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Christina Leanos Sherry Ann March 4, 2012 General Medical Conditions WEEK 7 1.) explanation of what the condition is, 2.) signs and symptoms of that condition, 3) treatment options, 4.) medication options, and 5.) how does it affect the athletic population including athletic participation. Please include documentation of sources of your information. Conjunctivitis Inflammation of the conjunctiva due to allergens or infection (bacterial or viral). Signs and symptoms: a. Itching b. Burning c. Mucous or draining from the eye d. Swollen, red appearance (Pink Eye) Treatment: e. Medication Medication options: f. Anti-histamines (allergies) g. Anti-inflammatories (allergies) h. Antibiotic eye drops (infection) i. Oral antibiotics (infection) Athletic participation: j. Conjunctivitis is easily spread to others, therefore athletic participation in activities that may allow contact should be avoided. Athletes should not share towels, or anything else that may have come in contact with the affected eye. Athletes should be encouraged to maintain vigorous hand washing to prevent infecting others, especially after touching the infected eye. O’Connor DP, Fincher AL. Clinical Pathology for Athletic Trainers. Recognizing Systemic Disease. Ed. 2. Thorofare, New Jersey. SLACK Incorporated. 2008. Hyphema Blood in the anterior chamber of the eye. Signs and symptoms: a. Eye pain b. Decreased vision c. “Falling curtain” Treatment: d. Immediate referral to team ophthalmologist or emergency room. e. Topical steroid f. Eye patch g. Decreased activity h. Hospitalization Medication: i. Topical steroid prescribed by physician. j. AVOID use of NSAID’s 2. Participation: a. Depends on the severity of the injury. b. Usually held out until normal vision returns. O’Connor DP, Fincher AL. Clinical Pathology for Athletic Trainers. Recognizing Systemic Disease. Ed. 2. Thorofare, New Jersey. SLACK Incorporated. 2008. Subconjunctival Hemorrhage 1. Bleeding under the clear conjunctiva of the eye. 2. Signs and symptoms: a. Bright, red patches on the white of the eye. 3. Treatment options: a. None. b. Condition typically resolves itself within 1 to 3 weeks. 4. Medication: a. None. 5. Participation: a. This condition does not affect participation in athletic activities. O’Connor DP, Fincher AL. Clinical Pathology for Athletic Trainers. Recognizing Systemic Disease. Ed. 2. Thorofare, New Jersey. SLACK Incorporated. 2008. Corneal Abrasion 1. Result from a direct blow to the eye by an external object (ball, elbow, finger, etc.). Corneal abrasions can also be caused by a foreign object trapped between the upper eyelid and cornea. 2. Signs and symptoms: a. Photophobia b. Eye pain c. Sensation of a foreign object in the eye d. Increased tearing e. Redness f. Possible swelling 3. Treatment: a. Referral to physician/ophthalmologist b. Topical antibiotics c. Eye patch d. Analgesics e. Patients should be reevaluated at 24 hours after injury. 4. Medication: a. Antibiotics b. Analgesics i. As prescribed by physician/ophthalmologist 5. Participation: a. Athletic trainer should work with physician/ophthalmologist to establish a protocol regarding corneal abrasions. O’Connor DP, Fincher AL. Clinical Pathology for Athletic Trainers. Recognizing Systemic Disease. Ed. 2. Thorofare, New Jersey. SLACK Incorporated. 2008. Corneal Laceration 1. A cut in the cornea 2. Signs and symptoms: a. Severe pain b. Tearing c. Sensitivity to light d. Blurred or decreased vision e. Bleeding (blood in the eye) f. The feeling that there is something in the eye 3. Treatment: a. Covering the eye and administering medication. b. Surgery. 4. Medication: a. Antibiotics i. Cefazolin 1. Ancef 2. Kefzol 3. Zolicef ii. Gentamicin 1. Gentacidin 2. Garamycin iii. Clindamycin 1. Cleocin iv. Vancomycin 1. Vancocin 5. Participation: a. Athlete may be encouraged to avoid activities that may place them at risk for eye trauma, and to use protective eye wear if they will be participating. Participation should be determined by the treating physician. Aronson AA. Corneal Laceration. Medscape Reference. 2011. http://emedicine.medscape.com/article/798005-overview. March 1, 2012. Orbital Fracture 1. Orbit is composed of 7 facial bones: frontal, zygoma, maxilla, lacrimal, ethmoid, sphenoid and palatine. Blow-out fractures occur when a blow to the eye increases pressure in the orbit, causing the weak floor or lamina papyracea to "blow out" into the maxillary sinus or ethmoid bone. 2. Signs and Symptoms: a. Depending on the severity of the injury and fracture i. Pain with attempted eye movement ii. Double vision (diplopia) 1. Resolves when the patient covers one eye iii. Numbness iv. Hypesthesia v. Distribution of the infraorbital nerve vi. Restricted ey movemnts in up- or down-gaze vii. Decreasesed sensation in the cheek or upper lip on the same side as the injury viii. Misalignment of the orbital rim on palpation ix. TTP 1. Sometimes a “crunchy feeling” x. Eyelid ecchymoses 3. Treatment: a. Surgical Repair i. Not all need repair 4. Medications: a. NONE 5. Participation a. Complete resolution of the signs and symptoms and my return to sport participation in approximately 2 to 4 weeks, with facial and eyewear protection for approximately 4 to 6 months Cuppett, M., & Walsh, K. M. (2012). General medical conditions in the athlete. (2nd ed., pp. 277-278). Mosby. Retinal Detachment 1. Retinal detachment occurs when the inner layer of the retina separates from the wall of the eye. 2. Signs and Symptoms: a. Brief flashes of light (photopsia) b. Curtain or shadow moving over the field of vision c. Loss of central visual acuity 3. Treatment: a. Surgery i. Use of lasers or cryoprobes to create adhesions between the detached retina and the back surface of the eye. ii. Silicone oil, filtered air, or special gases are sometimes injected into the vitreous cavity to push the retina against the back of the eye during the healing process 4. Medications: a. NONE 5. Participation a. Return to participation depends on the extent of the retinal injury and the success of the repair. It also depends on the sport involved. Lengthy discussion between the patient and the doctor are necessary to determine the athlete’s safety and risks of Cuppett, M., & Walsh, K. M. (2012). General medical conditions in the athlete. (2nd ed., pp. 278-279). Mosby.future visual loss when returning to sports. Oritis Externa 1. Otitis Externa is an inflammation or infection of the external auditory canal and tympanic membrane 2. Signs and symptoms: a. Pain b. Itching c. Burning d. Drainage e. Edematous and erythematous of the external auditory canal f. Pulling on the pinna will increase pain 3. Treatment: a. Ear drops b. Hot pack to the side of the face for its soothing properties 4. Medications a. Ear drops i. Acidifying agent 1. Aluminum acetate 2. Vinegar and a drying agent a. Isopropyl alcohol b. Oral antibiotics i. Usually in swimming athletes 5. Participation a. Athletes other than those in water sports may participated as symptoms allow, provided the head stays dry. b. Aquatic athletes are kept out of the pool until completing at least 24 hours of antibiotics. Cuppett, M., & Walsh, K. M. (2012). General medical conditions in the athlete. (2nd ed., pp. 300-301). Mosby. Otitis Media 1. The presence of fluid in the middle ear accompanied by signs and symptoms of infection 2. Signs and Symptoms: a. Earache b. Fever c. Feeling of fullness in the ear d. Dizziness e. Tinnitus f. Headache g. Diminished hearing 3. Treatment a. Antibiotics 4. Medications a. Antibiotics i. Amoxicillin ii. Cephalosporin iii. Erythromycin 5. Participation: a. After dealing with the discomfort that accompanies otitis media, the patient who is afebrile may participate in sports. Cuppett, M., & Walsh, K. M. (2012). General medical conditions in the athlete. (2nd ed., pp. 302-303). Mosby. Ruptured Tympanic Membrane 1. A ruptured eardrum is an opening or hole in the thin layer of tissue (eardrum) that separates the outer and middle ear. 2. Signs and Symptoms: a. Audible whistling sounds b. Decreased hearing c. Purulent fluid or bleeding 3. Treatment: a. Tends to heal itself b. Large or complicated ruptures may require surgical procedures i. Graft of surgical paper, fat, muscle or other material. 4. Medications: a. OTC analgesics for pain b. If the TMP was caused by an infection the physician will prescribe drying agent drops as well as topical and oral antibiotics. 5. Participation a. For small, uncomplicated perforations of the tympanic membrane should result in minimal time lost, especially in the non-swimming athlete. b. Divers may be held out of activity longer than swimmers because of the combination of water and pressure changes associated with the sport Cuppett, M., & Walsh, K. M. (2012). General medical conditions in the athlete. (2nd ed., pp. 302-303). Mosby. Allergic Rhinitis 1. Allergic Rhinitis is a hypersensitivity response to nasally inhaled allergens. 2. Signs and Symptoms: a. Clear nasal discharge b. Sneezing c. Nasal Congestion d. Cough e. Sensation of plugged ears f. Itchy, watering eyes 3. Treatment: a. Medications 4. Medication: a. Antihistamines i. Loratadine ii. Fexofenadine iii. Nasalcrom 5. Participation: a. Athletes may participate in athletics as able. Cuppett, M., & Walsh, K. M. (2012). General medical conditions in the athlete. (2nd ed., pp. 257-258). Mosby. Sinusitis 1. Sinusitis causes the cavities around your nasal passages (sinuses) to become inflamed and swollen. This interferes with drainage and causes mucus to build up. 2. Signs and Symptoms: a. Drainage of a thick, yellow or greenish discharge from the nose or down the back of the throat b. Nasal obstruction or congestion, causing difficulty breathing through your nose c. Pain, tenderness, swelling and pressure around your eyes, cheeks, nose or forehead d. Aching in your upper jaw and teeth e. Reduced sense of smell and taste f. Cough, which may be worse at night g. Ear pain h. Headache i. Sore throat j. Bad breath (halitosis) k. Fatigue l. Fever 3. Treatment: a. Medication 4. Medication Options: a. Saline Nasal Spray b. Nasal Corticosteroids i. Fluticasone (Flonase) ii. Mometasone (Nasonex) iii. Budesonide (Rhinocort Aqua) iv. Triamcinolone (Nasacort AQ) v. Beclomethasone (Beconase AQ) c. Decongestants i. Sudafed ii. Actifed iii. Drixoral iv. Phenylephrine (Neo-Synephrine, others) v. Oxymetazoline (Afrin, others) d. OTC Pain Relievers i. Aspirin ii. Acetaminophen (Tylenol, others) iii. Ibuprofen (Advil, Motrin, others) e. Antibiotics f. Antifungal Medications g. Immunotherapy 5. Participation: a. The athlete who is afebrile and feels well enough may be allowed to participate in athletics. Cuppett, M., & Walsh, K. M. (2012). General medical conditions in the athlete. (2nd ed., pp. 259). Mosby. Epistaxis 1. Nose Bleed 2. Signs and Symptoms: a. Blood coming from the nostrils 3. Treatment Options: a. Direct pressure applied b. Keep head elevated c. Ice can be applied d. Pinching of the nose e. Cotton plug can be inserted into the nose. 4. Medication: a. Saline nasal spray 5. Participation: a. If there is no indication of a nasal fracture, septal deviation, or septal hematoma, the athlete may return to participation once the nose has stopped bleeding. Cuppett, M., & Walsh, K. M. (2012). General medical conditions in the athlete. (2nd ed., pp. 260-261). Mosby. Pharyngitis/Tonsillitis 1. Inflammation of the Pharynx. 2. Signs and Symptoms: a. Sore Throat b. Pain with Swallowing c. Hoarseness d. Chills or fever e. Swollen tonsils 3. Treatment: a. Plenty of rest and fluids b. Medication 4. Medication Options: a. Antibiotics b. Acetaminophen 5. Participation: a. The athlete should be afebrile and must be able to tolerate fluids before vigorous athletic activities. Cuppett, M., & Walsh, K. M. (2012). General medical conditions in the athlete. (2nd ed., pp. 261-262). Mosby. Laryngitis 1. Inflammation of the Larynx. 2. Signs and Symptoms: a. Hoarse or weak voice b. Maybe unable to speak c. Urge to clear throat d. Fever e. Throat pain 3. Treatment: a. Voice Rest b. Humidifiers c. Medication 4. Medication: a. Acetaminophen b. Throat lozenges 5. Participation: a. Athletes with Laryngitis may participate as long as they are afebrile and feel well with the exception of the laryngitis. Cuppett, M., & Walsh, K. M. (2012). General medical conditions in the athlete. (2nd ed., pp. 262-263). Mosby. Rhinitis 1. Rhinitis is a viral, bacterial, or vasomotor-related inflammation or infection of the nasal passages. 2. Signs and Symptoms: a. Clear nasal discharge b. Sneezing c. Nasal Congestion d. Cough e. Sensation of plugged ears f. Itchy, watering eyes 3. Treatment: a. Medication 4. Medication: a. Antihistamines 5. Participation: a. Performance may be affected if the athlete is using sedating antihistamines. Typically athletes are able to participate in athletics with few limitations. Cuppett, M., & Walsh, K. M. (2012). General medical conditions in the athlete. (2nd ed., pp. 258-259). Mosby.