Heat-Related Illness in Athletes

2007 ◽  
Vol 35 (8) ◽  
pp. 1384-1395 ◽  
Author(s):  
Allyson S. Howe ◽  
Barry P. Boden
Keyword(s):  
Medical Staff ◽  
Sickle Cell Trait ◽  
Heat Stroke ◽  
Febrile Illness ◽  
Severe Form ◽  
Heat Illness ◽  
Stroke Treatment ◽  
Heat Exhaustion ◽  
Supplement Use ◽  
Life Threatening

Heat stroke in athletes is entirely preventable. Exertional heat illness is generally the result of increased heat production and impaired dissipation of heat. It should be treated aggressively to avoid life-threatening complications. The continuum of heat illness includes mild disease (heat edema, heat rash, heat cramps, heat syncope), heat exhaustion, and the most severe form, potentially life-threatening heat stroke. Heat exhaustion typically presents with dizziness, malaise, nausea, and vomiting, or excessive fatigue with accompanying mild temperature elevations. The condition can progress to heat stroke without treatment. Heat stroke is the most severe form of heat illness and is characterized by core temperature >104°F with mental status changes. Recognition of an athlete with heat illness in its early stages and initiation of treatment will prevent morbidity and mortality from heat stroke. Risk factors for heat illness include dehydration, obesity, concurrent febrile illness, alcohol consumption, extremes of age, sickle cell trait, and supplement use. Proper education of coaches and athletes, identification of high-risk athletes, concentration on preventative hydration, acclimatization techniques, and appropriate monitoring of athletes for heat-related events are important ways to prevent heat stroke. Treatment of heat illness focuses on rapid cooling. Heat illness is commonly seen by sideline medical staff, especially during the late spring and summer months when temperature and humidity are high. This review presents a comprehensive list of heat illnesses with a focus on sideline treatments and prevention of heat illness for the team medical staff.

scholarly journals Association between active cooling and lower mortality among patients with heat stroke and heat exhaustion

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259441
Author(s):  
Jun Kanda ◽  
Shinji Nakahara ◽  
Shunsuke Nakamura ◽  
Yasufumi Miyake ◽  
Keiki Shimizu ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Core Body Temperature ◽  
Heat Stroke ◽  
Case Series ◽  
Clinical Findings ◽  
Hospital Death ◽  
Heat Illness ◽  
Heat Exhaustion ◽  
Active Cooling ◽  
Severe Group

Body cooling is recommended for patients with heat stroke and heat exhaustion. However, differences in the outcomes of patients who do or do not receive active cooling therapy have not been determined. The best available evidence supporting active cooling is based on a case series without comparison groups; thus, the effectiveness of this method in improving patient prognoses cannot be appropriately quantified. Therefore, we compared the outcomes of heat stroke patients receiving active cooling with those of patients receiving rehydration-only therapy. This prospective observational multicenter registry-based study of heat stroke and heat exhaustion patients was conducted in Japan from 2010 to 2019. The patients were stratified into the “severe” group or the “mild-to-moderate” group, per clinical findings on admission. After conducting multivariate logistic regression analyses, we compared the prognoses between patients who received “active cooling + rehydration” and patients who received “rehydration only,” with in-hospital death as the endpoint. Sex, age, onset situation (i.e., exertional or non-exertional), core body temperature, liver damage, renal dysfunction, and disseminated intravascular coagulation were considered potential covariates. Among those who received active cooling and rehydration-only therapy, the in-hospital mortality rates were 21.5% and 35.5%, respectively, for severe patients (n = 231) and 3.9% and 5.7%, respectively, for mild-to-moderate patients (n = 578). Rehydration-only therapy was associated with a higher in-hospital mortality in patients with severe heat illness (adjusted odds ratio [aOR], 3.29; 95% confidence interval [CI], 1.21–8.90), whereas the cooling methods were not associated with lower in-hospital mortality in patients with mild-to-moderate heat illness (aOR, 2.22; 95% CI, 0.92–5.84). Active cooling was associated with lower in-hospital mortality only in the severe group. Our results indicated that active cooling should be recommended as an adjunct to rehydration-only therapy for patients with severe heat illness.

scholarly journals A Case of Exertional Heat Stroke Complicated by Hypoxic Hepatitis

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Bertram K. Woitok ◽  
Shawki Bahmad ◽  
Gregor Lindner
Keyword(s):  
Supportive Care ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Multiorgan Failure ◽  
Heat Stroke ◽  
Exertional Heat Stroke ◽  
Hypoxic Hepatitis ◽  
Threatening Condition ◽  
Life Threatening ◽  
Delayed Referral

Background.Exertional heat stroke is a life-threatening condition often complicated by multiorgan failure. We hereby present a case of a 25-year-old male presenting with syncope after a 10  km run in 28°C outside temperature who developed acute liver failure. Case Presentation. Initial temperature was found to be 41.1°C, and cooling measures were rapidly applied. He suffered from acute renal failure and rhabdomyolysis and proceeded to acute liver failure (ASAT 6100 U/l and ALAT 6561 U/l) due to hypoxic hepatitis on day 3. He did not meet criteria for emergency liver transplantation and recovered on supportive care. Conclusions. Acute liver failure due to heat stroke is a life-threatening condition with often delayed onset, which nevertheless resolves on supportive care in the majority of cases; thus, a delayed referral to transplant seems to be reasonable.

CONGENITAL CUTIS LAXA: A RARE GENODERMATOSIS

2021 ◽  
pp. 20-21
Author(s):  
Vinaya Ajaykumar Singh ◽  
Mazhar Khan ◽  
Poonam Wade ◽  
Navina Desai ◽  
Sushma Malik
Keyword(s):  
Metabolic Disorders ◽  
Skin Diseases ◽  
Febrile Illness ◽  
Menkes Disease ◽  
Female Child ◽  
Severe Form ◽  
Cutis Laxa ◽  
Facial Features ◽  
Elastic Tissue ◽  
Tissue Abnormalities

Cutis Laxa (CL) / generalized elastolysis / dermatomegaly is a heterogeneous group of disorders which are related to elastic tissue abnormalities. Depending on extent of abnormal elastic tissue, it may be mild or severe. Severe form presents with loose, inelastic, wrinkled skin resembling ill tted suit. Infant has characteristic facial features like old man appearance, a hooked nose, a short columella, a long upper lip with long philtrum, and everted lower eyelids. CL is categorised as congenital or acquired and the inheritance can be autosomal dominant or recessive, or X linked. Occasionally a few metabolic disorders like Menkes disease, disorders of glycosylation are associated with Congenital CL. Acquired cutis laxa has developed after a febrile illness and various inammatory skin diseases. Here we present a case of a full-term SGA (small for gestational age) female child born with features of CL.

The Pathophysiology of Exertional Heatstroke

2004 ◽  
Vol 90 (3) ◽  
pp. 135-138
Author(s):  
J. E. Smith
Keyword(s):  
Heat Stroke ◽  
Armed Forces ◽  
Heat Illness ◽  
Exertional Heat Illness ◽  
Military Unit

AbstractExertional heat illness remains a major cause of morbidity and occasional mortality within the Armed Forces. This review explores the normal responses to heat, known causes of exertional heatstroke, and suggests possible answers to the question of why one member of a military unit collapses with heat stroke, while matched controls at his side remain unaffected.

Risk factors for heat-related illnesses during the Hajj mass gathering: an expert review

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Saber Yezli
Keyword(s):  
Preventive Measures ◽  
Febrile Illness ◽  
Mass Gatherings ◽  
Expert Review ◽  
Hot Environment ◽  
Increased Risk ◽  
Modifiable Factors ◽  
Life Threatening ◽  
Nutrition And Hydration ◽  
And Behavior

Abstract Human exposure to a hot environment may result in various heat-related illnesses (HRIs), which range in severity from mild and moderate forms to life-threatening heatstroke. The Hajj is one of the largest annual mass gatherings globally and has historically been associated with HRIs. Hajj attracts over two million Muslim pilgrims from more than 180 countries to the holy city of Makkah, Kingdom of Saudi Arabia. Several modifiable and non-modifiable factors render Hajj pilgrims at increased risk of developing HRIs during Hajj. These include characteristics of the Hajj, its location, population, and rituals, as well as pilgrims’ knowledge of HRIs and their attitude and behavior. Makkah is characterized by a hot desert climate and fluctuating levels of relative humidity. Pilgrims are very diverse ethnically and geographically, with different adaptations to heat. Significant proportions of the Hajj population are elderly, obese, and with low levels of fitness. In addition, many have underlying health conditions and are on multiple medications that can interfere with thermoregulation. Other factors are inherent in the Hajj and its activities, including crowding, physically demanding outdoor rituals, and a high frequency of infection and febrile illness. Pilgrims generally lack awareness of HRIs, and their uptake of preventive measures is variable. In addition, many engage in hazardous behaviors that increase their risk of HRIs. These include performing rituals during the peak sunshine hours with no sun protection and with suboptimal sleep, nutrition, and hydration, while neglecting treatment for their chronic conditions. HRIs preventive plans for Hajj should incorporate measures to address the aforementioned factors to reduce the burden of these illnesses in future Hajj seasons. Lessons from the Hajj can be used to inform policy making and HRIs preventive measures in the general population worldwide.

Rhabdomyolysis in a Female Caucasian Adolescent Distance Runner: A Case Report

2016 ◽  
Vol 21 (6) ◽  
pp. 26-32 ◽  
Author(s):  
R. Mitchell Todd ◽  
Michelle Cleary ◽  
J. Susan Griffith
Keyword(s):  
Case Report ◽  
Laboratory Testing ◽  
Heat Stroke ◽  
Distance Runner ◽  
Heat Illness ◽  
Adolescent Female ◽  
Systemic Symptoms ◽  
Return To Competition

We present the case of an adolescent female collegiate distance runner competing in her first 6K race. She presented with multiple systemic symptoms of dizziness, nausea, confusion, muscle cramping, and syncope. The patient was immediately treated for heat stroke and, on follow-up, reported to the AT with a headache, lack of appetite, muscle aches, and dark-colored urine. Rhabdomyolysis should be considered following a heat illness event with necessary treatments performed immediately. Symptomatic patients must be referred to a physician for evaluation and laboratory testing. We present recommendations for a supervised return-to-participation protocol and acclimatization to safely return to competition readiness.

scholarly journals Fatal Firearm Injuries in Finland: A Nationwide Survey

2002 ◽  
Vol 91 (4) ◽  
pp. 328-331 ◽  
Author(s):  
I. Mäkitie ◽  
H. Pihlajamäki
Keyword(s):  
Medical Staff ◽  
Nationwide Survey ◽  
Anatomical Site ◽  
Death Certificates ◽  
Injury Patterns ◽  
Fatal Injury ◽  
Firearm Injuries ◽  
Life Threatening ◽  
Hospital Resources ◽  
The Mean

Background and Aims: Treatment of life-threatening firearm injuries represents major challenges to the involved medical staff. The aim of the study was to assess numbers, natures and injury patterns of fatal incidents by firearms in Finland over a 10-year period. Material and Methods: Retrospective analysis of all firearm-related deaths during the 10-year period from January 1990 to December 1999. Death certificates were obtained and reviewed with detailed analysis of non-suicidal deaths. Results: Over the 10-year period 1990 to 1999, 452 individuals (equivalent to 1.8 cases per 100 000 person-years) died in Finland as a result of accidental or violent shooting. There were no significant changes in numbers of cases from year to year. The malefemale ratio was 7:3. The mean age of the victims was 32 years. The shooting incident had been classified as an assault in 78 % of cases. Its nature was unspecified in 13 % of cases and clearly accidental in 9 %. The predominant anatomical site of fatal injury following assault was the chest in 43 %, the head in 42 % and the abdomen in 8 % of the cases. After accidental or unspecified nature shooting, the predominant site of injury was the head in 68 %, followed by the chest in 16 % and the abdomen in 10 % of the cases. Most victims (86 %) died at the scene of the shooting. Only 14 % were alive at hospital admittance. Most hospitalised victims died within 24 hours of admission. Conclusions: The annual incidence of fatal non-suicidal firearm injuries did not change significantly in Finland between 1990 and 1999. Victims of such injuries required only minimal hospital resources because in most cases they died at the scene of the shooting. The results of the study reported indicate that efforts to prevent fatal injuries from use of firearms or diminish their number should be focused mainly on prevention of firearm related assault.

scholarly journals Survey Instrument Validity Part I: Principles of Survey Instrument Development and Validation in Athletic Training Education Research

2011 ◽  
Vol 6 (1) ◽  
pp. 27-35 ◽  
Author(s):  
Laura J. Burton ◽  
Stephanie M. Mazerolle
Keyword(s):  
Data Collection ◽  
Survey Research ◽  
Athletic Training ◽  
Heat Stroke ◽  
Survey Instrument ◽  
Stroke Treatment ◽  
Instrument Validity ◽  
Collection Process ◽  
Data Collection Process ◽  
Development And Validation

Context: Instrument validation is an important facet of survey research methods and athletic trainers must be aware of the important underlying principles. Objective: To discuss the process of survey development and validation, specifically the process of construct validation. Background: Athletic training researchers frequently employ the use of survey research for topics such as clinical instruction and supervision, burnout, and professional development; however, researchers have not always used proper procedures to ensure instrument validity and reliability for the data collection process. Description: Four major methods exist to establish the validity of an instrument: face, content, criterion related, and construct. When developing a survey to measure a previously unexplored construct (eg, an athletic trainer's attitudes toward appropriate exertional heat stroke treatment), researchers should employ a four-step process: (1) defining constructs and content domain, (2) generating and judging measurement items, (3) designing and conducting studies to develop a scale, and (4) finalizing the scale. Clinical Advantages: Establishing the validity of a survey instrument strengthens the data yielded from the data collection process, which allows for greater confidence in the interpretation of the results from the survey. Conclusions: Construct validity, although a time-intensive process, is necessary to ensure accuracy and validity of the survey instrument.

Heat

2020 ◽  
pp. 1687-1689
Author(s):  
Michael A. Stroud
Keyword(s):  
Physical Activity ◽  
Body Temperature ◽  
Supportive Care ◽  
Physiological Responses ◽  
Heat Stroke ◽  
Heat Exposure ◽  
High Humidity ◽  
Heat Exhaustion ◽  
Clinical Presentations ◽  
Cold Core

Rising body temperature triggers behavioural and physiological responses including reduction in physical activity, alterations of clothing, skin vasodilatation, and sweating. Heat-related illness is relatively common, especially with high humidity or prolonged physical activity. Risk can be reduced by acclimatization with repeated heat exposure, but some individuals seem to be particularly susceptible. Clinical presentations of heat-related illness include (1) ‘heat exhaustion’—the commonest manifestation, with symptoms including nausea, weakness, headache, and thirst. Patients appear dehydrated, complain of being hot, and are flushed and sweaty. Treatment requires rest and fluids, given orally or (in severe cases) intravenously. (2) ‘Heat stroke’ victims often complain of headache, may be drowsy or irritable, and may claim to feel cold. Core temperature is usually 38–41°C, but the patient is shivering with dry, vasoconstricted skin. Treatment requires (a) aggressive rapid cooling; (b) close biochemical monitoring; (c) supportive care for organ failure. There is significant mortality.

scholarly journals P135: Administrative codes for heat illness: a validation study in Ontario, Canada

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S113-S113
Author(s):  
H. Baassiri ◽  
T. Varghese ◽  
M. Columbus ◽  
K. Clemens ◽  
J. Yan
Keyword(s):  
Gold Standard ◽  
Heat Stroke ◽  
Heat Exposure ◽  
Sample Size Calculation ◽  
Physical Exertion ◽  
International Classification Of Diseases ◽  
Administrative Database ◽  
Heat Illness ◽  
Predictive Values ◽  
Icd 10

Introduction: Extreme heat events due to climate change are becoming increasingly frequent and severe, and may have an impact on human health. Administrative database studies using International Classification of Diseases 10th revision codes (ICD-10) are powerful tools to measure the burden of acute heat illness (AHI) in Canada. We aimed to assess the validity of the coding algorithm for emergency department (ED) encounters for AHI in our region. Methods: Two independent reviewers retrospectively abstracted data from 507 medical records of patients presenting at two EDs in Ontario between May-September 2015-2018. The Gold Standard definition of an AHI is chart-documented heat exposure with a heat related complaint, such as syncope while working outdoors on a hot day. To determine ICD coding algorithm positive predictive value (PPV), records that were previously coded as ICD-10 heat illnesses were compared to the Gold Standard for AHI. To determine sensitivity (Sn), specificity (Sp) and negative predictive values (NPV), the Gold Standard was compared to randomly selected records. A total of 326,702 ED visits were included in study period with 208 having an ICD-10 code related to heat illness. Sample size calculation demonstrated a need to manually review 62 previously coded heat illnesses and 931 random cases, of which 50 and 474 have been reviewed, respectively. In both abstractions, 20% of cases underwent a blinded duplicate review. Results: In our review of 474 random records, 2 cases were identified as AHI but without an appropriate ICD-10 code, 445 were not AHIs, and no cases had been identified as having an AHI ICD-10 inappropriately applied. In our review of 50 previously coded heat illnesses, 34 were found to be appropriately coded and 16 inappropriately coded, as AHI ICD-10. Average patient age and gender of heat illness vs non-heat illness ED presentations were 32 and 48 years of age and 49% and 64% male, respectively. The leading complaint in AHI was heat stroke/exhaustion (39%), followed by headaches (15%), dizziness (9%), shortness of breath (9%) and syncope/presyncope (6%). 76% of all heat illness presentations presented following a period of physical exertion. Conclusion: Final calculation of Sn, Sp, PPV, NPV for the algorithm will occur upon completion of the review. Preliminary results suggest that ICD-10 coding for AHI may be applied correctly in the ED. This study will help to determine if administrative data can accurately be used to measure the burden of heat illness in Canada.

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