Pdf History Of Concussion And Exertional Heat Illness Symptoms Among College Athletes
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- History of Concussion and Exertional Heat Illness Symptoms among College Athletes
- Heat Illness
- Management Strategies for the Health and Well Being of the CMS Intercollegiate Student-Athlete
Metrics details. There is an increasing concern over adolescent concussions in sports due to risks of long-term negative effects. This study analyzed data over three school years on reported concussion incidence rates by season, high school grade levels and gender, and reported symptoms by school nurses versus athletic trainers, from New Jersey student-athlete concussion data available from an online school-based surveillance system.
History of Concussion and Exertional Heat Illness Symptoms among College Athletes
Douglas J. Casa, Julie K. DeMartini, Michael F. Bergeron, Dave Csillan, E. Randy Eichner, Rebecca M. Lopez, Michael S. Ferrara, Kevin C. Sawka, Susan W. J Athl Train 1 September ; 50 9 : — To present best-practice recommendations for the prevention, recognition, and treatment of exertional heat illnesses EHIs and to describe the relevant physiology of thermoregulation. Certified athletic trainers recognize and treat athletes with EHIs, often in high-risk environments. Although the proper recognition and successful treatment strategies are well documented, EHIs continue to plague athletes, and exertional heat stroke remains one of the leading causes of sudden death during sport.
The recommendations presented in this document provide athletic trainers and allied health providers with an integrated scientific and clinically applicable approach to the prevention, recognition, treatment of, and return-to-activity guidelines for EHIs.
These recommendations are given so that proper recognition and treatment can be accomplished in order to maximize the safety and performance of athletes. Athletic trainers and other allied health care professionals should use these recommendations to establish onsite emergency action plans for their venues and athletes.
The primary goal of athlete safety is addressed through the appropriate prevention strategies, proper recognition tactics, and effective treatment plans for EHIs. Athletic trainers and other allied health care professionals must be properly educated and prepared to respond in an expedient manner to alleviate symptoms and minimize the morbidity and mortality associated with these illnesses. The prevention, recognition, and treatment of exertional heat illnesses EHIs are core components of sports medicine services at all levels of sport.
Our current knowledge base has allowed us to greatly enhance the level of care that can be provided for athletes with these medical conditions. This document serves as the current position statement for the National Athletic Trainers' Association NATA and replaces the document that was published in The care of exertional heat-stroke EHS patients has come a long way in the past millennia.
We now possess the knowledge to nearly assure survival from this potentially fatal injury if EHS is quickly and appropriately recognized and treated at the time of collapse. Exercise-associated muscle cramps EAMCs are sudden or sometimes progressively and noticeably evolving, involuntary, painful contractions of skeletal muscle during or after exercise.
The signs and symptoms of incipient EAMCs can be described as tics , twinges , stiffness , tremors , or contractures , but these terms refer to conditions that are typically painless and do not demonstrate muscle activity on electromyography, unlike full-blown EAMCs. Heat syncope, or orthostatic dizziness, often occurs in unfit or heat-unacclimatized persons who stand for a long period of time in the heat or during sudden changes in posture in the heat, especially when wearing a uniform or insulated clothing that encourages and eventually leads to maximal skin vasodilation.
This condition is often attributed to dehydration, venous pooling of blood, reduced cardiac filling, or low blood pressure with resultant cerebral ischemia. Heat exhaustion is the inability to effectively exercise in the heat, secondary to a combination of factors, including cardiovascular insufficiency, hypotension, energy depletion, and central fatigue. Heat injury is a moderate to severe heat illness characterized by organ eg, liver, renal and tissue eg, gut, muscle injury associated with sustained high body temperature resulting from strenuous exercise and environmental heat exposure.
Body temperature is usually but not always greater than Exertional heat stroke is the most severe heat illness. Although this illness is most likely to occur in hot and humid weather, it can manifest with intense physical activity in the absence of extreme environmental conditions.
The first sign of EHS is often CNS dysfunction eg, collapse, aggressiveness, irritability, confusion, seizures, altered consciousness. These recommendations are presented to help certified athletic trainers and other health care providers maximize health, safety, and sport performance.
However, individual responses to physiologic stimuli and environmental conditions vary widely. Therefore, these recommendations do not guarantee full protection from exertional heat-related illnesses but could mitigate the risks associated with athletic participation and physical activity. These recommendations and prevention strategies should be carefully considered and implemented by certified athletic trainers and the health care team as part of an overall strategy for the prevention and treatment of EHIs.
Conduct a thorough, physician-supervised preparticipation medical screening before the start of the season to identify athletes with risk factors for heat illness or a history of heat illness Table 2.
Individuals should be acclimatized to the heat gradually over 7 to 14 days. If heat acclimatization is not maintained, the physiologic benefits provided by this process will decay within 3 weeks. Strength of recommendation: B.
Athletes who are currently sick with a viral infection eg, upper respiratory tract infection or gastroenteritis or other illness or have a fever or serious skin rash should not participate until the condition is resolved. Individuals should maintain euhydration and appropriately replace fluids lost through sweat during and after games and practices see the NATA position statement on fluid replacement in athletes Players should have free access to readily available fluids at all times, not just during designated breaks.
Instruct them to eat or drink appropriate sodium-containing fluids and foods to help replace sodium losses in sweat and urine and to enhance hydration ie, water retention and distribution. The sports medicine staff must educate relevant personnel ie, coaches, administrators, security guards, emergency medical services [EMS] staff, athletes on preventing and recognizing EHI and, in particular, EHS. Review and rehearsal of the emergency action plan should include all relevant members of the sports medicine team ie, coaches, athletic trainers, EMS.
Strength of recommendation: C. Appropriate medical care must be available, and all personnel must be familiar with EHI prevention, recognition, and treatment. When environmental conditions warrant, a cold-water or ice tub and ice towels should be available to immerse or soak a patient with a suspected heat illness.
Onsite facilities are needed for immediate treatment. No other field-expedient methods of obtaining core body temperature eg, oral, axillary, tympanic, forehead sticker, temporal are valid or reliable after intense exercise in the heat, and they may lead to inadequate or inappropriate treatment, thereby endangering a patient's health. Esophageal and gastrointestinal via ingestible thermistor measurements may be appropriate alternatives for temperature assessment but require advanced training for the former and careful planning for the latter.
Under all circumstances in which EHS is possible, a rectal temperature assessment should be able to be obtained. Strength of recommendation: A. Because the effects of heat are cumulative, athletes should be encouraged to sleep at least 7 hours per night in a cool environment; eat a balanced diet; and properly hydrate before, during, and after exercise.
Rest periods should incorporate meal times and allow 2 to 3 hours for food, fluids, electrolytes primarily sodium and chloride , and other nutrients to be digested and absorbed before the next practice or competition.
To anticipate potential problems, a preseason heat-acclimatization policy should be developed for organized sports and event guidelines formulated for hot, humid weather conditions based on the type of activity and wet-bulb globe temperature WBGT. Special attention should be given to practice drills that involve high-intensity activity and full protective equipment worn by players, as these factors may exacerbate the amount of heat stress on the body.
Individuals who may be particularly susceptible to EHI must be identified. Rest breaks should be planned and the work-to-rest ratio modified to match the environmental conditions and the intensity of the activity. Additionally, players should be permitted to remove equipment eg, helmets during rest periods.
The use of dietary supplements and other substances that have a dehydrating effect, increase metabolism, or affect body temperature and thermoregulation is discouraged. Minimal experimental evidence exists regarding the most effective method of preventing EAMCs due to the variety of causes. Clinicians should identify the patient's unique intrinsic eg, hydration, acclimatization, biomechanics, training status and extrinsic eg, climate conditions, exercise intensity risk factors that preceded EAMCs before implementing a prevention strategy.
A patient experiencing EAMCs will likely show 1 or more of the following signs and symptoms: visible cramping in part or all of the muscle or muscle groups, localized pain, dehydration, thirst, sweating, or fatigue. A thorough medical history should be obtained to distinguish muscle cramping as a result of an underlying clinical condition eg, sickle cell trait from EAMCs.
Most EAMCs related to overload or fatigue tend to be short in duration less than 5 minutes and mild in severity. A thorough medical history and physical examination should be performed to eliminate any other medical conditions that could cause syncope.
Other signs and symptoms of exertional heat exhaustion may include fatigue, weakness, dizziness, headache, vomiting, nausea, lightheadedness, low blood pressure, and impaired muscle coordination. It is strongly recommended that a rectal temperature be obtained to differentiate exertional heat exhaustion from the more serious EHS. With heat exhaustion, core body temperature measured rectally is usually less than After initial collapse, recognition is often delayed, and the patient may begin to cool passively, dropping below the Rectal temperature thermometry is the only method of obtaining an immediate and accurate measurement of core body temperature.
Other devices, such as oral, axillary, aural canal, tympanic, forehead sticker, and temporal artery thermometers, inaccurately assess the body temperature of an exercising person.
Because immediate treatment is vital in EHS, it is important to not waste time by substituting an invalid method of temperature assessment if rectal thermometry is not available.
Instead, the practitioner should rely on other key diagnostic indicators ie, CNS dysfunction, circumstances of the collapse. Signs and symptoms can include disorientation, confusion, dizziness, loss of balance, staggering, irritability, irrational or unusual behavior, apathy, aggressiveness, hysteria, delirium, collapse, loss of consciousness, and coma. In some cases, a lucid interval may be present; however, if EHS is present, the patient will likely deteriorate quickly.
Other signs and symptoms of EHS that may be present include dehydration, hot and wet skin, hypotension, and hyperventilation.
Most patients with EHS have hot, sweaty skin as opposed to those with the classical type of heat stroke the passive condition that typically affects children and the elderly , who present with dry skin. Table 3. Heat injury is a moderate to severe heat illness characterized by end-organ damage but the absence of the profound CNS dysfunction often found with EHS.
The immediate treatment for acute EAMCs related to muscle overload or fatigue is rest and passive static stretching of the affected muscle until cramps abate.
Fluid absorption, retention, and distribution are enhanced by beverages that contain sodium and carbohydrates. A high-sodium product eg, salt packet may be added to a beverage to help offset sodium lost via exercise-induced sweating. Patients with EAMCs are normally conscious and responsive and have normal vital signs. The use of intravenous fluids should be considered if the patient is noncompliant or unable to tolerate fluids.
Patients with recurring EAMCs should undergo a thorough medical screening to rule out more serious neuromuscular conditions eg, fatigue, hydration level, improper nutrition. The clinician should move the patient to a shaded area, monitor vital signs, elevate the legs above the level of the heart, cool the skin, and rehydrate. Removing any excess clothing and equipment increases the evaporative surface of the skin and facilitates cooling. The patient should be moved to a cool or shaded area.
Further body cooling should be accomplished via fans or ice towels if necessary. While monitoring vital signs, the clinician should place the patient in the supine position with legs elevated above the level of the heart to promote venous return.
If intravenous fluids are needed or if recovery is not rapid within 30 minutes of initiation of treatment and uneventful, fluid replacement should begin and the patient's care transferred to a physician. If the condition worsens during or after treatment, EMS should be activated. For any EHS patient, the goal is to lower core body temperature to less than The length of time the core body and particularly the brain is above the critical temperature threshold When EHS is suspected, the patient's body trunk and extremities should be quickly immersed in a pool or tub of cold water.
Removing excess clothing and equipment will enhance cooling by maximizing the surface area of the skin.
The system can't perform the operation now. Try again later. Citations per year. Duplicate citations. The following articles are merged in Scholar.
Douglas J. Casa, Julie K. DeMartini, Michael F. Bergeron, Dave Csillan, E. Randy Eichner, Rebecca M. Lopez, Michael S. Ferrara, Kevin C.
History of Concussion and Exertional Heat Illness Symptoms among College Athletes · Kent State University · University of South Dakota.
Management Strategies for the Health and Well Being of the CMS Intercollegiate Student-Athlete
Sudden cardiac arrest is the leading cause of death in young athletes. CardiacWise is a free online educational program designed to educate coaches, parents, athletes on the prevention of sudden cardiac arrest in athletes. Individuals who successfully complete this course will receive a certificate of completion. Once you have completed the quiz, print out your certificate and provide it to the athletic department to put on file.
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