Heat related illness

How much fluid is replaced

50% replaced before , during and after exercise

Treatment for exertional heat exhaustion

• Fluid ingestion (intravenousreplacement, ultimately) • Place in cool environment • Remove excess clothing Place in cool environment

Exertional hyponatremia

• Fluid/electrolyte disorder resulting in abnormally low concentration of sodium in blood • Caused by ingesting too much fluid OR who sweat over several hours are at risk (marathon and triathlon) • May be result of too little sodium in diet or to much ingested fluids over a period of prolonged exercise

Methods estimates distance away from lightening

• From the time lightning is sighted to the clap of thunder count, divide by 5 to calculate the number of mile away • Count of 30 indicates inherent danger • Count of 15 seconds everyone should leave the field • NATA and National Weather Service recommend returning to the field 30 minutes following the last clap of thunder or lightning strike

Adaptations

• Increased height = Reduced barometric pressure resulting in decreased partial pressure of oxygen = Less saturation of red blood cells

Common cold injuries

• Localized cooling can result in tissue damage • Formation of ice crystals between cells destroys cells, disrupts blood flow, and clotting may occur

Altitude sickness

• Most events do not occur at extreme heights • As height increases, maximum oxygen uptake decreases resulting in a decrease in performance • Body compensates through tachycardia and hyperventilation • Responses are a result of having fewer red blood cells than necessary to adequately capture available oxygen

Malignant hyperthermia

• Muscle disorder causing hypersensitivity to anesthesia and heat • Similar signs and symptoms to heatstroke - Muscle biopsy is needed to detect • Athlete will complain of muscle pain after exercise • Temperature will remain elevated for 10-15 minutes following exercise • Athletes with this condition should be disqualified from competition in hot and humid environments

Heat cramps

• Painful muscle spasms (calf and abdominal) due to excessive water loss and electrolyte imbalance • Occur in individuals in good shape that overexert themselves • Profuse sweating results in loss of water and electrolytes (sodium,potassium, magnesium, and calcium) • Prevented by consuming extra fluids and maintaining electrolyte balance • Treated with fluid ingestion and light stretching with ice massage • Return to play unlikely due to continued cramping

Signs and symptoms of hyponatremia

• Progressively worsening headache, nausea, vomiting headache, nausea, vomiting • Swelling of hands and feet, lethargy, apathy, or agitation Low blood sodium • Could compromise CNS and create a life-threatening situation

Acute mountain illness

1 out 3 will experience when making the jump from 700-8000 feet Experience headache, nausea , vomiting, sleep disturbance and dyspnea • Caused by brain disruption associated with sodium- potassium imbalance resulting in fluid retention and cellular pressure changes

How long should a person with a exertional heart stroke be out for

1 week and gradually return to full practice Must be a symptomatic and cleared by physician Death may occur if not treated correctly

Adults lose --Liters per hour

1.5L

Identify susceptible individuals

Athlete with large muscle mass Overweight athletes (due to increased metabolic rate ) Death from heat stroke increases 4:1 as body weight increases Women in physiologically more efficient with regard to body temperature regulation Poor fitness, history of heat illness or febrile condition , the young and the elderly

Hydration

Athletes should begin activity well hydrated Involves hydrating 24 hours prior to activity Urine should be a light yellow in color Dark urine is an indication of dehydration Fluids are to be consumed at reagular intervals 17-20 ounces or sports drinks 2-3 hours prior to activity Additional 7-10 fluid ounces 10-20 minutes before exercise

Uniform selection

Based on temperature and humidity Dress for weather and temperature Avoid rubberized suits

Heat rash (prickly heat)

Benign condition associated with red, raised rash, combined with prickling and sweat Result of continuously wet un-evaporated sweat Prevention: toweling the body Generally localized to areas covered with clothing

Fluid and electrolyte replacement

Body requires 2.5L of water daily when engaged in minimal activity 1-2% drop in body weight (due to dehydration) results in thirst Dehydration is more likely to occur when exercising outdoors, sweating heavily and engaging in strenuous exercise

Gradual acclimation

Most effective method of avoiding heat stress Involves becoming accostomed to heat and exercising in heat Early pre season training and graded intensity changes are recommended with progressive exposure over 7-day period 80% of acclimation can be achieved during first 5-6 days with 2-hour morning and after noon practice sessions Equipment restriction may help athlete gradually acclimate

Frostbite

Chilblains result from prolonged exposure causing redness and swelling and tingling pain in toes and fingers Remove wet clothes and cover with warm, loose clothing • Superficial frostbite involves only skin and subcutaneous tissue • Edema, redness, stiffness, transient tingling/ burning • Rewarm in warm water (98-104°)

Hypothermia

Cold weather vs nature of particular sport Most activity allows for adeqaute heat production (increased metabolism) and dissipation • Impact on warm-up and down time • Temperature in conjunction with wind, chillness, and dampness or wetness can increase chances of hypothermia

Preventing heat illness

Common sense and precaution Consume fluid and stay cool In conjunction with the NATA recommendations, multiple factors should be strongly considered HYDRATION

Heat stress

Extreme caution should be used when training in the heat (overexposure could result in illness) Preventable • Body must be able to dissipate heat to maintain homeostasis • Physiologically, the body will continue to function if body temperature is maintained Susceptible in athletes and the elderly

Losing weight correctly

Gradual process over weeks and months and should be a result of losing body fat

Monitoring heat index

Heat,sunshine, and humidity must be monitored closely Wet bulb globe temperature index(WBGT) provides objective measure for determining precautions • WGBT incorporates different thermometer readings to arrive at a formula • Dry bulb (standard mercury temperature) • Wet bulb (thermometer with wet gauze that is swung around in air) • Globe temperature (black casing that measures radiant heat) • WBGT = (0.1*DBT) + (0.7*WBT) + (GT*0.2)

Dehydration

Mild dehydration occurs when 2% of body weight is lost in fluid Will impair cardiovascular and thermoregulatory responses Signs and symptoms Thirst, dizziness, fry mouth, irratibility , excessive fatigue,a possible cramps Most move individual to cool enviroment and begin rehydration Return to normal weight and absence of symptoms

Using sports drinks

More effective then just replacing fluids with water Flavoring results in increased desire to consume Replaces fluids and electrolytes Water alone can prematurely stop thirst response and initiate fluid removal by kidneys Small amounts of sodium help ion retention of water Different drinks have different nutrient levels Optimal carbohydrate level is 14g per 8 ounces of water More carbohydrates results in slower absorption Effective for both short term and endurance activities

Frost nip

Involves ears, nose, chin, fingers, and toes Occurs with high wind and severe cold Skin appears firm with cold, painless areas that may peel and blister (24-72 hours)

Weight records

Keep track of before and after measures for first two weeks If increase in temperature and humidity occurs during the season weights should be again be recorded Greater than 2% loss of body weight could be a health threat and should be removed from practice until normal weight is achieved

If thirst is ignored

Nausea , vomiting, fainting and increased risk of heat illness

Heat stress: metabolic heat production

Normal metabolic function results in production of heat (will increase with intensity of exercise)

Altitude pulmonary edema

Occurs 9000-10000 feet Lungs accumulate fluid in alveolar walls forming pulmonary edema Signs/symptoms- dyspnea, cough, headache, weakness and occasionally unconsciousness • Treat by moving athlete to lower altitude and providing oxygen

Heat stress: conductive heat exchange

Physical contact with objects=heat loss or gain Body heat can be lost or gained depending on temperature of circulating medium

Heat stress: radiant heat exchange

Radiant heat from sunshine =increase in temperature

Heat syncope

Rapid fatigue and over exposure due to standing in heat for long periods of time Caused by peripheral vasodilation or pooling of blood in extremities resulting in dizziness and fainting • Treated by laying down in cool environment, consuming fluids, and elevating lower extremities

Hyperthermia

Require knowledge on environmental dangers Cause for number of deaths Must manage heat stress appropriately and plan accordingly with coaching staff

Lightning safety

Second cause of death by weather phenomena Emergency action plan must be set for this type of event Involving chain of command, monitoring of weather service, and decision making regarding removal and return to field

Prevention

Suitable apparel geared for weather to provide semitropical microlimatations for body and prevent chilling • Waterproof and windproof fabrics that allow passage of heat and sweat and allow movement • Layers and adjusting them are key to maintaining body temperature (during period of (activity/inactivity) • Be aware of inadequate clothing, improper warm-up, and chill factor; can lead to injury, frostbite, chilblains, and/or minor respiratory problems • Be aware of hydration levels as well to enhance blood volume and heat maintenance

Heat stress: evaporate heat loss

Sweat glands allow transport of water to surface Evaporation of water removes heat When radiant heat and enviroment temperature are higher than body temperature are higher than body temperature, loss of heat through evaporation is key Lose 1 quart per hour for up to 2 hours

Athletes should have unlimited

Water to prevent decrement in performance and hypo hydration

Adaptations: native

larger chest capacity, more alveoli, capillaries, and red blood cells

Sickle cell trait reaction

• 8-10% of African Americans have sickle-cell trait • Abnormality in red blood cell's hemoglobin structure • When hemoglobin is deoxygenated, cells clump together causing red blood cell to develop sickle shape making it easy to destroy • Causes enlarged spleen and could rupture at high altitudes

Prevent dysrhythmia

• Depart well rested • Eat according to time changes • Avoid dehydration • Training schedule • Use caffeine when travelling west • Adopt local time on arrival • Avoid alcohol before, during, and after the trip

Circadian dysrhythymia( jet lag)

• Desynchronization of biological and biophysical time clock • Body maintains cyclical mechanisms over 24-hour periods (circadian rhythms) • Body adapts over time to changes • Immediately (Protein metabolism) • Over 8 days (Body temperature) • Three weeks (Adrenal hormones) • Disrupts circadian rhythms and sleep-wake cycles • May cause fatigue, headaches, digestive disorder, changes in blood pressure, heart rate, hormone and endocrine releases, and bowel habits

Treatment Exertional heart stroke

• Drastic measures must be taken to cool athlete Remove clothing Sponge with cool water Use ice packs Do not immerse in water Transport to hospital immediately Cool first and then transport

Exertional heat exhaustion

• Result of inadequate fluid replacement • Inability to sustain adequate cardiac output • Symptoms include profuse sweating, pale skin, mildly elevated temperature, dizziness, nausea, vomiting or diarrhea, hyperventilation, persistent muscle cramps, and loss of coordination • May develop heat cramps or become faint/dizzy • Core/rectal temperature will be < 105° • Performance may decrease

Exertional heat stroke

• Serious life-threatening condition with unknown specific cause • Characterized by sudden onset : sudden collapse, LOC, CNS dysfunction, flushed hot skin, minimal sweating, shallow breathing, strong rapid pulse, and core temperature of > 105°F • Breakdown of thermoregulatory mechanism

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 • Gradual muscle weakness, swelling, pain, dark urine, and renal dysfunction • Severe case = Sudden collapse, renal failure, and death

Treatment for frost nip

• Treat with firm pressure, blow warm air, or place hands in armpits (if fingers are involved) Do not rub

High altitude cerebral edema

• Usually occurs in conjunction with other life- threatening conditions that can lead to coma or death • Occurs in ~1% of people adjusting to altitudes above 9,000 feet • Result of increased cerebral edema due to increased cerebral blood flow, which is caused by increased permeability of cerebral endothelium when exposed to hypoxia • Increased cerebral blood flow results in increased intracranial pressure • Signs and symptoms: severe, persistent headache, which may precede mental dysfunction and neurologic abnormalities • Descent to lower altitudes may save those with HACE

Adaptations: visitor

• increased breathing, heart action, hemoglobin, blood alkalinity, myoglobin, and changes in blood flow and enzyme activity

Psychrometer

• measures Dry bulb temperature (DBT) and wet bulb temperature (WBT) • Drier air = Greater depression of wet bulb temperature due to evaporation • Wet bulb will be lower due to evaporation of water

Adaptations: resident

• partial adaptations (increased mitochondria and hemoglobin; glycogen conservation)