Kin 145 heat factors
hydration rule of thumb
200-300ml per 15 minutes
Malignant Hyperthermia
Autosomal Muscle disorder causing hypersensitivity to anesthesia and heat Similar S&S to heatstroke - massive release of intracellular Ca+ Increased Metabolic demands can lead to Cardiac Arrest Temperature will remain elevated 10-15 minutes following exercise Athlete with condition should be disqualified from competition in hot, humid environments
Convectional heat exchange
Body heat can be lost or gained depending on circulation of medium Convection is heat transfer by mass motion of a fluid such as air or water when the heated fluid is caused to move away from the source of heat, carrying energy with it. Convection above a hot surface occurs because hot air expands, becomes less dense, and rises
Radiation heat exchange
Comes from sunshine and will cause increase in temperature Radiation is transfer of heat through electromagnetic waves through space. Unlike convection or conduction, where energy from gases, liquids, and solids is transferred by the molecules with or without their physical movement, radiation does not need any medium
Heat syncope
Fainting due to prolonged exposure to heat/lack of acclimatization to heat Etiology: peripheral vasodilation of superficial vessels in an effort to cool body Sxs: dizzy, nausea, fainting, tunnel vision, pale or sweaty skin, shallow/weak pulse Rx: place in cool environment and replace fluids, monitor vitals
CHO and hydration
If exercise session longer than 45-50' or intense, CHOs (sports drinks) during exercise is beneficial CHO concentration > 8% decreases fluid absorption Ideally, 6-7% CHO concentration
Na++ and hydration
Increase Na++ consumption during initial acclimatization or activity lasting 4+hrs Can achieve by salting foods or adding a little salt to sports drinks (will stimulate thirst and help to retain water)
Heat stress
Metabolic heat production (body temp increase) Conductive heat exchange (ie: turf) Convective heat exchange (air temp) Radiant heat exchange (sun) Evaporative heat loss=main form of heat loss
Signs of severe dehydration
Not urinating, or very dark yellow or amber-colored urine Dry, shriveled skin Irritability or confusion Dizziness or lightheadedness Rapid heartbeat Breathing rapidly Sunken eyes Listlessness Shock (lack of blood flow through the body) Unconsciousness or delirium
Conductive heat exchange
Physical contact with objects resulting in heat loss or gain Conduction is heat transfer by means of molecular agitation within a material without any motion of the material as a whole
High risk healthy individuals
Poorly acclimatized or poorly conditioned Inexperience or limited knowledge about heat Elderly Excessive muscle mass Using some sunscreens that block cooling
High risk in overweight individuals
Pre-existing dehydrated state or pre-existing heat injury Sleep deprived individuals Chronic Illnesses Acute illnesses with fever or gastric implications Alcohol or substance abusers Certain medications
Heat stroke steps
Remove all equipment and excess clothing. Cool the athlete as quickly as possible within 30 minutes via whole body ice water immersion (place them in a tub/stock tank with ice and water approximately 35-58°F); stir water and add ice throughout cooling process. If immersion is not possible (no tub or no water supply), take athlete into a cold shower or move to shaded, cool area and use rotating cold, wet towels to cover as much of the body surface as possible. Maintain airway, breathing and circulation. At any time but even after cooling has been initiated, activate emergency medical system by calling 911. Monitor vital signs such as rectal temperature, heart rate, respiratory rate, blood pressure, monitor CNS status. If rectal temperature is not available, DO NOT USE AN ALTERNATE METHOD (oral, tympanic, axillary, forehead sticker, etc.). These devices are not accurate and should never be used to assess an athlete exercising in the heat. Cease cooling when rectal temperature reaches 101-102°F (38.3-38.9°C). Exertional heat stroke has had a 100% survival rate when immediate cooling (via cold water immersion or aggressive whole body cold water dousing) was initiated within 10 minutes of collapse.
Acute Exertional Rhabdomyolysis
Sudden catabolic destruction and degeneration of skeletal muscle (myoglobin and enzyme leakage into vascular system) Occurs during intense exercise in heat and humidity resulting in: gradual muscle weakness, swelling, pain, dark urine, renal dysfunction severe case = sudden collapse, renal failure and death Associated with individuals that have sickle cell trait Should be referred to a physician immediately
Evaporative heat loss
Sweat glands allow water transport to surface Evaporation of water takes heat with it When radiant heat and environment temperature are higher than body temperature, loss of heat through evaporation is key Lose 1 quart of water per hour for up to 2 hours Air must be relative water free for evaporation to occur relative humidity of 65% impairs evaporation relative humidity of 75% stops evaporation
Signs of mild dehydration
Thirst Dry or sticky mouth Not urinating much Darker yellow urine Dry, cool skin Headache Muscle cramps
Wet Bulb Globe Temperature (WBGT)
WBGT device is a measurement tool that uses ambient temperature, relative humidity, wind, and solar radiation from the sun to get a measure that can be used to monitor environmental conditions during exercise. Establishing WBGT guidelines that dictate modifications in activity (work:rest ratios, hydration breaks, equipment worn, length of practice) at given WBGT temperatures play a huge factor in helping to prevent EHS
Heat exhaustion signs and symptoms
profuse sweating pale skin mildly elevated core temp (99-103.9) Ataxia (Decreased coordination) Headache Dizziness, weakness, light-headedness Hyperventilation rapid pulse
hyperthermia
-Abnormally high body temperature (Heat Stress) -Heat illnesses are a spectrum of illnesses that occur due to heat exposure. This heat exposure can come from either environmental heat (air temperature) or simply intense exercise. These conditions can range from minor heat cramps to life-threatening heat stroke. Contrary to popular belief, heat illnesses do not exist on a continuum. You do not need to have heat cramps or syncope before you have heat exhaustion. As with all emergency conditions, there are steps that you can take to prevent heat illnesses, such as proper hydration, heat acclimatization or body cooling. (Source: KSI)
What temp. do you want the athlete to get to before transport?
101
Proper Hydration
2-3 hrs prior17-20 oz. H2O or sport drink 10-20 min. prior7-10 oz. fluid Every 10-20 min. during7-10 oz. fluid 2 Purposes: decrease rate of hyperthermia maintain athletic performance
Exertional heat stroke treatment
AGGRESSIVE AND IMMEDIATE whole body cooling. Cold water immersion (35°-38° F) within minutes is the best treatment until core temperature reaches 101° -102°F. Contact emergency medical services for transport. Monitor airway, breathing, circulation, core temperature, and CNS. If immersion is not possible use alternate methods such as spraying the body with cold water, fans, ice bags or cold towels (replaced frequently), and transport immediately to a medical facility.
BSI
Body substance isolation
recognition of dehydration
Dry mouth, thirst, irritability, headache, weakness, dizziness, cramps, chills, vomiting, nausea, fatigue, decreased performance.
Heat cramps
Heat (muscle) cramps tend to occur later in activity with muscle fatigue and after fluid and electrolyte imbalance and increased. Dehydration, diet poor in minerals, and large losses of sodium and other electrolytes increase the risk of severe often whole body muscle cramps
Exertional heat stroke
Heat Stroke is a severe heat illness that occurs when a student-athlete's body created more heat than it can release, due to the strain of exercising in the heat. This results in a rapid increase in core body temperature, which can lead to permanent disability or even death if left untreated.
Heat exaustion
Heat exhaustion is a moderate heat illness that occurs when the student-athlete continues physical activity after they start suffering from the ill effects of heat, like dehydration. The student-athletes body struggles to keep up with the demands, leading to heat exhaustion.
return to play in terms of dehydration
If dehydration is minor and the student athlete is symptom free, continued participation is acceptable.
Exertional heat stroke recognition
Increase in core body temperature, usually above 104°F. Central nervous system dysfunction(CNS) (altered consciousness, seizures, confusion, emotional instability irrational behavior or decreased mental acuity. Other indicators include: nausea, vomiting, diarrhea, headache, dizziness, weakness, hot and wet or dry skin, increased heart rate, decreased blood pressure or fast breathing, dehydration, and combativeness
Recognition of heat cramps
Intense pain in muscles and persistent muscle contractions after prolonged exercise, most often with exercise in heat.
treatment of dehydration
Move student-athlete to a cool environment and rehydrate. Rehydrate with a sports drink including carbohydrates and electrolytes, and sodium. Give student-athletes convenient access to fluids. A nauseated or vomiting student-athlete should seek medical attention to replace fluids via an intravenous line.
recognition of Heat exaustion
Physical fatigue, dehydration and or electrolyte depletion, coordination loss, fainting, dizziness, profuse sweating, pale skin, headache, nausea, vomiting, diarrhea, stomach/intestinal cramps, rapid recovery with treatment.
Exertional heat stroke and return to play
Physician clearance is necessary before return to physical activity. The severity of the incident should designate the length of recovery time. The student-athlete should avoid exercise for the minimum of one week after release from medical care. Underlying conditions or illness needs to be ruled out. A gradual return to physical activity should begin under the supervision of an certified athletic trainer or other qualified medical professional.
Hyponatremia and return to play
Physician clearance is strongly recommended in all cases. In mild cases, activity can resume a few days after completing and educational session on establishing and individual-specific hydration protocol.
Hyponatremia recognition
Possible symptoms include increasing headache, nausea, vomiting (often repetitive), swelling of extremities, irregular diet with inadequate sodium intake, copious urine with low specific gravity following exercise, lethargy/apathy, and agitation. If the condition progresses, CNS changes (altered consciousness, confusion, coma, convulsions, altered cognitive functioning)
Hyponatremia treatment
Preventative methods to maintain proper sodium levels. Sodium intake via electrolyte drinks or other sources. If blood sodium levels cannot be determined onsite, hold off on rehydration and transport student-athlete to a medical facility.
EHI
exertion heat illness
Treatment of heat cramps
Regain normal hydration status and replace sodium losses via an electrolyte drink or other sodium source. Salty sweaters may need additional sodium earlier in activity. Light stretching, relaxation of involved muscles.
Treatment of Heat exaustion
Remove student-athlete from play to a shaded or air conditioned area, remove excess clothing and equipment. Cool student-athlete with legs propped above heart level. If not nauseated, or vomiting rehydrate with chilled water or sports drink. If student-athlete cannot take fluids orally intravenous fluids are indicated. Transport to an emergency facility if rapid improvement is not noted with prescribed treatment
Return to play considerations with Heat exhaustion
Student-athlete should be symptom free and fully hydrated. Clearance from a physician or at least consultation with a physician is recommended. Underlying conditions or illness needs to be ruled out. Intense practice in heat should be avoided for at least one day. If lack of acclimatization or inadequate fitness level was the cause of illness, correct this before the student-athlete returns to full-intensity training in heat.
Return to play considerations with heat cramps
Student-athletes should be assessed to determine if they can return to participation. Diet, rehydration practices, electrolyte consumption, fitness status and level of acclimatization and use of dietary supplements should be assessed and possibly modified.
Hyponatremia
When a student-athlete consumes more fluids than necessary, and/or sodium lost in sweat is not adequately replaced, sodium in the bloodstream becomes diluted and can cause cerebral and/or pulmonary edema.
Rectal thermometer
• Cover end of thermistor with disposable sheath and lubricating jelly or water • Drape athlete from waist and pull shorts down to midthigh • Hold thermistor and premarked black line or tape with one hand • Use other hand to shift one gluteal cheek to the side • Insert thermistor to premarked line • Loop rest of thermitor and tuck into side of shorts and pull shorts back up • Plug thermistor into thermometer receiver • Do not remove until athlete returns to normal temperature • To remove, pull thermistor out and clean probe - Wet wipe and Cidex solution - Rinse and dry thoroughly • Thoroughly wash hands
Intrinsic NATA risk factors
• History of heat illness • Inadequate heat acclimatization • Higher percentage body fat • Low fitness level • Dehydration or over-hydration • Presence of a fever • Presence of gastrointestinal illness • Salt Deficiency • Skin Condition • Ingestion of certain medications or supplements • Motivation to push self/warrior mentality • Reluctance to report problems, issues, illness, etc.
Extrinsic NATA risk factors
• Intense or prolonged exercise with minimal breaks • High temperature/humidity/ sun exposure • Inappropriate work/rest ratios • Lack of education and awareness of heat illness • No emergency plan • Limited duration and number of rest breaks • Minimal access to fluids before and during practice and rest • Delay in recognition of early warning signs
dehydration
• When student-athletes do not replenish lost fluids they become dehydrated. Dehydration as minimal as 2% body weight loss (BWL) can hinder performance and thermoregulatory function. You can become dehydrated if you lose too much fluid, don't drink enough water or fluids, or both. Your body may lose a lot of fluid from: Sweating too much, for example, from exercising in hot weather Fever Vomiting or diarrhea Urinating too much (uncontrolled diabetes or some medications, like diuretics, can cause you to urinate a lot)