Environmental Factors in Sports Medicine Michael Swartzon, MD

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 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

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

SPF 15 or greater Applied 20 minutes prior to sun Reapply often Exposure as child can lead to cancer Heat Syncope Vasovagal

Risk factors 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

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 40C (104F) 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? McArdles Myopathy in adolescence, check CPK Sickle cell trait Exertional sickling Cramps like jello Fast Heart Rate Collapse High temperature Risks

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 (<28F) Hands, feet, face Freezing of cellular water Treat by warming

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

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

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