr. Neufeld, Dr. Goodwillie, and Dr. Sgaglione), the Department of Orthopaedic Surgery, Long Island Jewish Valley Stream, Valley Stream, NY (Dr. Cohn), the Department of Orthopaedic Surgery, Long Island Jewish Medical Center, New Hyde Park, NY (Dr. Neufeld, Dr. Goodwillie, and Dr. Sgaglione), and the Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, Hempstead, NY (Dr. Cohn, Dr. Neufeld, Dr. Goodwillie, and Dr. Sgaglione)
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Wenger K, Williamson A, McNally M, Dutta E. Knowledge of emergency dental management among a localized sample of athletic trainers. Dent Traumatol 2024; 40:418-424. [PMID: 38234017 DOI: 10.1111/edt.12920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/31/2023] [Accepted: 01/01/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND/AIMS Athletic trainers are often the point person when sports-related traumatic dental injuries (TDIs) occur. The aim of this study was to assess knowledge levels of the management of TDIs among athletic trainers in the Midwest United States, as well as evaluate variables that may influence knowledge levels. MATERIAL AND METHODS A survey was sent to athletic trainers licensed in Minnesota, Nebraska, and Iowa. The survey included 28 multiple-choice and fill in the blank questions split into three sections. The three sections included background, emergency management of TDIs, and opinion questions. RESULTS Of the participants, 100% recalled receiving medical first aid training. However, only 71% recalled receiving formal training on emergency management of dental injuries. Although 75% were confident in managing a dental injury, over 63% of participants scored less than 70% in the knowledge score section. Majority of the participants (98.4%) reported that they believe training on the management of TDIs is important. Athletic trainers working with contact sports were more likely to have experienced managing TDIs more recently than those working in noncontact sports. CONCLUSIONS This study shows the gaps in knowledge among athletic trainers pertaining to management of TDIs and emphasizes the importance of sports community having adequate education on emergency management of such dental injuries.
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Affiliation(s)
- K Wenger
- University of Nebraska Medical Center College of Dentistry, Lincoln, Nebraska, USA
| | - A Williamson
- University of Nebraska Medical Center College of Dentistry, Lincoln, Nebraska, USA
| | - M McNally
- University of Nebraska Medical Center College of Dentistry, Lincoln, Nebraska, USA
| | - E Dutta
- University of Nebraska Medical Center College of Dentistry, Lincoln, Nebraska, USA
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Leone JE, Gray KA. A Recalcitrant Skin Lesion and Subsequent Infection in a Recreational Intramural Male Athlete: A Case Report. J Athl Train 2024; 59:779-784. [PMID: 38014795 PMCID: PMC11277276 DOI: 10.4085/1062-6050-0467.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
A 35-year-old intramural male athlete presented to the athletic training staff with a 4.5- × 2.2-cm itchy, painful, swollen, and infected insidious skin lesion on his right lateral malleolus due to an underlying dermatologic deficiency. Suspecting infection, the patient was referred to his nurse practitioner and was diagnosed with atopic dermatitis caused by a ceramide deficiency. He was placed on cefalexin and mupirocin 2% ointment but returned due to the lesion increasing to 8.5 × 6 cm, although the infection seemed controlled. He was instructed to use Ceravé topical cream, clobetasol propionate 5%, and to consume foods rich in healthy oils (omega-3 fatty acids, olive oil). Unmitigated, this lesion could have resulted in severe infection and tissue damage. Atopic dermatitis is relatively common in the general population, but its appearance in healthy athletes highlights that athletic trainers need to be well versed in not just apparent causes of skin ailments (ie, infection) but also root causes.
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Affiliation(s)
- James E. Leone
- Department of Health and Kinesiology, Bridgewater State University, MA
| | - Kimberly A. Gray
- Exercise Science, Human Sciences, Southern Illinois University, Carbondale
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Rallis E, Tertipi N, Sfyri E, Kefala V. Prevalence of Skin Injuries in Beach Volleyball Athletes in Greece. J Clin Med 2024; 13:2115. [PMID: 38610879 PMCID: PMC11012412 DOI: 10.3390/jcm13072115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Skin injuries often affect the sports community. Almost every type of athletic activity is associated with traumatic skin injuries, such as surface wounds, bruising, abrasions, subcutaneous hematomas, blunt trauma, nail injuries, friction burns, and blisters. Methods: The aim of this study was to assess the rates, location sites, and seasons of appearance of skin injuries in beach volleyball athletes in Greece. Seven hundred and eighty-five beach volleyball athletes participated in this study. The average age was 28.4 years. Skin injuries included superficial wounds (erosions, incisions, lacerations), deep wounds, hematomas, nail lacerations, friction burns, and friction blisters. The recorded variables encompassed gender, age, the time of year when athletes might be at higher risk of injuries, and the specific body regions affected. Additionally, data regarding training details such as years of practice, weekly training frequency, and daily training duration were also documented. Results: Incidence rates correlated to gender: (a) superficial wounds (p < 0.001), (b) years of training: hematomas (p < 0.001), and (c) average hours of daily training: superficial wounds (p < 0.001), deep wounds (p < 0.001), and friction blisters (p < 0.001). Conclusions: Although early detection, recognition, and treatment are essential, the prevention of skin injuries can also be linked to health and athletic performance.
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Affiliation(s)
| | - Niki Tertipi
- Department of Biomedical Sciences, School of Health Sciences, University of West Attica, GR-12243 Athens, Greece; (E.R.); (E.S.); (V.K.)
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Cusack B, Cash M, Tuohy K, Brady-Olympia J, Olympia RP. Management of Acute Injury and Illness in Pediatric Athletes by Athletic Trainers: Compliance With Emergency Medicine and Athletic Trainer Evidence-Based Guidelines. Pediatr Emerg Care 2023; 39:945-952. [PMID: 38019713 DOI: 10.1097/pec.0000000000003073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
OBJECTIVE This study aimed to determine athletic trainer compliance with emergency medicine and athletic training evidence-based guidelines for the on-the-field management of common pediatric sports-related injury and illness. METHODS A questionnaire was distributed electronically to selected members of the National Athletic Trainer Association. The questionnaire included 10 clinical scenarios describing common sports-related injury/illness (closed head injury, cervical spine injury, blunt chest injury, blunt abdominal injury, ankle injury, knee injury with laceration, heat-related illness). On-the-field management decisions for each scenario were compared with selected emergency medicine and athletic training guidelines. RESULTS Analysis was performed on 564 completed questionnaires (9% response rate). Responders were compliant with practice guidelines for both emergency medicine and athletic training except for blunt chest trauma with tachycardia, closed head injury with loss of consciousness, closed head injury with repetitive speech, closed head injury with a fall higher than 5 feet, cervical spine injury with paresthesias, and heat-related illness with persistent symptoms. Discrepancies between emergency medicine and athletic training guidelines included closed head injury with repetitive speech, closed head injury and height of fall, closed head injury and unequal pupils, and cervical spine injury with neck pain and paresthesias. CONCLUSIONS Based on our sample, athletic trainers were compliant with many guidelines supported by both emergency medicine and athletic training. We identified several deficiencies in the availability of evidence-based guidelines and discrepancies between these guidelines and athletic trainer responses. To provide optimal care to pediatric athletes who sustain injury or illness, emergency medicine and athletic training organizations should collaborate to improve these discrepancies.
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Affiliation(s)
- Bryan Cusack
- From the Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, PA
| | - Morgan Cash
- From the Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, PA
| | - Kyle Tuohy
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, PA
| | - Jodi Brady-Olympia
- From the Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, PA
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Wang J, Zhang D, Zhu Y, Mo X, McHugh PC, Tong Q. Astragalus and human mesenchymal stem cells promote wound healing by mediating immunomodulatory effects through paracrine signaling. Regen Med 2022; 17:219-232. [PMID: 35249360 DOI: 10.2217/rme-2021-0076] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background: Skin regeneration from an injury without a scar is still a challenge. Methods: A murine model of a skin wound was treated with a combination of extract of astragalus and exosomes of mesenchymal stem cells (MSCs). CD11b+ and CD45 macrophages were detected and levels of cytokines were tested. Results: The expression of growth factors VEGF, FGF2 and EGF was elevated after treatment administered to MSCs. The administration of ethanolic extract of astragalus decreased the expression of TNF-α, IL-1β and IL-6 and simultaneously increased the levels of IL-10. The combination sped up the process of wound healing. A sustained-release gel with both ingredients was developed to enhance restoration from granulation. Conclusion: The extract of astragalus promotes the efficacy of MSC-derived exosomes in skin repair.
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Affiliation(s)
- Jiaqi Wang
- Clinical Research Center, Changhai Hospital, Shanghai, 200433, China
| | - Dandan Zhang
- Arachna Skin Biotechnology Center, Eston Cell Technology (Shanghai) Co. Ltd, Shanghai, 201611, China
| | - Ying Zhu
- Department of Respiratory & Critical Care Medicine, Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
| | - Xiumei Mo
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, 201620, China
| | - Patrick C McHugh
- Centre for Biomarker Research, School of Applied Sciences, University of Huddersfield, HD1 3DH, UK
| | - Qiang Tong
- Department of Rheumatology & Immunology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200235, China
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Cabral MD, Patel DR, Greydanus DE, Deleon J, Hudson E, Darweesh S. Medical perspectives on pediatric sports medicine–Selective topics. Dis Mon 2022; 68:101327. [DOI: 10.1016/j.disamonth.2022.101327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Yeargin S, Lopez RM, Snyder Valier AR, DiStefano LJ, McKeon PO, Medina McKeon JM. Navigating Athletic Training Position Statements: The Strength of Recommendation Taxonomy System. J Athl Train 2020; 55:863-868. [PMID: 32577741 DOI: 10.4085/1062-6050-240-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Susan Yeargin
- Department of Exercise Science, University of South Carolina, Columbia
| | - Rebecca M Lopez
- Department of Orthopaedics & Sports Medicine, University of South Florida, Tampa
| | - Alison R Snyder Valier
- Department of Interdisciplinary Health Sciences; School of Osteopathic Medicine in Arizona; Research Support, A.T. Still University, Mesa, AZ
| | | | - Patrick O McKeon
- Department of Exercise Science and Athletic Training, Ithaca College, NY
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Knapik JJ, Farina EK, Ramirez CB, Pasiakos SM, McClung JP, Lieberman HR. Medical Encounters During the United States Army Special Forces Assessment and Selection Course. Mil Med 2020; 184:e337-e343. [PMID: 30941425 PMCID: PMC6614812 DOI: 10.1093/milmed/usz056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/24/2018] [Accepted: 03/08/2019] [Indexed: 01/24/2023] Open
Abstract
Introduction The Special Forces Assessment and Selection (SFAS) is an extremely physically and mentally demanding 19- to 20-day course designed to determine whether Soldiers are qualified to enter the Special Forces Qualification Course. As a first step to understand medical problems during SFAS, this study examined injuries, illnesses, and activities associated with injuries during the course. Materials and Methods Medical events during the SFAS course were compiled from Sick Call Trackers (a log of medical encounters maintained by medical personnel in the field) and Chronology of Medical Care (Standard Form 600). Descriptive statistics were calculated for each injury and illness and injuries were compiled by the activities performed when the injuries occurred. Results Of the 800 Soldiers who volunteered for the study, 38% (n = 307/800) and 12% (n = 97/800) experienced one or more injuries and/or illnesses, respectively. The most common injuries were blisters and abrasions/lacerations with incidences of 20% (n = 158/800) and 13% (104/800), respectively. The most common illnesses were respiratory infections, other infections, contact dermatitis, and allergies with incidences of 7% (n = 57/800), 2% (n = 14/800), 2% (n = 14/800), and 2% (n = 13/800), respectively. Among all injuries recorded (n = 573), the most common were blisters (46%), abrasions/lacerations (24%), pain (not otherwise specified) (19%), tendonitis (3%), and sprains (3%). Among all illnesses recorded (n = 133), the most common were respiratory infections (56%), allergies (11%), contact dermatitis (11%), and other infections (11%). Most injuries were experienced during land navigation (44%), team events (20%), and foot marching (11%), running (6%), and the obstacle course (5%), but when the estimated time involved for each event was considered, activities with the highest injury rates were the obstacle course (65 injuries/hr), running (27 injuries/hr), the Combat Readiness Assessment (activity involving combat-related tasks) (20 injuries/hr), and foot marching (16 injuries/hr). Conclusion The major limitations of this investigation were: 1) the low specificity with regard to many of the diagnoses/complaints; and 2) the fact that the medical problems reported here are only those seen by medical care providers and are likely an underestimate of the total morbidity in the SFAS course. Soldiers often self-treat and some may be reluctant to see medical personnel because of how it might affect their rating in the course. Nonetheless, this investigation alerts medical personnel to the injuries and illnesses to expect, and public health workers and leadership with activities to target for injury prevention measures during SFAS.
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Affiliation(s)
- Joseph J Knapik
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA.,Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Emily K Farina
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA
| | | | - Stefan M Pasiakos
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA
| | - James P McClung
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA
| | - Harris R Lieberman
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA
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