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Commotio Cordis
Commotio Cordis Background Sudden unexpected cardiac death that occurs in young people during sports participation is usually associated with previously diagnosed or undiagnosed structural or primary electrical cardiac abnormalities. Examples of such abnormalities include hypertrophic cardiomyopathy, anomalous origin of a coronary artery, arrhythmogenic right ventricular cardiomyopathy, and primary electrical disorders, such as congenital prolongation of the QTc interval and catecholaminergic, polymorphic ventricular tachycardia (CPVT). Sudden death due to ventricular fibrillation may also occur following a blunt, nonpenetrating blow to the chest, specifically the precordial area, in an individual with no underlying cardiac disease. This is termed commotio cordis. Much of our understanding of the clinical and pathophysiologic aspects of commotio cordis is the result of work by N.A. Mark Estes III, MD, and Mark S. Link, MD, from the New England Cardiac Arrhythmia Center at the Tufts University and School of Medicine in Boston, Massachusetts and data derived from the US Commotio Cordis Registry (Minneapolis, Minnesota). Relatively recent data from the registry of the Minneapolis Heart Institute Foundation show that commotio cordis is one of the leading cause of sudden cardiac death in young athletes, exceeded only by hypertrophic cardiomyopathy and congenital cornoary artery abnormalities.[1] Commotio cordis typically involves young, predominantly male, athletes in whom a sudden, blunt, nonpenetrating and innocuous-appearing trauma to the anterior chest results in cardiac arrest and sudden death from ventricular fibrillation. The rate of successful resuscitation remains relatively low but is improving slowly. Although commotio cordis usually involves impact from a baseball, it has also been reported during hockey, softball, lacrosse, karate, and other sports activities in which a relatively hard and compact projectile or bodily contact caused impact to the person's precordium. -
Version 3.4 OFFICIAL RULE BOOK
NATIONAL FLAG FOOTBALL RULES Version 3.4 OFFICIAL RULE BOOK 1 NATIONAL FLAG FOOTBALL RULES Version 3.4 TABLE OF CONTENTS TABLE OF CONTENTS 2 PLAYING TIME 3 DIVISIONS 3 FORMAT 3 PLAYER ATTIRE 3 EQUIPMENT 3 COACHES 3 POSSESSIONS 4 ONE WAY FIELD SET UP 4 TWO WAY FIELD SET UP 5 GENERAL OFFENSE 5 PASSING GAME 6 RECEIVING GAME 6 RUNNING GAME 6 GENERAL DEFENSE 6 FLAG PULLING 6 INTERCEPTIONS 7 NO RUN ZONES 7 RUSHING OF THE QUARTERBACK 7 REPLAY OF DOWN 7 DEAD BALLS 8 SCORING 8 EXTRA POINTS 8 SAFETIES 9 TIME SITUATIONS 8 OVERTIME 8 FORFEITS 9 PROTEST RULE 9 GENERAL PENALTY INFORMATION 9 WARNINGS 9 OFFENSIVE PENALTIES 9 DEFENSIVE PENALTIES 10 EJECTIONS 10 SPORTSMANSHIP 10 2 NATIONAL FLAG FOOTBALL RULES Version 3.4 PLAYING TIME All children should receive equal playing time for both offense and defense in each game they participate in. Coaches are asked to monitor each other and report any infractions that they see. If a coach is caught not evenly rotating his/her players, disciplinary action will be taken. DIVISIONS Players are placed on teams using a variety of methods including but not limited to school and grade. Teams are placed into divisions based on grade level. Divisions may be separate or combined depending on the number of children registered. Divisions are as follows: o Lombardi Division (Usually 1st grade and younger) o Shula Division (Usually 2nd and/or 3rd grade) o Madden Division (Usually 4th grade and older) FORMAT The game is played with five (5) players. However, a minimum of four (4) players must be on the field at all times. -
Sysa Softball Rules - 14U
SYSA SOFTBALL RULES - 14U THE PLAYING OF ALL GAMES IS GOVERNED BY ASA RULES AND REGULATIONS EXCEPT THOSE NOTED BELOW: Rule 1: Roster A. SYSA Softball shall assign players to all teams on the basis of their age, schools and neighborhoods, not on the basis of individual team, player parent or coach preference. B. The age group that a player is assigned to depends on the players' age on December 31 of the previous year. Exception: In the case of documented mental or physical impairment, SYSA Softball may approve a players assignment to a lower age group. C. Minimum roster is twelve (12) players. D. No players may be added to a team roster for league play after their sixth (6th) game, except to maintain a minimum roster (Rule 1 Item C) following the permanent loss of a player or at the discretion of SYSA Softball. All roster changes require written approval from SYSA Softball for both league or tournament rosters with notification to effected coaches. E. All Head and Assistant Coaches must be registered with SYSA Softball. F. TOURNAMENTS: Players may be added to the roster to replace rostered players unavailable for the tournament. Such additions must be: 1. added prior to the first pitch of the first tournament game 2. must identify the regular roster player(s) being replaced, 3. must be on the regular season roster of a registered SYSA team and, 4. must be eligible age-wise for team they are joining. Rule 2: Line-up A. All players present will play at least three (3) full innings. -
Medical Memoranda MEDICAJHRNA Haemodynamic Effects of Balloon
27 January 1968 Medical Memoranda MEDICAJHRNA 225 he had been after the myocardial infarction in March 1967. There- He was readmitted on 6 September again in supraventricular after he was maintained on lignocaine infusion 1 mg./min. to a tachycardia and with evidence of congestive failure. On three maximum of 500 mg. in 24 hours and remained in sinus rhythm for occasions over the next 48 hours a precordial thump converted this Br Med J: first published as 10.1136/bmj.1.5586.225 on 27 January 1968. Downloaded from 48 hours with only occasional extrasystoles. By this time the rhythm to sinus rhythm. On each occasion the procedure was infusion had been discontinued and he felt well, was in sinus performed with the patient monitored on the cardioverter, and with rhythm 80/min., and the blood pressure was 120/70. the shock paddles prepared and an intravenous drip available for At this time he suddenly relapsed to the original dysrhythmia- giving sodium bicarbonate or other drugs in the event of more supraventricular tachycardia with right bundle-branch block. On serious arrhythmia developing. In view of the continuing cardiac this occasion, as an alternative to further electrical cardioversion irritability with multifocal extrasystoles he was then put on a but while being monitored on the " cardioverter," he was given a procainamide continuous infusion, 4 g. in 24 hours, which had the sharp blow on the sternum with no effect. A similar heavy thump effect of almost clearing the ventricular ectopic beats. with the ulnar side of the clenched fist on the precordium at the cardiac apex immediately induced sinus rhythm with left bundle- COMMENT branch block (see Fig.). -
Precordial Thump
practical procedures resuscitation skills – part five Precordial thump phil Jevon, pGce, Bsc, rN, is tachycardia, asystole and resuscitation officer/clinical skills complete heart block where a lead, Manor Hospital, Walsall. precordial thump was delivered. The results were as follows: The precordial thump is a blow to l Ninety-one (49%) reverted to the lower half of the patient’s normal sinus rhythm; sternum using the lateral aspect l Seventy-seven (41%) had no of a closed fist. It can successfully change in rhythm; resuscitate the patient when l Nineteen (10%) were worse; given promptly following a l Overall, 90% of patients were cardiac arrest caused by either better or no change and Fig 1. check carotic pulse ventricular fibrillation (VF) or 10% were worse. ventricular tachycardia (VT) (Resuscitation Council (UK), 2006). Procedure This article describes the On discovering a collapsed procedure for delivering a unconscious patient: precordial thump. l Call out for help and activate the emergency buzzer; Mechanism of action l Lie the patient flat; The rationale for delivering a l Look, listen and feel for no precordial thump is that it longer than 10 seconds to generates a mechanical energy, determine if the patient is which is converted to electrical breathing normally (an occasional energy, which then may be gasp, slow, laboured or noisy sufficient to achieve successful breathing is abnormal) or has other cardioversion (Kohl et al, 2005). signs of life (Resuscitation Council Following the onset of VF, the (UK), 2006). If trained and threshold for successful experienced in assessing ill defibrillation rises steeply after a patients, a simultaneous Fig 2. -
Making the Rules of Sports Fairer
Making the Rules of Sports Fairer Steven J. Brams Department of Politics New York University New York, NY 10012 USA [email protected] Mehmet S. Ismail Department of Economics Maastricht University PO Box 616 6200 MD Maastricht The Netherlands [email protected] 2 Making the Rules of Sports Fairer Abstract The rules of many sports are not fair—they do not ensure that equally skilled competitors have the same probability of winning. As an example, the penalty shootout in soccer, wherein a coin toss determines which team kicks first on all five penalty kicks, gives a substantial advantage to the first-kicking team, both in theory and practice. We show that a so-called Catch- Up Rule for determining the order of kicking would not only make the shootout fairer but also is essentially strategyproof. By contrast, the so-called Standard Rule now used for the tiebreaker in tennis is fair. We briefly consider several other sports, all of which involve scoring a sufficient number of points to win, and show how they could benefit from certain rule changes, which would be straightforward to implement. 3 Making the Rules of Sports Fairer1 1. Introduction In this paper, we show that the rules for competition in some sports are not fair. By “fair,” we mean that they give equally skilled competitors the same chance to win—figuratively, they level the playing field. Later we will be more precise in defining “fairness.” We first consider knockout (elimination) tournaments in soccer (i.e., football, except in North America), wherein one team must win. -
Settling Ties in Handicap Competitions
SETTLING TIES IN HANDICAP COMPETITIONS How do you settle deadlocks-a halved match or a stroke-play tie-in a net competition? Rule 33-6 in the Rules of Golf requires that the Committee in charge of the competition announce a procedure for breaking ties before the competition starts. Simply stated, a halved match shall not be decided by stroke play; a tie in stroke play should not be decided by a match. Under Conditions of the Competition in Appendix I of the Rules of Golf, the USGA has some good recommendations that can help in these ticklish situations. Let's start with stroke play. One day our favorite duo, Uncle Snoopy and Woodstock, play 18 holes in a net competition at one of their favorite courses, Pumpkin Patch Golf Club. Uncle Snoopy's diligent work on his game has shaved his USGA Handicap Index down to 9.2, which translated into a Course Handicap of 11 that day. Woodstock meanwhile, has continued to struggle along with his 17.4 USGA Handicap Index, which resulted in a Course Handicap of 20 at Pumpkin Patch GC. At the end of 18 holes, Uncle Snoopy and Woodstock performed some beagle arithmetic on their scorecard. From the drawing, you can see that they both made net scores of 72. How should they proceed to break the tie? Sudden death is not recommended by the USGA in such cases. It's felt that playing hole-by-hole shouldn't decide a tie in stroke play. Instead, a playoff over 18 holes is the favored format. -
Risk of Injury from Baseball and Softball in Children
AMERICAN ACADEMY OF PEDIATRICS Committee on Sports Medicine and Fitness Risk of Injury From Baseball and Softball in Children ABSTRACT. This statement updates the 1994 American their thoraces may be more elastic and more easily Academy of Pediatrics policy statement on baseball and compressed.2 Statistics compiled by the US Con- softball injuries in children. Current studies on acute, sumer Product Safety Commission1 indicate that overuse, and catastrophic injuries are reviewed with em- there were 88 baseball-related deaths to children in phasis on the causes and mechanisms of injury. This this age group between 1973 and 1995, an average of information serves as a basis for recommending safe about 4 per year. This average has not changed since training practices and the appropriate use of protective equipment. 1973. Of these, 43% were from direct-ball impact with the chest (commotio cordis); 24% were from direct-ball contact with the head; 15% were from ABBREVIATION. NOCSAE, National Operating Committee on impacts from bats; 10% were from direct contact with Standards for Athletic Equipment. a ball impacting the neck, ears, or throat; and in 8%, the mechanism of injury was unknown. INTRODUCTION Direct contact by the ball is the most frequent aseball is one of the most popular sports in the cause of death and serious injury in baseball. Preven- United States, with an estimated 4.8 million tive measures to protect young players from direct Bchildren 5 to 14 years of age participating an- ball contact include the use of batting helmets and nually in organized and recreational baseball and face protectors while at bat and on base, the use of softball. -
Blunt Thoracic Trauma
CARDIOTHORACIC SURGERY II standard ATLSÔ principles, starting with control of the Airway. Blunt thoracic trauma While it is obvious that a chest injury may affect Breathing, the major effect of a tension pneumothorax and haemothorax is on Nathan Burnside Circulation. A chest drain will be both diagnostic and therapeutic. Kieran McManus Unlike penetrating injuries, most blunt chest injuries do not need immediate resuscitative surgery, but it is wrong to assume that they do not require surgical intervention at all. This presumption can Abstract result in the potential benefit of a specialist thoracic opinion being The restructuring of emergency healthcare services has led to more blunt ignored, and many injuries being undertreated. thoracic trauma being treated by a multidisciplinary team, including gen- eral, orthopaedic and trauma surgeons, often without immediate access Secondary survey to a thoracic surgeon. Having a critical mass of injured patients in a cen- tral location, it has been possible to bring expertise from other areas of When assessing chest injuries, the mechanism of trauma (Table 1) intensive care, radiology and surgery and apply new technology and tech- may be more relevant in terms of immediate injury and eventual niques to the trauma patient. We now see the regular use of endovascular outcome than the radiological images. The details of the accident stenting and embolization reducing the need for urgent surgery on unsta- are key to establishing the specific injuries that arise in connection ble patients and the increasing use of extracorporeal membranous with particular trauma situations and can often predict the late oxygenation (ECMO) to salvage patients with acute respiratory distress sequelae (Table 2). -
2021 Spring Golf Postseason Manual
2021 Spring Golf Postseason Manual POSTSEASON DATES Sectional tournaments: Class 1A, 2A & 3A will be held May 13 or 14, 2021, District tournaments will be held May 19, 20 or 21, 2021. Sectional and District assignments are posted online under Golf at www.iahsaa.org. State Tournament will be held May 27 & 28 with sites posted online. USGA RULES DURING THE POSTSEASON All IHSAA sanctioned tournaments will follow USGA playing rules unless otherwise specified in the IHSAA Spring Golf Manual. All rules and regulations in the Spring Golf Manual (General Rules for Interscholastic Golf & Code of Conduct) are applicable to postseason play. Please see Guidance for COVID-19 as it relates to safety precautions and possible adaptation per local rules on the IHSAA website. RULES JURY AND POSTSEASON A jury consisting of three coaches should be selected prior to the start of competition. The coaches’ jury is to handle code of conduct and other IHSAA rules and regulations—they would make those determinations in concert with a PGA pro if available. When there is an identified PGA pro or rules interpreter present—we prefer the PGA rules interpreter make USGA rulings because of his/her knowledge. We still want the coaches’ jury to help assist with communication and those areas that involve “local committee” rules such as IHSAA code of conduct, Coaching Rule, etc. We do not want individual coaches whether on the coaches’ jury or not making rulings in isolation by him/herself on the course. Any rules of golf interpretations/consultations may be directed to the following individuals at the Iowa Section of the PGA at their office at Casey Harvey, Tournament Coordinator at 319-775-7255 (call first); Greg Mason, Executive Director at 319-230-4934 (call second); Mike Downing, Director of Player Development at 828-260-0230 (call third); Tess Goudy, Junior Golf Director at 319-310-8728 (call fourth); Jazz Tulda, Junior Golf Coordinator at 262-758-4229 (call fifth); and the general office at 319-648-0026. -
Cardiac Concussion (Commotio Cordis)
PEDIATRIC EM • PÉDIATRIE D’URGENCE Cardiac concussion (commotio cordis) Rahim Valani, MD;* Angelo Mikrogianakis, MD;† Ran D. Goldman, MD† SEE ALSO COMMENTARY, PAGE 431. ABSTRACT Blunt chest trauma in pediatric patients can result in various injuries to the myocardium. Cardiac concussion (commotio cordis) is seen in patients in whom the precordium has been struck with rel- atively little force at a vulnerable period of the cardiac cycle. These patients have no predisposing cardiac problems, and autopsy reveals no evidence of heart damage. The usual clinical presenta- tion is that of immediate collapse secondary to a lethal arrhythmia. Prevention is the cornerstone of potentially decreasing the incidence with the aid of safety equipment and, possibly, immediate defibrillation. Key words: commotio cordis; chest trauma, pediatric; defibrillation; resuscitation RÉSUMÉ Un traumatisme contondant au thorax chez les patients pédiatriques peut causer diverses lésions au myocarde. On constate une commotion cardiaque (commotio cordis) chez les patients dont la région précordiale a subi un choc relativement faible à un moment vulnérable du cycle cardiaque. Ces patients n’ont aucun problème cardiaque prédisposant et l’autopsie ne révèle aucun signe de dommages cardiaques. Sur le plan clinique, le phénomène se manifeste habituellement par un ef- fondrement immédiat secondaire à une arythmie mortelle. La prévention constitue la pierre an- gulaire de la réduction possible de l’incidence au moyen de matériel de sécurité, et peut-être, d’une défibrillation immédiate. Introduction heart damage, even at autopsy.3,4 Emergency physicians, particularly those interested in injury prevention, should be Although trauma, in general, is the leading cause of mor- familiar with cardiac concussion because its mortality rate tality in children worldwide1,2 clinically significant isolated is as high as 85% and because it is often preventable.5 blunt chest trauma in children is rare. -
Cardiac Emergencies: Blunt Chest Trauma George Karatasakis, MD, FESC Onassis Cardiac Surgery Center, Athens, Greece
1955 Srce i krvni sudovi 2013; 32(3): 192-194 Pregledni rad UKS CSS UDRUŽENJE KARDIOLOGA SRBIJE CardiologY SOCIETY OF SERBIA Cardiac emergencies: Blunt chest trauma George Karatasakis, MD, FESC Onassis Cardiac Surgery Center, Athens, Greece Abstract Blunt chest trauma is considered a major health problem worldwide because of the tremendous incre- ase of the motor vehicle accidents. Any part of the heart or the great vessels can be injured. Hemope- ricardium and myocardial contusion are the most frequent cardiac lesions in patients who survive a motor vehicle accident. Rupture of a cardiac chamber, the aorta, or the coronary arteries is often fatal. Valve ruptures especially of the tricuspid valve carry a better prognosis. Diagnosis is based on troponin and cardiac enzymes measurement, ECG changes, chest X-ray, echocardiography and spiral computed tomography. Management of patients with compromised hemodynamics and progressive deteriora- tion is surgical often on an emergent basis. Key words blunt chest trauma, heart and great vessel injury hest injury may affect any organ situated in the tho- thermore, thoracic aorta damage is involved in 15% of racic cavity including the heart and great vessels. patients dying because of motor vehicle accidents2. This CBlunt mechanisms are more often involved in chest discrepancy, between clinical and autopsy findings, may wounds while penetrating traumas are less frequent. lead to the conclusion that the majority of severe injuries Injuries of the skeletal components of the chest (pec- of the heart and great vessels remain undiagnosed with toral muscles, ribs, clavicles etc.) have a better prognosis, lethal consequences. Rupture of a cardiac chamber, is provided that the broken bones do not penetrate any vi- encountered in 35-65% of autopsies, of patients dying tal organ.