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Environmental Considerations for Athletic Trainers

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					Environmental
Considerations
for Athletic Trainers

      Heat Illness,
      Hydration &
      Hypothermia
 Today’s topics...


  •   Clinical examination introduction
  •   Categories of Heat Illness
  •   Treatment of Heat Illness
  •   Reducing the Risk of Heat Illness
  •   Maintaining Hydration
  •   Cold injuries




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Clinical Examination of
Environmental Conditions

• Requires knowledge of
   – Symptoms
   – Environmental conditions
   – Predisposing factors
 Heat Illness

   •   Heat   rash
   •   Heat   syncope
   •   Heat   cramps
   •   Heat   exhaustion
   •   Heat   stroke




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Environmental Pathologies and
Related Special Tests

• Illnesses from heat or cold exposure are preventable.
• It is difficult to differentiate between types and severity.
Heat Illnesses
 • Hyperthermia
    – Effects of participating in hot, humid
      environment
Predisposing conditions


   •   Large body mass
   •   Age
   •   Conditioning level
   •   Poor hydration
   •   History of heat illness
   •   Medications
   •   Chronic disease
 Heat Cramps

   • Painful involuntary muscle spasms
   • Predisposing factors
      – Unconditioned
      – Un-acclimated
   • Cause unknown
      – Dehydration
      – Loss of electrolytes
      – Neuromuscular fatigue
   • Minimize risk for those prone to cramping
   • Typical locations
   • Treatment

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Heat Syncope

• Fainting spell caused by hot, humid
  environments
• Different than fainting caused by
  heat exhaustion
  – No elevated core temperature
  – Hydrated
Heat Exhaustion

• Sudden, extreme fatigue as the body attempts to
  supply blood to the brain, muscles, and skin

• Hypothalmus continues to function properly

• Two types of heat exhaustion
   – Water depletion heat exhaustion
   – Electrolyte depletion heat exhaustion
                  Heat Exhaustion


     • Variety of signs/symptoms
       1. Fatigue
       2. Cool, clammy skin
       3. Skin pale or grayish
       4. General weakness or uncoordinated gait
       5. Nausea, vomiting




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                    Heat Exhaustion

   • Symptoms, continued
     6. Small urine output
     7. Headache
     8. Rapid & shallow respirations
     9. Rapid, weak pulse
     10. Elevated core temperature (103°)
   • Treatment




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Heat Stroke


• Failure and shutdown of the body’s
  thermoregulatory system
• Core temperature > 104°F
• Death can occur within 20 minutes
• Classic or exertional heat stroke
Heat Stroke

 Exertional                           Classic

 • Profuse sweating occurs and       • Infants or the elderly
   fluids are not replaced           • Exposed to hot environment
    – Can occur without                and cannot cool or rehydrate
       significant dehydration         themselves
 • Athletes will be sweating         • Absence of sweat
 • How to tell on the field if its
   Heat exhaustion or heat
   stroke?
    – Neurologic changes
    – Violent or unconscious
    – Hot skin
    – Decerebrate position
   Heat Stroke
        Heat Stroke


   • Signs/symptoms of heat stroke
         1. Hot, dry, red skin
         2. Dizziness
         3. Light-headedness or headache
         4. Disoriented or incoherent
         5. Collapse or coma
         6. Marked temperature increase




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     Heat Stroke
          Heat Stroke


     • Symptoms represent failure of central
       nervous system
     • Temperatures above 104° risk brain
       damage
     • Seek medical attention immediately
     • Cool w/whatever means possible


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Emergency Cooling of an Athlete
Suffering from Heat Illness
    Heat Illness is Preventable




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   Reducing the Risk of Heat Illness

     • Precautions for exercising in the heat
     • Areas to consider
                   1. Environment
                   2. Acclimitization
                   3. Fitness level
                   4. Hydration status




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 Acclimitization


    • Time frame
    • Fluid needs
    • Sweat losses very high now




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   Can it get too hot to exercise?

 • Heat stress index 
     Wet-Bulb-Globe Temp
            WBGT
   WBGT = (.1Td) + (.7Tw) +
             (.2Tb)
              OR
   WBGT = (0.3 X Ta) + (0.7 X
               Tw)
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                WBGT Risk Chart*
                *assumes light-weight clothing

  WBGT             Flag Color       Level of     Comments
                                     Risk
  78° - 82°F          Green            Low       Risk on basis of
                                                 factors
  82.1°-86°F          Yellow         Moderate    Limits/ high alert

 86.1°-89.9°F          Red            High       Stop outdoor/
                                                 high alert
   > 90°F             Black         Extreme or   Reschedule/delay
                                    Hazardous    High alert
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      Can it get too hot to exercise?
       • Tools of the trade: sling psychrometer




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            Temperature & Humidity




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“HUMITURE” - VHSL RECOMMENDATION

105º and up: Recommend no outside activities.

95º to 104º:   Recommend no equipment (helmets, pads, etc)
               be used during activity.

90º to 94º:    Recommend equipment be removed as often as
               possible (during rest breaks, on sideline,
               etc). Careful monitoring of all athletes for signs of
               heat problems.

Below 89º:     Recommend adequate water supply at all
               practices and competitions with breaks every 20
               to 30 minutes for rehydration.
      Heat Illness is Preventable

  • Maintaining hydration
  • Optimal fluid replacement should match
    sweat loss
  • Team weigh-in pre/post practices
  • Team weigh-in during season
  • Practice times




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ACSM Guidelines for Fluid Replacement

       • Before exercise:
             1. Adequate fluids during 24 hours before an event
             2. Drink about 2 cups of fluid 2 hours before exercise
       • Adequate/excess
       • Check for hydration status




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ACSM Guidelines for Fluid Replacement

       • During exercise
             1. Replace sweat losses
             2. Drink early & at regular intervals
             3. Offer cool, flavored and/or sweetened fluids
             4. Make fluid containers readily      accessible




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      Put more in your mouth
        than on your head!




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ACSM Guidelines for Fluid Replacement



            • During exercise
                  1. Drink 20 - 40 oz. per hour
                  2. 5 - 10 oz. Every 15 - 20 minutes




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               Fluid Replacement


     • NATA?????




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     Monitor Fluid Loss After Exercise


     • Goal: To replace sweat & fluid losses
       completely
          **150% of fluid loss to compensate for
          fluids lost as urine
     • Ingest carbohydrate w/in 30 minutes
     • Avoid alcohol


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  Monitor Fluid Balance - Practical



   • Individual drink bottles
   • Towel off residual sweat before
     weighing
   • Weigh in minimal, dry clothing


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  Factors Affecting Fluid
   & Fuel Replacement

 • Opportunities to consume fluid
 • Sporting rules
 • Equipment & methods to assist
   fluid replacement
 • Special sporting/exercise
   situations


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The Ideal Fluid Replacement Beverage

 • Palatability
 • Composition that promotes
   absorption
 • Energy content
 • Electrolyte content




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  Fluids to Avoid While Rehydrating


   • Caffeinated beverages
   • Alcohol
   • Carbonated beverages




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      Children & Heat Stress


 • Tend to absorb more heat from
   surroundings
 • Produce more heat per unit of body mass
 • Have a lower sweating capacity
 • Are less capable of transferring heat to
   skin for dissipation




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      Recommendations for Children
  • Reduce intensity of prolonged exercise
  • Allow 10 - 14 days for acclimitization
  • Drink before exercise
  • Drink at least 5 oz of fluid during every 30
    minutes of exercise
  • Wear appropriate,
    lightweight clothing




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   Athletes with Chronic Diseases

  • Chronic disease can reduce or complicate an
    athlete’s heat tolerance
        1. Long term diabetics may have
        impaired ability to sweat
        2. Dehydration in the asthmatic athlete might
        increase risk of attack




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      Hydration Conclusions

    • Heat illness is preventable with adequate
      hydration & acclimitization
    • Become familiar w/S/Sx of heat illness
    • Know your athletes!
    • Monitor your athletes




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Cold Injuries
• Predisposed athletes
• Predisposing factors
Hypothermia

•   Systemic cooling of body
•   Cause
•   First sign of hypothermia
•   Degrees of hypothermia
     – Slight
     – Mild
     – severe
Characteristics of hypothermia
• Gradual onset
• Dilated pupils
• Slow, weak pulse
• Blood pressure drop (hypotension)
• Shallow & irregular breathing
• Muscular function
   – Slight
   – Mild
   – Severe
• Mental status
   – Slight
   – Mild
   – Severe
Frostbite

• Exposure to subfreezing temperatures
• Vascular physiology
• Superficial

• Deep
Preventing cold injuries

•   Know the conditions
•   Cover skin
•   Wear multiple layers
•   Diet
NCAA Guidelines

•   Layered clothing
•   Cover the head
•   Protect the hands
•   Stay dry
•   Stay hydrated
•   Warm thoroughly
•   Warm incoming air
•   Avoid alcohol & drugs
•   Never train alone
Calculating the wind chill factor
 Next time…..




            • Epidemiology!!!!!




7/26/2011                         48

				
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