Download Essentials of Athletic Injury Management 9th Edition

Essentials of Athletic
th
Injury Management 10
Edition
Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.
Chapter 7:
Understanding the Potential
Dangers of Adverse
Environmental Conditions
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Hyperthermia
• Athletic trainers require knowledge and information concerning temperature,
humidity and weather to adequately make decisions regarding
environmental dangers
• Has caused a number of deaths over the years
• Hyperthermia = increase in body temperature
• Anyone that supervises athletes practicing and competing must realize that
heat and humidity impact every geographic region of the United States
• Imperative to be able to recognize signs and symptoms associated with
heat-related illnesses and to be able to manage them appropriately
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Heat Stress
• Extreme caution should be used when training in the heat
– Overexposure could result in heat stress
• It is preventable
• Athletes that train under these extreme conditions are at
risk
• Physiologically the body will continue to function if body
temperature is maintained
• Body must dissipate heat to maintain homeostasis
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Heat Stress, cont.
• Heat can be dissipated from the body
through 4 mechanisms
– Conduction (direct contact)
– Convection (contact with cool air or water mass)
– Radiation (heat generated from metabolism)
– Evaporation (sweat evaporating from the skin)
* Heat can also be gained via these four
mechanisms
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Heat Stress, cont.
• 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 relatively water free for evaporation to occur
• relative humidity of 65% impairs evaporation
• relative humidity of 75% stops evaporation
– Heat illness can still occur in cold environment if body is
unable to dissipate heat
• Caused by dehydration and inability to sweat
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Monitoring Heat Index
•
Heat, sunshine and humidity must be monitored closely
– Takes into account ambient air temperature and relative humidity
– Attempts to determine how hot it feels to the body
•
Wet bulb globe temperature index (WBGT) provides objective measure for
determining precautions concerning participation in hot
– WGBT incorporates different thermometer readings
• Dry bulb (standard mercury temperature)
• Wet bulb (thermometer with wet gauze that is swung around in air)
• Black bulb (black casing that measures radiant heat)
– DBT and WBT can be measured with psychrometer (combines both
thermometers)
• Used to relative humidity
• Wet bulb will be lower due to evaporation of water
• Drier air = greater depression of wet bulb temperature due to
evaporation
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Heat Illnesses
• Heat Syncope (heat collapse)
– Associated with rapid fatigue and overexposure,
standing in heat for long periods of time
– Caused by peripheral vasodilation, or pooling of
blood in extremities resulting in dizziness and
fainting
– Treatment
• Lay athlete down in cool environment, elevate lower
extremities, consume fluids
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Exertional Heat Cramps
• Painful muscle spasms (calf, abdominal) due to
excessive water loss and electrolyte imbalance
• Occurs in individual in good shape that overexert
themselves
• Treatment
 Prevent by consuming extra fluids and maintaining
electrolyte balance
 Treat with fluid ingestion, light stretching with ice
massage
 Return to play unlikely due to continued cramping
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Exertional Heat Exhaustion
• Result of inadequate fluid replacement
• Signs & Symptoms
 Profuse sweating, pale skin, mildly elevated temperature,
dizziness, hyperventilation and rapid pulse
 May develop heat cramps or become faint/dizzy
 Core temperature will be ~102o
– Critical to obtain accurate core temperature
 Performance may decrease
• Treatment
 Immediate treatment includes fluid ingestion (intravenous
replacement, ultimately), place in cool environment
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Exertional Heatstroke
• Serious life-threatening condition, with unknown specific cause
• Need emergency action plan in place to manage this life threatening
condition
• Signs & Symptoms
 Sudden onset - sudden collapse, LOC, flushed hot skin, minimal
sweating, shallow breathing, strong rapid pulse, and core
temperature of > 104o F
• Drastic measures must be taken to treat & cool the athlete
 Strip clothing
 Sponge with cool water
 Immerse in water
 Transport to hospital immediately
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Exertional Hyponatremia
• Fluid/electrolyte disorder resulting in abnormally low
concentration of sodium in blood
• Caused by ingesting too much fluid before, during and
after exercise
• May be result of too little sodium in diet or in ingested
fluids over a period of prolonged exercise
• Athletes that ingest large quantities of water and sweat
over several hours are at risk (marathon, triathlon)
• Preventable – must maintain balance
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Preventing Heat Illness
• Must exercise common sense and precaution
– Consume fluids and stay cool
• Fluid and Electrolyte Replacement
– Single most important step taken by a coach to
minimize the chance of heat illnesses
– Continual re-hydration is critically important
– Generally only 50% of fluid is ever replaced and should
therefore be replaced before, during and after exercise
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Preventing Heat Illness, cont.
• Fluid replacement should match sweat loss
• Time of stomach emptying is critical
 Water is absorbed rapidly from intestine
 Drink with 6% CHO is eliminated at the same rate if
the individual is hydrated
 Cold drinks tend to empty rapidly and will not induce
cramping or put heart at risk
 Drinks with caffeine and alcohol will promote
dehydration
• Hydration levels can be monitored via urine
color and volume
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Preventing Heat Illness, cont.
• Using Sports Drinks
– More effective than 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 in retention of water
– Optimal CHO level is 14g per 8 ounces of water
– More CHO results in slower absorption
– Effective for both short & long term activities
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Gradual Acclimatization
• Most effective method of avoiding heat stress
• Involves becoming accustomed to heat and
exercising in heat
• Early pre-season training and graded intensity
changes are recommended with progressive
exposure over 7-10 day period
• 80% of acclimatization can be achieved during
first 5-6 days with 2 hour morning and afternoon
practice sessions
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Gradual Acclimatization, cont.
• Identifying Susceptible Individuals
 Athletes with large muscle mass
 Overweight athletes are at an increased risk
o Related to proportionality of metabolic heat
production to surface area
 Athlete with increased fluid loss
 Precautionary measures apply to both males and
females
 Medications or supplements may impair sweating and
may predispose them to injury
 Poor fitness levels, a history of heat-related illnesses or
anyone with febrile conditions are at increased risk
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Gradual Acclimatization, cont.
• Uniform Selection
• Base on temperature and humidity
• Dress for the weather and temperature
• Avoid rubberized suits
• 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 again be recorded
 A loss of 3-5% = reduced blood volume and could be a
health threat
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Hypothermia
• Cold weather vs. nature of particular sport
• Most activity allows for adequate heat production and dissipation,
allowing for sufficient functioning
• Temperature in conjunction with wind chill and dampness or wetness
can increase chances of hypothermia. With muscular fatigue, in cold
weather, rate of exercise begins to drop and rate of heat loss relative to
heat production may shift
• Results in impaired neuromuscular responses and exhaustion
• Drop in core stimulates shivering but stops after temp. drops below 8590oF
• Death is imminent when temp falls below 77-85oF.
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Cold Disorders
• Fluid replacement is critical
 Dehydration = decreased blood volume = less fluid
available for tissue warming
• May be useful to monitor weight of athletes training in cold
temperatures
• Injury/illness due to the cold can occur
 Endurance type activities
 Winter sports
 Swimming in cold water
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Cold Disorders, cont.
• Frost nip
 Involves, ears, nose, chin, fingers, and toes
 Occurs with high wind and/or severe cold
 Skin appears firm with cold painless areas
that may peel and blister (24-72 hours)
 Treat with firm pressure, blowing warm air or
hands in armpits (if fingers involved)
 Do not rub
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Cold Disorders, cont.
• Frostbite
 Superficial Frostbite involves only skin and
subcutaneous tissue
o Appears pale, hard, cold and waxy
o When re-warming the area will feel numb, then
sting and burn
o It may blister and be painful for several weeks
 Deep Frostbite indicates frozen skin requiring
hospitalization
o Gradual re-warming is necessary (100-110oF)
o Tissue will become blotchy red, swollen, painful
and may become gangrenous
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Cold Disorders, cont.
• Prevention
 Apparel geared for weather to provide semitropical
microclimate for body and prevent chilling
 Waterproof and windproof fabrics wick moisture away
from skin, allowing passage of heat and sweat
 Layers and adjusting them are key to maintaining
body temperature (during period of (in)activity)
 Inadequate clothing, improper warm-up and chill factor
can lead to injury, frostbite, and/or minor respiratory
problems
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Overexposure to Sun
• Precautions must be taken to protect athletes, coaches,
athletic trainers and support staff
• Long Term Effects on Skin
 Premature aging and skin cancer due to ultraviolet
exposure
o Premature aging is characterized by dryness,
cracking and inelasticity of the skin
o Skin cancer is the most common malignant tumor
found in humans
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Overexposure to Sun, cont.
• Sunscreen
– Can help prevent effects of UV radiation
– Sun Protection Factor (SPF)
• Sunscreen effectiveness
• Indicates how many times longer an individual can be exposed
to the sun with vs. without sunscreen before skin turns red.
– Use
• When outside considerable amount
• Individuals with fair complexion, light hair, blue eyes or skin that
burns easily
• Throughout the year
• Apply 15-30 minutes prior to exposure
• Re-apply after exposure to water, excess sweating, rubbing
skin with clothing or a towel
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Safety in Lightening and
Thunderstorms
• Emergency action plans must be set for this type of event
– Involving chain of command, monitoring of weather service,
decision making regarding removal and return to field
• NATA has a position statement
• Other guidelines
 Avoid large trees, flag/light poles, standing water, telephones,
pools, showers, and metal objects
 If hair stands up on hand you are in imminent danger and should
get down on the ground but not flat as that increases surface area
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Safety in Lightening and
Thunderstorms, cont.
• Additional Guidelines
 Lightening is generally accompanied by thunder
(except 20-40% of the time due to atmospheric
disturbances)
 Flash-to-bang methods estimates distance away for the
storm
o From time lightening is sighted to the clap of thunder
count, divide by 5 to calculate the number of mile
away
o Count of 30 indicates inherent danger and everyone
should leave the field
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Safety in Lightening and
Thunderstorms, cont.
• NATA, NCAA and National Weather
Service recommend returning to the field
30 minutes following the last clap of
thunder or lightening strike
• Major misconception is that lightening that
is seen striking is coming down
o In actuality it is the return stroke of the
lightening going back up after it has already hit
the ground
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Safety in Lightening and
Thunderstorms, cont.
Lightening Detectors
• Hand-held instrument with electronic system to
detect presence and distance of
lightening/thunderstorm activity (w/in 40 miles)
• Can determine level of activity and direction of
movement
• Provides audible and visual warning signals
• Inexpensive alternative to contracting weather
services
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