Care of the high school athlete: prevention and treatment of medical emergencies

Constance M Lebrun
Instructional Course Lectures 2006, 55: 687-702
An important duty of any sports medicine physician is the care of athletes on the field and at the sidelines. Orthopaedic surgeons, who are trained to treat most musculoskeletal injuries, may not be as well prepared to treat the variety of medical issues and emergencies that are encountered in the "on-the-field" setting. In treating adolescent and high school athletes, advance preparation by the physician is critical for such entities as exercise-induced asthma, anaphylaxis, certain cardiac conditions, seizures, diabetes, and heat illnesses. The initial approach to the athlete who "goes to ground" always remains the same--management of the airway (with cervical spine precautions); establishment and maintenance of breathing and circulation; a limited neurologic examination to assess function; and removal of the athlete from the hazardous environment. Additional treatment is dictated by the specific illness or injury. As is usually the case, prevention is the best form of treatment. Many conditions can be detected at the preparticipation physical examination, which includes a thorough history and focused physical examination. Specific cardiovascular conditions that may be screened for include hypertrophic cardiomyopathy, Marfan syndrome, some congenital coronary artery abnormalities, and electrophysiologic rhythm disturbances. This examination also offers one of the best opportunities to provide information to athletes regarding optimal management of any chronic medical diseases. In preparation for an athletic event, excessive environmental heat and humidity may be addressed with several preventive strategies. Physicians also may be asked to provide counseling and make decisions about return to play for athletes who have had certain infectious diseases, including upper and lower respiratory infections and infectious mononucleosis.

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