Download FASMED - Environmental Factors

Environmental Factors in Sports Medicine
Michael Swartzon, MD
Clinical Assistant Professor FIU
Team Physician Miami Dolphins
July 25, 2016
Disclosures
• None
Learning Objectives
• Prevent, Identification and Treatment of
– Heat Illness
• ABCs
– Sickle Cell Crisis
– Rhabdomyolysis
– Cold Injury
Epidemiology of Heat
• 1999-2003
– 3442 deaths due to heat
– In 2005 3 deaths from high school football
Risk factors
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Overweight
Poor conditioning
Previous history
Current illness
Caffeine, alcohol
Dehydration
Illicit drugs
Prescription medications
Chronic disease
Sickle cell trait
Getting Rid of Heat
• Control of body temperature
– Hormonal, Lungs, Blood vessels, Nerves
• Radiation: principal mechanism
– Dependent on ambient temperature
– Impeded by clothing, fat tissue
• Regulating blood flow in skin
– Flushing, dilation of skin blood vessels
• Evaporation
– Sweating
• Conduction
– blood flow
Adaptation to Heat
– Physiology
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Decreased core temp at rest
Decreased heart rate during exercise
Increased perspiration rate
Thirst at lower serum osmolality
Decreased sodium in sweat and urine
Expanded plasma volume
Acclimatized
– Athletes sweat more
• Same plasma volume
• Increased absorption of sodium
– Expanded plasma volume
• Elevated aldosterone levels
– Time
• Children: ≥2 weeks
• Adults 7-10 days
Monitoring
– Pre-participation screening
– Urine amount and color
– Pre & Post Weights
– Urine specific gravity
Peds
• Children:
– Increased surface area-to-mass ratio
– Produce more heat per Kg
– Sweat less than adults
– Limited heart output
– Poor thirst drive
– Use flavored water
Skin care
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SPF 15 or greater
Applied 20 minutes prior to sun
Reapply often
Exposure as child can lead to cancer
Heat Syncope
• Vasovagal
– Risk factors
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Previous Hx of syncope
Unaccustomed to heat
No food
Recent URI
Dehydrated
– ABCs, legs elevated, out from play
Heat Exhaustion
• Dehydration event
– High temperature
– High humidity
– Loss of 10% of BW
– Presentation
• Weakness, fatigue, cramps, dizziness, headache
• Pallor, vomiting, unsteadiness, collapse
• Minor mental status changes
– Tx: remove from activity, remove from heat
• Small frequent water
Hyponatremic dehydration
– Low sodium
– Risk factors
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Females
Prolonged exercise
Low sodium intake
High sodium loss
– Do not respond to water
• After 30 minutes add sodium fluid
• After 30 minutes transport
Heat Stroke
• Core above 40°C (104°F)
– Confusion irritability obtundation  coma
– Seizures, collapse, cardiac arrest
– Need core temp
– Tx:
• ABCs + Ice bath
Heat cramps
• Cause elusive
• Treatment
– No evidence based medicine
• Prevention
– Creatine?
– ACE?
– McArdle’s
• Myopathy in adolescence, check CPK
Sickle cell trait
• Exertional sickling
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Cramps “like jello”
Fast Heart Rate
Collapse
High temperature
• Risks
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Heat
Dehydration
Asthma
High intensity exercise
Altitude
Prevention in Sicklers
• Guidelines
– Gradual build up
• Intensity and duration
– Year-round conditioning
– Stop with symptoms
– Monitor sickle trait athletes
– Education of rhabdo
– Control asthma
Exertional Rhabdomyolysis
– Lactate buildup and acidosis
• Leads to death of muscle cells
– Myoglobin  glomerular injury
– Sx: muscle pain and weakness
• Red urine
• Swollen limb(s)
– Tx:
• Supportive, correct acidosis
Heat summary
– Heat illness preventable
– Period of acclimatization
– Heat exhaustion not better with water
• Hyponatremia
– Sickle cell trait
• Hydrate
• Condition
• Monitor
Cold Injury (away games)
• Frostbite (<28°F)
– Hands, feet, face
– Freezing of cellular water
– Treat by warming
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Must remove from cold
Warm bath for 15-30 minutes
Avoid friction
NSAIDs and Acetaminophen
– Risk for recurrence
Treatment
– Remove wet clothing (be gentle)
– Passive warming (blankets)
• Start with trunk, avoid afterdrop
– Active external warming
• Heat packs, warm baths
Questions?
Review Objectives
• Heat Illness
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Preventable
Allow adaptation
Know temperature
Push fluids
Limit exposure
Have action plan
ICE
• Sickle cell crisis
– Unusual cramps or
pain
– Hospital
• Rhabdo
– Unusual swelling
– Hospital
• Cold Injury
– Warming, no rubbing
– Hospital
Thank you