Ebook Emergency Care in Athletic Training: Part 2

Chapter 8 Environment-Related Conditions Keith M.Gorse,MEd,ATC KEY TERMS Acute mountain sickness Ataxia Cold exposure and illness Frostbite Heat cramps Heat exhaustion Heat exposure and illness Heat index Heat stroke High-altitude cerebral edema High-altitude pulmonary edema Hyperthermia Hypothermia Wind chill factor EMERGENCY SITUATION A college football team is practicing in the early evening on their outdoor practice field right next to the locker room facility.Without much warning a thunderstorm begins near the facility.The athletic trainer on duty does not have a lightning warn-ing device but decides to speak with the head football coach to warn him about the impending danger.The athletic trainer decides to have the entire team leave the playing field and go into the locker room.As the team is leaving the field,a bolt of lightning strikes the field area and knocks down two football players.Both players fall in the middle of the field and appear to be unconscious.What should the athletic trainer do to help the stricken football players? What should the athletic trainer do to prevent the possibility of this dangerous situation from occurring again? 145 146 Emergency Care in Athletic Training As more physically active individuals participate in out-door athletic activities, the frequency of environmentally related illnesses will increase. Participants in sporting events of long duration and those requiring particularly inclement weather and adverse conditions are especially prone to developing injury or illness. Heat-related illness, hypother-mia, lightning strikes, and high-altitude illnesses are multi-system emergencies that require immediate, specific thera-peutic treatments.Athletic trainers must be able to recognize the signs and symptoms of these medical emergencies and institute definitive care. Areas of interest for the proper recognition of emer-gency environmental conditions to be discussed in this chapter will include the following: 1. Heat exposure and illness including heat exhaus-tion and heat stroke 2. Cold exposure and illness including hypothermia and frostbite 3. Severe thunderstorms and lightning emergencies 4. Altitude illness including acute mountain sickness 5. Prevention and care of environmental emergencies in athletics Severe environmental conditions can cause injury to or illness in the athlete and may even cause death. For proper care to take place, specific intervention for environmental emergencies depends not only on the athlete’s physical con-dition, but also on the safety of the scene. The athletic trainer must educate the athletes, coaches, and administra-tors on basic preventive measures if they are going to partic-ipate in outdoor sporting activities. The athletic trainer must also be prepared and equipped with the means neces-sary to reduce injury and illness risk and carefully treat cases of athlete collapse as a result of severe environmental conditions. Heat-Related Emergenices Heat-related emergencies such as heat stroke claim the lives of athletes every year despite being among the most prevent-able of sports-related health problems. Although heat-related deaths have decreased in recent years, just one death is far too many when most of these problems can be con-trolled by simple measures and the proper education of health-care professionals and coaching staffs. Body Temperature Regulation Because the body depends on water for normal function, long duration of sweating or excessive sweating without fluid replacement could be dangerous to the athlete. Efficient function of many of the body’s various organs and systems require that core temperature be maintained within a narrow range. As the muscles work during exercise, a tremendous amount of heat is generated.The body relies on a number of different methods to help dissipate this heat and maintain core temperature within a desirable range. These include convection, conduction, evaporation, and radiation (Box 8-1). Of these, evaporation is the most effi-cient method for the body to lose excess heat. However, the rate of sweat evaporation from an athlete’s skin is highly dependent on the amount of heat and humidity already present in the air. The warmer and more humid the air is, the harder it will be for sweat to evaporate and the higher an athlete’s core temperature will become. As water is lost though sweating, electrolytes and other chemicals are also lost from the body. This loss of electrolytes can also con-tribute to an imbalance of the cooling system.1 and lead to hyperthermia.It is important for the athlete to replace both fluids and electrolytes as they are lost through sweating associated with exercise. As the body’s core temperature rises and water and electrolytes deplete, heat illnesses can become a reality if immediate proper care does not take place.2 Recognition of the early stages of heat illness in an athlete is vital. Although heat illnesses in athletics can appear in a pro-gressive manner, dangerous situations such as heat exhaustion and heat stroke may arise with little or no warning (Box 8-2). Box 8-1 Methods of Core Temperature Regulation Convection: the body will gain or lose heat depending on the temperature of the sur-rounding air or water.Example:an athlete in cold water will have a decrease in body temperature. Conduction:the body will gain or lose heat depending on the temperature of what-ever surface it is in contact with.Example: an athlete lying on hot artificial turf will have an increase in body temperature. Evaporation: water on a surface dissipates into the atmosphere,releasing heat. Example:sweat evaporating from the skin of an athlete results in a loss of heat and a lower body temperature. Radiation: heat is transferred from areas of high temperature to areas of lower tem-perature.Example:blood from working muscles travels close to the surface of the skin.If the blood is warmer than the air temperature surrounding the skin,heat will be transferred from the warmer blood to the cooler atmosphere. Chapter 8 Environment-Related Conditions 147 Box 8-2 Types of Heat Illnesses Heat cramps Heat exhaustion Heat stroke* *Medical emergency Heat Cramps Heat crampsare common in athletics and should not be over-looked because they can be considered as the first stage of heat-related emergencies. Heat cramps tend to occur mainly in the leg area such as the calf and hamstring muscles. They are usually recognized by intense pain with persistent muscle spasms in the working muscle during prolonged exercise.3 Heat cramps are generally thought to be caused by muscle fatigue with rapid water and electrolyte loss via the sweating mechanism. Other factors may include lack of acclimatization, resulting in a less-efficient sweat mecha-nism and excessive sweating; irregular meals, resulting in less than optimal electrolyte stores; and a history of cramp-ing.2 Treatment for cramping includes removing the athlete from activity and incorporating gentle passive stretching of the involved muscle group in combination with ice mas-sage (Box 8-3). It is vital that immediate water and elec-trolyte replacement take place to prevent further muscle cramping and the possible progression to more serious forms of heat illness.1 STAT Point 8-1.Heat cramps are generally thought to be caused by muscle fatigue with rapid water and electrolyte loss via the sweating mechanism. Heat Exhaustion emergency,although it is a serious condition and is considered to be a precursor to heat stroke. In an athlete suffering from heat exhaustion,the body’s cooling mechanisms are intact but are no longer functioning efficiently.2 The signs and symptoms of heat exhaustion are progressive in nature, and health-care professionals should take notice of them as soon as the athlete exhibits any of the signs (Box 8-4).4 STAT Point 8-2.An athlete suffering from heat exhaustion will experience difficulty losing heat,but the body’s cooling mechanism will remain intact. Treatment for heat exhaustion should begin immedi-ately. Fluid replacement and gradual cooling by getting the athlete out of the heat and sun and into a shaded or air-conditioned area is of major importance (Box 8-5).The ath-lete suffering from heat exhaustion should not return to sport activity until all vital signs return to normal and the athlete has been cleared by the team physician.5 Box 8-4 Signs and Symptoms of Heat Exhaustion Athlete has elevated core body tempera-ture. Athlete may feel generally weak or fatigued. Athlete may feel nauseated. Athlete has sweaty/wet skin. Athlete’s skin is pale. Athlete’s breathing is rapid and shallow. Athlete’s pulse is weak. Heat exhaustion is a condition when the body is near to total collapse because of dehydration and a dangerously elevated core temperature.Heat exhaustion is not considered a medical Box 8-5 Treatment of Heat Exhaustion Check all vital signs. Box 8-3 Treatment of Heat Cramps Measure core body temperature (rectal). Remove athlete from activity. Rehydrate and replace electrolyte losses. Try gentle passive stretching of involved muscle. Try light massage with ice to reduce the muscle spasm. Remove excess clothing. Cool athlete with ice towels/ice bags. Place athlete in a cool or shaded area. Start fluid replacement. Alert team physician or transfer athlete to local emergency care facility. 148 Emergency Care in Athletic Training Weight loss between practice sessions should be kept to only 2% to 3% of the athlete’s pre-practice bodyweight, or less if at all possible. Of course, this assumes the ath-lete’s original weight is reflective of a well-hydrated state. Team physicians should establish guidelines for weight loss between sessions. Excessive weight loss of approxi-mately 5% or more of an athlete’s body weight during one practice session should be closely monitored by the team physician; activity limits should be strongly considered for these athletes until they have replaced their fluid losses. Before and after athletic events, including practices, dur-ing warm weather months the athletic trainer should use weight charts to track weight changes (Fig.8-1).6 It is com-monly recommended that athletes drink approximately 15 ounces of fluid for every pound of body weight lost during a practice session. These fluids should also contain some electrolytes. Heat Stroke The most severe heat-related condition is heat stroke. This condition involves a breakdown of the body’s heat regula-tion mechanism resulting in a dangerously high core tem-perature. The most notable symptoms of heat stroke are hot and red-colored skin.4 Commonly a strong and rapid pulse is present, with a high chance of unconsciousness or mental confusion (Box 8-6). It is a common misconception that an athlete will first suffer from heat exhaustion before heat stroke. Although this can occur, it is not always the case and the sports medicine staff should always be looking for the signs and symptoms of heat stroke in any athlete exercising in the heat. STAT Point 8-3. The most notable symptoms of heat stroke are hot and red-colored skin. When heat stroke develops,it is critical that the body be cooled down immediately. The athlete should be moved out of the sun,and excessive clothing should be removed at once (Box 8-7). Cooling may be initiated with fans or ice towels, although a more effective and faster means of cooling is to place the athlete in a pool or tub of cool water (Fig. 8-2). Heat stroke is a true medical emergency that can result in death if not treated with urgency. Athletes suffering from heat stroke should be immediately cooled down, then trans-ported to an emergency care facility via ambulance.7 Prevention of Heat-Related Emergenices Initial prevention measures when considering heat illness emergencies involve the recognition of all environmental factors and being able to implement an on-site emergency action plan (EAP). The EAP should address the prevention and recognition of heat-related emergencies and then a plan of action to evaluate and treat the affected athlete.2 Weigh-In Chart PLAYER NAME IN OUT IN OUT IN OUT IN OUT IN OUT Adams, Harry A. Arn, John Barrett, Bo Boyer, Jeff Boyer, Michael Bunger, Jon Coley, Matt Cotter, Mark Dalton, Jake Danielowski, Ben Demus, Nate Demus, Ron Dimond, Nate Engelson, Blake Figure 8-1. Weight chart for pre- and post-practice weigh-ins. Chapter 8 Environment-Related Conditions 149 Box 8-6 Signs and Symptoms of Heat Stroke 2. Conduct an approved pre-participation physical examination on all athletes to acquire information about those athletes that may be predisposed to heat illness. Athlete has an increased core body tem-perature of more than 104°F. Athlete has hot and dry/wet skin. Athlete’s skin is red. Athlete’s pulse is strong and rapid (110–120 bpm). Athlete may be weak and nauseated. Athlete’s mental status is altered or athlete exhibits irrational behavior. Athlete may be unconscious. Box 8-7 Treatment of Heat Stroke Move the athlete out of the sun. Check and monitor all vital signs. Measure core body temperature (rectal is most accurate). Assess cognitive function. Activate emergency action plan. Remove all excess clothing. Lower the core body temperature as quickly as possible. Immerse body in pool or tub of cool water. Manage airway if athlete is unconscious. Transport to emergency care facility as quickly as possible. Athletic trainers and other health-care providers must be prepared to respond in a quick and appropriate manner to alleviate symptoms and minimize the chance of heat-related death. The EAP will prepare all involved in the proper management of all heat-related emergencies.2,6 Ways to prevent heat-related emergencies in athletics include the following2,6,8–11: 1. Ensure that appropriate medical personnel (athletic trainers) are present at all sporting events. This includes practices and games. 3. Educate athletes and coaches regarding recognition and care of heat illness and the risks associated with playing in the heat and humidity. 4. Develop practice and game guidelines for hot and humid weather using the heat indextable (Table 8-1). 5. Measure factors of heat and humidity by determin-ing the wet-bulb globe temperature (WBGT) using a sling psychrometer before and during all outdoor sporting events (Table 8-2). 6. Consider adjusting practice and game times with respect to heat and humidity factors.An example is to move an afternoon practice to the evening when the air temperature has decreased.Plan on rest breaks to match the conditions and intensity of activity. 7. Acclimatize properly before the season begins, making sure that the athlete is in proper condition for the heat and humidity. 8. Ensure sufficient fluid replacement is available and consumed before,during,and after athletic activities. There should be an unlimited access to water and sports drinks,and they should be consumed freely. 9. Minimize the amount of equipment and clothing worn by the athlete during athletic activity. 10. Weigh athletes before and after athletic activities when the weather is hot and humid.This is done to estimate amount of body water lost during activity and therefore determine what should be replen-ished before the next activity. Recovery and return to activity from heat-related emer-gencies are entirely based on physician assessment and clear-ance.6 Severity of the heat-related incident should dictate the length of recovery time. The athlete should carefully begin gradual return to physical activity to regain fitness and acclimatization under the supervision of a physician,athletic trainer, or other qualified health-care professional.9 Heat-related emergencies are potentially critical medical conditions that are common in outdoor athletics.It must also be stressed that heat-related emergencies are highly preventa-ble. Environmental factors such as high temperature, high humidity, and lack of wind contribute to the potential of an athlete to suffer any type of heat illness.11 It cannot be stressed enough that fluids should be consumed liberally before,dur-ing,and after practices and competitions.8 Cold-Related Emergencies Serious health conditions can result from prolonged expo-sure to cold weather. The most common cold-related emer-gencies are hypothermia and frostbite.12 Signs and symptoms ... - tailieumienphi.vn