Transcript
Morning.
As you see, I've got, Karen doctor Karen Stanton online this morning.
So, Karen, how are you doing this morning?
I'm great.
How are y'all?
I'm doing fantastic.
So just a quick, intro with Karen, and I'm gonna give it over to her.
So, I'm excited to have Karen on board.
We've talked about this for some time now, and, I've known Karen for probably 25 plus years.
Worked with her some and when she was here in Louisiana, but, she brings a a tremendous amount of experience, especially in the emergency care realm.
On our topic today, she kicks off this morning's session.
She's a 90 1998 graduate at University of Georgia and also, where she got her, athletic training credential through that program.
She earned a master of science and sport health care from A.
T.
Still University and also is current is also credentialed as a, strength, NSCA strength conditioning, specialist as well as an EMT.
She's in she's already completed her doctorate in May of 19 from Auburn University in Higher Education Administration with a focus on financial management of medical care expenses and student athletes in higher education.
Also, she's, like I said, she's done so many things.
She can tell more about it than I can, but, just fantastic person, I think, from a a from a recognition in the in the athletic training profession, she has been the recognized previously as the Alabama Athletic Trainers Association collegiate athlete trainer of the year in 2004.
She's received the award of merit.
And then in also in 2020, she was entered into the Alabama Athletic Training Association Hall of Fame.
So that's a mouthful, and I'm gonna turn it over to you, Karen.
Great great to have you here this morning.
Well, thank you so much, Ray.
I really appreciate this opportunity, and welcome everyone here.
So, yes, I've been in the field for quite a while.
I love it when I say, yes, I was credentialed last century, which is a 100% true.
And I'm an internship kid, so all the things that I do, the EMT, the CS, CS, all that stuff probably comes from that.
Being an internship route athletic trainer, which most of you may not even understand anymore.
You had to serve so many hats, so you got excited about so many hats, and and, therefore, that's where that all that comes from.
But let's go ahead and get started.
I don't share a screen.
Right?
Like, I don't share my Yes.
You can.
Yes.
Yeah.
Okay.
Yeah.
Because I tried that, and it says that I can't share it.
It says host is
Let's see here.
Let me try this.
Okay.
Now now If
they can just look at me, it's fine.
Yep.
So while you're doing that, you should be able to pull your your pull it up pull your PowerPoint up now.
We've got a great group of people coming on board this morning from Texas to North Carolina to, down in, up in Minnesota, even from Dubai.
So we have, folks logging in.
So excited to have everybody here.
So, Erin, you're able to, let me know if you've,
There we go.
Okay.
Now it's working.
There we go.
So I'm gonna give it over to you, then we'll turn off here for a little bit.
And just remember, everyone, if you have any questions, go ahead and pop them in the chat, and we'll get to them during the q and a session.
Okay.
And, also, everyone, since I explained I'm old, I can't monitor chat and run all these things, and technology is never my friend.
So I'll go back and look with that.
And, Ray, if you help me, if someone has a question specifically for me, I would obviously be happy to answer it.
Yeah.
I'll I'll I'll monitor those so just be able to help you out there.
Okay?
I just wanna be honest about what my gifts are, and technology has never been won.
And having said that so let's just let's get talking about asthma and how this works from a management and athletic training.
So a bunch of things to talk about.
We always wanna make sure that we consider state laws and practice acts.
If you are lucky like me and travel in your job, then you're gonna cross state lines.
You may be working for more than one entity licensed in more than one state.
My home locale is within, 20 miles of a state border, and so it's not uncommon for athletic trainers in my community to live in one state and work in another.
So I always wanna make sure we know what our practice and state laws are.
Your employer policies are obviously gonna have an input into what you do, what you don't do, sometimes what you carry and have access to.
So make sure that you're paying attention to all of those things.
For us, supervising or directing, however you wish to say that physician orders, or that relationship is very important.
I make sure that my physicians that work with me stay abreast of our practice act and developments of possible changes to that so that they can advocate for us so that we can better advocate for our student athletes and make sure that we're doing everything we can in an educated legal format to help support them.
One thing I am super excited about and have been since we've been doing it is considering practice setting.
I know that this is a sideline management type of talk or it's kinda focused on that, but I do not wanna discount the what have been called emergency practice settings or the nontraditional settings.
As athletic trainers are moving into these new spaces, you're not dealing with the adolescent or collegiate age athlete necessarily that has a certain assumed health status.
When you're moving into these other spaces, I have colleagues who work with fire departments in Texas, Texas, who work in the industrial setting in Alabama and in Louisiana.
Those patients your patients have different health status because sometimes they have different age, they have different educations, backgrounds, and their exposures are vastly different.
So you need to make sure that you are considering your patient's health status variance based on practice setting just in general.
Also, all of those new settings bring new challenges that sometimes we, in a, quote, sideline or on the court management, don't have to consider.
So I wanna make sure that that's a point that we make.
Going back to how to size up a scene, what we're looking for.
Always, always, always, you're wanting to determine how safe the scene is.
If you go into an unsafe situation or take other health care workers with you, you can become an additional patient, an additional stressor to your emergency action plan.
So we wanna make sure that we are assured that we are entering a safe scene.
Again, I can take something very specific to that.
If you're in an industrial setting, you have chemical exposure there.
If you're not sure that that's under control, you can create more patients for EMS.
Determine the nature of the illness.
In this case, we're talking about asthma, which as you know, is an, inflammatory of the bronchals sorry.
It's a respiratory condition characterized by chronic airway inflammation, and a difficult difficulty in exhaling.
So the nature of illness for asthma to consider as your sizing up the scene, what triggers are present, included but not limited to?
It's interesting that exercise is denoted as not not only a trigger, but a potential solution in management.
For asthma, outdoor air pollutants, allergens, dust, pollen, any type of respiratory illness or infection.
Air temperature is a big one.
Also, air humidity can be a big one depending on what your patient has a history of experiencing.
Certain sensitivities, smells, chemicals, fumes, those can all be triggers for asthma.
And there are all different ways to manage or prevent those depending on which one you're dealing with.
Emotions from a hyperventilation standpoint can also be a trigger.
So we need to be aware of how of how our athletes or our patients are responding.
There's a heightened airway sensitivity, allergens, pollutant exposure.
Again, temperature have been coined as a unique aspects to athletics.
Although we find those in the normal population as well, that is one that we wanted to bring up.
From a scene size up standpoint, once we determine what triggers are there, we want to know what medical condition status we have.
Have we identified and managed this asthma, or is this a case where the asthma has not been effectively controlled or compliance to the treatment plan has not been followed?
If this is an acute distress situation with a medical condition, and a cocondition of asthma, we have to assess what the trigger is, if there are additional things in play, and make sure we know what's going on.
Once we've done all that, we're addressing, obviously, life threatening according to training in the EAPs.
If you are in acute distress, that is referral to, emergency department for support and follow-up care.
That is activation of your EAP.
That is activating EMS if you are in that situation.
And do not do not do not hesitate to do that if your evaluation and scene assessment dictates that that's necessary.
Once we're getting into the more primary assessment where a general impression of the patient is necessary, we know the common signs of asthma include that tightness in the chest, coughing, wheezing, inability to control breathing.
A lot of us have seen our athletes or patients experiencing these before, and we wanna make sure we see which ones are going on.
Chief complaint or what's present currently, what symptoms, what signs are present currently are something we have to assess.
The ability to assess basic vitals, I understand that not everyone runs around with a BP cuff and and pulse oximeter and all of those things, but you can assess respiratory function.
You can assess pulse.
You can assess those things, without all the bells and whistles.
If you happen to have the bells and whistles, that's great and wonderful, But I do not make the assumption that everyone has access to all the fancy equipment out there in order to assess these, so do the best that you can.
There are a lot of ways to assess vitals, with just a BP cup or with just your brain, your hands, and your medical background.
You also wanna consider other interventions in this assessment.
Oxygen therapy is something that has come into the field of athletic training, and there are physician statements and protocols for that.
Also know what patient medications were in use, hopefully, if they're on a positive management straight up strategy or if there's a rescue medication that needs to be utilized.
Most, in the position statements to the NATA athletic trainers are recommended that their patients carry their inhalers, but also that we have rescue inhalers.
That's one of those times where your physician's orders, practice acts, employer policies are gonna come into play.
So make sure that you've talked to people about those things.
Secondary assessment.
This concept of q excuse me.
O p q r s t, an acronym that I've listed below in case you're not familiar with it.
Make sure when you're doing this secondary assessment that this is a conversation between you and the patient.
You want to make sure that your assessment is a reflection of them.
So when you're looking at someone who's having trouble breathing, who's having that chest wheezing, remember that they're going to be anxious, and they're going to be looking at you to calm them down.
They're gonna be looking to you to help them move into the safer space of this and relax the episode.
So your calm and rational and organized approach to this is gonna be very important, but don't lead them.
So onset, when did it start?
You may know this.
If you're there with the athlete, you may be aware.
You may have seen this happen as a result of participation in athletic activity.
You may have seen it as a result of change in venue.
You may have seen that come on because the pollen count is up, and you know that your athlete with asthma is very sensitive to that.
That's one of their triggers.
But you still need to try to ask them these questions so that they can determine the answer, and you're not making assumptions.
What provoked it?
What makes it worse?
What makes it better?
As well as what started it is an important piece here.
Quality.
What does the pain feel like?
A lot of people like to ask, is it sharp?
Is it dull?
If you do that, it does lead the patient.
If the patient is unable to generate a response, sometimes you can fill in some examples, and that may help lead them to some degree, but you wanna be careful about providing them an answer to a question because an anxious person is going to rapid fire, things like that.
Quality, you wanna know what it feels like.
Radiate, sometimes that word doesn't make sense when people's emotions run high.
So asking where does it start?
Does it move?
Show me where it goes?
Can you point to that?
Can you show me the path of travel?
Sometimes that helps.
And, again, having that conversation with them sometimes can calm help calm them down.
Severity, I like to use a 0 to 10 pain scale because we like some type of objective data to report in a situation like this.
But that is a subjective objective data if you wanna look at it that way.
Asking somebody to rate their pain on a 0 to 10 pain scale, you're gonna get one answer from 1 person and a different answer from another person that may be experiencing the same situation.
But you can use those numbers and changes in those numbers as the episode progresses to monitor what's going on.
If you weren't present when the episode began, you're gonna wanna know how long they've been experiencing it.
This is also okay to ask bystanders.
In an athletic situation where a lot of people are together exercising.
You may be able to get that type of information from someone else who was present if you didn't actually see the event begin.
Secondary assessments also include a sample history.
So you're gonna want to know the signs and symptoms.
Again, we've talked about the signs and symptoms with this, chronic respiratory condition being in an active episode.
They're gonna be coughing, wheezing, complaining of shortness of breath, complaining of trouble breathing.
You're gonna need to know any allergies that they have.
That's gonna be important, including just exposure to triggers such as pollutants.
Medications that they use, you're gonna wanna know all of those medications that may impact us, but definitely the medications they may have used directly prior.
If they have an EIB type of medication that they're supposed to use 10 to 15 minutes before exercise, did they actually do that?
Any other medical history that you're gonna wanna be aware of, the lateral intake of of anything so that if things progress in a certain method, you already have that information.
And any events or descriptions of what happened directly following directly preceding, excuse me, the incident, you're gonna wanna understand those.
And those also may be pieces of information, again, that you can provide since we know that air pollutants, and air quality is a trigger for asthma.
If those were already in play, if you know the pollen count is high before you're going out to your outdoor practice and you have someone with asthma, that's something that you can bring to the table, as well as getting information from them.
Management strategies.
Okay.
So there are a lot of different ways to do this.
If we know and can avoid things, athletic training at its core for me is still a prevention type field.
So if we can go and look and see, oh, maybe if we alter this or change this, so we can have a better outcome.
Breathing techniques, if you can, if it's safe again, if you're in acute respiratory distress, you need to go straight to the emergency department for that management.
But if you're in a situation where you can attempt things such as nose breathing, some people use a mask breathing, through a moistened cough.
I prefer a nose breathing technique to try to slow that down and work with them, stay with them, focus with them, and almost talk them through it.
From a management strategy, trigger avoidance is huge.
If you know that you have someone again, I'm picking on air quality and pollen because it's the time of year here.
But if you know someone is triggered by high pollen counts, can that person exercise indoors?
Can that person exercise at a different time?
What changes can we make to the exercise environment when possible?
I also recognize that it's not always within our right or ability to move a practice because of a high pollen count.
But what can we do to reduce that trigger or reduce that risk?
Making sure that they have done proper and progressive warm up for activities.
This is a big one for asthma.
It cannot only help reduce the management long term, but it helps allow them to acclimatize to the situation.
Medications.
So if we're using something like, a pre exercise inhaler like an albuterol, making sure that they're using that in an appropriate time frame.
And if they didn't, being able to help with their asthma action plan, monitor their use in that as the, episode starts to occur.
There are several other medications.
There's a lot of different options here.
Inhaled corticosteroids are used sometimes, not in a rescue situation, and sometimes the long acting beta agonists, which are recommended to be used in conjunction with the inhaler corticosteroids, Flivent is one that a lot of us have seen.
Those are also potential in this situation.
For management, if the situation progresses further than can be affected with what strategies you have in play, make sure that you are aware of what your EMS strategies are, how long they're out, and what other referral options are there.
From a management thing, I also make sure that I always do post incident follow ups.
So from a management standpoint, after the event is over, what can I do to make the situation better the next time?
And so I'm gonna look at medication reviews for this athlete, say what worked, what didn't.
Have you had your 6 to 12 month, regular check-in to make sure that this is still the best asthma management plan for you?
Making sure that they are compliant.
I know that everyone besides me has patients who listen to them all the time and follows all the directions.
But if you have a patient who maybe is not as compliant with their management medications as they need to be, that's one person I would bring into the doctor's office with me and say, let's go over this.
Let's make sure you understand why this is important and what we need to do to make sure that you are as successful as you wanna be in this space.
And a lot of times, it's simply reeducating them again after an incident, and they will likely increase their compliance.
Going back to the prevention piece of this, pre participation physical exams is where you're gonna get your number one piece of information.
Do they have asthma?
Do coming in, do you already know that?
Do they have just exercise induced type situations, Or are they coming in with signs that they may have asthma that's been undiagnosed, and therefore, we need further follow-up testing.
So your pre participation physical exam is a great place to start.
And if you're bringing in a new athlete and they then have medications that you're using maybe that are not allowed within your space, you have to remember that the ISOC, the NCAA, NAIA, they all have regulations, and you wanna make sure that whatever their doctors before they got to you have given them are still appropriate use for them from a legitimate standpoint and a non banned substance standpoint, but you also wanna make sure it's the best for them at this stage of life and at their medical condition that they are at.
So you wanna review that plan with them.
Make sure that they understand the use and they understand the importance of compliance, and work with them as much as you need to so that that they can become empowered to manage and own that themselves.
One thing about medication review, updates, and changes to the plans of the medications may be necessary when you relocate to go to school.
We have several student athletes who come from various aspects of the country.
And when they come, quote, to the south where the pollen count gets really high and it's abnormal for them, they have increased triggers.
They have new triggers.
So we wanna go over the fact that changes in geography can be important for them.
Also, changes in humidity, changes in temperature and air quality, those will also be effective triggers due if we're going to have someone traveling into those types of spaces, how we need to best manage and advise them so that we, again, work to prevent these attacks.
And traveling for competition is a special consideration.
You're not looking at a long term change in geography, air quality, air temperature, humidity, but you are looking at a shorter term one.
And will that impact your athlete or not?
That's a discussion to have prior to heading on the road.
So in conclusion, key management techniques, you wanna make sure you have a correct diagnosis and the correct identification of the condition.
You wanna make sure that your patient has the ability to control the symptoms.
And, again, prevention is the key here.
As much as possible, you wanna prevent, an acute situation.
Reducing complications, making sure that they're correctly using their medications.
They're not mixing medications.
Also, athletes sometimes have a tendency to borrow things when they forget their own things.
This is not a situation where that needs to happen.
Their medication needs to be just theirs.
Always review a plan.
Just like when you're doing your emergency time outs, before an event.
You wanna make sure that when somebody has a medication plan that they need to follow, that that is reviewed with them in a proper manner and that they're given the ability to ask questions or update.
Compliance with medications.
Again, making sure with acclimatization, different seasons.
Do we need to change things?
Do we need to watch a little closer and look for the possibility that we need to have a different action plan in place?
Evolution.
As things continue, you're gonna get more updates and more trainings, both for patients and caregivers, and you need to stay abreast of those.
Always advocating for your patient to make sure that they are an active person in their health care.
That's a big thing for me personally and professionally.
I wanna make sure that I am empowering my student athletes to become their own advocates, and so that does start with our relationship here and our relationship with our physicians who are assisting us.
So if that helps you in your management strategy, feel free to use it.
It's one that I really am passionate about here is empowering them to, again, advocate for themselves.
Different resources.
And then like I said, I can provide lists, if we need to.
I love the CDC sites for these.
I love the, national registry for EMT.
It has a lot of great information on emergency management and distress.
Again, the NATA, their journal, and their position statements are great resources for these types of things.
And I always like a good peer reviewed journal article.
I try to read those and review things as much as I can to make sure I'm staying abreast in all the spaces, that I need to, again, to advocate and empower my athletes.
So that that is me.
Fantastic.
That was a great overview, doctor Stanton.
I think, this is one of these topics that, you know, we talk about airway management.
It's it if you don't know the athlete, or you're dealing with, that becomes I I have a question about that in a minute.
I know there are some a lot of things are coming on board.
I know I have I wanna first get to our audience questions.
So I already have one sitting out there right now.
Okay.
For everyone there who's online, if you would, on the if you're in the Zoom call, just if you'd like to raise your hand, and I'll turn we turn the mic on, and you just have that conversation directly with doctor Stanton.
We can answer that question.
We always like that bird as but we will take the written version as well.
So, Jason, who is in Cabot, Arkansas I know, Jason, good morning.
And his question is, from a management standpoint, what about the sipping cold water or the breathe versus kinda kinda drown of the autonomic trick on the brain, or with nose breathing.
What is does that I guess, from, what I'm guessing from Jason, that was what he asked is how is that are those effective, effective, strategies or anecdotal strategies that typically do work in addition to your proto like, your written protocol that you're putting in place as well?
Right.
And I think that's a a big challenge when as I said, I've worked in situations where I have a significant amount of resource, and then I've worked in situations where I'm trying to figure it out.
And if you're in that situation, I don't know that there's any, statistically, significant data on, like, just drinking cold water.
I do know that nose breathing are slowing down the breathing.
If you have a constricting airway, slowing it down is not going to change the constricting airway, so you're gonna have to have another intervention.
You need to pay attention to the life saving things first.
But if you are in a situation where let's use an example, recently had an athlete that has an emotional trigger, and the hyperventilation, the chest pain, all of that was coming on.
For that patient, since I knew that patient had interaction there using a breathing technique such as a nose breathing technique to slow it down, was able to impact their situation so that we can make the next movement.
Recognizing that all these anecdotal things, if you try them, do not let that be your primary source.
Make sure that you're following the the asthma action plan that you were given.
And if definitely medications are involved.
Make sure you're utilizing those, in an attempt to address the episode.
Does that answer your question?
Yes.
I think it does.
Okay.
The, one thing that, I guess I'm getting another question for I shared this on Facebook live.
I think the just know that, also, this webinar, you can share it on Facebook live.
If you're also logging in to get, this have a recording of this as well.
This get we do have a caller who's I mean, one of the listeners who I'm a I'm a jump in on I'll turn the audio on.
But while I'm doing that Okay.
You hit on the kind of a critical part of this is is the the priority for interventions.
And I think this what what Jason's question gets us to the to the heart of how we're handling this is a medical emergency, and we have to we're thinking of from a men from a from a from a psychology standpoint, a mental health standpoint.
This is a this is a crisis.
So they're going into crisis mode because they are, high they're losing ability or hypoxic.
They're starting to decompensate pretty fast.
And from a priority standpoint, it is getting them a rescue rescue medication, oxygen, and continue try to control them through those various methods, but making sure you have something consistent in that process, correct, with, your protocol?
Correct.
You wanna follow protocols.
You wanna make sure that even in the back of your mind, if you're making if you're making progress in respiratory, even if it's mild respiratory distress is not a is not actually a term at all.
But if you're early in the process and you're intervening on behalf of your patient, you in the back of your mind still need to have the the emergency action plan ready to go.
Because if they decompensate and you have continually monitor them, if they decompensate and their rescue inhaler or your breathing techniques aren't making the intervention better, you have to be ready to pull the trigger and do the next thing.
So solving the issue and making sure you're paying attention to the life saving strategies are paramount in this.
Yeah.
I think with that, we get you know, think about the scene size up, those questions you mentioned, getting into recognizing if there's a problem with, circulation airway breathing, and that address those interventions immediately.
And then think about you'll get the vital signs after that.
You don't need to wait.
I'm trying to do a vital sign since you know that they're having a problem.
So, Jeff, you're Jeffrey, you're on the call.
So can you hear can you, you're you're good to go.
Jeff, you can turn the mic on, and if you would ask your question, we got time for one last question, and we can move on move move on with our next, presentation.
Hey, Ray.
Thank you.
Appreciate it.
Karen, you there?
Yes, sir.
Yeah.
Good morning from Arkansas.
Quick question.
Yes.
As we are called the natural state here, this pollen and every everybody else does.
Which environment, fall, winter, cold, has the highest exacerbation of of, asthmatic symptoms?
Is or is that very given whatever anybody else's physiological makeup?
I'm just wondering what season is it?
Cold, summer, rain?
I'm just trying to, you know, kinda give some heads up, you know, when athletic trainers need to be more aware.
If somebody's an asthmatic on there and one of their teams, this this type of year of environment, is probably gonna be a red flag or just to be more aware of.
Yeah.
You're gonna hate my answer.
So for us, pollen is a big trigger for a lot of the athletes I am managing on my roster.
But I have other athletic trainers who the sensitivity to temperature, that hypersensitivity in ventilation and breathing in cold air is a trigger for one of them, I'm thinking.
So, I would say it is a general idea when your air quality is highly affected.
If you're an outdoor sport with pollen or pollutants, that's gonna be your big time.
That can also be weather dependent.
Remember that sometimes with air quality, humidity changes, concentrates that differently than if that's not there.
So I think it it's gonna vary greatly.
I know for me, most of my asthmatics have its inhalant, its pollutant, and its pollen that gets them.
But I do know that sensitivity to air temperature is another one.
Like ice hockey.
We're up in the cold areas.
Well and like I said, you know, the other thing too, don't forget, you're thinking of all and we tend to think of outdoor, but I also know athletes, for example, swimmers who have sensitivity to inhaling the chlorine.
So since they're indoor in pools all day, you've gotta consider that.
So it's really it's environmental specific to each patient.
Overall, I would say pollen is probably our big one down here, but you really gotta consider your patient and kinda know their triggers.
Great.
Thank you, Jeff.
Okay.
I'm a take one last question.
We had a light hand raised.
So, Karen, go ahead and ask your question real quick, and this will be our last one, for this morning.
Karen, good morning.
Good morning.
I have found that if you put your hand on their back or their arm and you rub it in circles, deescalating from the point that they're at, that their breathing will follow your hand movement.
And I also say slow down, and you bring the cadence so that it is just a little bit lower than where they are in their breathing, and it it can help the situation a little bit faster sometimes.
And that's a good point.
I agree with that.
The the hands on approach, I am a big human contact person, and I think anytime you can develop and increase the human contact points between you and your patient, obviously, making sure that the boundaries are in place and that you're being sensitive to if they do or do not like to be touched.
But anytime you can develop or intensify that relationship where the 2 of you are working together, breathing together, where you're actually laying your hand on someone so that you have that human contact.
I do.
I agree with you.
I find in a situation where things are escalating and the motions are getting high, that that does help bring people back down.
Yes.
That's a very good point.
Thank you for sharing it.
Yep.
Definitely.
I think it wraps up.
Definitely, the the the end point of that is, calmness is contagious.
And I think that's a that contact, controlling the situation, knowing how to get them, the the importance of, having that you've gotta get the critical intervention in, which is gonna be medications for an asthma patient, also oxygen administration.
That's all part of that, but those definitely there's a nice little key.
That's a great ending comment question by Karen that, to do those hands on things that you can help calm the patient the best you can.
So with that, Karen, great, having you here this morning.
As always, great to see you, and good luck this this weekend with the, championships.
And, where are you exactly now?
You you're in
I'm in Ocala, Florida.
Yep.
For the equestrian championships.
Correct?
Yes, sir.
Good deal.
Good deal.
Well, best of luck, with that as well, and, we look forward to having you on here again soon.
Yes, sir.
Thank you, everyone, for letting me be here.
Y'all have a great day.
Great.
Thank you.
Great.
So we've got, Karen's jumping off and signing off, and we're gonna have, our next speaker, Caitlin Place, come on board.
Asthma In Action: Fast Track to Managing Athletic Respiratory Emergencies
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Updated Apr 23, 2024
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