Casey Riley’s scientific contributions

UNIQUENESS OF CASE BACKGROUND • Pneumothorax is the presence of air between the visceral and the parietal pleura of the pleural cavity 1 • A traumatic pneumothorax is caused by a penetrating wound to the chest, such as a fractured rib that violates the visceral pleura 1 • Research concerning pneumothorax in football is non-existent • Literature about pneumothorax in athletics in general is also non-existent PATIENT CHARACTERISTICS AND HISTORY • Male • 18 year old • African – American • High school football running back/linebacker • History of heat-related muscle cramping DIFFERENTIAL DIAGNOSIS • Heat-related illness • Rib Contusion • Lung Contusion • Part of athlete's signs and symptoms were attributed to: o 2 hours of playing both offense and defense o High heat and humidity o Dehydration due to playing both ways with little chance to adequately rehydrate o Treated earlier in scrimmage for muscle cramps • The athlete's pain level did not match with the seriousness of the injury EVIDENCE-BASED CLINICAL RECOMMENDATIONS • Check for lung sounds, even when you believe the injury may be benign • Use extra padding (hard, soft, or both) when recovering CLINICAL PRESENTATION • Athlete tackled while running the ball and fell onto his back • Speared on the left anterolateral aspect of his thorax • Signs & symptoms: SOB, point tenderness on ribs 5-10, no visible defects • Normal inspiration/expiration observed during breathing cycle • Auscultation was not performed initially TREATMENT • 10 days post-injury unresolved pneumothorax • Patient admitted to the hospital for a thoracostomy • Released 2 days later with instructions to rest and to wear a sling on the effected side • 24 days post-injury , patient was cleared to resume activity • 4 days later released for full, unrestricted play • Played in a game 28 days post-injury • Protection offered by an inner, soft, padded shirt and an outer, hard, shelled rib protector DIAGNOSTIC TESTING • X-ray and CT scan findings o Trace pneumothorax o Non-displaced incomplete fractures to the lateral L 4 th , 5 th , and 6 th ribs (Figures 1 & 2) o Non-displaced incomplete fractures to the posterior L 5 th , and 6 th ribs (Figures 1 & 2) REFERENCES 1. Cvengros RD, Lazor J. Pneumothorax – a medical emergency. J Athl Train. 1996; 31: 167-168 Outline of soft inner, soft padded shirt Fig. 1 -Day after injury x-rays Fig. 2 -Return to play x-rays

UNIQUENESS OF CASE BACKGROUND • Pneumothorax is the presence of air between the visceral and the parietal pleura of the pleural cavity 1 • A traumatic pneumothorax is caused by a penetrating wound to the chest, such as a fractured rib that violates the visceral pleura 1 • Research concerning pneumothorax in football is non-existent • Literature about pneumothorax in athletics in general is also non-existent PATIENT CHARACTERISTICS AND HISTORY • Male • 18 year old • African – American • High school football running back/linebacker • History of heat-related muscle cramping DIFFERENTIAL DIAGNOSIS • Heat-related illness • Rib Contusion • Lung Contusion • Part of athlete's signs and symptoms were attributed to: o 2 hours of playing both offense and defense o High heat and humidity o Dehydration due to playing both ways with little chance to adequately rehydrate o Treated earlier in scrimmage for muscle cramps • The athlete's pain level did not match with the seriousness of the injury EVIDENCE-BASED CLINICAL RECOMMENDATIONS • Check for lung sounds, even when you believe the injury may be benign • Use extra padding (hard, soft, or both) when recovering CLINICAL PRESENTATION • Athlete tackled while running the ball and fell onto his back • Speared on the left anterolateral aspect of his thorax • Signs & symptoms: SOB, point tenderness on ribs 5-10, no visible defects • Normal inspiration/expiration observed during breathing cycle • Auscultation was not performed initially TREATMENT • 10 days post-injury unresolved pneumothorax • Patient admitted to the hospital for a thoracostomy • Released 2 days later with instructions to rest and to wear a sling on the effected side • 24 days post-injury , patient was cleared to resume activity • 4 days later released for full, unrestricted play • Played in a game 28 days post-injury • Protection offered by an inner, soft, padded shirt and an outer, hard, shelled rib protector DIAGNOSTIC TESTING • X-ray and CT scan findings o Trace pneumothorax o Non-displaced incomplete fractures to the lateral L 4 th , 5 th , and 6 th ribs (Figures 1 & 2) o Non-displaced incomplete fractures to the posterior L 5 th , and 6 th ribs (Figures 1 & 2) REFERENCES 1. Cvengros RD, Lazor J. Pneumothorax – a medical emergency. J Athl Train. 1996; 31: 167-168 Outline of soft inner, soft padded shirt Fig. 1 -Day after injury x-rays Fig. 2 -Return to play x-rays