1. inflammatory phase
2. fibroblastic repair phase
3. maturation-remodeling phase

• redness (chemical activity, vasodilation)
• swelling
• tenderness and pain (chemical activity, pressure on nerve endings)
• increased temperature (chemical activity)
• loss of function

To determine if there is tissue infection

• S-swelling
• H-heat
• A-ache
• R-redness
• P-puss

fundamental reaction is designed to protect, localize and rid the body of some harmful agent in preparation for healing

• Initial vasoconstriction (vascular spasm) results in secondary hypoxic tissue death
• lasts 5-10 mins
• time to evaluate and transport
• evaluate with minimal effect of pain, spasm & swelling
• Vasodilation occurs after 10 minutes and lasts 24-36 hours
• increase in blood flow and viscosity creates swelling and increased cell permeability
• the increased blood viscosity is from cell debris
• chemical mediators
• vasodilation and increased permeability
• leukocytes concentrate, line up, and adhere to endothelial walls referred to as margination
• phagocytic activity, clean up the area debris (phagocytosis)
• Formation of a clot
• platelets adhere to the injured vascular wall
• clots obstruct lymphatic drainage and localize injury

• when the acute inflammatory does not eliminate the injuring agent and restore the tissue to its normal physiological state
• resistive to both physical and pharmacological treatments

• signs of inflammation subside
• growth of capillary buds (angiogenesis) into the wound is stimulated by a lack of oxygen
• development of granulation tissue, scar tissue, delicate connective tissue
• tissue is initially laid down in a loose network and gains strength as collagen fibers increase in number

• realign collagen fibers that make up the scar tissue according to the tensile forces to which that scar is subjected
• synthesis and lysis assist with tensile strength and aligning the fibers in a position of maximum efficiency
• at the end of three weeks a strong, contracted and non-vascular scar exists

• Wolf's Law
• brief controlled motion during initial stages of inflammation
• as healing progresses to fibroblastic repair phase controlled activity is directed toward the return to normal flexibility and strength combined with protective bracing, support
• maturation-remodeling phase, more aggresive range of motion and strengthen activities are used
• pain dictates the rate of progression
• any increase in pain, swelling or other clinical symptoms during or after exercise or activity indicates that the load is too great for the level of tissue repair or remodeling

• extent of injury (micro or macro tears)
• edema
• separates tissues, inhibits neuromuscular control, neurological changes, impedes nutrition
• hemorrhage
• poor vascular supply
• separation of tissue
• primary intention: wound with even edges in close approximation
• secondary intention: gaping wound with separated edges with large amounts of tissue loss
• muscle spasm
• atrophy
• corticosteroids
• keloid and hypertrophic scars
• infection
• humidity, climate, and oxygen
• health, age, nutrition

1. initial 2-4 days
2. initial vasoconstriction & secondary hypoxic tissue damage
3. required for normal healing
4. inflammation
5. Vasodilation
6. cellular breakdown releases chemical mediators
7. margination (leukocytes along the cell wall)
8. phagocytosis (clean up of debris)
9. clotting (12-48 hours platelets adhering to vascular wall)

• use of modalities
• use of medication
• use of support, immobilization

• signs associated with inflammation subside/decrease
• regenerative activity leading to scar formation and repair of the injured tissue
• fibroplasia-scar formation
• angiogenesis- redevelop vascular supply, provision of nutrients
• develop network of connective tissue (granulation tissue) as fibrin clot breakdowns
• tensile strength of the wound is increasing

• scar formation
• hours after injury or up to 4-6 weeks

• connective tissue
• bright red, beefy, granular mass that fills with wound gaps

• long term process
• realignment or remodeling of collagen fibers according to tensile forces which the scar is subjected to
• Wolff's law
• 3 weeks to a firm, strong, contracted, nonvascular scar but may take years to complete
• edges of wound blend

optimal recovery or predispose to further injury includes:

• muscle strength and  endurance
• cardiorespiratory fitness
• flexibility & ROM
• balance & reaction time

• acute bone fractures
• stress fractures
• dislocation
• subluxation
• ligament sprains
• muscle strains
• contusions

• partial or complete disruption
• can be open or closed
• presents with deformity, point tenderness, swelling, pain on active and passive ROM

• bones can be stressed or loaded to fail by tension, compression, bending, twisting and shearing
• either occur singularly or in combination
• amount of load also impacts the nature of the fracture
• more force results in a more comlex fracture
• while force goes into fracturing a bone, energy and force is also absorbed by adjacent soft tissues
• some bones will require more force than others

• no specific cause but with a number of possible causes
• everload due to muscle contraction, altered stress distribution due to fatigue, changes in durface, rhythmic repetitive stress vibrations
• begins with a dull ache and progressively becomes worse over time
• initially pain during activity and the progresses to pain following activity
• area of pain gradually becomes more point specific
• early detection is difficult, bone scan is useful, x-ray is effective after several weeks
• due to osteoblastic activity

• at least one bone in a joint is forced completely out of normal and proper alignment
• high level of incidence in fingers, elbow, and shoulder

• partial dislocations causing incomplete seperation of two bones
• often occur in shoulder and patella in females

• thickned portions of the joint capsule or totally separate bands
• dictates partially the motions of the joint
• provide joint support

damage to a ligament:

• Grade 1: some pain, minimal loss of function, no abnormal motion, mild point tenderness, slight swelling and stiffness
• Grade 2: pain, moderate loss of function, swelling and instability, some tearing of ligament fibers
• Grade 3: extremely painful, inevitable loss of function, severe instability and swelling, and may also represent subluxation

• Grade 1: some fibers have been strectched or actually torn resulting in tenderness and pain on active ROM, movement painful but full range present
• Grade 2: number of fibers have been torn and active contraction is painfulm usually a depression or divot is palpable, some swelling and discoloration result
• Grade3: complete rupture of muscle or musculotendinous junction, significant impairment, with initially a great deal of pain that diminishes due to nerve damage

• result of sudden blow to body
• can be both deep and superficial
• hematoma results from blood and lymph flow into surrounding tissue
• minor bleeding results in discoloration of the skin
• may be painful to the touch and with active movement
• must be cautious and aware of more severe injuries associated with repeated blows
• calcium deposits may form with fibers of soft tissue, myositis ossificans
• prevention relies on protection and padding, particularly when dealing with myositis ossificans
• protection and rest may allow for calcium re-absorbtion, surgery may be necessary to remove
• quadriceps and biceps are very susceptible to developing myositis ossificans

• Tendonitis
• tendosynovitis
• bursitis
• osteoarthritis

• tendon pathology, not really inflammation
• most common overuse problem in sports
• gradual onset, with diffused tenderness due to repeated microtrauma and degenerative causes
• obvious signs of swelling and pain, may also experience crepitus
• key for treatment is active rest and removal of causal factors, work to maintain fitness but avoid activities that aggravate condition

• inflammation of synovial sheath surrounding the tendon
• in acute case- rapid onset crepitus, and diffuse swelling
• chronic cases result in thickening of tendon with pain and crepitus

• bursae is fluid filled sac that develops in areas of friction
• sudden irritation can cause acute bursitis, while overuse and constant external compression can cause chronic bursitis results in increased fluid production, causing increases in pressure due to  limited space around anatomical structures
• signs and symptoms include swelling, pain, and some loss of function
• three most commonly irritated, subacromial, olecranon, and prepatellar bursa

• wearing away of hyaline cartilage as a result of normal use
• changes in joint mechanics lead joint degeneration
• may be the result of direct blow, pressure of carrying and lifting heavy loads, or repeated trauma from an activity such as running or cycling
• commonly affects weight bearing joints but can also impact shoulders and cervical spine
• syptoms include pain (as the result of friction), stiffness, grating, localized tenderness, creaking, and often is localized to one side of the joint of generalized joint pain

• swelling, soreness, loss of normal liver function
• SIGNS AND SYMPTOMS
• flu-like symptoms, fatigue, weakness, nausea, abdominal pain, fever, headache, and possible jaundice
• possible that individual will not exhibit signs and symptoms---antigen always present
• can be unknowingly transferred
• may test positive for antigen within 2-6 weeks of symptom development
• 85% recover within 6-8 weeks

• good personal hygiene and avoiding high risk activities (needles, unprotected sex)
• proceed with caution as HBV can survive in blood and fluids, in dried blood, and on contaminated surfaces for at least 1 week

• VACCINATION
• athletic trainers and allied health professionals should be vaccinated
• 3 dose vaccination over 6 months
• post-exposure vaccination is also available after coming into contact with blood or fluids

• a retrovirus that combines with host cell
• virus that has potential to destroy immune system
• transmitted by infected blood or other fluids
• SIGNS AND SYMPTOMS
• fatigue, weight loss, muscle or joint pain, painful or swollen glands, night sweats and fever
• antibodies can be detected in blood tests within 1 year of exposure
• may go for 8-10 years before signs and symptoms develop
• most that acquire HIV will develop acquired immunodeficiency syndrome (AIDS)
• managed like a chronic illness

Low

• lifestyle choices put people at risk, not athletic participation
• off-field risks include sharing of needles and unprotected sex
• some sports have higher risk due to close contact with bodily fluids
• wrestling
• boxing
• martial arts

• have established policies to prevent transmission
• develop educational programs concerning prevention, medical assistance
• follow universal precautions mandated by OSHA

Americans with Disabilities Act of 1991

states athletes infected cannot be discriminated against and may only be excluded with medically sound basis

(must be based on medically sound evidence and must take into consideration risk to patient and other participants and  means to reduce risk)

• OSHA (Occupational Safety and Health Administration) established standards for employers to follow that govern occupational exposure to blood-borne pathogens
• All sports programs should have exposure control plan
• including counseling, education, volunteer testing, and management of bodily fluids
• preparing the athlete
• prior to participation, all wounds and lesions should be covered with dressing that will not allow for transmission
• occlusive dressing lessens chance for cross contamination (reduces chance wound will reopen, as wound stays moist and pliable)

• athletes with active bleeding must be removed from participation and returned when deemed safe
• bloody uniform must be removed or cleaned to remove infectivity

• those in direct contact should use appropriate equipment including: latex gloves, gowns, aprons, masks, eye protection, disposable mouthpieces for recuscitation
• emergency kits should contain, gloves, resuscitation masks, and towelettes for cleaning skin surfaces
• doubling gloves
• extreme care must be taken with glove removal and hands and skin in contact with blood must be washed immediately

• chlorine bleach, antiseptics, proper receptacles for soiled equip and uniforms, wound care equip, and sharps container
• biohazard warning labels
• red bags or containers for potentially infectious material
• disinfectant: surfaces should be clean, contaminated towels should be bagged, labeled and separated from other soiled laundry and washed in hot water
• sharps: use extreme care in disposal, do not recap or bend needles
• scissors and tweezers should be sterilized and disenfected regularly

• use mouthpieces in high-risk sports
• shower immediately after practice or competition
• athletes exposed to HIV or HBV should be evaluated and immunized against HBV

• epidermis
• dermis
• subcutis

• outer layer
• acts as barrier
• has multiple layers
• helps contain water and electrolytes

• made of connective tissue
• contains blood vessels, nerves, sweat glands, sebaceous glands, and hair follicles
• interlocks with epidermis
• sebaceous glands secrete oil when stimulated by goose bumps to protect us against the cold, arrector pilli muscles cause goose bumps when they contract
• sweat glands are used for cooling the surface of the body, sweat contains antibacterial agents that control skin infections
• sensory nerve ending provide tactile sensation and detect temp changes

• contains subcutaneous fat
• fat storage, internal temperature control, mobility of skin over bony core

• calluses, hyperkeratosis
• blisters
• ingrown toenails

• epidermis increases in thickness in response to constant pressure and friction
• the callus moves as a mass when pressure and shearing forces are supplied to produce a rip or blister
• care includes shaving, wearing protective padding
• callus should be removed until the yellow skin just turns pink, otherwise a wound is created and the protective surface is removed

• collection of fluid below or within the epidermis
• caused by friction

• icing "hot spot" 
• using protective padding
• care for intact blisters
• cleaning and protecting
• use sterile technique for cleaning and wear latex gloves
• do not remove protective layer of skin, leave intact for the first 24 hours
• watch for infection
• SHARP (swelling, heat, ache, redness, pus)
• apparent within 8-48 hours

• nail grows into the lateral nail fold and enters the skin
• check shoe fit, and that the nail is cut straight across
• care includes: packing, filing down the thickness of the nail, "V" cut

• when rendering first aid is avoidance of exposure to whole blood that may transmit HIV or HBV
• majority of wounds as abrasions, lacerations, or incisions

• control bleeding
• prevent infection

• heal from the inside without scab formation to prevent infection pockets and having scab repeatedly torn off
• potential for infection, need to clean debris out of the wound

• need to be referred for tetanus shot
• tetanus boosters are every 10 years

• have jagged ends
• mouth lacerations usually heal quickly on their own because of the warm, moist environment
• wounds through the tongue, lip or mouth wall need to be stitched
• assess status of the teeth
• avulsions where skin is torn from the body

• stitches are required when underlying structures can be seen (adipose, tissue, bone or tendons)
• must keep stitches clean and dry for 3 days to prevent infection
• stitches may be also be required when the wound is in an area that is very mobile near a joint, over a large muscle mass

• wound may be steri-stripped instead of stitched if it is in an inactive area
• FDA has approved a medical version of super glue for skin closures

• ring worm, athlete's foot, jock itch
• manageable with commercial products and good personal hygiene

• herpes simplex
• warts

• highly contagious and directly transmitted
• recurrent attacks can be triggered by sunlight, emotional disturbances, illness, fatigue and/or infection
• signs/symptoms
• initial tingling, area of sensitivity
• localized swelling
• tender lymph nodes
• development of lesions with crusting
• careful of secondary infection

• plantar or common warts
• plantar warts get involved within calluses on the balls of the feet
• are painful
• removal created open, painful wounds, removal is usually by chemicals

• reddening of skin, hives, itching
• allergens may be food, drugs, clothing, dusts, pollens, plants, animals, heat, cold, light
• contact dermitits
• plants
• soaps, lotions, deodorants

• over exposure to ultraviolet rays
• first degree: pink/red coloration
• second degree: itching, swelling, blistering
• appears in 2-8 hours
• most extreme at 12 hours
• resolved within 3-4 days
• once burned more susceptible
• concerns:
• increased body temp
• dehydration
• secondary infection
• long term exposure causes premature againg and skin cancer

• prevention with sunscreen
• ice, cold showers, ice towels
• soothing lotions
• Tylenol for fever and pain

A: asymmetry

B: border irregularity

C: color (pigmentation should be uniform)

D: diameter

E: elevation

• remove stinger, do not squeeze
• ice area
• use bee sting kit if necessary
• epinepherin injection
• antihistamine tablets

• swellling
• muscle spasm
• pain

• reduces scar tissue
• maintains ROM
• facilitates rehabilitation

• 15-20 minute treatments
• careful over superficial nerves
• every 1 to 1.5 hours
• Ice until swelling is stabilized (up to 3 days)

• decrease of pain
• promote vasoconstriction
• decrease metabolism
• decrease muscle guarding
• slow the speed of nerve transmission
• pain control through gate control

• ice bags
• ice cup
• chemical packs
• ice bucket or bath
• cold whirlpool

• elevate extremity at or above the heart
• prevents pooling in the extremities
• assists with pain by eliminating pressure
• assists with lymphatic drainage
• elevation with compression most important part of swelling containment

• crutches 6" outer margin of shoe, 2" in front of shoe
• body weight forward
• 2-3 finger (1") widths of space in axilla (armpit)
• elbow 30-45 degrees of flexion
• greater the angle, more the shoulder girdle is used for stability vs. isolating just the biceps and triceps
• DO NOT lean on crutches (no resting axilla on crutches, can cause damage to nerves and arteries in the axilla)
• carry extremity in as anatomically correct position as possible

1. three point crutch gait
2. three point swing through gait
3. climbing stairs

• uninvolved leg advances up first
• uninvolved leg advances down the stairs first
• railing is more secure than crutches

• sharp, bright, burning
• fast or slow onset

• tendons, muscles, joints

• warning that something is wrong
• spasm to guard the area
• withdrawal response to prevent further contact

• once the injury/illness is diagnosed, pain has little purpose
• pain is often a symptom and not a pathology
• pain can persist after is is useful, it is a means of enhancing disability and inhibiting rehab efforts
• trigger points, hyperirritable areas within a muscle with nerves sending numerous pain signals to the brain

referred pain

1. mechanical
2. thermal
3. chemical
4. afferent
5. efferent

• stimulated by swelling and muscle spasm
• receptors respond to changes in stimulus

• respond to changes in temperature

increases, decreases

large diameter nerves transmit impulses faster than small diameter nerves

• large diameter, afferent, myelinated fibers
• carry nonpain impulses (sensation, temperature, proprioception info)

C fibers & A delta

• small diameter, afferent, unmyelinated fibers
• have slower impulses
• transmit pain impulses
• delta fibers transmit "fast pain"
• C fibers originate from superficial and deep tissues and transmit "slow pain"

• the body can only respond to a limited amount of stimuli at a time, gate control theory limits or controls the signals the brain is receiving
• A beta & gamma fibers for sensory stimulation

• once the pain signals reach the brain, they can be changed or not interpreted by the other areas of the brain as pain, not responded to 

1. sensory discrimination: locates the site of pain, its intensity and nature
2. motivational affective: mental state and personality characteristics and how they affect pain perception
3. cognitive-evaluate: concious thought process regarding pain

1. gate control
2. central biasing, cognitive adjustments
3. release of beta-endorphins

1. characteristics & expectations of the sport
2. past experiences
3. sex role stereotypes, "big boys dont cry"
4. presence of peers
5. maturity level
6. culture
7. placebo effect

• pain has psychological parameters
• perceived pain is pain
• you cannot guess how much pain someone is in
• pain perception varies with age, incident, maturity, experience, environment, etc.
• visual analog scales or numeric pain scales
• pain charts: McGill Pain questionnaire

• pain perception is influenced by anxiety, attention, depression, cultural experiences, and past pain preferences
• mental processes of pain perception can be modified through descending systems, for example:
• personality
• motivation to play
• aggression
• anger
• fear
• cognitive involvement is capable of producing pain in the absence of pathological conditions, for example:
• phobias
• fear
• depression
• anger
• grief
• hostility
• pain memory, associated with old injuries can result in pain perceptions and responses that are out of proportion to a new injury
• substance abuse can also alter pain perceptions
• all pain, even that which is thought to be psychosomatic pain, is very real to the client or athlete

application of any cold modality (32-65 degrees F) to the body

• skin temperature needs to be reduced to 57° for maximum benefits
• average treatments 15-20 minutes
• depth of treatment is 2cm

heat is removed from the body and absorbed by the cold modality

• the greater the temperature gradient the more quickly energy is absorbed
• each type of tissue conducts heat at different rates

• initial modality temperature: greater difference between the cold modality and the tissue being treated, the more rapid the exchange of heat
• duration of the application: longer treatment the greater depth of cooling
• surface area being treated: wrapping on an ice bag increases the transfer of cold by increasing area of contact and providing insulation
• conductivity of the tissue being treated: adipose tissue is the limiting factor in the effective depth of penetration, slows rewarming process

• treatment temperature: 57° is therapeutic
• skin insulation
• modality insulation
• size of treatment area
• vascularity of target tissues
• sensation of target tissues
• post-treatment activity

• acute stages of the inflammatory response
• before ROM exercise, especially joint application
• after physical activity
• control of musculoskeletal pain
• decreasing muscle spasm (INCREASES MUSCLE FLEXIBILITY)

• frost bite, nip
• shivering
• allergies to
• high blood pressure
• poor sensation, circulation

• superficial vasoconstriction
• lowered metabolic rate and need for oxygen (reduction of secondary hypoxic tissue damage)
• lowered inflammation due to lowered production of cellular wastes (soft tissue healing)
• lowers pain
• lowers muscle spasms
• lowers nerve conduction velocity (decrease pain, increase muscle flexibility)
• lowers muscular force production

• Rest limits the scope of the original injury
• ice decreases cell's metabolism and decreases pain
• compression & elevation decreases pressure gradient between the blood vessels and tissues, controls swelling
• most beneficial effect of cold alone for an acute injury is limiting the secondary hypoxic tissue damage

• decreases muscle's ability to rapidly contract for up to 30 minutes post treatment
• if used, requires proper warm up
• does not inhibit joint proprioception
• decreases muscle spindle activity for increase in muscle flexibility
• decreases the negative feedback loop

• initial temperature of the modality
• surface area being treated
• duration of application
• conductivity of the modality and tissue

• when the skin temperature rises rapidly
• if the rate of tissue temp increase is too slow, the associated increased blood flow will keep tissue temperatures low by dissipating the heat
• first 5-6 minutes of treatmetn the body absorbs the heat faster than it dissipates it
• at 7-9 minutes the temperature gradient begins to even out

• intensity is too great, exposure too long
• maximum vasodilation has occured and the intensity of the treatment stays constant the vessels begin to constrict
• mottling, blotchy discoloration of the skin
• can burn the skin

• superficial vasodilation
• increased rate of cell metabolism
• increased capillary permeability
• removal of metabolic wastes
• increased elasticity of tissue, decreased muscle tone & muscle spasm
• analgesia & sedation of nerves
• decreased pain
• increased nerve conduction velocity

• increased body temperature
• increased pulse rate
• increased respiratory rate
• decreased blood pressure

• through the accelerated metabolic rate and increased blood supply, increasing the delivery of oxygen, nutrients & antibodies required for healing
• increase in the delivery of leukocytes encouraging phagocytosis (as long as it is not too early in the acute inflammatory phase)
• encouraging venous & lymphatic return with the assistance of elevation, muscle contraction, compression boot and/or massage
• decreased muscle spasm
• increased temp reduces muscle spindle sensitivity to stretch
• used to elongate muscle and capsular tissues to regain function

• during sub-acute and later stages of soft tissue healing (stabilized swelling)
• decrease muscle spasm
• to assist with reduction of edema (lymphatic drainage) & ecchymosis (along with elevation, active muscle contraction, compression boot and/or massage)
• to improve ROM before participation or rehabilitation
• to promote drainage from an infected site

• applying heat to an injury in the acute inflammatory phase will increase the rate of cell metabolism and accelerate the amount of hypoxic injury that occurs, increases swelling
• if the skin begins to mottle, it is an indication of too much heat
• circulation disorders
• decrease sensitivity, superficial nerves
• poor thermal regulation (children, fever)

• used for transition from cryotherapy to thermotherapy
• generally begin in hot and end in cold if vasoconstriction is desired
• end in hot if relaxation and vasodilation is desired
• a lot of good sensory manipulation

Over-the-Counter Medications

OTCs

• available and used to self treat, self manage
• first line of defense against illness, primary care and then seek the care of an MD
• fits insurance coverage wants

• commonly used to assist with pain
• acetaminophen (metabolized in liver)
• ibuprofen (metabolized in the kidney)

• stay ahead of the pain
• use when necessary to establish/maintain sleeping patterns & moderate activity level
• dosage (two 200mg tablets every 4-6 hours)

Nonsteroidal anti-inflammatory

NSAID

• ibuprofen, naproxen sodium
• also have analgesic (pain) and antipyretic (fever) effects
• side effects include gastric irritation, increase in blood pressure
• not as likely to affect platelet aggregation as aspirin
• 200mg dose does not require prescription and is used for analgesia
• at a dose > 400mg requires a prescription, the effects are then both analgesic and anti-inflammatory
• common prescription dosage is 2400-3200mg/day
• primarily used for reducing joint and muscle pain
• inflammation is a wanted part of soft tissue healing
• use acetaminophen for first 3 days and then switch to NSAIDS
• best results if taken the same time every day to maintain blood levels
• naproxen sodium is most effective after 5-7 days of use at anti-inflammatory level
• ibuprofen is effective more quickly

Acetominophen

(Tylenol)

• has analgesic and antipyretic effects
• does not have significant anti-inflammatory capabilities
• primary advantage is no gastric upset and does not affect the clotting mechanism
• this is the drug of choice for the aches/pains/fever of cold and flu
• this is the drug of choice for pain associated with soft tissue healing and injury
• dosages for infants and children are packaged in different concentrations
• acute liver toxicity with an overdose

• use acetaminophen or NSAID if necessary
• a low grade fever is a defense mechanism against viral and bacterial infections
• focus on hydration, good nutrition & rest
• allow to practice or compete

• use acetaminophen or NSAID
• focus on hydration, good nutrition & rest
• no practice or competition, or consult with physician

• can have fever with both
• viruses take 7-10 days
• can have secondary bacterial infection right after the viral infection due to compromised immune system
• treat symptoms (pain, congestion, sore throat)
• stay home, rest, hydration & nutrition
• consult physician if 
• fever develops, changes, or reaches 102°
• mucus is green
• develop a deep, non-productive cough

• do not overuse! antibiotic resistant strains
• complete prescription as directed

• administration of a drug is giving a single dose of a particular medication, dispensing of medication is giving a drug in a quantity greater than would be used in a single does
• in most states athletic trainer cannot dispense medication but can legally administer a does of nonprescription medication
• cannot under any circumstance dispense or administer prescription medication
• cannot dispense of administer drugs to those under 18