Can Temperate-Water Immersion Effectively Reduce Rectal Temperature in Exertional Heat Stroke? A Critically Appraised Topic

2017 ◽  
Vol 26 (5) ◽  
pp. 447-451 ◽  
Author(s):  
Tyler T. Truxton ◽  
Kevin C. Miller
Keyword(s):  
Rectal Temperature ◽  
Water Immersion ◽  
Heat Stroke ◽  
Medical Emergency ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Temperate Water ◽  
Bottom Line ◽  
Exertional Heat Stroke ◽  
Cooling Rates

Clinical Scenario:Exertional heat stroke (EHS) is a medical emergency which, if left untreated, can result in death. The standard of care for EHS patients includes confirmation of hyperthermia via rectal temperature (Trec) and then immediate cold-water immersion (CWI). While CWI is the fastest way to reduce Trec, it may be difficult to lower and maintain water bath temperature in the recommended ranges (1.7°C–15°C [35°F–59°F]) because of limited access to ice and/or the bath being exposed to high ambient temperatures for long periods of time. Determining if Trec cooling rates are acceptable (ie, >0.08°C/min) when significantly hyperthermic humans are immersed in temperate water (ie, ≥20°C [68°F]) has applications for how EHS patients are treated in the field.Clinical Question:Are Trec cooling rates acceptable (≥0.08°C/min) when significantly hyperthermic humans are immersed in temperate water?Summary of Findings:Trec cooling rates of hyperthermic humans immersed in temperate water (≥20°C [68°F]) ranged from 0.06°C/min to 0.19°C/min. The average Trec cooling rate for all examined studies was 0.11±0.06°C/min.Clinical Bottom Line:Temperature water immersion (TWI) provides acceptable (ie, >0.08°C/min) Trec cooling rates for hyperthermic humans post-exercise. However, CWI cooling rates are higher and should be used if feasible (eg, access to ice, shaded treatment areas).Strength of Recommendation:The majority of evidence (eg, Level 2 studies with PEDro scores ≥5) suggests TWI provides acceptable, though not ideal, Trec cooling. If possible, CWI should be used instead of TWI in EHS scenarios.

Should Cooling Vests Be Used to Treat Exertional Heatstroke? A Critically Appraised Topic

2017 ◽  
Vol 26 (3) ◽  
pp. 286-289
Author(s):  
Megan L. Keen ◽  
Kevin C. Miller
Keyword(s):  
Cold Water ◽  
Core Body Temperature ◽  
Water Immersion ◽  
Heat Stroke ◽  
Cold Water Immersion ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Bottom Line ◽  
Cooling Rates ◽  
Central Nervous System Dysfunction

Clinical Scenario:Exercise performed in hot and humid environments increases core body temperature (TC). If TC exceeds 40.5°C for prolonged periods of time, exertional heat stroke (EHS) may occur. EHS is a leading cause of sudden death in athletes. Mortality and morbidity increase the longer the patient’s TC remains above 40.5°C; thus, it is imperative to initiate cooling as quickly as possible. Acceptable cooling rates in EHS situations are 0.08–0.15°C/min, while ideal cooling rates are above 0.16°C/min. Cooling vests are popular alternatives for cooling hyperthermic adults. Most vests cover the anterior and posterior torso and have varying numbers of pouches for phase-change materials (eg, gel packs); some vests only use circulating water to cool. While cooling vests offer several advantages (eg, portability), studies demonstrating their effectiveness at rapidly reducing TC in EHS scenarios are limited.Clinical Question:Are TC cooling rates acceptable (ie, >0.08°C/min) when hyperthermic humans are treated with cooling vests postexercise?Summary of Findings:No significant differences in TC cooling rates occurred between cooling vests and no cooling vests. Cooling rates across all studies were ≤0.053°C/min.Clinical Bottom Line:Cooling vests do not provide acceptable cooling rates of hyperthermic humans postexercise and should not be used to treat EHS. Instead, EHS patients should be treated with cold-water immersion within 30 min of collapse to avoid central nervous system dysfunction and organ failure.Strength of Recommendation:Strong evidence (eg, level 2 studies with PEDro scores ≥5) suggests that cooling vests do not reduce TC quickly and thus should not be used in EHS scenarios.

scholarly journals Cooling Rates of Hyperthermic Humans Wearing American Football Uniforms When Cold-Water Immersion Is Delayed

2018 ◽  
Vol 53 (12) ◽  
pp. 1200-1205 ◽  
Author(s):  
Kevin C. Miller ◽  
Timothy A. Di Mango ◽  
Grace E. Katt
Keyword(s):  
Rectal Temperature ◽  
Cold Water ◽  
Thermal Sensation ◽  
Water Immersion ◽  
Heat Stroke ◽  
Cold Water Immersion ◽  
American Football ◽  
Exertional Heat Stroke ◽  
Cooling Rates ◽  
Treatment Delays

Context Treatment delays can be contributing factors in the deaths of American football athletes from exertional heat stroke. Ideally, clinicians begin cold-water immersion (CWI) to reduce rectal temperature (Trec) to <38.9°C within 30 minutes of collapse. If delays occur, experts recommend Trec cooling rates that exceed 0.15°C/min. Whether treatment delays affect CWI cooling rates or perceptual variables when football uniforms are worn is unknown. Objective To answer 3 questions: (1) Does wearing a football uniform and delaying CWI by 5 minutes or 30 minutes affect Trec cooling rates? (2) Do Trec cooling rates exceed 0.15°C/min when treatment delays have occurred and individuals wear football uniforms during CWI? (3) How do treatment delays affect thermal sensation and Environmental Symptoms Questionnaire responses? Design Crossover study. Setting Laboratory. Patients or Other Participants Ten physically active men (age = 22 ± 2 y, height = 183.0 ± 6.9 cm, mass = 78.9 ± 6.0 kg). Intervention(s) On 2 days, participants wore American football uniforms and exercised in the heat until Trec was 39.75°C. Then they sat in the heat, with equipment on, for either 5 or 30 minutes before undergoing CWI (10.6°C ± 0.1°C) until Trec reached 37.75°C. Main Outcome Measure(s) Rectal temperature and CWI duration were used to calculate cooling rates. Thermal sensation was measured pre-exercise, postexercise, postdelay, and post-CWI. Responses to the Environmental Symptoms Questionnaire were obtained pre-exercise, postdelay, and post-CWI. Results The Trec cooling rates exceeded recommendations and were unaffected by treatment delays (5-minute delay = 0.20°C/min ± 0.07°C/min, 30-minute delay = 0.19°C/min ± 0.05°C/min; P = .4). Thermal sensation differed between conditions only postdelay (5-minute delay = 6.5 ± 0.6, 30-minute delay = 5.5 ± 0.7; P < .05). Environmental Symptoms Questionnaire responses differed between conditions only postdelay (5-minute delay = 27 ± 15, 30-minute delay = 16 ± 12; P < .05). Conclusions Treatment delays and football equipment did not impair CWI's effectiveness. Because participants felt cooler and better after the 30-minute delay despite still having elevated Trec, clinicians should use objective measurements (eg, Trec) to guide their decision making for patients with possible exertional heat stroke.

scholarly journals Temperate-Water Immersion as a Treatment for Hyperthermic Humans Wearing American Football Uniforms

2017 ◽  
Vol 52 (8) ◽  
pp. 747-752 ◽  
Author(s):  
Kevin C. Miller ◽  
Tyler Truxton ◽  
Blaine Long
Keyword(s):  
Rectal Temperature ◽  
Cold Water ◽  
Thermal Sensation ◽  
Water Immersion ◽  
Cold Water Immersion ◽  
American Football ◽  
Body Core Temperature ◽  
Temperate Water ◽  
Cooling Rates ◽  
Before And After

Context:  Cold-water immersion (CWI; 10°C) can effectively reduce body core temperature even if a hyperthermic human is wearing a full American football uniform (PADS) during treatment. Temperate-water immersion (TWI; 21°C) may be an effective alternative to CWI if resources for the latter (eg, ice) are unavailable. Objective:  To measure rectal temperature (Trec) cooling rates, thermal sensation, and Environmental Symptoms Questionnaire (ESQ) scores of participants wearing PADS or shorts, undergarments, and socks (NOpads) before, during, and after TWI. Design:  Crossover study. Setting:  Laboratory. Patients or Other Participants:  Thirteen physically active, unacclimatized men (age = 22 ± 2 years, height = 182.3 ± 5.2 cm, mass = 82.5 ± 13.4 kg, body fat = 10% ± 4%, body surface area = 2.04 ± 0.16 m2). Intervention(s):  Participants exercised in the heat (40°C, 50% relative humidity) on 2 days while wearing PADS until Trec reached 39.5°C. Participants then underwent TWI while wearing either NOpads or PADS until Trec reached 38°C. Thermal sensation and ESQ responses were collected at various times before and after exercise. Main Outcome Measure(s):  Temperate-water immersion duration (minutes), Trec cooling rates (°C/min), thermal sensation, and ESQ scores. Results:  Participants had similar exercise times (NOpads = 38.1 ± 8.1 minutes, PADS = 38.1 ± 8.5 minutes), hypohydration levels (NOpads = 1.1% ± 0.2%, PADS = 1.2% ± 0.2%), and thermal sensation ratings (NOpads = 7.1 ± 0.4, PADS = 7.3 ± 0.4) before TWI. Rectal temperature cooling rates were similar between conditions (NOpads = 0.12°C/min ± 0.05°C/min, PADS = 0.13°C/min ± 0.05°C/min; t12 = 0.82, P = .79). Thermal sensation and ESQ scores were unremarkable between conditions over time. Conclusions:  Temperate-water immersion produced acceptable (ie, >0.08°C/min), though not ideal, cooling rates regardless of whether PADS or NOpads were worn. If a football uniform is difficult to remove or the patient is noncompliant, clinicians should begin water-immersion treatment with the athlete fully equipped. Clinicians should strive to use CWI to treat severe hyperthermia, but when CWI is not feasible, TWI should be the next treatment option because its cooling rate was higher than the rates of other common modalities (eg, ice packs, fanning).

scholarly journals Exertional Heat Stroke in Athletes

2013 ◽  
Vol 1 (1) ◽  
pp. 135-139
Author(s):  
Metodija Kjertakov ◽  
Yoram Epstein
Keyword(s):  
Core Temperature ◽  
Water Immersion ◽  
Heat Stroke ◽  
Medical Emergency ◽  
Body Core Temperature ◽  
Exertional Heat Stroke ◽  
Hot Environment ◽  
Body Core ◽  
Nerve System ◽  
Ice Water

Exercising in hot and especially humid environment can cause rise in body core temperature to such a critical level that it does not only reduce performance, but also may ultimately lead to exertional heat stroke (EHS). This illness is true medical emergency that can result in significant morbidity and mortality, if not early recognized and promptly treated. Diagnostic criteria for EHS are body core temperature above 40ºC and central nerve system dysfunction. Any athlete experiencing such symptoms should be immediately exposed to aggressive cooling treatment aimed to lower the elevated core temperature to near normal as quickly as possible. Ice water immersion is highly recommended as a cooling method because it provides the fastest cooling rates and is associated with lowest mortality rates. Athletes cooled rapidly soon after the onset of EHS usually recover without complications and are able to return to normal training in hot environment within a few weeks. EHS is also a preventable condition, and its occurrence can be minimized by implementing a few simple measures.

scholarly journals High Schools Struggle to Adopt Evidence Based Practices for the Management of Exertional Heat Stroke

2021 ◽  
Author(s):  
SE Scarneo-Miller ◽  
RM Lopez ◽  
KC Miller ◽  
WM Adams ◽  
ZY Kerr ◽  
...  
Keyword(s):  
Health Behavior ◽  
Rectal Temperature ◽  
Process Model ◽  
Cold Water ◽  
Water Immersion ◽  
Heat Stroke ◽  
Adoption Process ◽  
Online Questionnaire ◽  
Exertional Heat Stroke ◽  
Facilitators And Barriers

Abstract Context: Exertional heat stroke (EHS) deaths can be prevented by adhering to best practices. Objective: We investigated the adoption of policies and procedures for the recognition and treatment of EHS and the factors influencing the adoption of a comprehensive policy. Design: Cross Sectional. Setting: Online questionnaire. Patients or Other Participants: Athletic trainers (ATs) practicing in the high school (HS) setting. Main Outcome Measure(s): Using the NATA Position Statement: Exertional Heat Illness, an online questionnaire was developed and distributed to ATs to ascertain their schools' current written policies for the use of rectal temperature and cold-water immersion (CWI). The Precaution Adoption Process Model (PAPM), allowed for responses to be presented across the various health behavior stages (“Unaware if have the policy”, “Unaware for the need for the policy”, “Unengaged”, “Undecided”, “Decided Not to Act”, “Decided to Act”, “Acting”, and “Maintaining”). Additional questions included perceptions of facilitators and barriers. Data are presented as proportions. Results: A total of 531 ATs completed this questionnaire. Overall, 16.9% (n=62) report adoption of all components for proper recognition and treatment of EHS. The policy component with the highest adoption was “cool first transport second” with 74.1% (n=110) of ATs reporting “Acting” or “Maintaining.” The most variability in the PAPM responses was for a rectal temperature policy, with 28.7% (n=103) of ATs reporting “Decided not to Act” and 20.1% (n=72) reporting “Maintaining.” The most commonly reported facilitator and barrier for rectal temperature included state mandate from state HS athletics association (n=274,51.5%) and resistance or apprehension from parents or legal guardians (n=311,58.5%), respectively. Conclusions: ATs in the HS setting appear to be struggling to adopt a comprehensive EHS strategy, with rectal temperature continuing to appear as the biggest undertaking. Tailored strategies based on health behavior, facilitators and barriers may aid in changing this paradigm.

scholarly journals Prehospital management of exertional heat stroke at sports competitions: International Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020

2021 ◽  
pp. bjsports-2020-103854
Author(s):  
Yuri Hosokawa ◽  
Sebastien Racinais ◽  
Takao Akama ◽  
David Zideman ◽  
Richard Budgett ◽  
...  
Keyword(s):  
Rectal Temperature ◽  
Working Group ◽  
Olympic Games ◽  
Heat Stroke ◽  
International Olympic Committee ◽  
Exertional Heat Stroke ◽  
Weather Impact ◽  
Prehospital Management ◽  
Adverse Weather ◽  
Expert Working Group

ObjectivesThis document aimed to summarise the key components of exertional heat stroke (EHS) prehospital management.MethodsMembers of the International Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020 summarised the current best practice regarding the EHS prehospital management.ResultsSports competitions that are scheduled under high environmental heat stress or those that include events with high metabolic demands should implement and adopt policy and procedures for EHS prehospital management. The basic principles of EHS prehospital care are: early recognition, early diagnosis, rapid, on-site cooling and advanced clinical care. In order to achieve these principles, medical organisers must establish an area called the heat deck within or adjacent to the main medical tent that is optimised for EHS diagnosis, treatment and monitoring. Once admitted to the heat deck, the rectal temperature of the athlete with suspected EHS is assessed to confirm an elevated core body temperature. After EHS is diagnosed, the athlete must be cooled on-site until the rectal temperature is below 39°C. While cooling the athlete, medical providers are recommended to conduct a blood analysis to rule out exercise-associated hyponatraemia or hypoglycaemia, provided that this can be safely performed without interrupting cooling. The athlete is transported to advanced care for a full medical evaluation only after the treatment has been provided on-site.ConclusionsA coordination of care among all medical stakeholders at the sports venue, during transport, and at the hospital is warranted to ensure effective management is provided to the EHS athlete.

The Use of Breathing Exercises in the Treatment of Chronic, Nonspecific Low Back Pain

2017 ◽  
Vol 26 (5) ◽  
pp. 452-458 ◽  
Author(s):  
Barton E. Anderson ◽  
Kellie C. Huxel Bliven
Keyword(s):  
Quality Of Life ◽  
Low Back Pain ◽  
Back Pain ◽  
Lung Function ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Low Back ◽  
Bottom Line ◽  
Breathing Exercises

Clinical Scenario:Research has shown a link between poor core stability and chronic, nonspecific low back pain, with data to suggest that alterations in core muscle activation patterns, breathing patterns, lung function, and diaphragm mechanics may occur. Traditional treatment approaches for chronic, nonspecific low back pain focus on exercise and manual therapy interventions, however it is not clear whether breathing exercises are effective in treating back pain.Focused Clinical Question:In adults with chronic, nonspecific low back pain, are breathing exercises effective in reducing pain, improving respiratory function, and/or health related quality of life?Summary of Key Findings:Following a literature search, 3 studies were identified for inclusion in the review. All reviewed studies were critically appraised at level 2 evidence and reported improvements in either low back pain or quality of life following breathing program intervention.Clinical Bottom Line:Exercise programs were shown to be effective in improving lung function, reducing back pain, and improving quality of life. Breathing program frequencies ranged from daily to 2–3 times per week, with durations ranging from 4 to 8 weeks. Based on these results, athletic trainers and physical therapists caring for patients with chronic, nonspecific low back pain should consider the inclusion of breathing exercises for the treatment of back pain when such treatments align with the clinician’s own judgment and clinical expertise and the patient’s preferences and values.Strength of Recommendation:Grade B evidence exists to support the use of breathing exercises in the treatment of chronic, nonspecific low back pain.

The Effect of Dry Needling on Patient-Reported Outcomes in Individuals With Chronic Ankle Instability: A Critically Appraised Topic

2019 ◽  
Vol 24 (5) ◽  
pp. 186-192
Author(s):  
Jennifer F. Mullins ◽  
Arthur J. Nitz ◽  
Matthew C. Hoch
Keyword(s):  
Patient Reported Outcomes ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
The Other ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Dry Needling ◽  
Bottom Line ◽  
Patient Reported

Clinical Scenario: Chronic ankle instability (CAI) and its associated recurrent sprains, feelings of instability, and decreased function occur in approximately 40% of individuals that suffer an ankle sprain. Despite these continued deficits, more effective treatment has yet to be established. Decreased sensorimotor function has been associated with CAI and may be amenable to dry needling treatment, thereby improving patient-reported outcomes (PROs). Focused Clinical Question: Does dry needling improve PROs in individuals with CAI? Summary of Key Findings: Two studies were identified that examined dry needling in participants with CAI. One of the two studies reported improvements in PROs (PEDro score 7/10) while the other study did not identify any changes (PEDro score 9/10). The inconsistent results were likely related to different treatment durations and follow-up timelines across the included evidence. Clinical Bottom Line: Based on the included studies, there is inconsistent evidence that dry needling can improve PROs in individuals with CAI. Strength of Recommendation: Utilizing the Strength of Recommendation Taxonomy (SORT) guidelines, level B evidence exists to recommend dry needling treatment to improve PROs for individuals with CAI.

The Effectiveness of Open Repair Versus Percutaneous Repair for an Acute Achilles Tendon Rupture

2016 ◽  
Vol 25 (4) ◽  
pp. 404-410 ◽  
Author(s):  
Heidi Krueger ◽  
Shannon David
Keyword(s):  
Achilles Tendon ◽  
Open Repair ◽  
Supporting Evidence ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Bottom Line ◽  
Physically Active ◽  
Men And Women ◽  
Percutaneous Repair ◽  
Tendon Ruptures

Clinical Scenario:There are 2 approaches available for surgical repair of the Achilles tendon: open or percutaneous. However, there is controversy over which repair is superior.Focused Clinical Question:Which type of surgery is better in providing the best overall patient outcome, open or percutaneous repair, in physically active men and women with acute Achilles tendon ruptures?Summary of Search, “Best Evidence” Appraised, and Key Findings:The literature was searched for studies of level 3 evidence or higher that investigated the effectiveness of open repair versus percutaneous repair on acute Achilles tendon ruptures in physically active men and women. The literature search resulted in 3 studies for possible inclusion. All 3 good-quality studies were included.Clinical Bottom Line:There is supporting evidence to indicate that percutaneous repair is the best option for Achilles tendon surgery when it comes to the physically active population. Percutaneous repair has faster surgery times, less risk of complications, and faster recovery times over having an open repair, although it is acknowledged that every patient has a different situation and best individual option may vary patient to patient.

The Diagnostic Accuracy of Screening Tools to Detect Eating Disorders in Female Athletes

2016 ◽  
Vol 25 (4) ◽  
pp. 395-398 ◽  
Author(s):  
Alyssa J. Wagner ◽  
Casey D. Erickson ◽  
Dayna K. Tierney ◽  
Megan N. Houston ◽  
Cailee E. Welch Bacon
Keyword(s):  
At Risk ◽  
Eating Disorders ◽  
Eating Disorder ◽  
Sensitivity And Specificity ◽  
Female Athletes ◽  
Screening Tools ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Bottom Line ◽  
Questionnaire Version

Clinical Scenario:Eating disorders in female athletes are a commonly underdiagnosed condition. Better screening tools for eating disorders in athletic females could help increase diagnosis and help athletes get the treatment they need.Focused Clinical Question:Should screening tools be used to detect eating disorders in female athletes?Summary of Key Findings:The literature was searched for studies that included information regarding the sensitivity and specificity of screening tools for eating disorders in female athletes. The search returned 5 possible articles related to the clinical question; 3 studies met the inclusion criteria (2 cross-sectional studies, 1 cohort study) and were included. All 3 studies reported sensitivity and specificity for the Athletic Milieu Direct Questionnaire version 2, the Brief Eating Disorder in Athletes Questionnaire version 2, and the Physiologic Screening Test to Detect Eating Disorders Among Female Athletes. All 3 studies found that the respective screening tool was able to accurately identify female athletes with eating disorders; however, the screening tools varied in sensitivity and specificity values.Clinical Bottom Line:There is strong evidence to support the use of screening tools to detect eating disorders in female athletes. Screening tools with higher sensitivity and specificity have demonstrated a successful outcome of determining athletes with eating disorders or at risk for developing an eating disorder.Strength of Recommendation:There is grade A evidence available to demonstrate that screening tools accurately detect female athletes at risk for eating disorders.

Sign in / Sign up

Export Citation Format

Share Document