ABP Sports Medicine cheat sheet

The preparticipation evaluation (PPE) is performed annually and includes a comprehensive history plus physical examination; the AHA 14-point cardiovascular screen targets exertional chest pain, syncope, dyspnea, and family history of sudden death before age 50.

Cardiovascular red flags requiring further evaluation before clearance include exertional syncope or near-syncope, chest pain, disproportionate dyspnea, a family history of sudden cardiac death before age 50, and known cardiomyopathy or channelopathy.

In children and adolescents, hypertension is blood pressure at or above the 95th percentile for age, sex, and height on at least three separate occasions; stage 2 hypertension is at or above the 99th percentile plus 5 mmHg.

PPE clearance has four categories: cleared, cleared after additional evaluation, not cleared, and clearance pending; documentation should specify restrictions and follow-up requirements.

Sudden cardiac death is the leading medical cause of death in young athletes during sport; hypertrophic cardiomyopathy is the most common underlying cause identified in the United States.

Sickle cell trait status should be confirmed rather than assumed; NCAA rules require documentation of status, and the trait generally permits participation with hydration, heat, and altitude precautions.

Baseline neurocognitive testing is not required before sports participation and does not replace individualized postinjury assessment; a history of concussion prompts review of recovery and recurrence risk.

The PPE should include vision, cardiovascular, musculoskeletal, and mental health screening, with attention to weight-sensitive sports and signs of disordered eating.

The phosphagen system fuels maximal efforts lasting about 0 to 10 seconds; glycolysis dominates from roughly 10 seconds to 2 minutes; oxidative phosphorylation supplies most energy beyond about 2 minutes.

The Fick equation states that oxygen consumption equals cardiac output multiplied by the arteriovenous oxygen difference: VO2 = CO x (a-vO2 diff).

Estimated maximal heart rate is more accurately calculated as 208 minus 0.7 times age (Tanaka) than as 220 minus age, particularly in children and older adults.

The Borg rating of perceived exertion scale ranges from 6 to 20; a rating of 13 to 14 corresponds approximately to moderate intensity, and 17 or higher to vigorous intensity.

Carbohydrate intake recommendations range from 3 to 5 g/kg/day for light training to 8 to 12 g/kg/day for high-intensity or prolonged training; postexercise recovery uses about 1 to 1.2 g/kg/hour.

Protein intake for athletes is generally 1.2 to 2.0 g/kg/day, distributed across meals; higher intakes are not routinely required and do not replace adequate total energy.

Body mass loss of about 2% impairs performance and thermoregulation; replace roughly 1.25 to 1.5 liters of fluid for each kilogram of body mass lost during exercise.

Heat acclimatization requires approximately 10 to 14 days of gradual exposure and produces plasma volume expansion, earlier sweating, and lower core temperature at a given workload.

Altitude performance effects become important above about 1500 meters; a live-high, train-low strategy can support acclimatization while preserving training intensity at lower altitude.

Ottawa ankle rules indicate radiography when there is malleolar pain plus tenderness at the posterior lateral malleolus or distal 6 cm, tenderness at the navicular or fifth metatarsal base, or inability to bear weight for four steps.

The Lachman test is performed with the knee flexed 20 to 30 degrees and the tibia pulled anteriorly; it is highly sensitive for anterior cruciate ligament disruption and is preferred acutely when swelling limits other tests.

Salter-Harris physeal fracture types I through V are remembered as SALTR: I through the physis, II through physis and metaphysis, III through physis and epiphysis, IV through both, and V a crush injury.

Ligament sprains are graded I (microtears, stable), II (partial tear, mild laxity), and III (complete tear, instability); muscle strains are similarly graded by extent of fiber disruption.

Acute compartment syndrome is suggested by pain out of proportion, paresthesia, pallor, paralysis, and pulselessness; compartment pressure within 30 mmHg of diastolic pressure supports urgent fasciotomy.

In skeletally immature athletes, traction apophysitis includes Osgood-Schlatter disease at the tibial tubercle and Sever disease at the calcaneal apophysis; management centers on load modification and rehabilitation.

Anterior shoulder instability is assessed with the apprehension and relocation tests; impingement provocation includes the Neer and Hawkins tests, though these findings are nonspecific.

Meniscal injury is suggested by joint line tenderness, swelling, and a positive McMurray test; mechanical locking or a true block to extension warrants prompt orthopedic evaluation.

Every musculoskeletal examination should document neurovascular status, including distal pulses, capillary refill, sensation, and motor function, before and after splinting or reduction.

Exercise-induced bronchoconstriction produces cough, wheeze, chest tightness, or dyspnea minutes after exercise; a 10% or greater fall in FEV1 after exercise challenge supports diagnosis, and pre-exercise short-acting beta-agonist is standard.

Concussion management requires removal from play, no same-day return, and a gradual stepwise return; symptoms lasting beyond four weeks warrant evaluation for persistent postconcussive symptoms.

Athletes with diabetes should check glucose before, during, and after exercise; exercise generally lowers glucose, and 15 to 30 grams of rapid carbohydrate treats hypoglycemia.

Sickle cell trait increases risk of exertional collapse, rhabdomyolysis, and heat illness under extreme conditions; precautions include hydration, gradual acclimatization, and avoidance of maximal exertion when ill or dehydrated.

Hypertrophic cardiomyopathy is a leading cause of sudden cardiac death in young athletes; most affected athletes should avoid competitive collision, high-intensity, and endurance sports according to published guidelines.

Infectious mononucleosis requires avoidance of contact sports for at least four weeks and until splenomegaly resolves; splenic rupture risk is highest in the first month after infection.

Athletes with well-controlled epilepsy generally participate with appropriate supervision and medication adherence; precautions apply to swimming, climbing, and other activities where sudden loss of consciousness is dangerous.

Disordered eating and relative energy deficiency should be screened in athletes with recurrent injury, menstrual dysfunction, fatigue, or unexplained performance decline; treatment addresses energy availability and bone health.

The primary survey follows ABCDE: airway, breathing, circulation, disability, and exposure; the secondary survey evaluates history, vital signs, and a head-to-toe examination after immediate threats are addressed.

High-quality CPR uses compressions at 100 to 120 per minute, a depth of 5 to 6 cm in adults, full chest recoil, and a compression-to-ventilation ratio of 30:2 for single rescuers before an advanced airway is placed.

An automated external defibrillator should be applied as soon as available for suspected sudden cardiac arrest; early defibrillation is the strongest determinant of survival in ventricular fibrillation.

Commotio cordis is ventricular fibrillation triggered by a blunt chest impact during a vulnerable cardiac cycle; immediate CPR and defibrillation are critical, and survival declines with delayed response.

Exertional heat stroke presents with core temperature above 40 degrees Celsius and central nervous system dysfunction; immediate cold-water immersion is the priority, and antipyretics are ineffective.

Exertional hyponatremia causes confusion, seizures, or coma from excessive fluid intake; severe symptomatic cases require hypertonic saline, while asymptomatic or mild cases are managed with fluid restriction.

Anaphylaxis is treated with intramuscular epinephrine 0.01 mg/kg, maximum 0.3 to 0.5 mg, in the lateral thigh, repeated every 5 to 15 minutes as needed, with airway support and transport.

Suspected cervical spine injury requires manual stabilization, spinal motion restriction, and log-roll transfer; helmets and shoulder pads are removed only when needed for airway access or CPR.

Lightning safety uses the 30-30 rule: seek shelter when the time between flash and thunder is 30 seconds or less, and wait 30 minutes after the last thunder before resuming activity.

Neuromuscular warm-up programs emphasizing landing mechanics, balance, core control, and cutting reduce anterior cruciate ligament injury rates in young athletes, especially with consistent long-term use.

Return-to-play criteria generally include pain-free full range of motion, strength at least 90% of the contralateral limb, functional testing, sport-specific skills, and psychological readiness.

Concussion return to sport follows gradual stages from symptom-limited activity through light aerobic exercise, sport-specific drills, noncontact training, full contact, and game play, with at least 24 hours between stages.

After anterior cruciate ligament reconstruction, return is typically delayed 9 to 12 months and requires quadriceps strength at least 90% of the uninvolved limb plus passing hop tests.

Balance and proprioceptive training after lateral ankle sprain reduces recurrence; bracing or taping during high-risk sport also lowers reinjury risk.

Tendinopathy rehabilitation emphasizes progressive eccentric or heavy slow resistance loading and load management rather than complete rest, which reduces tendon capacity.

Acute soft tissue injury management has shifted from prolonged rest and ice toward protected loading, elevation, compression, and early controlled movement as pain allows.

Injury prevention should address training load, sleep, nutrition, prior injury, and sport-specific demands; rapid increases in training volume are associated with overuse injury.

Children have a higher surface area-to-mass ratio and less efficient thermoregulation than adults; they require scheduled fluid breaks, gradual heat acclimatization, and avoidance of intense exercise in extreme heat.

Relative energy deficiency in sport results from insufficient energy availability and can impair metabolism, bone health, immunity, menstrual function, and performance even without all female athlete triad components.

Masters athletes have lower maximal heart rate and VO2max and higher cardiovascular risk; preparticipation screening should address prior sedentary status, medications, and exertional symptoms.

Pregnant athletes generally may perform about 150 minutes of moderate-intensity exercise weekly, avoiding contact sports, scuba diving, high altitude, and prolonged supine positions.

In spinal cord injury above T6, autonomic dysreflexia causes severe hypertension, headache, bradycardia, and sweating; sit the athlete upright, identify and remove the trigger, and treat urgently.

Youth strength training is safe and effective when supervised, technique-focused, and matched to maturity; maximal lifting attempts are not required and growth plate injury should prompt evaluation.

Transgender athlete participation policies vary by governing body and typically address testosterone levels, timing, and sport-specific rules; clinicians should document individualized assessment.

Mental health screening in athletes should address depression, anxiety, eating disorders, substance use, and sleep; stigma and time demands are common barriers to care.

An emergency action plan specifies roles, communication, equipment location, venue access, and transfer routes; it should be rehearsed annually with all staff and adapted to each venue.

A negligence claim requires duty, breach of the standard of care, causation, and damages; documentation and appropriate emergency planning help demonstrate reasonable care.

For minors, informed consent generally requires a parent or guardian plus the athlete's assent; emergency treatment may proceed under implied consent when delay would be dangerous.

Confidentiality is governed by HIPAA and state law; medical information should be shared with coaches only on a need-to-know basis and with appropriate authorization.

Therapeutic use exemptions permit athletes to use prohibited medications for legitimate medical indications; approval must come from the relevant anti-doping organization before competition.

Protective equipment should meet recognized standards such as NOCSAE for football helmets and masks; equipment must be properly fitted, maintained, and replaced after significant impact.

Heat and lightning policies should be written, venue-specific, and based on measured environmental conditions; activity modification and cancellation thresholds should be defined in advance.

The Americans with Disabilities Act and related laws require individualized assessment and reasonable accommodation rather than blanket exclusion from sport based on diagnosis.