Transcript
Chris, good to have you today.
Chris is assistant professor in the master's of science of athletic training program and in apartment of kinesiology at Cal State at Fresno.
Chris has his doctorate, degree in education with an emphasis in higher education, managed Tracy from the University of Pacific.
I got that in 2014.
Prior to that, he got his master's of science in kinesiology, with a emphasis in health science from Cal State, and my guys bachelor's of science degree in sports medicine.
From Cal State and Fresno as well.
Chris his previous responsibilities include a representative of the NatA conference planning committee, professional ethics, a member of the student leader, shared committee, was an ambassador to the NAT Research Education Foundation.
And a reviewer in the Journal of Athletic Training Education Journal of Body Work Movement And Therapy.
Chris, it is so good to have you today.
And to be talking about respiratory emergencies and urinary long conditions and the floor is yours.
Chris?
I appreciate that.
Thank you for that very nice introduction.
Good morning, everybody.
I'm gonna walk you through we're gonna have a conversation about a couple of respiratory elements or conditions that you might come into contact with in your daily practice.
In an overview of all this, you know, assessing vitals and practicing good good good hygiene is going to be highlighted throughout, especially with these conditions in our athletic population.
Just to give you a a quick rundown or disclaimer.
I have no financial conflicts to disclose.
Anything I share within this presentation is is my opinion, in my opinion only.
And I don't think I'm supporting or promoting any specific products or services.
And if I do mention anything, it's unplanned.
So let's go ahead and kick this off.
We're gonna go through about 5 or 6 specific diseases or elements that you may see in your practice.
We're gonna talk about the path of mechanics, the pathogenesis of each of these, common signs and symptoms that you may see or be told about And then we're gonna get into the evaluation, the treatment, prevention mechanisms, and then potential return to play protocols that you may have to employ with these different diseases.
We're specifically gonna cover pneumonia, pulmonary embolisms, spontaneous neophorax.
We'll talk generally about neophorax.
We'll spend most of the time talking about spontaneous neophorax.
We'll highlight hyperventilation, and then we'll talk about both upper and lower respiratory infections.
So for pneumonia, we're gonna start off with understanding the pathophysiology.
The etiology and pathophysiology.
When we think about pneumonia, we need to understand that it's an infection in one or both of the lungs.
Now the 2 types or 2 common types we may see in our emergency settings or our clinical settings are bronchial pneumonia and globular pneumonia.
And bronchial pneumonia means the infection is in multiple areas of a lung or both lungs.
And then lobular or lobular pneumonia is when it's confined to one spot of a lobe or in just a single lobe.
Now specifically with these infections or these microorganisms, bacterias, fungi or viral.
These, in affect the lungs in a way that the alveoli or the air sacks, the lungs fill up with fluid or pus from the infection.
And that makes it hard for the patient to breathe and to be functional.
So common signs and symptoms.
And you'll see on the bottom of each of these slides, I have some links.
And these links in all my presentations, I I put them there as a reference for you that you can go back and do a little more of your own due diligence if you have more interest in the areas.
But you'll see this in almost every slide that there's a link for you if you'd like to find out more information.
One other potential pathology I want to talk about when it comes to pneumonia, and we don't talk a lot about it.
Is the aspirational pneumonia.
That's where we get some aerobic pathogens from our actual GI system that bubble up through our stomach sphere into our esophagus and back up into our lungs.
So now it could still be bacterial or fungal, but Oftentimes, if somebody's having this, they'll have very similar signs and symptoms to a general pulmonary sorry, a bronchial pneumonia or a globular pneumonia.
The common signs and symptoms of pneumonia are gonna be a cough, which may be dry, productive with a thick yellow green brown or a potentially blood stained mucus or or phlegm, They're gonna have difficulty breathing.
Rapid heart rate, 100, 110, up to 115 or 20.
They're probably gonna have a fever because it is an infectious organism that's causing the symptoms.
They're gonna have a general feeling of unwell or sickness.
They might be sweating or shivering.
They'll have a loss appetite.
And one of the other primary complaints is chest pain, which will get worse through the infection as they continue to cough and with each breath, it'll be a little more painful from the excess coughing.
Some less common symptoms you might see with the pneumonia, is the coughing up of the blood or the hematosis or hematosis?
They may have a headache, both from the infection or the the fever, and from the straining of the thorax and the the cervical musculature.
General fatigue or malaise, nausea, potentially vomiting, wheezing or other breath sounds, general joint and muscle pain.
Sorry.
The light in the background is gonna go off.
It's on a motion sensor.
And then when they're feeling ill, they just might generally feel disoriented.
Maybe even confused.
And that's a common sign and something you'll see.
In our older or geriatric populations.
So how do we manage somebody with pneumonia?
Well, we need to evaluate them first to to make sure that we know they're not having some other emergency or medical concerns.
So general history review, signs and symptoms, a good clinical or field assessment to start with would be pulse oximetry.
Looking at the peripheral oxygen saturation and seeing if their their numbers are dropping below 94, 92, 91, and then doing consultations to see if there's any abnormal breath sounds.
Ultimately, if somebody does have an pneumonia, it's outside of our our scope to provide most interventions outside of over the counter medications to treat some of the symptoms.
But sending them to the emergency room if it symptoms are severe or giving them an appointment with a primary care physician to get on antibiotics.
Once you see the physician or the the medical provider, they're probably gonna do a chest x-ray just to check and see where the infection has progressed.
Again, if it's in the lower lobes, if it's one whole lung, multiple lobes or both lungs.
They're probably gonna do urine or sputum or blood samples, do a CBC to look at potentially other concerns that they may have going on or other comorbidities.
The common treatment is going to be antibiotic for a bacterial infection.
And then depending on the severity, if it is a viral infection, they may put some antiviral meds.
But usually gonna let us run this course.
As an AT out in the field, if somebody's we suspect they're they're suffering from pneumonia, What we can do is treat them symptomatically and potentially put them on some supplemental oxygen till we can get them more advanced care.
But here, how do we prevent this?
Well, knowing some of the risk factors for pneumonia is probably important.
People who are sixty five years old are older, is something that we need to be aware of.
The mortality and more mobility of the geriatric population with pneumonia, we have a greater risk of further harm or or additional pathologies being associated with it.
And one thing we need to know is that they have cancer, diabetes, other elements like renal disease, cardiovascular disease.
We can try and talk to our population, make sure that they're not smoking or intaking any other drugs or alcohol, and make sure they're getting proper nutrition will be beneficial.
General hygiene is highlighted with this and the other pathologies we're going to talk about.
We don't want them sharing cups or plates or forks or different drinking cups.
And we wanna practice washing our hands and making sure we're cleaning surfaces off when we're around people that are sick.
And if we have in our athletic populations, we have this cohort model where the the student athletes or the active individuals are typically in groups of people.
So if somebody's having symptoms or we have people who are infected and are suffering from pneumonia, isolating them, keeping our distance, and making sure we're not sharing items with them to cross contaminate Now if they are diagnosed with pneumonia, before they go back to work or before they go back to to activity, we need to make sure that the signs and symptoms have subsided.
Making sure the fevers broke and that they are cleared to return to play.
Now again, like we mentioned earlier, If they're over the age of sixty five, they do have some vaccines that are recommended for for the geriatric population.
That's a consideration as we get older.
But making sure we as healthcare providers use our gloves, use our masks, and make sure we keep our facilities clean, and practice general good hygiene and and cleaning.
Soap and water at minimum after we interact with each patient.
Moving on to the next pathology is a pulmonary embolism.
And with the pulmonary embolism, I thought it was a good idea to share some epidemiological data with you.
Around 80% of people who present with pulmonary embolisms have some evidence of deep vein thrombosis.
So pain and swelling or tenderness in one or both legs is a common indication of deep pains thrombosis, And if they have clots, the skin may feel warm, reddish skin tone, and they're probably gonna have some discomfort in the back of their legs.
So we're in back of the leg with the DVT.
And then of those people who have the DVT, 50% of the patients that have pulmonary embolisms had proximal DVT.
That's on the upper half of the lower legs of the thigh area, quads and hamstring areas where the associated DBT has been.
Now another name for this that you might hear in the literature when you're talking to your other medical and healthcare providers outside of the the term pulmonary embolism is a Venuous thromboembolism or VTE is another name it'll go by.
When we're evaluating for a potential pulmonary embolism, we need to understand what it is and Most of us in our undergrad and grad work, we've talked about this a dozen times in our course works, but it's basically a blockage in the lung.
Most often, it's a blood clot that comes from the the deep veins in the leg.
I remember in undergrad years ago being warned about post event activities and doing deep tissue massage in the calf and lower leg, in the possibility that a clot was there, and we broke it off in the post event massage.
And it would go straight up the respiratory or the pulmonary or the sorry.
The cardiovascular system and end up lodging up in the lungs or somewhere in the cardiovascular system.
Now, outside of a potential blood clot, there are other ways that this can manifest.
It can be a post surgery, post trauma, or a result of severe infection or of inflammation due to infection or injury.
So It may not be traditional DVT.
It may be hematoma in the legs from quad contusion and the the athlete of the patient.
Is starts to be active and a piece of that breaks off and shoots straight up the vascular system to the lungs.
So how do we evaluate this from the athletic training lens?
Our traditional evaluation process, history signs symptoms, special tests.
So looking at the signs and symptoms, The vital signs are important, heart rate, respiration rate, blood pressure, and looking at pulse oximetry.
Mean, almost every one of these respiratory pathologies we're gonna be talking about, those who we're looking at, the vitals, the the heart rates, the blood pressures, and the pulse peripheral oxygen saturation.
But we also may need to to pull out our stethoscope and listen to the lungs.
And see if there's any absence of sounds or altered sounds that we need to be aware of on an Ipsy on an Ipsy lateral lung or bilateral sounds.
Ultimately, this is going to need to have an X-ray done.
To confirm that there is a clot or some form of blockage in the lung.
Common signs and symptoms that we're gonna have for somebody suffering from a pulmonary embolism is chest pain, shortness, severe shortness of breath, pain with deep breathing, rapid breathing, a heart rate, an elevated heart rate above a 100, usually around a 110, for our active individuals between the ages of 15 35.
Some less common symptoms you might see with the pulmonary embolism is a cough with or without blood depending on how much damage the clot has done or how far it's moved into the very small pulmonary vessels.
The patient may complain or or at least make you aware that they're feeling anxious or they have this thought of impending doom or dread.
And they might be sweating anything from a light sweats sweat from the anxiety to more profuse that may resemble having a cardiovascular incident or accident.
So having the chest pain and and some of these other symptoms People often think that they're having a heart attack as well.
So making sure we pull out our tools and do our vital signs, check our vital signs, do a pulse oximetry to see if there's any change in the normal oxygen saturation and then listening to the lungs to see if there's abnormal breath sounds or absence of sounds in the lungs.
So for treatment for a pulmonaryism, there's not a lot we can do as athletic trainers outside of managing the vitals, trying to calm the patient, and potentially putting supplemental oxygen on them.
So Anytime we have somebody dropping below 90, 92, 91% of pulse ox, we need to put them on supplemental oxygen.
And a pulmonary embolism would be a pathology that that should become a common practice for us to consider putting that on just to help keep them and their oxygen saturation levels or proof of oxygen saturation levels at a at a higher standard.
We need to be prepared if something severe happens as an emergency where they go into cardiac arrest or They have any pulmonary disruptions or respiration disruptions.
We need to be prepared to do CPR.
We need to prepare to give rescue breaths.
And depending on your seat practice act, if they have a history of pulmonary embolisms or a history of blood clot or DVT, they may have anticoagulants or vasopressor medication, and as an athletic trainer, we're not typically going to be dispensing that or administering it.
But in your evaluation, giving you history to see if they have those meds, you may be telling them to take their meds or at minimum preparing them for transport or getting them to the physician or a medical team as soon as possible.
Prevention for to prevent a pulmonary embolism.
We need to avoid traumas.
We need to avoid anything that's gonna potentially lead to a clot breaking off.
11 o'clock developing, 2 o'clock breaking off and moving into that area of the lungs or any severe inflammatory conditions or diseases, anything that's going to lead to additional Claudine.
Now somebody who has DVT or pulmonary embolism or even a lung infarction, in fraction.
We need to have them fully recovered before they return to activity or return to play.
So working with your physicians or your medical team to make sure that the pulmonary embolism has resolved or They had surgery to remove the embolism, whatever how it manifested.
They need to be fully killed, and people who have a history of pulmonary embolism, they're probably gonna be put on some form of medication.
Either anticoagulant or vasopressin to some some some type But full recovery is possible.
Those who have had these pulmonary embolism, we need to be cautious of future clocks breaking off and just be prepared to manage that if it does happen.
Let's see.
Yep.
Avoid falling, avoid trauma.
Moving on to the next one.
We have a spontaneous pneumothorax.
And before we get into specifics about the spontaneous, I I wanna quickly review the other potential pneumothoraxes.
Having a closed pneumothoraxes, basically, just a collapse of the lung in its in its compartment.
Now you can have an open pneumothorax, which a puncture to that pleural lining or pleural cavity and the negative pressure in there gets offset, and the lung will collapse.
And then we have a tension pneumothorax.
And spontaneous pneumothorax and attention pneumothorax are similar, but attention pneumothorax tends to have more obvious and more aggressive symptoms that we'll see.
And the spontaneous pneumothorax is gonna be classified as a primary, secondary, which we'll talk about here shortly.
So with this idea of a spondylinemethorax, the etiology is unknown.
It's spontaneous.
It's it's random.
And it's where air enters that plural cavity or the pleural spacing between the lung and its outer lining in the thorax.
And that pressure from or the negative pressure gets disrupted and the lung ends up collapsing.
Now with spontaneous, again, we have no real known cause.
It can be multiple factors, but There's nothing that we can identify as the sole cause or the common cause.
There are 3 broad categories when we're talking about pneumothoraxes, traumatic.
I I hate to How do we pronounce it?
I ate rogen, hydrogen, which is where somebody's inserting a airway and health care provider, and it disrupts that flow cavity or spontaneous.
And spontaneous means that it happens.
We don't really know why.
Some symptoms you might see with spontaneous pneumothorax is shortness of breath, acute chest pain, decrease in blood pressure, decrease in peripheral oxygen saturation, and an increase in heart rate.
When one of the lungs are down, our body needs to compensate.
Now there are other potential pathologies associated with pneumothoraxes, somebody with COPD, asthma, cystic fibrosis, somebody who has pneumonia, or a severe respiratory infection.
If they have cancer, any connective tissue disorders like Marfans or rheumatoid arthritis, if they've inhaled a foreign object.
And worry about that moving around your lungs and potentially causing harm to the the the lung.
And it's lining.
Now from a field or clinical lens looking at the evaluation.
Like the other pathology, they need to have a thorough history.
Looking at the signs and symptoms, we need to assess their vitals, heart rate, respiration rate, blood pressure.
And you can see here that each of those vitals are affected from the spontaneous pneumothorax.
Looking at the peripheral oxygen saturation, and then potentially, if we have a stethoscope to take pulmonary consultations and listen for an absence or abnormal sound.
Now we, as ATs, can't do very much with us from a treatment standpoint, but getting them to advanced level care facility is optimal.
In the chance that we as athletic trainers or acute health care providers have been trained.
The treatment for this is a needle decompression or aspiration.
And if we can't do that or we don't have the equipment to do that or we haven't been trained at minimum putting them on supplemental oxygen to try and compensate for the lung that's not functioning normally is recommended.
Now, With patients who are stable but are suffering from a acute spontaneous pneumothorax, supplemental oxygen and observation are recommended for at least 6 hours based on the the current evidence for pneumothoraxes.
It was 2016.
We did a active shooter training and a cupulmonary injury lab.
And we had a couple mannequins where a physician came in and taught us how to do the needle decompressions or aspirations and finding the intercostal spacing and making sure we put it in there.
But before we were ever did an aspiration or the decompression, we had to confirm that the lung had collapsed.
Now with a closed sorry, an open pneumothorax.
We may need to do a sucking chest wound care.
Putting a occlusive or a non porous dressing over the wound and making sure that three of the four sides are covered so that if there's any blood coming out, it can leak out.
How do we prevent this for spontaneous pneumothoraxes?
There's not really known prevention, but standard precautions to reduce the risk of pneumothoraxes in general, traumas, direct direct pressure, and scuba diving or high low pressure changes like a baro trauma.
We wanna we wanna reduce those potentials.
But you also general rule is to avoid things like smoking cigarettes or vaping.
Return to play.
Once the spontaneous pneumothorax has been returned to normal after aspiration or decompression, We typically give it 3 to 6 weeks before we consider having them go back to activity or back to sport.
Now working with the medical team to make that decision is gonna be the minimum.
Making sure you have the correct practitioners reevaluating, reassessing to ensure that it's healed, and there's a limited probability of it happening again acutely.
Now one contrary case for somebody who has a history of pneumothoraxes or spontaneous pneumothoraxes or is recovering from a pneumothorax or specifically a spontaneous pneumothorax is air travel.
You don't want to be changing the altitudes and pressures when you're recovering from an amethorax because the quick change in pressure from something like air flight or travel via air flight can disrupt that pressure negative pressure gradient while they're healing.
So somebody who's recovering in this should avoid any air travel altitude, aggressive altitude changes for 2 to 3 weeks, especially after a decompression or a chest tube removal.
Moving on to the next one is hyperventilation.
The Another term for this is just over breathing, but it's where it involves rapid or deep breaths.
A lot of time, this is associated with anxieties, stresses, being overwhelmed, changing environments, And the the pathophysiology and the etiology is just rapid deep breathing that's caused by anxiety or a panic.
This over breathing, as I mentioned, is called sometimes, leaves the patient feeling breathless, And then when they inhale, they're they're building up CO2 in their or they're losing excessive CO2 in their blood.
So it's a low level carbon dioxide in their bloodstream.
And I think it was mentioned in the previous lecture that not having enough CO2 in your blood can create some trouble for us both physiologically and mechanically with the lungs.
So some of the symptoms that we might see your dizziness, light headedness, shortness of breath, maybe a chronic bulging or burping, dry mouth, a weakness or confusion, maybe a sleep disturbance from somebody who's having chronic bouts of of hyperventilation.
They may suffered from numbness and tingling in their distal extremities, maybe even around their mouth.
And then they're probably gonna have some peripheral muscle spasms or discomfort, followed by chest pains or chest palpitations.
Moving back a little bit, some of the causes, specific causes, the hyperventilation that have been documented commonly are anxiety disorders, panic attacks, asthma, general stress, excessive stress, worry, a really hard or assertive exercise or activity, people with other comorbidities or other lung diseases side effects from certain drugs, high altitude training or transition, post head injury or concussion and shock.
How do we manage this as an AT or a sports medicine provider?
Well, we gotta evaluate it.
And like the other pathology, we do our basic sideline or or emergent or even clinical evaluation.
We look at the history, the signs and symptoms, and we do our physical exam.
Our physical exam, looking at our vitals, heart rate, respiration rate, blood pressure, peripheral oxygen saturation.
And then if we do have the ability to do pulmonary consultations, we should Listen, just to ensure that there's not something else going on in there.
The vitals and peroxy saturation are gonna tell us a lot.
But we we need to know what's going on.
And our treatment for this would be to raise the carbon dioxide levels.
And we've probably all seen the the pictures and heard about people breathing into a bag, but really just breathing into their hands to try and keep an elevated level of CO2 in their respirations is beneficial for the have a bag available, you could use that.
But also ensuring or reassuring the individual that They're okay, putting them in a comfortable or controlled environment, getting them out of a a very stressful area, Get them off the sideline, get them off the the competitive field, get them in a place where they can relax and begin to recover.
And then working to increase that carbon dioxide in their blood.
How do we prevent this from happening?
It's hard, but we need to remove the trigger, the stress.
Whatever led to this episode of hyperventilation.
If they do have a history of anxiety or panic attacks, work working with a mental health professional, a psychologist or a psychologist sorry, a psychologist or a psychiatrist, a social worker.
A therapist to try and manage those mental health concerns, learn different breathing exercises, how to control their breathing, the the the typical in your nose, out your mouth, and focus on their breathing.
Make sure they're breathing from their belly.
Not their thorax.
Practicing relaxation techniques, meditation, imagery, progressive muscle relaxation, and then making sure that they're getting regular, moderate exercise.
For somebody who has a history or episodes of hyperventilation, There's no real return to play protocol outside of the other potential pathologies they may dealing with.
If they have excessive anxiety or stress, We probably need to help them with with those issues, concerns, or pathologies before we put them right back in.
But there's no standard protocol that we have for somebody who's suffering from from hyperventilation on what to return them back to outside of basic vitals.
So removing the stress, the anxiety, the trigger and making sure that their basic vitals are at a level where they can be returned to activity or returned to play.
Those anxieties, those stresses, if we don't manage those, it's gonna continue to have these these episodes of hyperventilation, and it's just a a cyclical process of stress, anxiety, panic, worry that leading to that general anxiety hyperventilation, then you have more symptoms, and the hyperventilate, then they fill on well, and the hyperventilate.
So it's just a vicious cycle and we need to help the patient or the individual find a way to remove those triggers or those stressors.
The last area we're going to talk about here before we open up some questions.
If you have questions along the way, I I should have said this beginning, feel free to stop stop me and ask or I think the q and a box is open.
But we're going to end talking about some various respiratory infections.
Now the etiology of these are broken down into upper or lower respiratory infections.
And with upper respiratory infections, we're about the common cold, We're about cyanitis.
We worry about pharyngitis.
We're about laryngitis.
And most of these infections are viral.
Influenza, the flu is a common one for upper respiratory, but you can have bacterial pharyngitis as well.
And it's most commonly caused by streptococcus bacterium.
The lower respiration infections, respiratory infections, or bronchitis, or pneumonia, and these are caused by either viral or bacterial pathogens.
Streptococcus pneumoniae is a common bacterial infection for lower respiratory infections.
See here, the pathogenesis for these are whatever the pathogen is.
So for upper respiratory, somebody's inhaled droplets of a microbe, and they are replicating in a way that the body can't manage and we can't fight off leading to redness, edema, hemorrhage, and then sometimes the exodus that we're, you know, triggering our cough with For lower respiratory infections, we get these in a similar way through inhaling droplets or or aspirations from other people around us.
We may also get it from sharing utensils.
But just like upper respiratory, we end up the infection ends up causing inflammation, mucus secretion, and then limiting our pulmonary function.
Now, somebody with a severe lower respiratory infection, we worry about fluid buildup, potential necrosis in the lungs, and small blockages of the airways leading to pneumonia.
Or other various obstructive disorders.
So what are some common symptoms?
Well, let's start with upper respiratory infections.
Runny nose, Carissa, I believe it's called, which is the right nose, Stuffy nose, sneezing.
But often, there's not a fever.
If there is a fever, They're gonna have difficulty breathing, maybe muffled speech, drooling.
They may have an increase in heart rate.
They may have some respiratory sounds like strider or wheezing, and then potential cyanitis.
Are bluing of the distal extremities and the lip area.
For lower respiratory infections, a cough, fever, chest pain, tachympenia, or increased respiration, and then production of phlegm or sputum.
Now, Going back to the very first pathology, we talked about pneumonia, patients with pneumonia, a megs of it, no respiratory symptoms but are confused.
Have a headache or tension in their upper cervical spine and head.
They might have general malaise or fatigue, abdominal pain from the coughing, nausea, potential vomiting, and possibly diarrhea.
Excuse me.
As a healthcare provider, we need to be able to evaluate this to make the the appropriate referral pattern or to begin some type of intervention.
So going through our bay basically, our basic evaluation history signs symptoms, and then our physical exam, again assessing our vitals, looking at the heart rate, blood pressure and the respiration rate to see if there's any abnormal ranges, doing pulse oximetry, to see if supplemental oxygen is needed, or an immediate referral because it's the approved oxygen saturation has dropped too low and being able to do a thorough, excuse me, a thorough oscillatory assessment of the lungs to see If we have any abnormal sounds, absence of sounds, and knowing specifically what lung it's in, what part of the lobe so we can make the most appropriate referral with the best information.
Now once we do end up making a referral for this, 1 to be reassessed by a medical provider, 2, to potentially do diagnostics.
Looking at this from CT scan or a x-ray to see if If there's any inflammation that we can note, doing a a a pulmonary functional test, So the peak flow meter or spirometry.
The physician or medical provider is also gonna do a a culture or a swab to see what the pathogen is, the microorganisms that's causing these infections.
How do we treat it?
From an AT standpoint, we monitor their vitals.
And if need be, the pulse ox is dropping low, we can put them on supplemental oxygen, but we need to get them referred to the most appropriate provider, whether that's their primary care provider or to an acute care or emergency room depending on their signs and symptoms.
The treatment's gonna be an antiviral or antibiotic to treat the infection.
What do we got here?
But we can recommend they stay hydrated, get good rest, taking their medication as recommended, as recommended, and then making sure they're they are getting tested and vaccinated when appropriate.
And the vaccine is looking at something like the flu.
How do we prevent this?
Well, if we get our our vaccines, if they're available, and if It's warranted, making sure that we as healthcare providers use our protected barriers, our gloves, our our gowns, our goggles, our masks, and then just practicing good hygiene, making sure we're washing our hands and using our protective barriers.
One thing I did want to talk about, and most of you probably know this But with COVID happening a few years ago, the World Health Organization and a few medical groups, the American The Journal or the American Medical Association did a study that looked at the travel distance of respiratory discharge from sneezing and coughing and the direction.
So when you think about preventing, people are gonna get sick.
And with our athletic populations and most of them are in these cohort based settings.
Now, if they are sick, stay home, isolate, get treatment, rest.
But you can encourage them when they cough, if they're not wearing a mask to cough into their their elbow or their their clothing, cough downward instead of outward, coughing into their hands downward to try and prevent this exhalation of droplets coming out of an infected person because the the new data is showing that these droplets can travel up to 27 feet, and they are moving when they leave the infected person's body upwards of a speed of a 100 feet per second.
So practicing management of the illness and of the exhalation of the infected people could be helpful.
And then return to pay play guidelines.
If they have a fever, a fever needs to be gone, and they need to be symptom free.
So their pulse ox needs to be normal, respirations need to be normal, heart rate needs to be normal, If they are taking medications, it's a good idea to have them finish that medication before we make a full investment on whether they need to return or not to ensure that the infection is gone.
But one thing that we should probably talk about with with respiratory infections and these other respiratory pathologies is creating policy around these.
Now, I think COVID highlighted this for us, and we created return to play protocols.
We created management protocols for those that are infected and testing protocols.
It's not a bad idea to develop policies and procedures for your health care team at your individual settings, and not just for COVID, but looking at respiratory infections, looking at pneumonias, having policies and procedures will streamline the steps that need to happen and the the care that should be provided for for most of these pathologies.
So consider as you are treating your patients and seeing these potential pathologies both in an emergency settings and in your your clinical settings.
Let's have a policy.
Let's start drafting some some language that can help guide our practitioners and our administrators in the care of our patients and our student athletes.
On that note, Do we have any questions?
Right.
Great job, Chris.
Let's see here.
If you have a question for Chris, I got I got some, but I'll let others go before me.
When we clean the coast here, the coast, the coast here.
And, Chris, this topic It's interesting to me, and as I was sitting and listening to you with pneumonia, pulmonary embolism, spontaneous pneumothorax, type of ventilation, respiratory infections, and we didn't I mean, that's the shortlist.
Right?
We didn't get to asthma or even Chlorisy and others.
And Then you mix in the cardiac side with acute coronary syndrome, cardiac tamponade, a cardiac section, like, pretty soon, it's like a it's like a stew pot of things that can go wrong.
And so an athlete walks into the athletic training room, and he just says, man, I just don't feel good.
He's I got, what's wrong?
My chest pain.
I just can't catch my breath.
Like, what could that be?
Right?
Like, like, what could be going on?
And so as an athlete trainer, You have to start pulling apart, like like, what exactly do I have here?
And and it doesn't have to be an athlete trainer.
It could be on the field during competition.
I'm taking a look at differential diagnosis, and you have athletes, and you have this this this huge list of things that could be wrong in the respiratory to circulatory.
When do you know you've crossed a lot where you have to now activate your emergency action plan and I left somebody
real quick.
I'm sorry, Ronnie.
Maybe on my end, let me check.
Got you.
Am I still here?
Thumbs up in a chat or somebody can still hear me.
Yeah.
Good.
Take care.
Hi, Chris.
Are you still there?
Like that.
I've lost our audio.
Everybody.
Is it on my end, or can you hear Ronnie?
Yeah.
I can hear.
Yes.
Okay.
Let me see what I can do on my end.
I apologize.
Yeah.
No problem.
I can give the host back to you and let's see if that helps anything.
Well, we work on this this issue, which is you gotta love technology.
Right?
It is what it is and would do our best to resolve it.
And give it a few minutes here for Chris and to work out this audio issue and then we will continue on with this next two sessions.
So Chris can use No problem.
Chris, we can hear you.
So, Chris, can you hear me?
Go ahead and speak.
I'm sorry.
I think I fixed it.
Yeah.
Never get sweet.
Alright.
Alright, Chris.
Chris, the eventual diagnosis, like, this is a This is a stew pot of potential problems that could happen.
You listed out all of the unique signs in symptoms.
Tell me where you would go, what what path do you start to try to decide this is pulmonary embolism, and this simultaneously, like like, it could be bad stuff and you can't just assume, where do you start in the assessment to try to distinguish any of these are legit?
Issues that need quick activation.
Yeah.
I'm a large proponent of a thorough medical history, and understanding what's going on in their life outside of what I've seen.
So making sure that I'm asking very specific questions about their their personal history, their recent health history, and then family history.
We can get a lot of information to sift through from that detailed history I can get from them.
And I would prod different questions based on the response that I'm giving and the signs and symptoms that either I'm seeing or they're telling me about And I would go through a mental list of potential pathologies that I might consider or the differentials like you'd said.
And then I would lead into my my mechanical assessment.
So looking at the the vitals that would tell me, okay, I'm rolling this out, rolling this in, as opposed to what pathology I might be looking to rule out or rule in.
So, respiration, count, respiration, heart rate, Polsox is gonna be a big one with all these.
But the medical history, the evaluation gonna take me down a path to rule things in or out.
And what what what I'm thinking in my head for potential pathologies.
Yeah.
So what would what would the criteria be on any of these to say now that you have sorta isolated it down, maybe what it's not like not asthma because I don't hear wheezing.
No history.
And you've ruled out respiratory infections, and body got a good history.
And they just are still struggling, and their chest is still are.
When when do you know you've you've sort of crossed the line?
And I know that's a pretty vague question, and I could drill down deeper.
But when do you know that that this respiratory system is under stressing out to where it's beyond the scope of an athletic trainer, you need to be moving.
If the pulse ox is dropping and I can't get it managed, that's gonna be a a key indicator for me.
But any any cyanosis any light headedness or dizziness they're getting that's progressively negative.
I'm gonna send them out.
The the the patients I've had over the years that that have had any of these respiratory elements that transition from normal sensation of the peripheral extremities to the tingling is a good indicator that something is is spiraling out of control in their Their the oxygen is not getting to where it needs to be.
So the bluing of the digital extremities, their respiration in the the amount and the volume that's changed.
If they're picking up their their respiration count and they're shallower or or they're longer with a deeper breath.
Anything where I notice that their pulmonary system is becoming more and more stressed I'm gonna progress the the the the call to EMS or jump in the car and take them to our local urgent care or ER.
Yeah.
I know my rule of thumb is you don't play with the respiratory system.
It is not a it it's very conservative and, like like can you say in the last one, especially when you don't know a history.
It's like being credibly conservative and moved forward.
And if it resolves itself in that interim time, then it resolves itself and you sound a refusal of care.
Are you you go back to your normal life or whatever, but it is one where it is quite challenging to pull apart.
All of these respiratory conditions into underlying calls and requires experience and expertise to do just that.
So Alright.
Chris, any any last words before we wrap up?
I don't see a question yet, but any last words of wisdom to athlete trainers that are looking to continuously grow and learn more about how to be better at evaluating and treating your respiratory system.
Yeah.
Don't don't forget the basics.
Start with the basics that you learned in your your athletic training program or in your your education.
And if if you're signs and symptoms and your your your gut is telling you, this is something I need to refer out.
Refer out.
Don't second guess yourself.
It's always better to get them to the advanced care than it is to delay the care.
So trust your gut, trust your your clinical expertise and win in doubt, refer out.
Excellent words of wisdom, Chris.
I hope you have a a good day today, and good to have you here.
I'm sure we're gonna have you back.
We have a lot lot lot more in emergency medicine that we will provide for half of the trainers.
Will have you back in in due time.
So
Respiratory Conditions and Underlying Mechanisms
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Updated Jan 22, 2024
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