背景:健康,22岁,NCAA一级职业棒球游击手感到困惑,胸痛,在淡季的队间混战中紧张。患者没有任何显著的头部损伤病史或机制。经过运动教练的初步评估,患者的认知状态开始迅速下降。紧急行动计划迅速到位,并将患者转介到当地的急诊诊所。
方法:到达急诊科后,进行心电图检查以排除心肌梗死或中风。第一次心电图结果为任何心脏病变都是阴性,但有人发出了中风警报.然后,由于持续的认知能力下降,患者被转移到II级创伤中心。该患者被诊断为继发于未诊断的卵圆孔未闭(PFO)的短暂性脑缺血发作(TIA),随后在初次TIA事件后2个月进行进一步评估。经过多次诊断和实验室检查,直到进行2D超声心动图检查并由心脏病专家进行评估,才发现PFO.
方法:确认先天性缺陷后,使用导管插入术进行手术干预以纠正PFO.尽管参加了多次预检查,心电图,和检查过去的家族史,直到患者出现TIA症状,才发现PFO.在这个22岁的运动个体中发现PFO是不寻常的,因为传统的筛查技术(心电图和参与前检查)未能检测到先天性缺陷。
结论:由于运动教练的紧急和及时的行动,患者已经完全康复,能够在体育赛事中充分竞争。这个案例研究放大了所有体育赛事对运动教练的需求,更新和审查了紧急行动计划,在运动个体中快速识别TIA,以及TIA后运动员重返赛场的协议。
BACKGROUND: A healthy, 22-year-old, male NCAA Division I
baseball shortstop was experiencing confusion, chest pain, and tightness during an off-season intersquad scrimmage. The patient did not have any significant medical history or mechanism of head injury. After initial evaluation from the athletic trainer, the patient\'s cognitive status began to quickly decline. The emergency action plan was put in place rapidly and referred the patient to the local emergency clinic.
METHODS: Upon arrival at the emergency department, an electrocardiogram was performed to rule out myocardial infarction or stroke. The first electrocardiogram results returned negative for any cardiac pathology, but a stroke alert was called. The patient was then transported to a level II trauma center due to continual cognitive decline. The patient was diagnosed with transient ischemic attack (TIA) secondary to an undiagnosed patent foramen ovale (PFO) that would later be diagnosed with further evaluation 2 months after the initial TIA incident. After multiple diagnostic and laboratory tests, the PFO went undetected until a 2D echocardiogram was performed and evaluated by a cardiologist.
METHODS: After the confirmation of the congenital defect, surgical intervention was performed to correct the PFO using catheterization. Despite multiple preparticipation examinations, electrocardiograms, and examination of past family history, the PFO went undetected until the patient experienced symptoms of TIA. The discovery of PFO in this 22-year-old athletic individual is unusual because traditional screening techniques (electrocardiogram and preparticipation examinations) failed to detect the congenital defect.
CONCLUSIONS: Due to the emergent and timely actions of the athletic trainer, the patient has made a full recovery and is able to compete fully in athletic events. This
case study amplifies the need for athletic trainers at all sporting events, updated and reviewed emergency action plans, rapid recognition of TIA in athletic individuals, and return-to-play protocol for an athletic individual after TIA.