Evaluation and Treatment of Heat-Related Illnesses

Evaluation And Treatment Of Heat-Related Illnesses

Its mid-July at high-school mini-camp; 102.3 degrees outside on the football field, the cornerback suddenly collapses onto the turf. He has warm, sweaty skin and the majority of his skin is red. The first person in response has a few duties: first to evaluate and hopefully recognize what is wrong with the athlete, and second to take whatever action necessary to treat the athlete and get them back to normal working condition. In this situation, the first responder should realize that the athlete has suffered some sort of a heat-related illness. In order to take the necessary precautions, the first responder must be properly informed. The different types and severities of the multiple heat-related illnesses, as well as the approved and suggested treatment methods must all be explored for the first responder to know how to take care of the athlete. Common sense would say to remove the athlete from the hot environment and cool him down as quickly as possibleÐ'... this may not be completely true. In fact it is very deleterious to the athlete to submerge them in water right away. Other methods should be implicated to cool down the athlete.

There are many different types of heat-related illnesses, including: heat exhaustion, heat stroke, heat syncope, and heat cramps. Of those, heat stroke is definitely the most severe, while heat cramps are probably the most non-threatening. A simple way for aiding prevention of all heat-related illnesses is proper and adequate hydration before, during, and after workout sessions. Decrements of performance and impaired cognitive function have been seen at only 1-2% hypohydration (Yeargin). Signs and symptoms of each illness are different, as well as the methods for treating them are different.

Heat stroke is a very severe illness that is a medical emergency and, if not treated correctly, can quickly escalate to permanent damage or even death. Prompt assessment and rapid treatment of heat stroke it extremely vital to the amount of recovery time the athlete will need to return to full, unrestricted activity (Casa). Two key components must be examined when assessing the athlete: dysfunction of the central nervous system and determining the athlete's body temperature. Severe conditions, such as: convulsions, coma, dizziness, irritability, hysteria, confusion, disorientation, etc. can occur as a result of heat affecting the athlete's brain. Heatstroke generally occurs when the body's thermoregulatory mechanisms fail and the internal temperature of the athlete uncontrollably rises (Veronesi). When the temperature of the athlete eclipses the 105 degrees farenheight benchmark, it is determined that the athlete has suffered exertional heatstroke. Since heatstroke presents itself in such an array of different ways, it is sometimes difficult for the physician to accurately diagnose the athlete. This in itself is extremely dangerous, as the detrimental effects of heatstroke are quite immediate and very severe.

The recent epidemic of heat-related illnesses, mainly heatstroke, has caused a rumble in the health field. Many different studies have taken place to determine the safest and most efficient method to treat athletes that suffer from this condition. Obviously, the athlete's core temperature must be reduced to a normally functioning number, but the argument between healthcare providers occurs hereÐ'... Veronesi states, "(Rapid cooling) can be done by placing the patient in a tub of iced waterÐ'... several studies have found this method rapidly reduces core temperature with no complications or fatalities." But some studies now say that method is now obsolete and can actually be derogatory to the patient's health. M.D. Mustafa Khogali cites seven objections to ice-water immersion and strongly advises against it. He says evaporative cooling should be used in adjunct with other methods to reduce the core temperature of the patient. The seven objections are: (1) Intense venous constriction which keeps blood away from the skin and can, in fact, paradoxically elevate the body temperature, (2) quick movement from hot to cold environments can cause shivering, which is the body's natural reaction to cold, it twitches the muscles all over the body to create warmth, (3+4) ice-water immersion is extremely discomforting to the patient as well as the medical attendants, (5) if the patient goes into cardiac arrest, it is very difficult to perform cardiopulmonary resuscitation (C.P.R.) in water, (6) it is very difficult to monitor the vital signs of the patient in water, and (7) if common reactions to heatstroke Ð'- vomiting and/or diarrhea Ð'- occur, it is very unpleasant and unhygienic for the treatment environment (Khogali).

The use of ice-water immersion should strictly be used as a last resort method for cooling the athlete. Treatment of the athlete should begin with an esophageal or rectal probe for continuous monitoring of his/her core temperature. The initial cooling of the patient should occur by removing all clothing and exposing as much body surface area to the air as possible. The goal for initial treatment is to reach the core temperature of 102.2 to prevent permanent damage. If immediate cooling goes past that mark, overcooling occurs. The remainder of the cooling to the body's natural temperature of 98.6 is vital, but will naturally occur. Evaporative cooling methods are most ideal for situations involving heatstroke. In evaporative cooling, several high-speed fans are constantly blowing on the body, and continuous spraying of water on the body is necessary. As the