FISA DE CONSULTATIE MEDICINA
SPORTIVA
Nr........
NUME………………................................PRENUME…………………….............................
data
nasterii……………...........CNP..........................................................................................
Sportul
practicat…………...………..clubul/scoala…………………Nr.
Legitimatie…………...
ANTECEDENTE
HEREDO-COLATERALE
....................................................................................................................................................
ANTECEDENTE
PERSONALE FIZIOLOGICE
.....................................................................................................................................................
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………………………………………………………………………………….....
............................................................................................................................................................
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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