Preparticipation Physical Examination

 

Name:                                                              Year in school:

Date:                                                               Phone number:                       

Sex:                                                                 Birthdate:

Address:

 

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Height   ____________________________      

Weight  ____________________________

Vision   ____________________________  

Hearing ____________________________

BP         ____________________________ 

Pulse     ____________________________       

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Orthopedic and Doctor Evaluation:

 

Body Part	Normal	Abnormal	Notes
Head, face, scalp
Neck
Upper extremity:      Shoulder      Elbow      Wrist      Hand
Lower extremity:      Hip      Knee      Ankle      Feet
Spine
Abdomen
Ears
Lungs
Heart
Nose and sinuses
Endocrine system
Neurological system

           

- – - – - – - – - – - – - – - – - – - – - – - – - – - – - – - – - – - – - – - – - – - – - – - – - – - – - – - – - – - – - -

Notes on EKG results:

Notes on Blood work:

 

*Results will be stapled to back of this form

Have you had any of the following health problems? Explain positive answers below

 

	Yes	No
Diabetes
Epilepsy/Seizures
Heart Problems
Lung Disease
Kidney Disease
Chronic Skin Problems
Liver Disease
Hepatitis- Types A, B or C
Drug or alcohol abuse
HIV or AIDS
Hearing Problems
Vision Problems
Back Pain
Psychological Problems
Paralysis
Other Health Problems

 

 

List any allergies you have to medications:

 

 

What medications do you take on a regular basis?

 

 

 

 

 

SOAP NOTE

 

Patient: Joe                                                                              Examiner: Ashley Bowen

Date of Injury: 3/12/05-4/12/05 (On-going)                           Date of Evaluation: 4/12/05

Area of Injury: R wrist

 

 

Subjective

            History: 40 y.o. male golfer.  Pt. stated that he did not get a direct blow to the

Wrist but that the problem has been ongoing.  C/o pain in wrist c numbness down into the hand (middle & ring fingers).  Pt. stated that pain and numbness increase at night & he would wake up c a numb hand.  Pain rating at night is 6/10 & during that day it is 2/10.  No h/o previous injury to the R wrist.  Pt. also stated that he does a lot of typing at his job and the pain and numbness has been an ongoing problem, getting worse c time.  He has not done anything to help treat his wrist & has not seen any doctors for it.  Also, flexion & extension of the wrist was a little bit painful.

 

Objective

            Observation: Pt. was point tender over carpal tunnel on R wrist w/o crepitation.  There was a little bit of swelling in the wrist but not a whole lot.  No obvious deformity was found, however, the R thenar eminence was smaller due to atrophy of the muscles.

 

            PROM/AROM: AROM: Wrist Flexion: 83               Finger flexion(MCP): 70

                                                     Wrist Extension: 87           Finger extension(MCP):43

                                                      Wrist radial deviation: 20 Finger abduction: 25

                                                      Wrist ulnar deviation: 30  Finger adduction: 23

                                      PROM: Wrist Flexion: 85                 Finger flexion(MCP): 75

                                                    Wrist extension: 90             Finger extension(MCP): 47

                                                    Wrist radial deviation: 27   Finger abduction: 28

                                                     Wrist ulnar deviation: 33   Finger adduction: 25

 

            RROM/MMT: Wrist flexion: 5/5                        Finger adduction: 5/5

                                    Wrist extension: 5/5                    Thumb MP and IP flexion: 5/5

                                    Finger MP flexion: 5/5                Thumb MP and IP extension: 5/5

                                    Finger PIP and DIP flexion: 5/5  Thumb abduction: 5/5

                                    Finger MP extension: 5/5             Thumb adduction: 5/5

                                    Finger abduction: 5/5

 

 

 

 

 

 

 

            Neurological Testing (Reflexes, dermatomes, myotomes):

            Dermatomes- C6, C7, C8 (All WNL)

            Reflexes- Biceps (C5-C6) (WNL)

                            Brachioradialis (C6) (WNL)

                            Triceps (C7) (WNL)

 

            Cardiovascular Testing:

            Radial artery: WNL

            Ulnar artery: WNL

            BP: 130/87

            P: 70 BPM

 

Special Tests: Tinel’s sign at wrist (+), Phalens (+), EMG test showed deficit in the median nerve.

 

Assessment: Carpal tunnel syndrome of the R wrist

 

Plan: Pt. will manage pain c ultra sound & will be given a splint to sleep in at night.  Pt. will also be ordered to stop activities that involve much use of the wrist (e.x. typing).  A cortisone injection will be shot into the carpal tunnel and if that does not take surgery will be needed.

Short term goals: Manage pain c ultra sound pre-surgery and NSAIDS

Post surgery start light strengthening activities such as squeezing a stress ball several times qd

Long term goals: Regain ROM by going flexion/extension activities @ wrist at least once

qd and slowly add and increase resistance.  Get pt. back to how they were pre-injury.

Re-evaluate on: 4/15/05 (before surgery), 4/25/05 (after surgery), and 4/27/05

 

 

ATS signature:                                                            LAT Signature:

Date: 4/12/06                                                              Date:

 

To Roderick McDavis,

 

 

            The current athletic training facility in the Convocation Center has not been renovated since its opening in 1968.  It serves as a primary health care facility for 8 sports teams but lacks adequate space to hold that number of athletes.  In addition to its small size, it lacks the equipment required to provide efficient health care services.  The Convocation Center athletic training room does not serve as an appropriate learning environment for the growing number of student athletic trainers. 

 

            Being that the facility was built in 1968 there is a chance that the materials used back then could pose a serious health concern for individuals now.  We do not believe the current facility will meet OSHA standards.  In addition to its health concerns, the athletic training room is poorly designed and most of the equipment is out of date. 

 

            We would like to propose a renovation of the Convocation’s athletic training facility to help it become a safer environment for all.  Attached to this letter is our zero based budget.  There you can fine everything we plan to do during the renovation and the prices for it.  Please review our proposal carefully and reply with your thoughts and/or concerns.  Thank you and have a wonderful summer break!

 

 

 

 

Sincerely,

 

 

 

 

 

 

 

Ashley Bowen

Ashley Lammers

Greg Schneider

Emergency Action Plan

High School Football team

Address of the High School:

            7348 Tumbelhill Road

            Cincinnati, Ohio 45255

 

Emergency Personnel:

Certified Athletic Trainer(s) and student athletic trainers on site for practice and competition; Ambulance and EMS on site for games; Physician, rescue squad, medical technicians.

 

Emergency Communication:

All athletic trainers and coaches have cell phones, fixed telephone line in the athletic training room.

 

Mike Riden- ATC in charge: (513) 987-0984

Brandon Millen- Head ATC: (513) 795-0004

Tom Winder- Head coach: (513) 884-0009

Ben Biller- Assistant coach: (513) 998-4058

 

Emergency Equipment:

Supplies (Trauma kit, splint kit, spine board) Maintained in the football athletic training room (On the first floor of the building, right inside the east entrance, to the right hand side of the locker rooms.)  Additional equipment is found in the ambulance that is on side at the games.

 

Roles of the First Responder:

Head athletic trainer- Immediate care of the injured student athlete

Athletic trainer in charge- Emergency equipment retrieval

Athletic trainer in charge- Activation of emergency medical system (EMS)

            911 call (provide name, address, telephone number; number of individuals injured; condition of injured; first aid treatment; specific directions; other information as requested)

Onsite personnel- Direction of EMS to scene

            Open appropriate doors

            Designate individual to “flag down” EMS and direct to scene

Onsite Personnel- Scene control: Limit scene to first aid providers and move bystanders out of the way.

 

Venue Directions:

Football stadium is located on corner of Straten Street and Mollen Street adjacent to Wal-Mart.  Two gates provide access to the arena: Gates 1 and 3. 

Miller Street: Drive leads to arena as well as re a r door of complex (locker room, Athletic training room.)

 

 

Sports Medicine Staff and Phone Numbers:

Mike Riden- ATC in charge: (513) 795-0005

Brandon Millen- Head ATC: (513) 495-0485

Justin Watten- Team physician: (513) 394-3048

In case of an emergency Mike Riden calls Brandon Millen and Brandon Millen calls Justin Watten

Hospital number: (513) 487-9405

 

In case of lightening:

If the storm is 6 miles away: The event is called.

If the storm is 3 miles away: Leave the field immediately and seek shelter inside the building.

Return to play 30 minutes after sound of thunder or lightening.

 

In case of lightening, the Athletic trainers (Mike Riden, and Brandon Millen) and  Coaches (Tom Winder, Ben Biller) will make the determination of whether or not the game should be called.

 

If the event is called the team and all the occupants of the stadium will take shelter.  The team will go to the locker rooms and the rest of the occupants in the stadium will go into the gym, the auditorium, or take shelter in their cars.

 

Journal from fall quarter Freshman year:

Observation #1- 2:30-4:30

I went to Nelsonville High School today and observed football with Erin.  It was a slow day and not much went on.  The only things I got to see were one of the players getting his shoulder iced, another player had to be stretched because he had inflammation around his knee, and another player had to have his leg stretched because there was tightness in his quadriceps.  One of the trainers pulled the players leg up and help it there to do this stretch.  She then repeated the stretch on the other leg.  It seems to me that there is a lot of down time in this profession, but if a lot is happening it keeps you on your feet and that is something I want in a job.

 

Journal from Fall Quarter Senior year:  Shows much improvement

Wrestling practice was pretty intense this week.  On Wednesday one of the guys was wrestling the coach.  He took a hard hit right to the head and fell straight to the floor.  Hanna and I rushed over to him to find he was very out of it.  He started laughing uncontrollably then immediatly started to cry.  We knew he had suffered trauma to the head but we were unsure of just how serious it was.  We continued to evaluate him for a concussion by asking him retrograde and anterograde questions.

In the middle of the evaluation he was getting noticably worse so we sat him over by the wall and he passed out.  Knowing something was seriously wrong we got him to the hospital where they did a brain scan.  He had suffered a bad concussion and would be out for quite a while.  After all of this happened we checked his medical records and found that he had suffered 2-3 concussions previously.  When he saw the team doctor it was concluded that the symptoms from his concussion in July had not completely gone away and he should not have been practicing. 

One thing I learned from this event is to never mess around with a head injury.  If you suspect an athlete is suffering a serious concussion get them to a hospital.  In this case, the athlete had suffered concussions previous to this one.  We should have done a better job making notes of the teams previous injuries. 

On Thursday right before practice was over we had another little incident.  One of the wrestlers suffered a pretty bad dislocation of the 5th phalange of the hand.  The distal portion of the finger was literally pointing out.  I had never seen anything like this before so I found it really interesting.  Matt was helping us out that day and he immediatly took the athlete to the athletic training room to avoid an audience.  He distracted the athlete by asking him questions then placed traction on the finger until it moved back into place.  We then placed him in a finger splint and sent him to see the team doctor.

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