Preventing infectious disease in sports.

Preventing infectious disease in sports is fundamental to maintaining team effectiveness and helping individual athletes avoid the adverse effects of illness. Good general hygiene practices, immunization, efforts to minimize exposure to specific diseases, and certain prophylactic measures are essential. Teammates, coaches, athletic trainers, officials, and healthcare providers should actively participate in these preventive efforts, and community public health resources may be involved when appropriate. In addition to treating individual athletes, the team physician's role is to increase awareness, vigilance, and compliance with procedures to prevent the spread of disease.

Meningococcemia.

In brief Meningococcemia is a dangerous disease requiring early and aggressive treatment to prevent a potentially lethal outcome. It often occurs in relatively closed groups, including sports camps and athletic teams. A high index of suspicion must be maintained when evaluating acute febrile illness, particularly in people younger than 20. Treatment includes antibiotics and intensive care support. Prophylaxis in the intimately exposed population, and education about signs and symptoms of the disease for more peripheral contacts are critical for successfully limiting any outbreak.

Neck Injuries.

In brief When a neck injury is suspected, the on-site physician must first provide basic trauma care, which includes establishing an airway as necessary, assessing breathing, and checking circulation and neurologic compromise. A few targeted questions during history taking and a directed physical exam will help rule out serious cervical injuries, which are uncommon. More common are minor injuries, such as "burners." Team physicians must also be well-versed in immobilizing and transporting the patient, administering a thorough neurologic exam, and establishing when the athlete can return to competition.

Assessing Acute Abdominal Pain.

In brief The etiology of abdominal pain is diverse, but, for immediate purposes, the team physician must simply focus on whether the process requires surgical intervention. An effective history includes a detailed description of the pain and its onset, and an accounting of associated symptoms and events. Pain from a serious condition typically arises suddenly and is continuous, progressively worse, and long lasting; begins during inactivity; and is not near the umbilicus. Portions of the physical exam that require physical contact should begin farthest away from the site of maximal pain. Auscultation should precede palpation to avoid alteration of peristalsis.

When Anxiety Attacks.

In brief The athlete who panics or hyperventilates requires immediate stabilization and assessment to rule out more serious diagnoses. Repeated attacks may indicate panic disorder, which can be treated effectively with a combination of psychological and pharmacologic therapy. Drug options include selective serotonin reuptake inhibitors, benzodiazepines, tricyclic antidepressants, and monoamine oxidase inhibitors.

Advanced Cardiac Life Support.

In brief Changes in the advanced car-brief diac life support guidelines in-elude a new classification system for interventions, training in the use of automated defibrillators, and required early defibrillation for ventricular fibrillation. The algorithms for treating ventricular fibrillation and pulseless ventricular tachycardia, pulseless electrical activity, and asystole are reviewed. Cardiac arrest caused by special circumstances-hypothermia, near drowning, trauma, and electrical injuries-presents additional treatment considerations.

Immediate Reduction of Shoulder Dislocation.

In brief Anterior shoulder dislocations are common injuries in sports medicine. Associated fractures and neurovascular injuries are rare but need to be identified by physical examination and x-ray before reduction is attempted. The authors present a preferred reduction method based on the technique described by Matsen et al;5 other methods can also be used. In the patient under 30 years of age, postreduction immobilization and strengthening exercises are important to help prevent redislocation; in older patients, range-of-motion exercises are more critical.

Laryngeal Trauma.

In brief Blunt laryngeal injury is a rare but potentially catastrophic event. If the airway is not totally obstructed, the on-site physician should manage the upper airway following basic airway protocols. If the airway becomes totally obstructed on-site, orotracheal intubation using a small-diameter endotracheal tube is the procedure of choice. Translaryngeal ventilation and surgical cricothyrotomy are relatively contraindicated but may need to be used as a last resort. When the need for advanced airway procedures is likely, the patient should be transported expediently by advanced life support ambulance to the nearest appropriate emergency department.

Pneumothorax.

In brief A pneumothorax can accompany high-energy trauma, penetrating injury, or nonpenetrating impact, and spontaneous pneumothorax is common. No matter what the cause of the pneumothorax, however, rapid diagnosis is of utmost importance because this injury is a true on-field medical emergency. The key to expedient diagnosis is proper recognition of chest pain, dyspnea, and other telltale signs and symptoms. Auscultation and x-rays are usually required for a definitive diagnosis. Prompt treatment can help save the patient's life and includes maintaining the airway and monitoring vital signs. Often, tube thoracostomy is required to completely resolve the injury.

Oral Trauma.

In brief Sports participation can result in three types of dental trauma: fracture, displacement, and avulsion. On-field physical exam and classification of dentoalveolar injury can expedite referral for definitive treatment. Emergency measures to control bleeding and store avulsed teeth can help preserve dental integrity. Physicians can help prevent dental trauma by promoting mouth guard use.

Emergency Removal of Football Helmets.

In brief when a football player has a brief suspected head or neck injury, when and how to remove the football helmet become critical issues. Protocols differ; however, the National Collegiate Athletic Association guidelines, which state that the helmet should only be removed on the field under very special circumstances, are appropriate. An understanding of the technologically advanced design and tight fit of modern football helmets will help guide medical personnel through each step of the helmet removal process.

When the Dog Bites.

In brief The physician treating an active brief Patient's dog bite injury faces some controversial treatment decisions: Should the wound be sutured? Is tetanus or rabies immunization indicated? Are prophylactic antibiotics appropriate?

Anesthesia for the Injured Hand.

In brief When an active patient sustains a hand or finger injury, a digital nerve block is often the appropriate anesthetic technique. A thorough knowledge of the area's anatomy, the materials needed, the proper technique, and the potential complications can help the primary care physician perform the procedure smoothly.

Instituting the Updated CPR Protocol.

In brief Because the team physician may be called on to provide basic life support for athletes or spectators, knowing the latest CPR protocol is essential in developing an emergency response plan and training personnel. Practice with removing protective equipment and performing cardiopulmonary resuscitation on a mannequin can be helpful.