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Physiology and pharmacology of pain

The International Association for the Study of Pain (IASP) defines pain as ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage’. It is clear from this definition that the degree of tissue damage and perception of pain are not necessarily correlated. Pain perception is a complex phenomenon, involving sensory, emotional and cognitive processes. Thus, although…

Local anaesthetic agents

Local anaesthetics are analgesic drugs that suppress action potentials by blocking voltage-activated sodium ion (Na + ) channels (VASCs) in excitable tissues. Examples include the amides (e.g. lidocaine, bupivacaine, levobupivacaine, ropivacaine) and esters (e.g. cocaine and procaine) ( Table 5.1 ). Other drugs that can inhibit VASCs, such as diphenhydramine (a first-generation histamine H 1 receptor antagonist) and amitriptyline (a tricyclic antidepressant), also have local anaesthetic…

Intravenous anaesthetic agents and sedatives

A wide variety of therapeutic and non-therapeutic substances will obtund cerebral function and produce a continuum of cognitive states from almost fully awake to unexpected death ( Table 4.1 ). The clinically useful part of this spectrum is characterised by the American Society of Anaesthesiologists as levels of sedation and general anaesthesia ( Table 4.2 ). Any centrally acting depressant agent may produce sedation or general…

anaesthetic agents and medical gases

Inhalational and volatile anaesthetic agents are used widely for the induction and maintenance of general anaesthesia throughout the world. Since the famous demonstration of an ether anaesthetic by William Morton in 1846, the development of volatile anaesthetic agents paved the way for the introduction of modern surgical practices, procedures and techniques. Early agents such as diethyl ether, chloroform, ethyl chloride, cyclopropane and trichloroethylene, although effective, were…

Data, statistics and clinical trials

Statistics is the science of learning from data – from collection and organisation through to analysis, presentation and dissemination. Like all sciences, it has its own vocabulary and can sometimes appear somewhat impenetrable to the uninitiated. This chapter gives an overview of statistical processes and methods, but readers are advised to consult more detailed texts on medical statistics for further information. Whenever data are collected, in…

General principles of pharmacology

Basic principles A drug is a molecule or particle that produces a therapeutic effect by modifying how a biological system responds to a physical or chemical stimulus. This effect can occur locally at the site of administration or after absorption and delivery to a more distant site of action through carriers or mass transit. Most drugs undergo passive or active transport across membranes as part of…

Acute Leg Pain in a Patient With Cellulitis

Case Study A rapid response was initiated by the bedside nurse (RN) for a patient with severe leg pain. Upon the arrival of the rapid response team, the patient was a 48-year-old male with a known history of type 2 diabetes mellitus with insulin dependence, stage III chronic kidney disease, and chronic hypertension. The patient had been admitted two days earlier for lower extremity cellulitis, for…

Acute Foot Discoloration in a Patient With Peripheral Vascular Disease

Case Study A rapid response event was initiated by the bedside nurse after the patient had symptoms of sudden pain in his left foot. Prior to calling the condition, the nurse assessed the patient’s pulse in the affected foot, and she did not feel it. On prompt arrival of the rapid response team, a quick chart review suggested that the patient was a 55-year-old male with…

Muscle Spasms in a Patient With a History of Thyroidectomy

Case Study A rapid response was initiated by the bedside registered nurse for uncontrollable spasms in the hands and feet. Upon the arrival of the rapid response team, the patient was a 72-year-old gentleman with a known history of coronary artery disease, diabetes, hypothyroidism, and morbid obesity. The patient had been admitted earlier for viral gastroenteritis associated with intractable nausea and vomiting. The patient had been…

Transgender athlete sport inclusion polices: the current state

Sport participation policy Sport participation policies influence who has access to sport and competition, which in turn shapes our idea of who is an athlete. While inclusion policies can be based on age, school attendance, or geography, they are frequently also based on gender. Rules about gender classifications affect access to sport for transgender athletes. This chapter will – cover a brief history of athletic participation…

The history of transgender athletes in sport

Introduction The discussion of gender in sports is not new in the world of professional, amateur, and even high school athletic events. This chapter starts by exploring historic definitions of gender within the context of sport and then outlines some of the challenges that remain with the current methods used to determine gender in competition. Conversations regarding the fairness in athletic competition have been ongoing in…

Gender affirmation surgery

Introduction The purpose of gender-affirming surgery is to help alleviate distress associated with anatomical structures which (1) cannot be altered or eliminated by medical treatment, (2) have not changed enough with medical treatment, or (3) require the patient to take additional medication to maintain their body in congruence with their gender. Not all individuals who identify as transgender (or gender diverse) want or need surgery. However,…

Becoming whole: Mental health and psychosocial considerations of the transgender athlete

I think the beauty of being human is that we are incredibly, intimately near each other, we know about each other, but yet we do not know or never can know what it’s like inside another person (O'Donahue, 2008). Jordan K.’s personal story: being different meant violence If you asked me where I was from, I would most likely give you a series of locations and…

The effects of the gender transition on musculoskeletal health

Introduction The estimated prevalence of transgender individuals in the United States is 390 in 100,000 [ ]. In order to better care for the transgender athlete, a provider must understand the biochemical changes that occur during gender transition and their potential effect on athletes' physiology, injury risk, and performance. It is important to gather a detailed history on pharmacological agents and other interventions used throughout patients'…

Introduction to medical transition

For some transgender individuals, medical transition represents an important aspect of gender affirmation and alleviation of feelings of gender dysphoria. As with other aspects of gender transition, personal preferences and goals related to medical transition can vary widely between individuals. Broadly, interventions can be divided into gender-affirming hormone therapy and surgical interventions. Some transgender individuals choose to undergo medical transition, some choose to undergo surgical interventions,…

Special considerations for the transgender and nonbinary athlete

Epidemiology An estimated 0.6% of adults in the United States identify as transgender [ ]. The prevalence of transgender youth has been more difficult to predict. In one study, the youngest group was those aged 13–17 and it was predicted that 0.7% of individuals identified as transgender, which is slightly higher than that of the adult population [ ]. Although the exact prevalence of nonbinary identities…

What does transgender mean?

Introduction Before a practitioner can begin work with a Transgender Athlete, it is important to be comfortable with a vernacular that is applicable to all individuals, but often exclusively associated with members of the LGBTQ+ community. In modern society, terms like Gender, Sex, Identities, Pronouns, and Sexual Orientation , are often viewed through rainbow-colored glasses, despite the universality of these domains. Although these topics apply to…