By M. Sugut. York College, York Nebraska.

Supplementation with individual amino Burke LM ayurslim 60caps mastercard, Read RS: Dietary supplements in sport 60caps ayurslim fast delivery. The USP establishes stan- Burke LM: Nutritional needs for exercise in the heat generic ayurslim 60caps amex. Carrithers JA discount 60caps ayurslim visa, Williamson DL 60 caps ayurslim for sale, Gallagher PM, et al: Effects of postexercise carbohydrate-protein feedings on muscle glyco- SUMMARY gen restoration. Nutrition for Sport A balanced diet that provides the proper amounts of and Exercise. This is especially impor- College of Sports Medicine position stand: Exercise and fluid tant for the athlete who might be training intensely or replacement. The three primary Coyle EF, Coggan AR, Hemmert MK, et al: Muscle glycogen uti- energy systems used during running are the power, lization during prolonged strenuous exercise when fed carbo- speed, and endurance systems. Coyle EF, Jeukendrup AE, Wagenmakers AJ, et al: Fatty acid oxi- used and energy requirements will vary for each indi- dation is directly regulated by carbohydrate metabolism during vidual depending on such factors as mode of activity, exercise. To aid Davis JM, Jackson DA, Broadwell MS, et al: Carbohydrate in peak performance it is recommended that the ath- drinks delay fatigue during intermittent, high-intensity cycling lete pay special attention to preevent, event, and in active men and women. This will help ensure Deuster PA, Day BA, Singh A, et al: Zinc status of highly trained adequate hydration, glucose intake, and recovery. Am J Clin Nutr Finally, the use of such methods as glycogen loading 49:1295–1301, 1989. National Academy of Sciences: Recommended Dietary Allowances, Fogelholm M: Indicators of vitamin and mineral status in ath- 10th ed. National Academy of Sciences: Dietary reference intakes for cal- Helge JW, Richter EA, Kiens B: Interaction of training and diet cium, phosphorus, magnesium, vitamin D, and fluoride. National Academy of Sciences: Dietary Reference Intakes for Houtkooper L: Food selection for endurance sports. Med Sci thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, Sports Exerc 24:S349–59, 1992. Washington, DC, Hurley BF, Nemeth PM, Martin WH, III, et al: Muscle triglyc- National Academy Press, 1998. J Appl National Academy of Sciences: Dietary reference intakes for vita- Physiol 60:562–67, 1986. Nicklas BJ: Effects of endurance exercise on adipose tissue Janelle KC, Barr SI: Nutrient intakes and eating behavior scores metabolism. Jeejeebhoy KN: Vegetable proteins: Are they nutritionally equiva- Pasman WJ, van Baak MA, Jeukendrup AE, et al: The effect of lent to animal protein. Jentjens RL, van Loon LJ, Mann CH, et al: Addition of protein and Int J Sports Med 16:225–30, 1995. Jeukendrup A, Brouns F, Wagenmakers AJ, et al: Carbohydrate- Romijn JA, Coyle EF, Sidossis LS, et al: Regulation of endoge- electrolyte feedings improve 1 h time trial cycling perform- nous fat and carbohydrate metabolism in relation to exercise ance. Schena F: Iron status in athletes involved in endurance and in American College of Sports Medicine, American Dietetic prevalently anaerobic sports, in Kies C, Driskell JA (eds. Kleiner SM, Bazzarre TL, Ainsworth BE: Nutritional status of Sherman WM, Costill DL, Fink WJ, et al: Effect of exercise- nationally ranked elite bodybuilders. Int J Sport Nutr 4:54–69, diet manipulation on muscle glycogen and its subsequent uti- 1994. Int J Sports Med 2:114–18, Kleiner SM, Bazzarre TL, Litchford MD: Metabolic profiles, 1981. Latzka WA, Montain SJ: Water and electrolyte requirements for Gaithersburg, MD, Aspen, 1998, p 45. Sugiura K, Kobayashi K: Effect of carbohydrate ingestion on Lemon PW, Tarnopolsky MA, MacDougall JD, et al: Protein sprint performance following continuous and intermittent exer- requirements and muscle mass/strength changes during intensive cise. Tarnopolsky MA, Atkinson SA, MacDougall JD, et al: Ma J, Betts NM: Zinc and copper intakes and their major food Evaluation of protein requirements for trained strength ath- sources for older adults in the 1994–96 continuing survey of letes. J Nutr 130:2838–43, Tsintzas OK, Williams C, Singh R, et al: Influence of carbohy- 2000. Martin WH, III: Effect of endurance training on fatty acid metab- Eur J Appl Physiol Occup Physiol 70:154–60, 1995. Med Sci Sports Exerc Turcotte LP: Role of fats in exercise: Types and quality. Millard-Stafford M, Sparling PB, Rosskopf LB, et al: Fluid van der Beek EJ, van Dokkum W, Schrijver J, et al: Thiamin, intake in male and female runners during a 40-km field run in riboflavin, and vitamins B-6 and C: Impact of combined the heat.

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With slit lamp buy ayurslim 60 caps on-line, can see actual red cells floating effective ayurslim 60caps, Vary with area of involvement purchase ayurslim 60 caps overnight delivery. TREATMENT Obtain ophthalmologic consultation buy generic ayurslim 60caps line, as many will EXAMINATION admit for observation buy cheap ayurslim 60 caps. Emphasize strict bed rest, ele- Athorough eye examination is important, but do not vate head of bed to 30o, and eyeshield at all times to apply pressure to the globe. CHAPTER 28 OPHTHALMOLOGY 165 TREATMENT Higher risk sports include activities of small, fast Place an eye shield over area and send for immediate projectiles, hard projectiles, fingers, close contact, ophthalmologic consultation. ORBITAL WALL FRACTURES CHOOSING EYE PROTECTION Most often seen after significant blunt trauma. May Always have professionals assist the athlete in selecting have pain with eye movements or diplopia (suggests proper eye protection extraocular muscle entrapment). If infraorbital nerve Professionals include an ophthalmologist, opto- involved, may have numbness on the cheek. EXAMINATION Acomplete eye examination, with special focus on THE MONOCULAR ATHLETE extraocular motility, facial numbness, and palpation of the bony orbits. TREATMENT Must be required to wear ASTM approved eye pro- Give cefalexin 500 mg qid and oxymetazoline nasal tection for all practices and games that carry risk for spray bid for 14-day course (to prevent orbital cellulitis). PREVENTION OF EYE INJURIES REFERENCES PROTECTIVE EYEWEAR American Academy of Pediatrics: Protective eyewear for young Eyewear should be made of polycarbonate lenses, athletes. Napier SM, Baker RS, et al: Eye injuries in athletics and recre- If a helmet is required for the sport, then protective ation. Rodriguez JO, Lavina AM: Prevention and treatment of Contact lenses offer no protection whatsoever. Am Fam Phys 67:1481–1488, Eye protection can reduce the risk of eye injury by 2003. J Am Sports goggles with polycarbonate lenses are recom- Optom Assoc 69:395–413, 1998. Ocular trauma Blood, avulsed teeth, mouth guards, or other objects in Major League baseball players. Arch Ophthalmol 113:749–752, The history should include the mechanism of injury, 1995. An important question to ask is, “Does it feel the same when you (the athlete) bite down? Prim and imaging (if there is any question about the diag- Care 11:161, 1984. Observation includes evaluation of facial sym- Easterbrook M, Johnston RH, Howcroft MJ: Assessment of ocular foreign bodies. Palpation includes the Rhee DJ, Pyfer MF, Rhee DM: The Wills Eye Manual. This may be blood or cerebral spinal fluid Norwalk, CT, Appleton & Lange, 1999. The “ring test” is a method of detecting CSF Vinger PF: A practical guide for sports eye protection. This represents a severe facial fracture and requires immediate transport. X-rays may be help- 29 OTORHINOLARYNGOLOGY ful in determining the presence of a facial fracture; how- ever, computed tomography (CT) is the gold standard. Charles W Webb, DO Return to play guidance is based on the history and physical examination. Suspected fractures, airway obstruction or impending obstruction, bleeding, loss of consciousness, and changes in vision are con- INTRODUCTION traindications for return to play. They comprise 4–19% of all sports EAR INJURIES related injuries depending on age and gender. One- third of all dental injuries are sports related (Truman EAR LACERATION et al, 2002). In the pediatric age ranges, one-third of injuries are sports related (Luke and Micheli, 1999).

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