Athletic Training-environmental considerations

High altitude cerebral edema (HACE)

)- 1% of people adjusting to altitudes > 9,000 ft, usually in conjunction w/ HAPE

Acute mountain sickness

1 out 3 people at 7,000-8,000 ft. Symptoms include headache, nausea, vomiting, sleep disturbance, and dyspnea

Sports drinks are more effective than water for fluid replacement Optimal level of carbohydrates is..

14 grams per 8 oz of water

High altitude pulmonary edema (HAPE)

9,000-10,000 ft; lungs accumulate a small amount of fluid w/in alveolar walls

Convective Heat Exchange

A mass of air or water moves around an individual = heat loss or gain

Identify Susceptible Individuals

Athletes w/ large muscle mass and overweight individuals Death from heat stroke increases at a ratio of ~4:1 as body weight increases Women are more efficient at body temp regulation than men Same precautionary measures Young Elderly Relatively poor fitness levels Hx of heat illness Anyone w/ febrile condition

Fluid and Electrolyte replacement

Average adult doing physical activity > 2.5 liters (~10 glasses of water) a day When body weight drops by 1-2%, begin to feel thirsty Do NOT rely on thirst to know when to drink Most people only replace 50% of the water they lose through sweating Consume fluids before, during and after exercise

Maintaining weight records

Before and after practices ~ 2 weeks or as long as heat and humidity persist >2%body weight loss= hold from practice

Heat Rash

Benign condition w/ red, raised rash- accompanied by sensations of prickling and tingling during sweating Usually localized- areas covered by clothing Keep skin dry

Factors and Prevention for hypothermia

Factors for hypothermia Lack of warm-up or inactivity for an extended period of time Wind-chill factor Dampness/wetness 65% of heat produced by the body is lost through radiation Head and neck account for 50% of total heat loss Prevention Wear proper clothing, dress in layers of clothing that can be added and removed Warm-up suits (before, during, after, and rest periods) Fluid replacement

Appropriate Hydration

Should start 24-hours preceding activity Urine color- Light yellow = well hydrated Dark urine= dehyrdated Recommendation: 17-20 fl oz of water or sports drink 2-3 hours before 7-10 fl oz of water or sports drink 10-20 minutes before

Treatment of Exertional Heat stroke

Cool body to normal temp ASAP- the longer temp is above 104 degrees = higher mortality rate Cool environment Remove clothing Immerse in cold water bath (35-58 degrees), or sponge w/ cool water and fan w/ towel Try to lower temp to 101 degrees Call EMS Need to get to hospital but recommended to cool down first RTP- avoid exercises for a minimum of a week and gradually return asymptomatic and cleared by a physician

Recommendation

Ideally- arrive 2-3 weeks before competition Realistically- 3 days before competition

Treatment of Exertional heat exhaustion

Immediately removed from play and taken to cool-shaded area Remove excess clothing and lie down w/ legs elevated Rehydrate immediately- orally or IV Monitor heart rate, blood pressure, and core temp Referral to ER if no improvement RTP- only once completely rehydrated and should be cleared by a physician

Selecting appropriate uniforms

Temp and humidity Initially: Short-sleeves, shorts, and socks Next: Short-sleeved net jerseys, light-weight pants, and socks

Lightening safety

Lightning is #2 cause of death by weather phenomena NATA position statement on lightning safety EAP Generally, if you hear thunder or see lightning, you are in immediate danger and seek a protective shelter

Metabolic Heat Production

Normal metabolic function = production and radiation of heat Higher metabolic rate = more heat produced

Synthetic turf

Numerous different types Advantages and disadvantages: More likely to cause injury- no conclusive evidence Possibly lose inherent shock absorption Most common injuries: abrasions and turf toe

Major factors in altitude adaptation

Oxygen deficiency Native, resident, or visitor Dehydration

Conductive Heat Exchange

Physical contact with other objects = heat loss or gain

Long term effects on skin exposure to sun

Premature aging of skin- dryness, cracking, and decrease in skin elasticity Skin cancer- most common malignant tumor Basal cell carcinoma Squamous cell carcinoma Malignant melanoma

Gradual Acclimatization

Preseason conditioning Progressive exposure over a 7-10 day period 1st 5-6 days- 2 hr practice in AM and 2 hr practice in PM 20min of work, 20min of rest in shade Possible equipment restrictions NCAA mandates

Heat Stress

Preventable Prolonged exposure to extreme heat- hot, humid, sunny Young athletes and elderly- more susceptible Can still happen in cold environments Important to maintain normal body temperature

Radiant Heat Exchange

Radiant heat from sun increases body temp On a cloudy day, body emits radiant heat (ex. blood vessels) Heat loss or again

Physiological and pathological affects caused by hypohydration

Reduced muscular strength and endurance Decreased blood and plasma volume Altered cardiac function Impair thermoregulation Decreased kidney function Reduced glycogen stores Loss of electrolytes

Heat Syncope (aka heat collapse)

Standing in heat for long period of time or not accustomed to exercising in heat Peripheral vasodilation of superficial vessels, hypotension, or pooling of blood in extremities Lay in cool environment and replace fluids

Air pollution

Stop or significantly decrease physical activity during periods of high pollution When commuter traffic has lessened and when ambient temp is lowered

Evaporative Heat loss

Sweat glands in skin allow water to come to the surface, allowing it to evaporate Normal person = 1 quart of water per 2 hours Heat loss through evaporation is: Impaired @ 65% relative humidity Stops @ 75% relative humidity

Frost nip

exposure to a damp, freezing cold Affects the ears, nose, cheeks, chin, fingers, and toes Skin appears very firm, w/ cold, painless areas that may peel or blister in 24-72 hours Treated by early sustained pressure of the hand or by hot breath on the spot

Altitude

This loss in maximum oxygen uptake represents 4-8% deterioration in an athlete's performance in duration events Body compensates with tachycardia Hyperventilation Fewer red blood cells

Treatments for Exertional Hyponatremia

Treatment If blood sodium levels cannot be determined on-site, delay rehydration and athlete should be transported to a medical facility immediately At the facility: Delivery of sodium, certain diuretics, or IV fluids RTP- should be cleared by a physician

Lightning detectors

Typically detects lightning within 40 mile radius

Dehydration

Will occur whenever exercising Mild dehydration = fluids lost are less than 2% of normal body weight Can impair cardiovascular and thermoregulatory response Reduces capacity for exercise and (-) effect of performance Signs and Sx: thirst, dry mouth, headache, dizziness, irritability, lethargy, excessive fatigue, and possibly cramps. Rehydrate and move to cool environment Fluid intake should equal fluid loss

Monitoring the Heat Index

With all 3 readings: WBGT= 0.1 x DBT + 0.7 x WBT + GT x 0.2 With WB and DB only: WBGT= 0.3 x DBT + 0.7 x WBT Pscyhrometer (aspiration and sling)

Flash to bang theory

an estimation of how far away lightning is Number of seconds from lightning flash until the sound of thunder divided by 5 30 seconds or less = danger RTP- 30min after the last sound of thunder or lightning is seen

Acute Exertional Rhabdomyolysis-

characterized by sudden catabolic destruction and degeneration of skeletal muscle accompanied by leakage of myoglobin (muscle protein) and muscle enzymes into the vascular system Healthy individuals during intense exercise in extremely hot and humid environmental conditions Gradual onset of muscle weakness, swelling, and pain; presence of darkened urine and renal dysfunction Severe cases- sudden collapse, renal failure and death Associated w/ individual with SCT Refer to physician immediately

Exertional Hyponatremia

condition involving a fluid/electrolyte disorder that results in an abnormally low concentration of sodium in the blood Causes: Ingesting so much fluid before, during, and after exercise that the concentration of sodium is decreased. Too little sodium in the diet Ingested fluids over a prolonged period of exercise Common in marathons and triathlons Signs and Sx's: Progressively worsening headache Nausea and vomiting Swelling of the hands and feet Lethargy, apathy, or agitation Low blood sodium Can compromise the CNS

Exertional heat exhaustion

dehydration to where he/she is unable to sustain adequate cardiac output and cannot continue intense exercise Environment heat stress and strenuous physical exercise Signs and symptoms Mild hyperthermia Rectal temp <104 degrees and no CNS dysfunction Pale skin; profuse sweating; stomach cramps w/ nausea, vomiting, or diarrhea; headache; persistent muscle cramps; dizziness w/ loss of coordination

Circadian Dysrhythmia (jet lag)

desynchronization of the athlete's biological and biophysical clock Causes fatigue, headache, problems w/ the digestive system, and changes in blood pressure, heart rate, hormonal release, endocrine secretions, and bowel habits.

Frostbite

exposure to dry temperatures well below freezing Chillblains- skin redness, swelling, tingling, and pain in the toes and fingers Superficial frostbite- only skin and subcutaneous tissue. The skin appears pale, hard, cold, and waxy Deep frostbite- serious injury, tissues are frozen. Requires immediate hospitalization. Initially cold, hard, pale or white, and numb

Sunscreens

help prevent many of the damaging effects of UV radiation Sun protection factor (SPF) Should be worn by everyone over the age of 6 months March-November 10 a.m. - 4 p.m.

Exertional heat stroke

life- threatening emergency, most severe form of heat illness Characterized by CNS abnormalities and potential tissue damage due to significantly elevated body temp Specific cause is unknown- can occur suddenly w/o warning Signs and symptoms: Sudden collapse w/ CNS dysfunction (altered consciousness, seizures, confusion, emotional instability, irrational behavior, or decreased mental acuity) Flushed, hot skin w/ sweating (75% of time); shallow, fast breathing; rapid, strong pulse; nausea, vomiting, or diarrhea; headache, dizziness, or weakness; decreased blood pressure; and dehydration

Globe Temperature (GT)

measures sun's radiation and has a black metal casing at end of thermometer

Dry bulb temperature (DBT)

mercury thermometer

Wet bulb temperature (WBT)

wet wick or piece of gauze wrapped around the end of a thermometer

Exertional heat cramps

painful muscle spasms, mainly in calves and abdomen Related to excessive loss of water and electrolytes or ions (sodium*, chloride, potassium, magnesium, and calcium) Adequate replacement of ions and fluids Salt tablets, adding salt to food, bananas, dairy products Ingestion of large quantities of fluids and a mild, prolonged stretch with ice massage

Wet bulb globe temperature index (WBGT)

provides an objective means for determining necessary precautions for activity

Malignant hyperthermia

rare, genetically inherited muscle disorder that causes hypersensitivity to anesthesia and extreme exercise in hot environments Muscle temp increase faster than core temp, similar Sx's to heat stroke C/o muscle pain after exercise, rectal temp remains elevated for 10-15 min post-exercise Muscle tissue is destroyed and may damage kidneys and cause acute renal failure Can be fatal if not treated immediately Should warrant disqualification from hot, humid environments

Other altitude illness

sickle cell trait reaction