CYCLING ILLNESS & INJURY

Transcription

1 1 CYCLING ILLNESS & INJURY Mark Greve MD FACEP Clinical Asst Prof Emergency Medicine Warren Alpert School of Medicine Brown University Division of Sports Medicine Team MD Team Novonordisk

2 2 Medical Emergencies in Cycling Course Field Management of Competitive Cycling Injuries and Illness Demographics Mechanisms Injury Patterns Interventions Collapsed Athlete

3 3 Injury Factors Event Criterium Road Race Time Trial Trigger Other rider Obstacle Pedestrian Animal Motor Vehicle Other

4 Mechanism of Injury 4

5 5 Injury Location! Torso+5.6%+ Chest!5.2%! Abdomen!0.4%! Lower+Extremity+ 42.8%+ Pelvis/Hip!15.5%! Thigh!7.9%! Knee!14.8%! Lower!Leg!2.4%! Ankle!1.7%! Foot!0.5%! Back/Neck+6%+ Neck!1.9%! Upper!Back!1.1%! Lower!Back!3.0%! Cranio'facial+5.7%+ Head!1.9%! Face!3.8%!! Upper+Extremity+31.6+%+ Shoulder!13.6%! Upper!Arm!0.7%! Elbow!6.3%! Forearm!3.5%! Hand/Wrist!7.5%!!!!

6 6 Injury Type Freq Other Concussion Abrasion or laceration Penetrating Trauma Freq Ligament inj Dislocation Fracture

7 7 Traumatic Cycling Injuries Chest Trauma Pneumo(hemo)thorax Cardiac Tamponade Tracheobronchial disruption Traumatic Brain Inj Maxillo-facial Abdominal Injury Soft Tissue Injury

8 8 Chest Trauma Penetrating vs. Blunt Aortic injury Tension pneumothorax Hemothorax with active bleeding Pericardial tamponade Tracheobronchial disruption

9 9 Pneumothorax Simple Pneumothorax Tension Pneumothorax Hemothorax

10 10 Cardiac Tamponade External forces on heart preventing filling. Becks Triad 1. Low arterial pressure 2. Distended neck veins 3. Muffled heart sounds Mediastinal Shift

11 11 Tracheobronchial disruption Blunt or Penetrating Blunt- Most common near carina Subcutaneous Emphysema- Think Upper Neck Respiratory distress Hemopytsis

12 12 CNS Trauma Mild TBI (13-15) Moderate (9-12) Severe (3-8) Brain injury is a dynamic process Questions? 1. Do they have a neurosurgical injury? 2. Can they safely continue?

13 13 Severe TBI Severe TBI GCS < 8 after resuscitation Protocol driven mgmt ú Early intubation ú Rapid ACLS transport ú Early CT scan ú Immediate evacuation of mass lesions ú Meticulous ICU mgmt Primary Injury ú Damage from direct trauma including blunt, penetrating, acceleration, deceleration and rotational forces. Secondary Injury ú Bimolecular and physiological cascade ú Hypoxia ú Hypotension

14 14 Maxillo-facial Trauma Suction = Airway Traumatized upper airway. Potential CNS/C Spine Trauma

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17 17 Abdominal Trauma Blunt Spleen Liver Doudenal Hematoma Pelvic Penetrating Fast Scan? When is it an emergency?

18 18 Skin/Tissue Road Rash Early and aggressive cleaning/ debridement Topical Antibacterial Dressing to race During events Joints? Massive Hemorrhage Vascular Injury

19 19 Staple a face?

20 20 Collapsed Athlete Immobilize C-Spine Adapted from Malik S et al. Sports Cardiology Essentials, part 2: The Collapsed Athlete. 2011, pages Absent/Unstable Pulse and Respirations Stable Pulse and Respirations Shockable Rhythm? Yes Vfib/ VTach AED No Cardiac Resp. Cause Normal Mental Status Collapse -in Exercise Trauma Cardiac Anaphylaxis Heat- Exhaustion Collapse -post Exercise Exercise- Associated Collapse Trauma Seizure Tox CVA Cardiac Exhaustion Abnormal Mental Status Test Blood Sugar, Temp, Sodium Heat Stroke Hypoglycemia Hyponatremia Hypothermia CPR Transport Illness- Specific Treatment Oral fluids Elevate Legs Illness- Specific Treatment D50 Glucagon Rapid Cooling Fluid Restrict 3% Passive External Warming

21 21 Cardiac Collapse in Athletes Etiology Hypertrophic Cardiomyopathy 36%-46% Coronary Artery Abnormalities 19% Cardiac contusion Arrhythmia inducing drugs, supplements etc Long QT Syndrome Intervention 1. EMS Activation, get electricity! (survival drops 5-10% every minute) 2. BLS Responder early CPR. Hands only, Staying Alive 3. Defibrillation 95% survival if within first minute Ø ACLS and Rapid Transport

22 22 Heat Related Illness Cramps-Fluids, Na+, Pickle Juice? Heat Syncope-LOC with regained MS. Heat Exhaustion-Cognitive changes but responsive. Exertional Heat Stroke >40 o C (104 o F), Persisting Altered MS. Possible Sz, Dry? Rapid Cooling ABC IV Tour of California 2013 Palm Springs- 107 O F

23 23 Allergies/Anaphylaxis Minor reaction Rash Swelling Upper respiratory Lower respiratory Ø Treat symptomatically (MDI, Antihistamine, consider steroids) Severe reaction Not looking good- wheezing and swelling, tiring out, rash is extensive Ø Steroids, anti-histamines, consider EMS Anaphylaxis vs. Anaphylactic Shock Epi IM 0.4ml 1/1000, IV 0.4ml 1/10000 High Dose Rapid Steroids Diphenhydramine (H 2 Blocker, glucagon)

24 24 Exercise induced anaphylaxis Exercise Induced Anaphylaxis (EIA) and Food Dependant Exercise Induced Anaphylaxis (FDEIA) Common triggers- Wheat, NSAIDS, Shellfish 5% to 15% of all anaphylactic cases

25 25 Exercise induced bronchospasm An increase in airway osmolarity secondary to hyperventilation Cold air exposure. 37.4% XC skiers -20% FEV1 Allergy Symptoms- seasonal allergies Poor Perceivers Testing Treatment WADA Limit Albuterol

26 26 Hypoglycemia Glucose < 20 - Expect depression in level consciousness with possible seizures. Death can occur without intervention Glucose Typically will feel weak, nauseous. Often will have a headache, rapid heart rate and profuse sweating. Generally will have depressed level of consciousness Glucose Typically will be conscious with milder symptoms. Interventions 1. Oral Sugar 2. Glucagon 3. IV therapy 4. Epinephrine?

27 27 Hyponatremia Exercise Associated Hyponatremia Over drinking, high Na loss, decreased kidney output. Hyperthermia? Hyponatremia o Nausea and vomiting. o Headache. o Confusion. o Loss of energy and fatigue. o Restlessness and irritability. o Muscle weakness, spasms or cramps. o Seizures. o Coma.

28 28 Performance Enhancing Drugs Amphetamines Epo Insulin Anabolics Diuretics Caffeine

29 29 Final Thoughts