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Cardiovascular screening in young athletes is widely recommended and routinely performed prior to participation in competitive sports. While there is general agreement that early detection of cardiac conditions at risk for sudden cardiac arrest and death (SCA/D) is an important objective, the optimal strategy for cardiovascular screening in athletes remains an issue of considerable debate. At the centre of the controversy is the addition of a resting ECG to the standard preparticipation evaluation using history and physical examination...

CONTEXT: Exercise conducted in hot, humid environments increases the risk for exertional heat stroke (EHS). The current recommended treatment of EHS is cold-water immersion; however, limitations may require the use of alternative resources such as a cold shower (CS) or dousing with a hose to cool EHS patients. OBJECTIVE: To investigate the cooling effectiveness of a CS after exercise-induced hyperthermia. DESIGN: Randomized, crossover controlled study...

BACKGROUND: Shoulder dislocations account for almost 50% of all major joint dislocations and are mainly anterior. OBJECTIVE: The aim is a comparative retrospective study of different reduction maneuvers without anesthesia to reduce the dislocated shoulder. METHODS: Patients were treated with different reduction maneuvers, including various forms of traction and external rotation, in the emergency departments of four training hospitals between 2009 and 2012...

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OBJECTIVE: To examine the effect of ascent rate on the induction of acute mountain sickness (AMS) in young adults during a climb to Jiaming Lake (3350 m) in Taiwan. DESIGN: Prospective, nonrandomized. SETTING: Climb from 2370 to 3350 m. PARTICIPANTS: Young adults (aged 18 to 26 years) (N = 91) chose to participate in either the fast ascent (3 days; n = 43) or slow ascent (4 days; n = 48) group (1 and 2). ASSESSMENT OF RISK FACTORS: Two criteria were used to define AMS...

BACKGROUND: Evidence-based guidelines on the use of immobilization in the management of common acute soft-tissue knee injuries do not exist. Our objective was to explore the practice patterns of emergency physicians (EPs), sports medicine physicians (SMPs) and orthopedic surgeons (OS) regarding the use of early immobilization in the management of these injuries. METHODS: We developed a web-based survey and sent it to all EPs, SMPs and OS in a Canadian urban centre...

Intense exercise evokes a rapid and transient increase in circulating cell-free DNA (cf-DNA), a phenomenon that is commonly observed in a variety of acute and chronic inflammatory conditions. While the potential value of cf-DNA for the prediction of disease outcome and therapeutic response is well documented, the release mechanisms and biological relevance of cf-DNA have long remained enigmatic. The discovery of neutrophil extracellular traps (NETs) provided a novel mechanistic explanation for increased cf-DNA levels...

A number of intermittent team sports require that two consecutive periods of play (lasting for ~30-45 min) are separated by a 10-20 min half-time break. The half-time practices employed by team-sports players generally include returning to the changing rooms, temporarily relaxing from the cognitive and physical demands of the first half, rehydration and re-fuelling strategies, addressing injury or equipment concerns, and receiving tactical instruction and coach feedback. However, the typically passive nature of these actions has been associated with physiological changes that impair performance during the second half...

No abstract text is available yet for this article.

The use of point-of-care ultrasound (US) by non-radiologists is not new and the expansion into sports medicine practice is relatively young. US has been used extensively to evaluate the musculoskeletal system including the diagnosis of muscle, tendon and bone injuries. However, as sports medicine practitioners we are responsible for the care of the entire athlete. There are many other non-musculoskeletal applications of US in the evaluation and treatment of the athlete. This paper highlights the use of US in the athlete to diagnose pulmonary, cardiac, solid organ, intra-abdominal and eye injuries...

BACKGROUND: Exertional heat illness (EHI) affects military personnel, athletes and occupational groups such as agricultural workers, despite knowledge of preventive measures. AIMS: To evaluate EHI diagnoses during US Army basic training and its associations with fitness and body fat on entering military service. METHODS: From February 2005 to September 2006, US Army recruits at six different military entrance stations took a pre-accession fitness test, including a 5-min step test scored as pass or fail...

CONTEXT: The Falmouth Road Race is unique because of the environmental conditions and relatively short distance, which allow runners to maintain a high intensity for the duration of the event. Therefore, the occurrence of exertional heat illnesses (EHIs), especially exertional heat stroke (EHS), is 10 times higher than in other races. OBJECTIVE: To summarize the occurrence and relationship of EHI and environmental conditions at the Falmouth Road Race. DESIGN: Descriptive epidemiologic study...

PURPOSE: We examined the effect of differences in body surface area-to-lean body mass ratio (AD/LBM) on core temperature cooling rates during cold water immersion (CWI, 2°C) and temperate water immersion (TWI, 26°C) after exercise-induced hyperthermia. METHODS: Twenty male participants were divided into two groups: high (315.6 ± 7.9 cm·kg, n = 10) and low (275.6 ± 8.6 cm·kg, n = 10) AD/LBM. On two separate occasions, participants ran on a treadmill in the heat (40...

BACKGROUND: When associated with a knee dislocation, management of the medial ligamentous injury is challenging, with little literature available to guide treatment. QUESTIONS/PURPOSES: We (1) compared MRI findings of medial ligament injuries between Schenck KDIIIM and KDIV injuries, (2) compared clinical outcomes and health-related quality of life as determined by Lysholm and Veterans Rand 36-Item Health Survey (VR-36) scores, respectively, of reconstructed KDIIIM and KDIV injured knees, and (3) determined reoperation rates of reconstructed KDIIIM and KDIV injured knees...

Exertional heat illness is rarely encountered by individual EMS providers but can be common in certain settings and events. The notion that significantly altered mental status must accompany elevated core temperature in heat illness may delay recognition and treatment. We report on a series of marathon and half-marathon runners who suffered exertional heat illness during a marathon race in relatively mild conditions. Altered mental status was not uniformly present. All patients were treated in the finish line medical tent and responded well to cooling...

PURPOSE: Approximately 6500 high school football athletes are treated annually for exertional heat illness (EHI). In 2009, the National Athletic Trainers Association (NATA)-led Inter-Association Task Force (NATA-IATF) released preseason heat acclimatization guidelines to help athletes become accustomed to environmental factors contributing to EHI. This study examines compliance with NATA-IATF guidelines and related EHI prevention strategies. METHODS: The study used a cross-sectional survey completed by 1142 certified athletic trainers (AT), which captured compliance with 17 NATA-IATF guidelines and EHI prevention strategies in high school football during the 2011 preseason...

The Wilderness Medical Society (WMS) convened an expert panel to develop a set of evidence-based guidelines for the recognition, prevention, and treatment of heat-related illness. We present a review of the classifications, pathophysiology, and evidence-based guidelines for planning and preventive measures as well as best-practice recommendations for both field- and hospital-based therapeutic management of heat-related illness. These recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks or burdens for each modality...

After reading this article, readers should 1. Appreciate that exertional heatstroke is the leading cause of preventable death in youth sports.2. Know the importance of progressive acclimatization to minimize the risk of exertional heat illness in youth sports.3. Be able to identify other contributing risk factors and effective ways to improve exercise-heat tolerance and reduce exertional heat illness risk in youth sports.4. Be prepared to educate others on their roles and responsibilities in improving safety and well-being of youth participating in outdoor sports in the heat...

PURPOSE: It remains unclear whether exercise-induced muscle damage (EIMD) increases heat strain during subsequent exercise heat stress, which in turn may increase the risk of exertional heat illness. We examined heat strain during exercise heat stress 30 min after EIMD to coincide with increases in circulating pyrogens (e.g., interleukin-6 [IL-6]) and 24 h after EIMD to coincide with the delayed muscle inflammatory response when a higher rate of metabolic energy expenditure (M˙) and thus decreased economy might also increase heat strain...

No abstract text is available yet for this article.