exss 288 exam 3 unc

how does Environmental stress affect an athlete?

Adversely impact an athletes performance and pose serious health threats

when looking at Environmental stress what are some areas of concern

Areas of concern:

Hyperthermia

Hypothermia

Lightning storms

define Hyperthermia

Increase in body temp

May be within normal range

May be outside normal range- This is area of concern

when looking at Hyperthermia thermal load what is included

Thermal load on the body generated internally(body) or externally(environment)

Muscle

Environment

Hyperthermia concerns

Interaction of many variables:

Temp (athlete and environment)

Weather

Humidity

Hydration

Serious consequences when not managed properly

All above contribute to a level of heat stress

what contributes to level of heat stress

Temp (athlete and environment)

Weather

Humidity

Hydration

What is heat stress?

Our body will attempt to maintain a physiological temp

It is the poor management of the thermal load that leads to heat illness

In athletics we can see elevated body temp it is when we see temp elevated outside the normal range that illness may ensue

Body temp regulation

what are the 5 main factors affecting body temp

Metabolic heat production

Conductive heat exchange

Convective heat exchange

Radiant heat exchange

Evaporative heat loss

describe Metabolic heat production

normal body heat

Normal metabolic function generates heat

Exercise will always result in an increase in heat

Greater the intensity exercise → higher the metabolism → greater heat production

the Greater the intensity of exercise leads to what

Greater the intensity exercise → higher the metabolism → greater heat production

describe Conductive heat exchange

DIRECT CONTACT

Direct physical contact with an object/structure

Heat is then transferred into or out of the body

Physical contact with other objects can result in either a heat loss or gain

give an example of Conductive heat exchange

Touching a hot stove

touching a cold baseball bat

describe Convective heat exchange

AIR OR WATER

Contact with air or water

Body heat can be either lost or gained depending on the temp of the circulating medium

The cool/hot air/water moving against the athletes skin absorbs and adds heat

give an example of Convective heat exchange

running outside

swimming in water

describe Radiant heat exchange

THE SUN

Radiant heat from sunshine causes an increase in body temp

Sun's energy contacting the skin

Body emits radiant heat energy too

Metabolic processes release energy

Transferred to tissue as heat

describe Evaporative heat loss

Sweat has to evaporate to reduce body temp

Sweat glands in skin transport water to the surface

Effects of humidity

Relative humidity of 65% of impairs evaporation

Relative humidity of 75% STOPS evaporation

Not cooling the body

Heat illness can still occur in cold environments body can't dissipate heat

Dehydration and inability to sweat

Relative humidity of 65% of impairs

evaporation of sweat

Relative humidity of 75% STOPS

evaporation of sweat

what are the 3 ways to Preventing heat illness

Monitoring heat index

Appropriate hydration

Gradual acclimatization

define Heat index

Combines air temp and relative humidity to determine the human perceived equivalent temp

Determining heat index what instruments do you use

Wet bulb globe temp (WBGT)

Reading from 3 thermometers:

Dry bulb temp (DBT)

Wet bulb temp (WBT)

Globe temp (GT)

define Dehydration

When the loss of water and salts is more than is replenished

Water makes up how much of body mass

approximately 60% of the male body mass and 50% of the female body mass

Water makes up how much of muscle mass and fat mass?

Water makes up 75% of muscle mass, but only 25% of fat mass

Lower body weight = more water

Signs and symptoms of dehydration

Thirst***

Dry mouth

Headache

Dizziness

Irritability

Lethargy

Excessive fatigue

Poor skin turgor

Dangers of dehydration

Dehydration can lead to any of the following:

Cramps

Headaches

Diarrhea

Fever

Vomiting

Hallucinations

Death

Types of dehydration

Mild-less than 5% weight loss

Moderate- 5-10% weight loss

Severe- 10-15% weight loss

Requires immediate medical attention and can lead to death

Dehydration during activity

Athletes greatly increase their water loss

Large increases in sweat loss

Some decreases in urine loss

Athletes need to increase water intake

Athletes often fail to consume adequate amounts of fluids to maintain optimal hydration status

Monitoring dehydration

Establish a hydration protocol

Determine individual sweat rate

Changes in body weight

1 pound= 1 pint additional fluids during exercise

May also account for urine volume

Goal: no weight loss (or

if the athlete looses 1 pound how much fluid do they need to replenish

1 pint additional fluids during exercise

when monitoring dehydration what is the goal

Goal: no weight loss (or

Maintain proper hydration

Athletes should begin all exercise sessions well hydrated

Emphasize continual fluid replacement

Replace fluids as they are lost

Practice fluid replacement

Gradually increase fluids

Body adapts to increase fluid consumption

Generally, cold fluids more rapidly absorbed

Cause body temp is higher than liquid

Use individual clear bottles for visual monitoring

Old rule of thumb

0.5-1 cup per 10-15 mins

Individualized is far better

what is a good rule of thumb for monitoring hydration

0.5-1 cup per 10-15 mins

why do cold fluids usually absorb faster?

Generally, cold fluids more rapidly absorbed

Cause body temp is higher than liquid

Strategies for avoiding dehydration

Hyperhydration (increasing hydration before exercise)

1 pint, 15-30 mins prior to exercise

Limited benefits

Post exercise rehydration

Ideally completed within 2 hrs

1 pound weight loss= 1.5-2 pts fluid replacement

ACSM rec: 16-24 oz per pound weight loss

1-1.5 pts per pound weight loss

Replace CHO (carbs) and electrolytes at same time to speed rehydration

Additional considerations for hydration

Susceptible individuals

Large muscle mass

Overweight

Sex

Age

Fitness level

History of heat related illness

Fever

Understand sport dynamics

Anticipate high risk conditions

Appropriate uniforms

Acclimatization (get use to heat)

Additional considerations for hydration

Susceptible individuals

Susceptible individuals

Large muscle mass

Overweight

Sex

Age

Fitness level

History of heat related illness

Fever

Gradual acclimatization

Preseason conditioning program- Introduces the athlete to the heat before the actual competitive season begins

Progressive exposure

Heat illness (order of severity)(least-most)

Heat syncope

Heat cramps

Heat exhaustion

Heat stroke

Hyponatremia- Abnormally low sodium levels in the body

what is Hyponatremia

Abnormally low sodium levels in the body

Heat syncope

AKA heat collapse

Fainting as a result of temp

Exposure to hot environment for long periods or not being acclimatized

Heat syncope causes

Peripheral vasodilation (tunnel vision)

Pooled blood in extremities

Heat syncope signs and symptoms

Fatigue → dizziness → fainting

Heat syncope treatment

Move to cool environment

Lay athlete down

Cold liquid consumption (don't give if in/out of consciousness)

Exertional heat cramps etiology

Imbalance between fluids and electrolytes (Na, Cl, K, Mg, Ca)

When we sweat we lose electrolytes

Electrolytes help with muscle contract/relax

Commonly caused by overexertion and poor hydration and electrolytes replacement

Where in the body is Exertional heat cramps most common?

Calf

abdomen

Exertional heat cramps treatment

PREVENTION!!

Well hydrated

Nutrition

Fluid ingestion

Extra fluid

Extra electrolytes

Light stretching

ice massage

IVs

Return to play once balance is restored

Exertional heat exhaustion causes

Athlete becomes so dehydrated they are unable to sustain adequate cardiac output for exercise

Not pushing out enough blood

Mild hyperthermia

Obtaining accurate body temp is important in distinguishing between heat exhaustion and heat stroke

How? Rectal temp

Exertional heat exhaustion signs and symptoms

Increased core temp (~102 F)

Profuse sweating

Pale skin

Vomiting

Dizziness

Hyperventilation

Rapid pulse

Possible cramping

Performance decrease

Exertional heat exhaustion treatment

Immediately removed from play

Excess clothing or equipment removed

Elevate feet

Return of blood to heart

Immediate fluid replacement - orally or through IV

If no rapid improvement, transport to emergency facility

If improperly managed, can progress to heatstroke

Exertional heat stroke

Life threatening emergency**

Characterized by CNS alteration and potential tissue damage resulting from a significantly elevated body temp

Can occur with sudden onset without warning

Usually progresses from heat exhaustion

Exertional heat stroke signs and symptoms

Altered consciousness seizures

Confusion

Emotional instability

Irrational behavior

Loss of consciousness

Increased core temp

Greater than 104

Collapse

Flushed, hot skin

Minimal sweating or no sweating

Shallow breathing

Rapid pulse

Decrease BP

Exertional heat stroke treatment

Strip clothing

Aggressive and immediate whole body cooling

Ice bath plunge

Multiple ice packs

COOL FIRST, TRANSPORT SECOND

Longer temp stay elevated=more damage

Exertional heat stroke is what type of emergency

MEDICAL EMERGENCY

why is Exertional heat stroke a medical emergency?

Longer temp stay elevated=more damage to cells

following Exertional heat stroke

Avoid exercise for a MINIMUM of one week

Gradually return to full practice

Prevention of ALL heat related illness

sports drinks

rest

adequate cooling

clothing and equipment

fans

monitoring environment

acclimatization

Exertional hyponatremia

Hyponatremia is unusual compared to prevalence of dehydration/other heat illness

Know risk factors/situations

Watch out for too much of a good thing

Fluid intake should not exceed losses

Sodium content of sport drinks are useful in preventing hyponatremia

Sodium concentration in sports drink is more dilute than in sweat

Palatability issues

Exertional hyponatremia common cause

Excessive fluid consumption (too much water not enough electrolytes)

Too little Na+ in diet

Excessive sodium loss in sweat

Excessive sweating

"Salty sweaters"

Long periods of sweating

Exertional hyponatremia risk factors

Heat stress environment

Long duration

Non-acclimatized athletes

Low body weight

Sickle cell trait

Genes: pass traits (like eye color) or health conditions

The sickle gene (S) affects red blood cells

Sickle cell trait (AS) occurs when a person inherits a typical gene (A) from one parent and a sickle gene (S) from the other

The sickle gene (S) is most predominant in african americans and those of

Mediterranean

Middle eastern

Indian

Caribbean

South and central america ancestry

***Persons of all races and ancestry may test positive for sickle cell trait

Why is it important to know about sickle cell trait

People with sickle cell trait (AS) may have:

Blood in urine, from time to time

Some pain and discomfort at high altitudes (like in the mountains or in certain cities high above sea level)

Problems with extreme exercise in hot, humid weather

Sickle cell trait and student athletes

The Division I Legislative Council (Proposal 75-B-1) mandate:

Division I student-athletes must be tested for sickle cell trait, show proof of a prior test, or sign a waiver releasing an institution from liability if they decline to be tested

What are the risks to athletes with sickle cell trait?

Red blood cells can sickle during intense exertion blocking blood vessels

Heat, dehydration, altitude, and asthma increase the risk for S-A with sickle cell trait

Screening and simple precautions may prevent deaths

***Athletes with sickle cell trait can participate in all sports

Training guidelines for athletes with sickle cell trait

Building up slowly in training with paced progressions, allowing longer periods of rest and recovery between repetitions

Participating in pre-season strength and conditioning programs to enhance the preparedness of athletes for performance testing which should be sport specific

Cold disorders

Fluid replacement vital in cold as well

Dehydration =

Decreased blood volume because less fluid available for tissue warming

Commonly present in endurance activities

Winter sports and swimming in cold water

"Frost Nip"- Chilblains

Most often involves hands, feet, fingers, toes

Most distal extremities

Painful inflammation of small blood vessels in response to repeated exposure to cold

Sin appears firm with cold painless areas that may peel and blister (24-72 hours)

May be itchy, bumpy

Treat with firm pressure, blowing warm air or hands in armpits (if fingers involved)

DO NOT RUB!

Can cause damage to skin and below skin

superficial Frostbite

Superficial frostbite involves only skin and subcutaneous tissue

Appears pale hard, cold and waxy

When rewarming the area will will numb, then sting and burn

It may blister and be painful for several weeks

deep frostbite

Deep frostbite indicated frozen skin requiring hospitalization

Rapid rewarming is necessary (100-110F)

Tissue will become blotchy red, swollen, painful and may become gangrenous

Hypothermia is when the body temp

Body temp drops below 95F (35C)

Hypothermia signs

Shivering (may be absent in the later stages of hypothermia)

Numbness

Glassy stare

Apathy

Weakness

Impaired judgment

in the case of severe Hypothermia

The victim may be unconscious

Breathing may be slowed or stopped

The body may feel stiff as the muscles become rigid

Hypothermia care

Check and care for life threatening conditions

Call 911

Carefully remove wet clothing and dry the victim

Move the victim to a warm environment

Warm their body

If available, apply hot water bottles, chemical heat packs or other heat sources to the body

Use where blood vessels are superficial

If the victim is alert, give warm non alcoholic and decaffeinated liquids to drink

Alcohol is a depressant- can cause more issues in body

Rewarm the victim gradually

Handle gently

Monitor breathing and signs of life and continue to warm the victim until EMS arrives

Be prepared to give CPR if necessary

prevention for hypothermia

prevention is key

appropriate apparel

waterproof/windproof fabrics

layering

proper warmup

Lightening is the # what cause of death by weather phenomena

#2

during a lightening storm if your hair stands up what should you do

If your hair stands up

you are in Imminent danger

Squat down

Lightening concerns

National Athletic Trainers Association (NATA) has established guidelines

Need an EAP

In event of lightning storm: shelter must be obtained

Totally enclosed (including closed doors)

Avoid large trees, flag/light poles, standing water, telephones, pools, showers, metal objects

Last resorts- ravine, ditch, valley for safety (lowest possible point)

What if you are caught in a lighting storm

Heels touching- enter in an put

If not touching the lightning will travel through the body

Lightning concerns. Need a reliable way to monitor the weather

Commonly accompanied by thunder

Flash to bang method

Lightning to thunder count

Divide by 5 to calculate mileage distance

30 sec → inherent danger (can strike from up to miles away)

15 sec → immediately clear field

Lightning detector

Instrument to detect atmospheric charge changes

Cheaper alternative to local weather service system

define poison

A poison is any substance that can cause injury, illness or death when introduced into the body

Poisons can be solid, liquid or gasses/vapors

Different forms = different types of entry into body

define toxin

A toxin is a poisonous substance produced by a microorganism that causes a disease

Checking the scene

Unusual odors

Flames or smoke

An open medicine cabinet

Open or spilled containers

Overturned or damaged plants

Drug paraphernalia or empty container

Care for poisoning

If the victim is conscious, ask questions

What type of poison did the victim ingest, inhale, inject or come into contact with

How much poison did the victim ingest, inhale, inject or come into contact with

When did the poisoning take place (approx time)

Time between exposure and arrival

The longer the more effects poison has

Severity of a poisoning depends on

Type/amount

How/where

Time

Victim size, weight, age, medical condition

Ingested poisons are

chemical or toxin

Ingested poisons signs and symptoms

Nausea, vomiting

Chest, abdominal pain

Change in LOC

headache, dizziness

Sweating

Difficulty breathing

Abnormal skin

Abnormal skin

Abnormal vision

Burning around mouth

care for Ingested poisons

Call poison control

May induce vomiting

May dilute the poison (eat or drink)

when caring for a victim who has Ingested a poison you should NOT induce vomiting if the victim

Is unconscious

Is having a seizure

Is pregnant

Has ingested a corrosive substance or a petroleum product

Corrosive: Drain clear, oven cleaner

Petroleum: kerosene

Is known to have heart disease

Inhaled poisons

Notices clues at the scene

Unusual odors

Strong smell of fuel

Hissing sound (something is leaking)

A commonly inhaled poison is carbon monoxide (gas)

Colorless

Odorless

All victims of inhaled poison needs oxygen as soon as possible

If you find an unconscious victim

Remove victim from scene if safe to do so

Call 911

Give care

inhaled poisons signs and symptoms

Lack of oxygen

Difficulty breathing

Cyanosis

Headache

Coughing

what poison does not need an open wound or other clear entrance in the body

Absorbed poisons like poison ivy

Absorbed poisons enter the body

Enters the body after is contacts skin

Come from plants such as poison ivy, poison oak as well as fertilizers and pesticides used in lawn and plant care

Don't need open wound to be absorbed by body

Care for a victim who came in contact with poisonous plant

Immediately rinse the affected area

If a rash or weeping lesion develops, seek advice from a pharmacist or physician

Antihistamine

If victims condition worsens, seek a physician

Care for victim who had contact with chemicals

Flush the area continuously with water

Call 911

If running water is not available, carefully brush off any dry chemicals with a gloved hand

Injected poisons

Insect and animal bites and stings are the most common sources of injected poisons

Injected poisons enter the body through

Hypodermic needles

Drugs

Misused medications

Bites or stings of

Insets

Spiders

Scorpions

Ticks

Marine life

Snakes

Preventing poisoning

Keep household products and medications out of reach of children

Use childproof safety caps

Use special latches and clamps to keep children from opening cabinets

Keep products in their original containers

Use poison symbols to identity dangerous substances

Dispose of outdated meds and household products

Use chemicals in well ventilated areas

Wear proper clothing

Immediately wash areas of the body that came in contact with poison

Bites and stings

Some of the most common types of bites and stings are from

Insects

Ticks

Spiders and scorpions

Marine life

Snakes

Domestic and wild animals

Humans