Page 59 - Athletic Health Handbook
P. 59
most often caused by the inappropri- heat stroke victim begins with an Table 1: Risk factors
ate, excessive use of hypotonic rehydra- assessment of the patient’s airway, for heat stroke
tion solutions such as water during breathing, and circulation.2 A secure Dehydration
endurance events. Decreased plasma airway and intravenous access are Febrile illness
sodium concentration can result from necessary because of the risk of seizure. History of prior heat injury
replacement of large amounts of sweat Rapid cooling is the most important Poor acclimatization
loss with plain water. The typical step in treatment and should be Cardiac disorders (hypertension)
hyponatremic athlete is competing in started as soon as the diagnosis is Metabolic disorders
an endurance event in the heat and suspected. Mortality significantly (hyperthyroidism,
develops subtle mental status changes. increases when cooling is delayed.3 diabetes mellitus)
Most hyponatremic athletes can toler- On the field, cooling should consist Sickle cell trait
ate their electrolyte changes, but more of moving the athlete out of the hot Obesity
severe hyponatremic patients may environment, fanning, and removing Medications
present with athletic collapse. Nausea, clothing and equipment. Immersion
vomiting, headache, and dizziness in an ice water bath is an effective Anticholinergics
are other associated symptoms. The method to rapidly lower core body Antihistamines
best means to differentiate between temperature. Evaporative cooling, Benzodiazepines
exertional heat stroke and exertional which involves spraying the athlete Beta blockers
hyponatremia is by measuring the with cool water while warmed air is Calcium channel blockers
core body temperature. Heat stroke passed over the body, is another effec- Neuroleptics
is excluded as the diagnosis if the tive means to lower body temperature. Ephedra/ma huang
core body temperature is normal. There is conflicting evidence as to Environmental factors such
The definitive diagnosis of exertional which of these methods is superior.4 as high humidity
hyponatremia is made by measure- An adjunctive method of cooling Sunburn
ment of serum sodium. Since most involves the application of ice packs Sleep deprivation
athletic events are not equipped to to the neck, groin, and axilla. Cooling
measure sodium, transportation to efforts should be discontinued when American Academy of Pediatrics
the emergency room is required for the rectal temperature reaches 101°F Committee on Sports Medicine
definitive diagnosis. As with heat (38°C) to prevent overcorrection recommend the following for
stroke, the best treatment for exer- with resultant hypothermia.1 Patients prevention of heat illness:10
tional hyponatremia is prevention. should be transported to an emer- 1. At the beginning of a strenuous
Coaches, trainers, athletes, and parents gency department as soon as possible
need to be educated on the dangers for identification and treatment of exercise program or after traveling
of drinking excessive amounts of potential medical problems that to a warmer climate, the intensity
regular water during endurance events accompany heat stroke. and duration of exercise should be
in the heat. Due to the concern of limited initially and then gradually
exertional hyponatremia, the American Prevention increased during a period of 10 to
College of Sports Medicine recom- 14 days to allow time for acclima-
mends the inclusion of sodium in The most effective treatment of heat tization. When this period of
the rehydration solution ingested stroke is prevention. As such, it is time is not available, the length of
during exercise lasting longer than critical to remain cognizant of the practice sessions and competition
one hour.7 latest developments in this issue. should be shortened.
For example, in early 2004 the Food 2. The use of the Wet Bulb Globe
Treatment and Drug Administration banned Temperature, which is an index of
the use of Ephedra because of safety climatic heat stress, should be used
Treatment of heat stroke begins with concerns. Sports medicine physicians as a guide for exercising in the heat.
prompt recognition of the signs and need to educate athletes, parents, and 3. Hydration should begin before
symptoms.5,6–9 Early diagnosis is coaches about the potential hazards the exercise period. Five hundred
based on a high index of suspicion in of high-intensity exercise in hot, ml of fluid should be consumed
any athlete who exhibits an altered humid climates as well as the impor-
level of consciousness while exercising tance of acclimatization and proper
in the heat. Initial management of a hydration. The Guidelines from the

ON-THE-FIELD MANAGEMENT OF HEAT STROKE 59
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