External Heat Illness
Early s/s of Hyponatremia (5)
1) Altered mental status 2) Disorientation, confusion, incoordination 3) exhaustion, weakness 4) Nausea, vomiting 5) Headache, dizziness
Educate those involved (3)
1) Athletes, coaches, parents, ect 2) Let them know to inform someone if they feel lightheaded or sick 3) Inform them what to look for and do
Replace fluids Regularly (2)
1) Before, during, and after px 2) Thirst is not good (already dehydrated)
S/S of Exertional Heat Stroke (17)
1) CORE TEMP >104*** 2) ALTERED CONSCIOUSNESS** 4) Irritability, confusion 5) Dizziness, headache 6) Disorientation 7) Convulsions/seizures 8) LOC/Collapse 9) Rapid pulse, decrease BP 10) Rapid Breathing 11) Nausea, vomiting, diarrhea 12) Dehydration 13) Hysteria 14) Weakness, malaise 15) Unsteady gait 16) Red, hot, flushed skin 17) Decreased sweating (?)
What can low sodium levels lead to? (3)
1) Coma 2) Pulmonary/Cerbral Edema 3) Death
Predisposing factors of heat exhaustion (8)
1) Dehydration 2) Diarrhea 3) Vomiting 4) Inadequate fluid replacement 5) Heavy sweat rates 6) GI illness 7) Electrolyte loss 8) Non-acclimated
S/S of Heat Syncope (6)
1) Dizziness 2) Nausea 3) Tunnel Vision 4) Fainting 5) Pale and sweaty skin 6) Body temp NOT elevated
Predisposing Factors of Exertional Heat cramps (4)
1) Excessive sweat loss 2) Electrolyte loss/imbalance 3) Dehydration 4) Vomiting, diarrhea, and GI illness
Predisposing factors for excertional hyponatremia (4)
1) Excessive sweating 2) Excessive sodium loss 3) Inadequate dietary sodium 4) Over indulgence of water
S/S of exertional heat exhaustion (15)
1) Fatigue, weakness 2) Dry mouth, thirst 3) Headache 4) Dizziness, fainting 5) Collapse bc of physical exhaustion 6) Sweating 7) Decrease in urine volume 8) Nausea/vomiting 9) Decreases appetite 10) Weight loss 11) Rapid and shallow breathing 12) Rapid pulse 13) Decreased blood pressure 14) SLIGHT DECREASE IN MENTAL STATUS **** 15) CORE TEMP <104****
Predisposing Factors Heat Stoke (12)
1) High Temperatures, humidity, solar radiation, and low wind 2) Older athletes 3) Obese athletes 4) Not acclimated 5) No rest periods 6) Untrained/unconditioned 7) Use of antihistamines & other meds 8) Athletes with sunburn, psoriasis, skin infections/rashes 9) Fever 10) Lack of sleep 11) Dark, heavy, non breathable clothing 12) Heavy muscled athletes
Preventions of Heat Illness (10)
1) Identify athletes at risk 2) Educate those involved 3) Replace fluids regularly 4) Replace electrolytes regularly 5) Weigh in.. Weigh out 6) Appropriate uniforms 7) Ensure adequate sleep 8) Allow 7-10 d's for acclimatization 9) Take days off between practices 10) Apropriate timing and type of activity
Identify athletes at risk (8)
1) Larger muscle mass (insulator) 2) Higher body fat (insulator) 3) Out of shape 4) PMH (Past medical history) 5) Sunburned 6) Fever 7) People who live up north 8) Monitor everyone
Tx of Heat Syncope (3)
1) Laying down in cool area 2) Elevate legs 3) Drink fluids
Appropriate uniforms (5)
1) Lightweight 2) Mesh 3) Cotton 4) light color 5) Adjust wearing pads and helmets based on current environment/temperature
TX of Exertional Heat Stroke (4)
1) Maintain ABCs 2) EMS 3) Rapid cooling in ice water (41-59 degrees) - ice packs on head, neck, axilla, groin, and knees, fans, cool until temp at 100-102 4) IV
Effects of Exertional Heat Stroke (5)
1) Medical Emergency 2) Systems begin to shut down 3) Organ damage 4) CNS Damage 5) Death
Factors of Heat Balance (5)
1) Metabolic heat production 2)Conductive heat exchange 3)Convective heat exchange 4)Radiant heat exchange 5)Evaporative heat loss
Appropriate timing and type of activity (4)
1) Monitor temp, humidity, wind, sun 2) Dont px at the hottest/most humid times 3) Alter activity, time, uniform, duration, intensity 4) Periodic rest periods out of the sun
Later s/s of Hyponatremia (4)
1) Muscle twitching, tingling, sensation 2) Swelling of hands/fingers 3) Seizures, DIB (difficulty in breathing) 4) Coma, cardiac arrest, respiratory arrest
Hyponatremia (2)
1) Oral Salt intake (increased daily NaCI consumption or sport drink) 2) Caution w/ IV
What are the MOI of heat syncope? (4)
1) Peripheral vasodilation 2) Blood pools in extremities 3) Common if standing in the heat 4) Common if immediately stop intense activity without cooling down
Weigh in.. Weigh out
1) Replace "weight"/water loss
TX of Heat Exhaustion (4)
1) Rest 2) Fluids/Electrolytes 3) Cooling for comfort (removing from heat, remove clothing, place in cold tub, apply ice to neck, groin, armpits) 4) f/u w/ physician, IV
Replace electrolytes regularly (2)
1) Sports drinks 2) Lightly salted foods
Predisposing factors of heat syncope (5) (factors that lead to..)
1) Unacclimated (not used to environment) 2) Standing in place in the heat 3) Immediately stopping after intense activity 4) Dehydration 5) GI Illness, diarrhea, vommiting
Tx of Heat cramps (6)
1) Water 2) Electrolytes 3) Ice (decreases pain and muscle spasm) 4) Stretch (light) 5) Massage (light) 6) IV (full body cramp)
What are the different types of heat illness? (5)
1)Heat syncope 2)Heat cramps 3)Heat exhaustion 4)Heat stroke 5)Hyponatremia
Heat loss is ___x _______ in water than in the air of the same temperature
2-4 Greater
Cautious if >__% lost
3
__% RH (relative humidity) decreases evaporation
65
Allow ___ days for acclimatization
7-10 Gradually increase work load and intensity Must slowly get used to environment
__% RH (relative humidity) ceases evaporation
75
When an athlete with EHS receives immediate tx (rapid cooling/rehydration), there is a ____% survival
90-95%
Alcohols, juice, sodas?
Alcohol= No Soda= Blood goes to the gut instead of muscles Juice= has fructose, which results in diarrhea and causes loss in water and electrolytes (Not the best but still helps with hydration if nothing else)
Convective Heat Exchange
Body heat can be lost or gained depending on the temp of the air or water
Heat Gain=Heat Loss
Body temperature maintained to keep the body functioning
Humidity ______ sweat evaporation potential
Decreases
Cold Towel?
Doesn't really cool you off Traps heat
Heat Syncope
Fainting caused by over exposure
F/U
Follow up
GI
Gastrointestinal illness
What prevents evaporation of sweat?
Humidity; no cooling
Exertional Heat Exhaustion
Inability to continue exercise in the heat because of cardiovascular insufficiency
What are other factors that cause an increase of metabolic heat production?
Increases with exercise (aerobically unfit, higher ambient temps, overweight, heavily muscled)
Exertional Heat Cramps
Involuntary muscle spasm because loss of electrolytes and fluids
S/S of Exertional Heat Cramps (1)
Involuntary muscle spasms
Is conductive heat exchange more significant in heat gain or loss?
Loss (ice)
Hypoatemia
Low concentration of Na (sodium) in the blood
Dry fans
Not the best, but helps Cools Drys sweat
Hyperthermia
Our core temperature increases to an unsafe level and our body overheats
Metabolic Heat Production
Our normal bodily functions produce heat (core=96.6)
Exertional Heat Stroke
Overloading or failure of our thermo-regulatory system Heat buildup via the environment and metabolic heat production exceeds the body's ability to dissipate the heat
Conductive Heat Exchange
Physical contact with surface can cause heat loss or gain
Radiant Heat Exchange
Radiant heat from the sun increases body temperature
Steps leading up to exertional heat exhaustion
Salt depletion+ Water Depletion -> Dehydration+Decrease in blood plasma volume -> Decrease in cardiac output (Like running out of gas in your car)
What naturally decreases body temperature?
Sweat
Evaporative Heat Loss
Sweat glands in the skin allow H2O to be transported to the surface, where it evaporates, taking heat with it
Causes of Hyponatremia
Sweat or if sodium not replaced through the athletes diet/ fluids,
Evaporative Heat Loss
Sweating alone does not dissipate heat; If sweat does not evaporate, heat is not lost
Heat Gain>Heat Loss
When body temperature exceeds the limits of that range, the body is unable to maintain normal functioning
When is Hyponatremia more common?
When hydration is mainly H2O Causes even more of an imbalance between Na and H2O
Cold tubs
YES #1 Choice
Misting Tents
Yes 20-25 degrees colder than outside Stay in it long enough
Misting fans
Yes But can also add to humidity
Cold showers
Yes Stay in it long enough bc only 70 degrees Better to get it colder (50-60) Sit down