Publications by authors named "Chad Asplund"

58 Publications

Preparticipation Cardiovascular Screening: An Infrastructure Assessment in Collegiate Athletics.

Clin J Sport Med 2020 07;30(4):315-320

Greenville Health System, University of South Carolina School of Medicine, Greenville, South Carolina.

Objective: To assess the available infrastructure for secondary testing after preparticipation cardiovascular screening of collegiate athletes.

Design: Cross-sectional study.

Setting: National Collegiate Athletic Association (NCAA) athletic programs PARTICIPANTS:: Team physicians.

Interventions: Online survey distributed by the NCAA and American Medical Society for Sports Medicine.

Main Outcome Measures: Availability of secondary cardiovascular diagnostic testing and services.

Results: Team physicians from 235 schools completed the assessment, representing 21% of all NCAA schools. Ninety (38.3%) NCAA team physicians reported screening athletes using electrocardiogram (ECG). Division I schools were more likely than Division II and III schools to perform both screening ECG (RR, 2.38, P < 0.0001) and echocardiogram (RR, 2.83, P = 0.01). More than 97% of schools had access to resting echocardiogram, stress ECG/echocardiogram, and Holter monitoring within 25 miles with no significant variability between divisions, regions, or size of undergraduate student body. Cardiac magnetic resonance imaging and electrophysiology studies were available within 25 miles of more than 80% of schools, and genetics testing was available within 25 miles for 64.8%.

Conclusions: Secondary testing for cardiovascular abnormalities seems to be readily available for NCAA athletes, regardless of division, region, or school size.
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http://dx.doi.org/10.1097/JSM.0000000000000616DOI Listing
July 2020

Triathlon Medical Coverage: A Guide for Medical Directors.

Curr Sports Med Rep 2017 Jul/Aug;16(4):280-288

1Georgia Southern University, Statesboro, Statesboro, GA; 2Sports Medicine, Carilion Clinic; 3Virginia Tech/Carilion School of Medicine; 4Division of Cardiothoracic Surgery, University of Mississippi Medical Center, Jackson, MS; 5Sports Medicine and Athletic Performance Cayuga Medical Center Ithaca, NY; 6University of Chicago Pritzker School of Medicine/Northshore University Healthcare; 7TriRock San Diego, ITU San Diego World Championships Kaiser Permanente Sports Medicine, San Diego, CA; 8Riverside Methodist Sports Medicine, Columbus, OH; 9 ITU Medical Committee, University of Hawaii Medical School, Honolulu, HI; and 10Ironman Triathlon World Championship.

Interest and participation in triathlon has grown rapidly over the past 20 yr and with this growth, there has been an increase in the number of new events. To maximize the safety of participation, triathlons require medical directors to plan and oversee medical care associated with event participation. Provision of proper medical care requires knowledge of staffing requirements, common triathlon medical conditions, impact of course design, communication skill, and a familiarity of administrative requirements. These guidelines serve as a tool for triathlon medical and race directors to improve race safety for athletes.
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http://dx.doi.org/10.1249/JSR.0000000000000382DOI Listing
March 2018

International recommendations for electrocardiographic interpretation in athletes.

Eur Heart J 2018 04;39(16):1466-1480

Department of Cardiology, Hospital de Clinicas de Porte Allegre, Brazil.

Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural, or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly over the last decade; pushed by a growing body of scientific data that both tests proposed criteria sets and establishes new evidence to guide refinements. On 26-27 February 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington, to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD.
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http://dx.doi.org/10.1093/eurheartj/ehw631DOI Listing
April 2018

International criteria for electrocardiographic interpretation in athletes: Consensus statement.

Br J Sports Med 2017 May 3;51(9):704-731. Epub 2017 Mar 3.

Department of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.

Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly, advanced by a growing body of scientific data and investigations that both examine proposed criteria sets and establish new evidence to guide refinements. On 26-27 February 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington (USA), to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD.
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http://dx.doi.org/10.1136/bjsports-2016-097331DOI Listing
May 2017

International Recommendations for Electrocardiographic Interpretation in Athletes.

J Am Coll Cardiol 2017 Feb;69(8):1057-1075

Department of Cardiology, Hospital de Clinicas de Porte Allegre, Brazil.

Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural, or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly over the last decade; pushed by a growing body of scientific data that both tests proposed criteria sets and establishes new evidence to guide refinements. On February 26-27, 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington, to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD.
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http://dx.doi.org/10.1016/j.jacc.2017.01.015DOI Listing
February 2017

Hypothesised mechanisms of swimming-related death: a systematic review.

Br J Sports Med 2016 Nov 3;50(22):1360-1366. Epub 2016 Mar 3.

Division of Cardiothoracic Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA.

Background: Recent reports from triathlon and competitive open-water swimming indicate that these events have higher rates of death compared with other forms of endurance sport. The potential causal mechanism for swimming-related death is unclear.

Objective: To examine available studies on the hypothesised mechanisms of swimming-related death to determine the most likely aetiologies.

Material And Methods: MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews (1950 to present) were searched, yielding 1950 potential results, which after title and citation reviews were reduced to 83 possible reports. Studies included discussed mechanisms of death during swimming in humans, and were Level 4 evidence or higher.

Results: A total of 17 studies (366 total swimmers) were included for further analysis: 5 investigating hyperthermia/hypothermia, 7 examining cardiac mechanisms and responses, and 5 determining the presence of pulmonary edema. The studies provide inconsistent and limited-quality or disease-oriented evidence that make definitive conclusions difficult.

Conclusions: The available evidence is limited but may suggest that cardiac arrhythmias are the most likely aetiology of swimming-related death. While symptoms of pulmonary edema may occur during swimming, current evidence does not support swimming-induced pulmonary edema as a frequent cause of swimming-related death, nor is there evidence to link hypothermia or hyperthermia as a causal mechanism. Further higher level studies are needed.
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http://dx.doi.org/10.1136/bjsports-2015-094722DOI Listing
November 2016

AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current evidence, knowledge gaps, recommendations and future directions.

Br J Sports Med 2017 Feb 22;51(3):153-167. Epub 2016 Sep 22.

Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA.

Cardiovascular screening in young athletes is widely recommended and routinely performed prior to participation in competitive sports. While there is general agreement that early detection of cardiac conditions at risk for sudden cardiac arrest and death (SCA/D) is an important objective, the optimal strategy for cardiovascular screening in athletes remains an issue of considerable debate. At the centre of the controversy is the addition of a resting ECG to the standard preparticipation evaluation using history and physical examination. The American Medical Society for Sports Medicine (AMSSM) formed a task force to address the current evidence and knowledge gaps regarding preparticipation cardiovascular screening in athletes from the perspective of a primary care sports medicine physician. The absence of definitive outcome-based evidence at this time precludes AMSSM from endorsing any single or universal cardiovascular screening strategy for all athletes, including legislative mandates. This statement presents a new paradigm to assist the individual physician in assessing the most appropriate cardiovascular screening strategy unique to their athlete population, community needs and resources. The decision to implement a cardiovascular screening programme, with or without the addition of ECG, necessitates careful consideration of the risk of SCA/D in the targeted population and the availability of cardiology resources and infrastructure. Importantly, it is the individual physician's assessment in the context of an emerging evidence base that the chosen model for early detection of cardiac disorders in the specific population provides greater benefit than harm. AMSSM is committed to advancing evidenced-based research and educational initiatives that will validate and promote the most efficacious strategies to foster safe sport participation and reduce SCA/D in athletes.
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http://dx.doi.org/10.1136/bjsports-2016-096781DOI Listing
February 2017

AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current Evidence, Knowledge Gaps, Recommendations and Future Directions.

Curr Sports Med Rep 2016 Sep-Oct;15(5):359-75

1Department of Family Medicine, University of Washington, Seattle, WA; 2Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; 3Department of Family Medicine, University of North Carolina, Greensboro, NC; 4Department of Health and Kinesiology, Georgia Southern University, Statesboro, GA; 5Department of Family Medicine, University of South Carolina Greenville School of Medicine, Greenville, SC; 6Department of Family Medicine, Carolinas Healthcare System, Charlotte, NC; 7Departments of Orthopedic Surgery, Family & Community Medicine, and Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX; 8Departments of Pediatrics, Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI; 9Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN.

Cardiovascular screening in young athletes is widely recommended and routinely performed prior to participation in competitive sports. While there is general agreement that early detection of cardiac conditions at risk for sudden cardiac arrest and death (SCA/D) is an important objective, the optimal strategy for cardiovascular screening in athletes remains an issue of considerable debate. At the center of the controversy is the addition of a resting electrocardiogram (ECG) to the standard preparticipation evaluation using history and physical examination. The American Medical Society for Sports Medicine (AMSSM) formed a task force to address the current evidence and knowledge gaps regarding preparticipation cardiovascular screening in athletes from the perspective of a primary care sports medicine physician. The absence of definitive outcomes-based evidence at this time precludes AMSSM from endorsing any single or universal cardiovascular screening strategy for all athletes, including legislative mandates. This statement presents a new paradigm to assist the individual physician in assessing the most appropriate cardiovascular screening strategy unique to their athlete population, community needs, and resources. The decision to implement a cardiovascular screening program, with or without the addition of ECG, necessitates careful consideration of the risk of SCA/D in the targeted population and the availability of cardiology resources and infrastructure. Importantly, it is the individual physician's assessment in the context of an emerging evidence-base that the chosen model for early detection of cardiac disorders in the specific population provides greater benefit than harm. AMSSM is committed to advancing evidenced-based research and educational initiatives that will validate and promote the most efficacious strategies to foster safe sport participation and reduce SCA/D in athletes.
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http://dx.doi.org/10.1249/JSR.0000000000000296DOI Listing
February 2017

AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current Evidence, Knowledge Gaps, Recommendations, and Future Directions.

Clin J Sport Med 2016 Sep;26(5):347-61

*Department of Family Medicine, University of Washington, Seattle, Washington; †Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ‡Department of Family Medicine, University of North Carolina, Greensboro, North Carolina; §Department of Health and Kinesiology, Georgia Southern University, Statesboro, Georgia; ¶Department of Family Medicine, University of South Carolina Greenville School of Medicine, Greenville, South Carolina; ‖Department of Family Medicine, Carolinas Healthcare System, Charlotte, North Carolina; Departments of **Orthopedic Surgery; ††Family and Community Medicine; and ‡‡Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas; Departments of §§Pediatrics; and ¶¶Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; and ‖‖Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota.

Cardiovascular (CV) screening in young athletes is widely recommended and routinely performed before participation in competitive sports. While there is general agreement that early detection of cardiac conditions at risk for sudden cardiac arrest and death (SCA/D) is an important objective, the optimal strategy for CV screening in athletes remains an issue of considerable debate. At the center of the controversy is the addition of a resting electrocardiogram (ECG) to the standard preparticipation evaluation using history and physical examination. The American Medical Society for Sports Medicine (AMSSM) formed a task force to address the current evidence and knowledge gaps regarding preparticipation CV screening in athletes from the perspective of a primary care sports medicine physician. The absence of definitive outcomes-based evidence at this time precludes AMSSM from endorsing any single or universal CV screening strategy for all athletes including legislative mandates. This statement presents a new paradigm to assist the individual physician in assessing the most appropriate CV screening strategy unique to their athlete population, community needs, and resources. The decision to implement a CV screening program, with or without the addition of ECG, necessitates careful consideration of the risk of SCA/D in the targeted population and the availability of cardiology resources and infrastructure. Importantly, it is the individual physician's assessment in the context of an emerging evidence base that the chosen model for early detection of cardiac disorders in the specific population provides greater benefit than harm. American Medical Society for Sports Medicine is committed to advancing evidenced-based research and educational initiatives that will validate and promote the most efficacious strategies to foster safe sport participation and reduce SCA/D in athletes.
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http://dx.doi.org/10.1097/JSM.0000000000000382DOI Listing
September 2016

Should Electrocardiograms Be Part of the Preparticipation Physical Examination?

PM R 2016 Mar;8(3 Suppl):S24-35

Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester; and Mayo Clinic Sports Medicine Center, 600 Hennepin Ave, #310, Minneapolis, MN 55403(‖). Electronic address:

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http://dx.doi.org/10.1016/j.pmrj.2016.01.001DOI Listing
March 2016

Exercise Testing: Who, When, and Why?

PM R 2016 Mar;8(3 Suppl):S16-23

Department of Health and Kinesiology, Georgia Southern University, Statesboro, GA 30458(†). Electronic address:

There are different modalities of exercise testing that can provide valuable information to physicians about patient and athlete fitness and cardiopulmonary status. Cardiopulmonary exercise testing (CPX) is a form of exercise testing that measures ventilatory and gas exchange, heart rate, electrocardiogram, and blood pressures to provide detailed information on the cardiovascular, pulmonary, and muscular systems. This testing allows an accurate quantification of functional capacity/measure of exercise tolerance, diagnosis of cardiopulmonary disease, disease-progression monitoring or response to intervention, and the prescription of exercise and training. CPX directly measures inhaled and exhaled ventilator gases to determine the maximal oxygen uptake, which reflects the body's maximal use of oxygen and defines the limits of the cardiopulmonary system. CPX is the ideal modality to evaluate causes of exertional fatigue and dyspnea, especially in complex cases in which the etiology could be cardiac, pulmonary, or deconditioning. Exercise tolerance has become an important outcome measure in patients with chronic obstructive pulmonary disease and congestive heart failure, as well as other chronic diseases, and is a well-recognized predictor of mortality. Older athletes or those with underlying medical conditions could benefit from exercise testing for risk stratification and clearance to participate, as well as to help set their training zones and determine their functional limitations.
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http://dx.doi.org/10.1016/j.pmrj.2015.10.019DOI Listing
March 2016

The Evidence Against Cardiac Screening Using Electrocardiogram in Athletes.

Curr Sports Med Rep 2016 Mar-Apr;15(2):81-5

1Athletic Medicine, Division of Health Services, Health and Kinesiology, Georgia Southern University, Statesboro, GA; and 2Military and Emergency Medicine, Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Bethesda, MD.

Sudden cardiac death (SCD) in young athletes is publicly remarkable and tragic because of the loss of a seemingly healthy young person. Because many of the potential etiologies may be identified with a preparticipation electrocardiogram (ECG), the possible use of an ECG as a screening tool has received much attention. A good screening test should be cost-effective and should influence a disease or health outcome that has a significant impact on public health. The reality is that the prevalence of SCD is low and no outcome-based data exist to determine whether early detection saves lives. Further, there is insufficient screening infrastructure, and the risk of screening and follow-up may be higher than that of the actual disease. Until outcomes data demonstrate a benefit with regard to SCD, universal screening cannot be recommended.
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http://dx.doi.org/10.1249/JSR.0000000000000237DOI Listing
December 2016

Challenging Return to Play Decisions: Heat Stroke, Exertional Rhabdomyolysis, and Exertional Collapse Associated With Sickle Cell Trait.

Sports Health 2016 Mar-Apr;8(2):117-25. Epub 2015 Nov 16.

Military and Emergency Medicine, Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Context: Sports medicine providers frequently return athletes to play after sports-related injuries and conditions. Many of these conditions have guidelines or medical evidence to guide the decision-making process. Occasionally, however, sports medicine providers are challenged with complex medical conditions for which there is little evidence-based guidance and physicians are instructed to individualize treatment; included in this group of conditions are exertional heat stroke (EHS), exertional rhabdomyolysis (ER), and exertional collapse associated with sickle cell trait (ECAST).

Evidence Acquisition: The MEDLINE (2000-2015) database was searched using the following search terms: exertional heat stroke, exertional rhabdomyolysis, and exertional collapse associated with sickle cell trait. References from consensus statements, review articles, and book chapters were also utilized.

Study Design: Clinical review.

Level Of Evidence: Level 4.

Results: These entities are unique in that they may cause organ system damage capable of leading to short- or long-term detriments to physical activity and may not lend to complete recovery, potentially putting the athlete at risk with premature return to play.

Conclusion: With a better understanding of the pathophysiology of EHS, ER, and ECAST and the factors associated with recovery, better decisions regarding return to play may be made.
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http://dx.doi.org/10.1177/1941738115617453DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4789928PMC
December 2016

Medical Evaluation for Exposure Extremes: Heat.

Wilderness Environ Med 2015 Dec;26(4 Suppl):S69-75

Department of Family Medicine, Georgia Regents University, Augusta, Georgia (Dr Asplund).

Exertional heat illness can be a serious consequence of sports or exercise in hot environments. Participants can possess intrinsic or face extrinsic risk factors that may increase their risk for heat-related illness. Knowledge of the physiology and pathology of heat illness, identification of risk factors, and strategies to combat heat accumulation will aid both the practitioner and the participant in preparing for activities that occur in hot environments. Through preparation and mitigation of risk, safe and enjoyable wilderness adventure can be pursued.
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http://dx.doi.org/10.1016/j.wem.2015.09.009DOI Listing
December 2015

Medical Clearance for Desert and Land Sports, Adventure, and Endurance Events.

Wilderness Environ Med 2015 Dec;26(4 Suppl):S47-54

Primary Care Sports Medicine, Marymount University, MedStar Medical Group, Arlington, Virginia (Dr Usman).

Endurance events are increasing in popularity in wilderness and remote settings, and participants face a unique set of potential risks for participation. The purpose of this article is to outline these risks and allow the practitioner to better guide the wilderness adventurer who is anticipating traveling to a remote or desert environment.
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http://dx.doi.org/10.1016/j.wem.2015.09.005DOI Listing
December 2015

General Medical Considerations for the Wilderness Adventurer: Medical Conditions That May Worsen With or Present Challenges to Coping With Wilderness Exposure.

Wilderness Environ Med 2015 Dec;26(4 Suppl):S20-9

Department of Family Medicine, Georgia Regents University, Augusta, Georgia (Dr Asplund).

Participation in wilderness and adventure sports is on the rise, and as such, practitioners will see more athletes seeking clearance to participate in these events. The purpose of this article is to describe specific medical conditions that may worsen or present challenges to the athlete in a wilderness environment.
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http://dx.doi.org/10.1016/j.wem.2015.09.007DOI Listing
December 2015

Preparticipation Evaluation of the Wilderness Athlete and Adventurer.

Wilderness Environ Med 2015 Dec;26(4 Suppl):S1-3

Wilderness Medical Society and Sports Medicine, Department of Family and Community Medicine, Texas Tech University, El Paso, Texas.

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http://dx.doi.org/10.1016/j.wem.2015.09.017DOI Listing
December 2015

Medical Evaluation for Exposure Extremes: Heat.

Clin J Sport Med 2015 Sep;25(5):437-42

*Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs, Connecticut; †Military & Emergency Medicine Department, F. Hébert School of Medicine, Bethesda, Maryland; ‡Uniformed Services University of the Health Sciences, Bethesda, Maryland; §Department of Family Medicine and Community Health, Division of Sports Medicine, John A. Burns School of Medicine, University of Hawaii, Mililani, Hawaii; and ¶Department of Family Medicine, Georgia Regents University, Augusta, Georgia.

Exertional heat illness can be a serious consequence of sports or exercise in hot environments. Participants can possess intrinsic or face extrinsic risk factors that may increase their risk for heat-related illness. Knowledge of the physiology and pathology of heat illness, identification of risk factors, and strategies to combat heat accumulation will aid both the practitioner and the participant in preparing for activities that occur in hot environments. Through preparation and mitigation of risk, safe and enjoyable wilderness adventure can be pursued.
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http://dx.doi.org/10.1097/JSM.0000000000000248DOI Listing
September 2015

Medical Clearance for Desert and Land Sports, Adventure, and Endurance Events.

Clin J Sport Med 2015 Sep;25(5):418-24

*Central Maine Sports Medicine (A Clinical Division of CMMC), Lewiston, Maine; †Lynchburg Family Medicine Residency, Lynchburg, Virginia; ‡Department of Family and Community Medicine, Paul L. Foster School of Medicine, El Paso, Texas; §Family Medicine, Georgia Regents University, Augusta, Georgia; ¶Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota; and ‖Primary Care Sports Medicine, Marymount University, MedStar Medical Group, Arlington, Virginia.

Endurance events are increasing in popularity in wilderness and remote settings, and participants face a unique set of potential risks for participation. The purpose of this article is to outline these risks and allow the practitioner to better guide the wilderness adventurer who is anticipating traveling to a remote or desert environment.
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http://dx.doi.org/10.1097/JSM.0000000000000228DOI Listing
September 2015

General Medical Considerations for the Wilderness Adventurer: Medical Conditions That May Worsen With or Present Challenges to Coping With Wilderness Exposure.

Clin J Sport Med 2015 Sep;25(5):396-403

*Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado; †Department of Family Medicine and Community Health, University of Minnesota, St. Paul, Minnesota; ‡Department of Emergency Medicine, Institute for Altitude Medicine, Telluride, Colorado; §Department of Family Medicine, Tufts University School of Medicine, Boston, Massachusetts; ¶Department of Sports Medicine, The Vancouver Clinic, Vancouver, Washington; ‖Department of Orthopedics/Community & Family Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; **Department of Family Medicine, Group Health Cooperative, Everett, Washington; ††Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina; ‡‡Departments of Medicine, Pediatrics and Pathology, Oregon Health and Science University, Portland, Oregon; §§Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah; ¶¶Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado; and ‖‖Department of Family Medicine, Georgia Regents University, Augusta, Georgia.

Participation in wilderness and adventure sports is on the rise, and as such, practitioners will see more athletes seeking clearance to participate in these events. The purpose of this article is to describe specific medical conditions that may worsen or present challenges to the athlete in a wilderness environment.
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http://dx.doi.org/10.1097/JSM.0000000000000229DOI Listing
September 2015

Preparticipation Evaluation of the Wilderness Athlete and Adventurer.

Clin J Sport Med 2015 Sep;25(5):381-2

*Student Health Services and Sports Medicine, Georgia Regents University Augusta, Georgia; †American Medical Society for Sports Medicine, Longs Peak Family Practice, Longmont, Colorado; ‡Family Medicine, University of Utah School of Medicine, Salt Lake City, Utah; and §Wilderness Medical Society and Sports Medicine, Department of Family and Community Medicine, Texas Tech University, El Paso, Texas.

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http://dx.doi.org/10.1097/JSM.0000000000000225DOI Listing
September 2015

Brain damage in American Football Inevitable consequence or avoidable risk?

Br J Sports Med 2015 Aug;49(15):1015-6

Professor and Pomerene chair, Department of Family Medicine, Ohio State University, Columbus, OH 43221, USA.

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http://dx.doi.org/10.1136/bjsports-2014-h1381repDOI Listing
August 2015

Brain damage in American Football.

BMJ 2015 Mar 24;350:h1381. Epub 2015 Mar 24.

Department of Family Medicine, Ohio State University, Columbus, OH 43221, USA.

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http://dx.doi.org/10.1136/bmj.h1381DOI Listing
March 2015

Cardiac preparticipation screening for the young athlete: why the routine use of ECG is not necessary.

J Electrocardiol 2015 May-Jun;48(3):311-5. Epub 2015 Jan 28.

University of Minnesota, A682 Mayo Building, 420 Delaware Street SE, Minneapolis, MN.

The addition of an electrocardiogram (ECG) to the current United States athlete preparticipation physical evaluation (PPE) as a screening tool has dominated the PPE discussion over the past decade despite the lack of demonstrable outcomes data supporting the routine use of the diagnostic study for reduction of sudden cardiac death (SCD). A good screening test should influence a disease or health outcome that has a significant impact on public health and the population screened must have a high prevalence of the disease to justify the screening intervention. While SCD is publicly remarkable and like any death, tragic, the prevalence of SCD in young athletes is very low and the potential for false positive results is high. While ECG screening appears to have made an impact on SCD in Italian athletes, the strategy has made no impact on Israeli athletes, and the overall impact of ECG screening on American athletes is unclear. Until outcomes studies show substantial SCD reduction benefit, the addition of routine ECG PPE screening in young athletes should not be instituted.
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http://dx.doi.org/10.1016/j.jelectrocard.2015.01.010DOI Listing
February 2016

Author's reply to Lipman: 'correct wilderness medicine definitions and their impact on care'.

Sports Med 2015 Apr;45(4):603-4

Department of Emergency Medicine, State University of New York Upstate Medical University, Syracuse, NY, USA.

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http://dx.doi.org/10.1007/s40279-014-0295-2DOI Listing
April 2015

Effects of excessive endurance activity on the heart.

Curr Sports Med Rep 2014 Nov-Dec;13(6):361-4

1Department of Family and Community Medicine, Eisenhower Army Medical Center, Fort Gordon, GA; and 2Student Health and Sports Medicine, Family Medicine, Georgia Regents University, Augusta, GA.

Regular moderate exercise confers many cardiovascular and health benefits. Because of this, endurance sports events have become very popular with participation increasing tremendously over the past few years. In conjunction with this increase in popularity and participation, people also have increased the amount that they exercise with many training for and competing in ultraendurance events such as ultradistance running events, iron distance triathlons, or multiday races. This excess endurance activity may appear to increase the risk of cardiac abnormalities, which may increase the risk for long-term morbidity or mortality. While it is known that moderate exercise has benefits to cardiovascular health, ultimately, the long-term cardiac effects of excessive endurance activity are unclear. What is clear, however, is that moderate exercise is beneficial, and to date, the evidence does not support recommending against physical activity.
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http://dx.doi.org/10.1249/JSR.0000000000000097DOI Listing
July 2015

Managing collapsed or seriously ill participants of ultra-endurance events in remote environments.

Sports Med 2015 Feb;45(2):201-12

Department of Physical Medicine and Rehabilitation, University of California Davis Medical Center, Sacramento, CA, USA,

Increasing participation in ultramarathons and other ultra-endurance events amplifies the potential for serious medical issues during and immediately following these competitions. Since these events are often located in remote settings where access may be extremely limited; the diagnostic capabilities, treatment options, and expectations of medical care may differ from those of urban events. This work outlines a process for assessment and treatment of athletes presenting for medical attention in remote environments, with a focus on potentially serious conditions such as major trauma, acute coronary syndrome, exertional heat stroke, hypothermia, hypoglycemia, exercise-associated hyponatremic encephalopathy, severe dehydration, altitude illness, envenomation, anaphylaxis, and bronchospasm. A list of suggested medical supplies is provided and discussed. But, given that diagnostic and treatment options may be extremely limited in remote settings, it is important for medical providers to understand how to assess and manage the most common serious medical issues with limited resources, and to be prepared to make presumptive diagnoses when necessary.
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http://dx.doi.org/10.1007/s40279-014-0270-yDOI Listing
February 2015