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ContextFor an acute cardiac event, on-field equipment removal is suggested, although how lacrosse equipment removal may alter the time to first chest compression and time to first automated external defibrillator (AED) shock remains unknown.ObjectiveTo determine the time to first chest compression and first AED shock in 2 chest-exposure procedures with 2 pad types.DesignCrossover study.SettingSimulation laboratory.Patients or Other ParticipantsA total of 36 athletic trainers (21 women, 15 men; age = 30.58 ± 7.81 years).Main Outcome Measure(s)Participants worked in pairs to provide 2 rescuer cardiopulmonary resuscitation (CPR) interventions on a simulation manikin outfitted with lacrosse pads and helmet. Participants completed 8 trials per pair (2 chest-exposure procedures × 2 pad types × 2 participant roles). The dependent variables were the time to first compression (seconds) and time to first AED shock (seconds). The independent variables were chest-exposure procedure with 2 levels (procedure 1: removal of the helmet while initiating CPR over the pads, followed by pad retraction and AED application; procedure 2: removal of the helmet and pads, followed by CPR and AED application) and pad type (Warrior Burn Hitman shoulder pads; Warrior Nemesis chest protector).ResultsWe found a significant interaction between chest-exposure procedure and pad type for the time to first compression (F1,35 = 4.66, P = .04, ω2p = 0.10), with faster times during procedure 1 for both the Nemesis pads (16.1 ± 3.4 seconds) and Hitman pads (16.1 ± 4.5 seconds) than during procedure 2 (Nemesis pads: 49.6 ± 12.9 seconds, P < .0001; Hitman pads: 53.8 ± 14.5 seconds, P < .0001).ConclusionsCompleting the initial cycle of chest compressions over either shoulder pads or a chest protector hastens the time to first chest compression without diminishing CPR quality, which may improve patient outcomes. The time to the first AED shock was not different between equipment procedures or pad types.

► The study is the first to measure comprehensively the shoulder force in a rugby tackle and influencing factors. ► When measured in a laboratory setting, the mean shoulder force was 1660N compared to 1997N in a field setting. ► Shoulder force was unaffected by shoulder pads and body side in this study. ► Shoulder force reduced with tackle repetition. ► Shoulder force magnitude was not associated with player position, skill level and player size. In rugby union football the tackle is the most frequently executed skill and one most associated with injury, including shoulder injury to the tackler. Despite the importance of the tackle, little is known about the magnitude of shoulder forces in the tackle and influencing factors. The objectives of the study were to measure the shoulder force in the tackle, as well as the effects of shoulder padding, skill level, side of body, player size, and experimental setting on shoulder force. Experiments were conducted in laboratory and field settings using a repeated measures design. Thirty-five participants were recruited to the laboratory and 98 to the field setting. All were male aged over 18 years with rugby experience. The maximum force applied to the shoulder in an active shoulder tackle was measured with a custom built forceplate incorporated into a 45 kg tackle bag. The overall average maximum shoulder force was 1660 N in the laboratory and 1997 N in the field. This difference was significant. The shoulder force for tackling without shoulder pads was 1684 N compared to 1635 N with shoulder pads. There was no difference between the shoulder forces on the dominant and non-dominant sides. Shoulder force reduced with tackle repetition. No relationship was observed between player skill level and size. A substantial force can be applied to the shoulder and to an opponent in the tackle. This force is within the shoulder's injury tolerance range and is unaffected by shoulder pads.

Shoulder-to-helmet (STH) impacts have been shown to cause approximately twenty percent of concussions in football yet little research has investigated shoulder pad design and STH impacts. This study aimed to characterize STH impacts and identify the effect of shoulder pad design on the struck head kinematics. Additional padding was added to a shoulder pad, and was then compared to an unmodified control shoulder pad. Participants performed a series of tests where they struck a helmeted Hybrid III dummy with both shoulder pad variations to compare struck head linear and rotational kinematics. The study found the modified shoulder pad reduced peak linear acceleration by 31% (Δµ = − 9.13 g’s (− ∞, − 7.25), (p = 4.10e−08)), rotational acceleration by 28% (Δµ = − 565 rad s-2(− ∞, − 435), (p = 2.10e−07)), peak rotational velocity by 10% (Δµ = − 2.42 rad s−1 (− ∞, − 1.54), (p = 6.9e−05)), and increased impact duration by 40% (Δµ = 9.96 ms (8.06, ∞), (p = 1.142e−08)). Impact response corridors were developed for both shoulder pad conditions and can be used to establish a controlled lab test setup that replicates STH impacts. Our findings suggest that shoulder pads have the potential to reduce head injury in football and warrant further research.

“Shoulder pad” sign resulting from deposition of amyloid in the periarticular soft tissue is rare but it is pathognomonic for immunoglobulin amyloidosis (AL). Although the detection remains a challenge, it gives a strong clue leading to prompt diagnosis. “Shoulder pad” sign resulting from deposition of amyloid in the periarticular soft tissue is rare but it is pathognomonic for immunoglobulin amyloidosis (AL). Although the detection remains a challenge, it gives a strong clue leading to prompt diagnosis.

ObjectiveThe initiation of cardiopulmonary resuscitation (CPR) can be complicated by the use of protective equipment in contact sports, and the rate of success in resuscitating the patient depends on the time from incident to start of CPR. The aim of our study was to see if (1) previous training, (2) the presence of audiovisual feedback and (3) the presence of football shoulder pads (FSP) affected the quality of chest compressions.MethodsSix basic life support certified athletic training students (BLS-ATS), six basic life support certified emergency medical service personnel (BLS-EMS) and six advanced cardiac life support certified emergency medical service personnel (ACLS-EMS) participated in a crossover manikin study. A quasi-experimental repeated measures design was used to measure the chest compression depth (cm), rate (cpm), depth accuracy (%) and rate accuracy (%) on four different conditions by using feedback and/or FSP. Real CPR Help manufactured by ZOLL (Chelmsford, Massachusetts, USA) was used for the audiovisual feedback. Three participants from each group performed 2 min of chest compressions at baseline first, followed by compressions with FSP, with feedback and with both FSP and feedback (FSP+feedback). The other three participants from each group performed compressions at baseline first, followed by compressions with FSP+feedback, feedback and FSP.ResultsCPR performance did not differ between the groups at baseline (median (IQR), BLS-ATS: 5.0 (4.4–6.1) cm, 114(96–131) cpm; BLS-EMS: 5.4 (4.1–6.4) cm, 112(99–131) cpm; ACLS-EMS: 6.4 (5.7–6.7) cm, 138(113–140) cpm; depth p=0.10, rate p=0.37). A statistically significant difference in the percentage of depth accuracy was found with feedback (median (IQR), 13.8 (0.9–49.2)% vs 69.6 (32.3–85.8)%; p=0.0002). The rate accuracy was changed from 17.1 (0–80.7)% without feedback to 59.2 (17.3–74.3)% with feedback (p=0.50). The use of feedback was effective for depth accuracy, especially in the BLS-ATS group, regardless of the presence of FSP (median (IQR), 22.0 (7.3–36.2)% vs 71.3 (35.4–86.5)%; p=0.0002).ConclusionsThe use of audiovisual feedback positively affects the quality of the depth of CPR. Both feedback and FSP do not alter the rate measurements. Medically trained personnel are able to deliver the desired depth regardless of the presence of FSP even though shallower chest compressions depth can be seen in CPR with FSP. A feedback device must be introduced into the athletic training settings.

A poem is presented.

Interpreting an abnormal serum calcium level in subjects with chronic kidney disease (CKD) requires the simultaneous evaluation of various clinical and laboratory parameters. An excessive intake of calcium salts and vitamin D overdosing may be the most common etiologies of hypercalcemia in individuals with advanced CKD. Nevertheless, it should be noted that such patients are susceptible to all diseases that may cause hypercalcemia in subjects without renal disease. In this report, we describe the case of a male chronic hemodialysis patient who developed asymptomatic hypercalcemia associated with polyarticular swelling. On the basis of the findings of systemic workup, he was finally diagnosed as having multiple myeloma. The so-called shoulder pad sign, which is pathognomonic for light chain amyloidosis, although its detection remains a challenge for physicians, was a clue leading to the prompt diagnosis of the disease in the current case. The impact of articular manifestations on the diagnostic strategy for assessing multiple myeloma is also discussed.

A poem is presented.