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Exertional heat-related illness (EHRI) is comprised of several states that afflict physically active persons when exercising during conditions of high environmental heat stress. If not treated EHRI in the extreme cases can be life threatening. Exertional heat stroke (ie a core body temperature of >40 ° C and mental status changes) is the most severe form of EHRI, and calls for immediate treatment (rapid body cooling) to reduce morbidity and mortality. EHRI consists of a spectrum of conditions that range from mild (heat oedema, heat rash) to life-threatening (heat stroke). Deaths from sports-related heat stroke appear to be increasing, with eg football players at high risk.[1] Types of Heat Illness[edit | edit source]Heat illness is classified into two types:
It should be noted that the treatment and identification do not change between these two types of heat illness but illustrates the fact that athletes should be aware of the signs of heat illness even in cooler and less humid climates.[3] Levels of Heat Illness[edit | edit source]Heat-related illnesses start out mildly uncomfortable and progress all the way to life-threatening. The conditions are, from least serious to most serious: heat oedema, heat rash, heat syncope, heat cramps, heat exhaustion and heatstroke.[2][3][4]
Criteria for Diagnosis of Heat Illness[edit | edit source]
[2] Risk Factors[edit | edit source]Risk factors for the development of heat illness can generally be categories into 2 areas:
Populations at high risk of heat illness include the elderly, children, and those with comorbid medical conditions which will inhibit their thermoregulatory ability. Alcoholism, living on the higher floors of multi-story buildings, and the use of psychiatric medications, like tricyclic antidepressants and typical antipsychotics, contribute to an increased risk of developing heat stroke.[10] Internal Factors
External (Environmental) Factors
Treatment[edit | edit source]The goal is to get core body temperature down to a normal acceptable level (below 38°C or 100.4° F) as quickly as possible. It’s important to note that although fevers generally present at similar temperatures as hyperthermia (temperatures above 100.9° F) the underlying mechanism is different.[13] The main focus of heat-related illnesses is to cool the athlete down as quickly as possible to protect the athlete’s brain and vital organs. To do that, the critical first step is to identify that a player is in trouble. This step is often missed, which allows heat illness to progress to serious levels. Evaluation of the ABC's is important in addition to removing equipment and clothing. Move the player away from direct sunlight and into a shaded, cooler environment. Finally, use cold applications - this can include dousing with cold water from a hose or shower, wrapping in cold towels, applying ice packs or immersion in an ice bath, and having them ingest cold fluids.[3] Specific Strategies are as follows:
On-Field Treatment[edit | edit source]
Treatment involves the replacement of fluid losses with a preference towards oral rehydration over parenteral rehydration. Supine positioning with leg elevation above the level of the heart can be helpful. Orthostatic sign measurements are often considered as an adjunct to monitor for adequate replacement additionally to the resolution of symptoms during positional changes.[14] [15] Prevention[edit | edit source]The best ways to prevent heat-related illness are to heat acclimatise prior to training heavy or racing in hot weather, monitor and manage hydration requirements, and incorporate cooling techniques to assist manage core body temperature. These things will help to reduce the physiological strain of training and racing in the heat and optimize performance.[16][13] Heat Acclimation[edit | edit source]Acclimatization to heat and humidity for at least 10-14 days prior to competition.[13] Hydration[edit | edit source]Dehydration is one of the key precursors to developing a heat-related illness. Although dehydration occurs due to an inadequate intake of fluids, it may be made worse by an additional amount of fluid loss through sweating, putting an athlete in a state of hypohydration. During strenuous exercise in the heat, sweat rates can reach 1.5 litres/hour or higher sometimes. The ideal recommendations are to consume 16 – 24 ounces of the fluid hourly, but endurance athletes in hot environments often need to consume 2-3 times that much. An athlete can figure out the approximate sweat rate by weighing themselves pre- and post-workout.[13] Cooling Practices[edit | edit source]Wear light-coloured, loose-fitting clothing, and protective against the sun.[2][13] Modifying controllable factors[edit | edit source]These preventive measures have been mentioned below:
[edit | edit source]NCAA Guidelines[edit | edit source]5-day acclimatization period at the beginning of the season— restricted to no more than 1 practice session a day lasting <3 hours
ACSM Guidelines[edit | edit source]6-day acclimatization period at the beginning of the season - no more than 1 practice lasting <3 hours during this time
Fluid Management during Exertion: Specific Guidelines[edit | edit source]
[2][17][20] Return to Play[edit | edit source]For milder forms of heat illness, it is probably safe for athletes to return within 24 hours with proper hydration. athletes should be evaluated by a physician prior to return to play. In order to successfully return to full participation after an exertional heat stroke (EHS), a specific return-to-play (RTP) strategy should be implemented. These guidelines are as follows:
References[edit | edit source]
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