daily answer
Scott Rand
An important aspect of the Preparticipation Physical Exam is the blood pressure reading. Which statement below is true regarding blood pressure readings in children?
A. The JNC 7 classification of hypertension in adults can be also be used for children under age 18
B. Stimulant use is rarely a cause for blood pressure elevation in children under age 18
C. One isolated elevation in a child's BP greater than 95th percentile should fully restrict sports participation
D. Blood pressure charts based on sex, age and height percentile should be used for children under age 18
Correct: D
In the PPE setting, blood pressure should be measured with an appropriately sized cuff, should be repeated after sitting quietly for 5 minutes if initially elevated,and if needed checked again after 10-15 minutes of supine rest. Percentile of elevated blood pressure in children under age 18 should be determined from charts for classification by age, sex, and height percentile. Athletes with elevated blood pressure should be questioned about stimulant use (caffiene, nicotine, ephedrine). Mild to moderate hypertension (>95th percentile) does not necessarily preclude the athlete from sports participation, but may require modified clearance until further evaluation. Severe hypertension (>99th percentile) would require temporary clearance restriction until further evaluation.
1. Preparticipation Physical Evaluation, third edition. AAFP, AAP, AMSSM, AOSS, AOASM. Published by The Physician and Sports Medicine, Div of McGraw-Hill. 2005.
2. Charts for classification by age,sex, and height percentile can be found at http://www.nhlgi.nih.gov?guidelines/hypertension/child_tbl.htm.
Scott E Rand, MD FAAFP CAQSM
Director, Primary Care Sports Medicine Fellowship
Co Director of Sports Medicine, Houston Methodist Orthopedics and Sports Medicine Willowbrook
Assistant Professor of Clinical Family Medicine Houston Methodist Academic Institute
Adjunct Assistant Professor of Family and Community Medicine, Texas A&M University
Assistant Professor of Family Medicine in Clinical Medicine Weill Cornell Medical College.
13802 Centerfield Dr Suite 300
Houston, TX 77070
Scott Rand
An 800 meter open water swim is part of a short-course triathlon with over 800 registered athletes. It will be held in a shallow, protected lake that is usually calm but has been notorious for sudden weather changes. The race was cancelled the prior year because of excessive wave chop and poor visibility and a duathlon (bike & run race) was held in its place. Since that time, you have implemented some changes to improve safety in the case of any adverse events. Which of the following is an adequate safety measure for this race?
A. Local volunteer swim club members will be on hand at the finish to deal with common minor conditions
B. A "mass start" will begin the swim to assure the race finishes at an early time
C. There will be one certified lifeguard for every 50 swimmers in this non-ocean race
D. There will be large, highly visible buoys positioned 1000 meters or so apart and secured in a manner that will limit their movement in the most severe wave conditions in that body of water
E. A highly mobile, powered watercraft will be "on-call" in the area to facilitate any emergency plan that is implemented
Correct: C
USA Triathlon event sanctioning guidelines suggest that this ratio be no lower than
one lifeguard for every 50 athletes in non-ocean swims and one lifeguard for every
35 athletes in ocean swims. (Triathlon Canada guidelines recommend a minimum ratio
of one lifeguard for every 25 swimmers). "Wave" starts minimize the number of compettors in the water at any one time. The rescuers should ideally have lifeguard training and minimally first responder training. Several highly mobile watercraft should be on site to facilitate any emergency. Large, highly visable buoys every 100 meters should be secured in a manner to limit movement in severe conditions.
1. Dallam, Medical Considerations in Triathlon Competition; Recommendations for Triathlon Organizers, Competitors and Coaches; Sports Med 2005:35 (2): 143-161
2. Martinez J., Managing Triathlon Competition; Current Sports Medicine Reports 2003, 2:142-146.