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Propunere S.Ro.M.S.

FISA DE CONSULTATIE MEDICINA SPORTIVA

Nr........


NUME………………................................PRENUME…………………….............................
data nasterii……………...........CNP..........................................................................................
Sportul practicat…………...………..clubul/scoala…………………Nr. Legitimatie…………...

ANTECEDENTE  HEREDO-COLATERALE
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ANTECEDENTE PERSONALE  FIZIOLOGICE
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ANTECEDENTE PERSONALE PATOLOGICE
.....................................................................................................................................................

I. ANAMNEZA MEDICO-SPORTIVA

vechime in sport………….....rezultate……………………..........obiective…….....……………….
nr.antrenamente…………......volum antrenamente......................pofta antrenament……...................
consum excitante ……….......alimentatie………...…......... somn…………....apetit…………..…....
medicatie/suplimente….....……………………………………………………………………........
mijloace de refacere…………….....………………………………………………………….........

II. STAREA DE SANATATE
Acuze subiective……………………………………...……………………………………….........
                           ………………………...…………….………………………………………......
Examen clinic pe aparate si sisteme
- tegumente si mucoase : ……………….........……………..
- sistem ganglionar…………………………………....……………………………………............
- aparat locomotor......................……………………...………………………………….…..........
- aparat respirator.............................................................................................................................
- aparat cardio-vascular: TA…………AV…………s. arterial…..……...…s.venos………..............
                                          Ex.clinic cord……………………………………………………..........
                                                                 ........................................................................................
- aparat digestiv (si anexe)………………………………………………………………….………
- aparat uro-genital………………………………………………………………………................
-sistem nervos: manevra Chwostek……………ROT……….......Babinski…….……………...........
      Teste de echilibru………………..........reflex pupilar……..……................................................
- focare stomatologice.......................................................................................................................
Examene paraclinice
Laborator…………………………………………………..………………………....…………..
Altele………………………………………………………..…………………….....……………

III. DEZVOLTARE FIZICA
Somatoscopie:
Coloana vertebrala :  Plan sagital……………………………plan frontal…………...…………….
Torace............................................................................................................................................
Membre.........................................................................................................................................

Somatometrie:
Talie……......greutate………...bust…………anvergura………
DBA…..…DBT….....diam. ant-post........diam. trans.......Dap-Dt (v.n. >8)....................................
Perimetre toracice: normal……….. inspir………......expir.……....elasticitate toracica....................
Perimetre osoase:    pumn......genunchi…..glezna……indice osos (suma/talie v.n.m<43; M>46)...…
Plici adipoase: brat……....subscapular……….abdominal……….coapsa……..........fesier………..
Mobilitate………
Tonus : contractie……........relaxare……….....diferenta………............
Interpretare: G optima……….
                     MA actuala...………MA optim………MA actuala-MA optima…………................
                     TA actuala....…….. .TAoptim ……….TA actuala-TA optim………………….........
                     Indice alura atletica (DBA-DBT) (v.n. 5-12 cm)…………….....................................
                     Indicele Adrian-Ionescu (B-Talie/2) (v.n. 3-4 b/4-5 f).............................................
                     Indice de armonie Erissman (PT – Talie/2) (v.n. >0 peste 18 ani).................................
                     Prognoza crestere (daca e cazul)..…………………………………………………...

IV. STARE FUNCTIONALA SI CAPACITATE DE EFORT

EKG repaus.....................................................................................................................................
EKG efort (daca e cazul)..................................................................................................................

Proba clino-orto: Clinostatism TA…………AV……              Interpretare………………................
                             Ortostatism   TA…...…….AV……
                              
Proba Astrand (capacitate aeroba de efort) 
             Watt…….. ..Watt/kgcorp……..
             Rezultate efort:   AV ………TA ………revenire: AV ……................TA …………...........
                         Interpretare:
                         VO2max………..VO2/kgcorp actual…………..……
                         VO2/kgcorp standard…….…procent (ideal/standard x 100)………………………
                         STT (AVxTAmax)/ watt/kg: actual……..standard……..procent……indicativ…...…
                         PWC…………………
                         Concluzie…………………………………………..………………………............

Travaliul Total Realizat  (capacitate anaeroba de efort)
10 sec  valoare actuala........valoare standard............procent........interpretare.....................................
20 sec  valoare actuala........valoare standard............procent........interpretare.....................................
45 sec  valoare actuala........valoare standard............procent........interpretare.....................................
60 sec  valoare actuala........valoare standard............procent........interpretare.....................................
Watt maxim......................

Proba Ruffier: AV 1 …………AV 2………….AV 3………indice Ruffier………....
                         Interpretare………………………………………………………............................

Proba Flack.: cm col. Hg….........Timp de apnee.................
                       AV  0......5......10....15......20.....25......30......35.......40......45.....50.....55........60 sec
                       Interpretare..................................................................................................................

Alte probe...........................................................................................................................................

V. DIAGNOSTIC

1.Stare de sanatate……………………………………………………………………......................
...........................................................................................................................................................

2.Dezvoltare fizica…………………………………………................................................................
 ……………………...........................................................................................................................

3.Stare functionala si capacitate de efort………………………………………....................................
 ……………………………………………………………………………………………………...

VI. CONCLUZII………………………………………………………………………………….....
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VII. RECOMANDARI:

1.MEDICALE ………………………………………………………………………………...…...
……………………………………………………………………………………………....……..
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2.MEDICO-SPORTIVE

ALIMENTATIE………………………………………………………………………………..…
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MEDICATIE………………………………………………………………………………………
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REFACERE……………………………………………………………………………………
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ANTRENAMENT……………………………………………………………………………
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