GVGS Heat Illness information

The following information was collected from various sources to be used by the Coaches, Parents and Players to ensure participant safety during times of high heat.

Heat related illnesses and appropriate actions 1

HEAT CRAMPS: Painful spasms usually in the muscles of legs and abdomen with heavy sweating. First Aid: Firm pressure on cramping muscles or gentle massage to relieve spasm. Give sips of water. If nausea occurs, discontinue water.

HEAT EXHAUSTION: Heavy sweating; weakness; cold, pale, clammy skin; thready pulse; fainting and vomiting but may have normal temperature. First Aid: Get victim out of sun. Once inside, the person should lay down and loosen his or her clothing. Apply cool, wet cloths. Fan or move victim to air conditioned room. Offer sips of water. If nausea occurs, discontinue water. If vomiting continues, seek immediate medical attention.

HEAT STROKE (or sunstroke): High body temperature (106° F or higher), hot dry skin, rapid and strong pulse, possible unconsciousness. First Aid: HEAT STROKE IS A SEVERE MEDICAL EMERGENCY. SUMMON EMERGENCY MEDICAL ASSISTANCE OR GET THE VICTIM TO A HOSPITAL IMMEDIATELY. DELAY CAN BE FATAL. While waiting for emergency assistance, move the victim to a cooler environment reduce body temperature with cold bath or sponging. Use extreme caution. Remove clothing, use fans and air conditioners. If temperature rises again, repeat process. Do NOT give fluids. Persons on salt restrictive diets should consult a physician before increasing their salt intake.

GVGS Heat Illness 01/19/2012 11:28 AM Page 1 of 10 Preventing Heat Related Illness 2

Most forms of heat illness can be avoided by following basic prevention guidelines. Even so, it's essential for athletes and coaches to know the warning signs of a developing heat-related emergency and understand the level of severity of each condition.

Normally, our body temperature is regulated by sweating. A number of factors can limit the sweat response, including intense exercise in high temperatures or high humidity, age, obesity, fever, dehydration, illness, medications and alcohol. When an athlete develops a heat illness, it usually occurs after several hours of exertion and excessive sweating that leads, first to dehydration, and then to electrolyte impalances.

To prevent heat-related illness, follow these precautions:

 Drink the Right Amount of the Right Fluids Finding the right amount of fluid to drink depends upon a variety of individual factors including the length and intensity of exercise and other individual differences.  Replace Lost Electrolytes Sweat leeches salt and minerals from the body. It's important to maintain sodium and electrolyte levels if you are sweating profusely and exercising more than 90 minutes. The easiest way to replace these are with salty foods or sports drinks.  Wear Appropriate Clothing Choose lightweight, light-colored, loose-fitting clothing. In the hot sun, a hat and sunscreen is helpful. Wear light, loose-wicking clothing so sweat can evaporate. Better yet, invest in some clothes made with CoolMax®, Drymax®, Smartwool or polypropylene. These fibers have tiny channels that wick the moisture from your skin to the outer layer of the clothing where it can evaporate more easily.  Use Sunscreen and Avoid Sunburn Sunburn decreases your ability to cool yourself and causes fluid loss. Use sunblock with SPF 15 or higher. Wear a hat that provides shade and allows ventilation.  Acclimate to the Heat You will have a greater tolerance for exercise in the heat if you become accustomed to it slowly over one to two weeks. If traveling to a hotter climate, allow several days to acclimate before doing intense exercise. Avoid exercise during the hottest time of day; train closer to sunrise or sunset.  Use Common Sense Avoid hot foods, alcohol and heavy foods that increase your core temperature. If you feel any headaches, fatigue or irritability or notice your exercise performance decreasing, stop exercising and cool off.

Remember, it is easier to prevent heat illness than to treat it once symptoms develop.

GVGS Heat Illness 01/19/2012 11:28 AM Page 2 of 10 Types of Heat related Illness 2

Mild Heat Illness

Conditions that are considered mild heat illness include the following:

1. Heat Edema Heat edema is a mild heat illness characterized by the swelling of hands and feet after prolonged exercise in heat. The core body temperature is usually normal.

2. Heat Rash Heat rash (sometimes called prickly heat) is a skin irritation that occurs when the sweat ducts become clogged and prevent the release of sweat onto the skin. Once trapped, the sweat causes a mild inflammation and an itchy rash that is generally seen in sweaty areas underneath clothing. Core body is usually not affected by heat rash.

3. Heat Syncope The signs and symptoms of heat syncope include dizziness and/or fainting; an athlete may also experience weakness. Heat syncope is a posture-related event, and athletes recover immediately after lying down with his or her feet elevated. Heat syncope is seen in athletes who are insufficiently acclimated to heat, and who become dehydrated. Unlike other serious heat illness, athletes with heat syncope have a normal core body temperature and recover quickly once they are fully hydrated.

4. Heat Cramps The signs and symptoms of heat cramps include painful muscle contractions that are associated with dehydration and electrolyte loss after exercising in the heat. An athlete's core body temperature will likely be elevated, but will not be over 104°F (40°C).

Moderate Heat Illness

5. Heat Exhaustion Heat exhaustion is considered a moderate heat illness that requires immediate attention. The signs and symptoms of heat exhaustion include an elevated core body temperature in the range of 98.6°F - 104°F (37°C – 40°C). An athlete will complain of dizziness, fatigue, headache and occasionally will experience nausea or vomiting. The skin is usually flushed and sweaty but it may be cold or clammy.

Severe Heat Illness

6. Heat Stroke Heat stroke is considered the most severe heat illness. An athlete with heat stroke has a core body temperature over 104°F (40°C) and appears confused and disoriented. As heat stroke progresses loss of consciousness may occur. With heat stroke, many patients will stop sweating. Athletes, however, generally suffer from exertional heat stroke, in which they continue to sweat. This is a medical emergency.

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Heat Cramps Symptoms and Prevention 2

Heat cramps are painful muscle spasms that occur in the arms, legs, or abdomen that usually occur after several hours of exertion in the heat. In addition to muscle cramps, other symptoms of heat cramps may include faintness, dizziness, weakness, and excessive sweating.

Usually an athlete suffers from heat cramps after several hours of exertion and excessive sweating that results in dehydration.

What Causes Heat Cramps?

The exact cause of heat cramps is unknown, but the theories most commonly cited include:

 Altered neuromuscular control  Dehydration  Electrolyte depletion  Poor conditioning  Muscle fatigue  Doing a new activity

Muscle cramps are more common during exercise in the heat because sweat contains fluids as well as electrolyte (salt, potassium, magnesium and calcium). When these nutrients, particularly sodium, fall to certain levels due to excessive sweating, the incidence of heat cramps increase.

Treating Heat Cramps

As soon as you recognize any of the symptoms of a heat illness, take the following actions:

 Stop activity, and sit quietly in a cool place.  Drink a sports beverage with electrolytes (you can make you own sodium-based solution with 1/4 teaspoon table salt mixed in a quart of water).  Gently stretch and massage the cramping muscle.  Hold the joint in a stretched position until the cramp stops.  Seek medical attention for heat cramps if they do not subside in 1 hour.

Preventing Heat Cramps

Follow these tips to minimize your risk of developing heat cramps:

 If you are going to exercise in hot weather, it's important to acclimatize to the heat for about a week before beginning any intense exercise. This allows your body to gradually adapt to the heat.  Hydrate well before and during exercise and replace lost electrolytes such as sodium, potassium and magnesium with food or a sports drink (drink 16 to 20 oz/hour).  Avoid exercising during the hottest time of day; train closer to sunrise or sunset.

GVGS Heat Illness 01/19/2012 11:28 AM Page 4 of 10  Wear light, loose clothing, so sweat can evaporate. Better yet, invest in some clothes that wick moisture from your skin to the outer layer of the clothing where it can evaporate more easily. Brands like CoolMax®, Drymax®, Smartwool or polypropylene all have this property.  Use sunscreen to prevent sunburn, which can limit the skin's ability to cool itself.  Wear a hat with a brim.  If you feel your abilities start to diminish, stop activity and seek out a cool, shaded place.  Do not drink alcohol or beverages with caffeine before exercise because they increase the rate of dehydration.  Remember, it is easier to prevent heat illness than to treat it once symptoms develop.

Preventing Muscle Cramps

Until we learn the exact cause of muscle cramps, it will be difficult to say with any confidence how to prevent them. However, these tips are most recommended by experts and athletes alike:

 Improve fitness and avoid muscle fatigue  Stretch regularly after exercise  Warm up before exercise  Stretch the calf muscle: In a standing lunge with both feet pointed forward, straighten the rear leg.  Stretch the hamstring muscle: Sit with one leg folded in and the other straight out, foot upright and toes and ankle relaxed. Lean forward slightly, touch foot of straightened leg. (Repeat with opposite leg.)  Stretch the quadriceps muscle: While standing, hold top of foot with opposite hand and gently pull heel toward buttocks. (Repeat with opposite leg.)

Most muscle cramps are not serious. If your muscle cramps are severe, frequent, constant or of concern, see your doctor.

GVGS Heat Illness 01/19/2012 11:28 AM Page 5 of 10 Heat Exhaustion Symptoms and Prevention 2

Athletes are especially prone to heat exhaustion and other heat illness, such as heat stroke and dehydration, when exercising in hot and humid conditions. Taking precautions and recognizing the symptoms or early warning signs of heat exhaustion is essential if you exercise in hot weather.

What Is Heat Exhaustion?

Heat exhaustion is the body's response to dehydration and an excessive loss of water and salt through sweat. Heat exhaustion typically occurs after long periods of heat exposure. Heat exhaustion occurs when the body becomes overwhelmed by heat and the sweat response stops working properly.

Signs and Symptoms of Heat Exhaustion

The following are the most common signs and symptoms of heat exhaustion:

 nausea  dizziness  weakness  headache  pale, cool and moist skin  fast and weak pulse  disorientation.  paleness  muscle cramps  tiredness  fainting

Heat Exhaustion vs. Heat Stroke

If heat exhaustion is left untreated, it may lead to heat stroke. The key difference between heat stroke and heat exhaustion is the presence of confusion and other mental status changes during heat stroke. During heat stroke, the neurological system is affected and can cause odd behavior, delusions, hallucinations, and eventually seizures or a coma.

At the first signs of heat exhaustion, you should stop activity and cool the body by seeking shade, shelter or a cool room, and drinking cold fluids.

Seek medical attention immediately if symptoms are severe.

Heat Exhaustion Treatment

If you recognize the symptoms of heat exhaustion, take the following actions:

 Stop activities and rest  Drink cool, non-alcoholic beverages  Take a cool shower, or bath  Move to an air-conditioned room

GVGS Heat Illness 01/19/2012 11:28 AM Page 6 of 10  Remove extra clothing

Preventing Heat Exhaustion

Follow these tips to minimize your risk of developing heat exhaustion:

 If you are going to exercise in hot weather, it's important to acclimatize to the heat for about a week before beginning any intense exercise. This allows your body to gradually adapt to the heat.  Hydrate well before and during exercise and replace lost electrolytes such as sodium, potassium and magnesium with food or a sports drink (drink 16 to 20 oz/hour).  Avoid exercising during the hottest time of day; train closer to sunrise or sunset.  Wear light, loose clothing, so sweat can evaporate.  Better yet, invest in some clothes made with CoolMax®, Drymax®, Smartwool or polypropylene. These fibers have tiny channels that wick the moisture from your skin to the outer layer of the clothing where it can evaporate more easily.  Use sunscreen to prevent sunburn, which can limit the skin's ability to cool itself.  Wear a hat with a brim.  If you feel your abilities start to diminish, stop activity and seek out a cool shaded place.  Do not drink alcohol or beverages with caffeine before exercise because they increase the rate of dehydration.  Remember, it is easier to prevent heat illness than to treat it once symptoms develop.

GVGS Heat Illness 01/19/2012 11:28 AM Page 7 of 10 Heat Stroke Symptoms and Prevention 2

What Is Heat Stroke?

The human body usually can regulate its temperature. When the body gets too hot, it uses several strategies to cool down, including sweating. But if a person spends too much time in the heat without taking in enough fluids, the body's cooling processes can't work properly. When the body becomes dehydrated, it can no longer cool itself by sweating. When this happens, body temperature can rise high enough to make the person sick.

The first symptoms of heat illness occur as the body temperature climbs above normal, and can include headache, nausea, vomiting, muscle cramps and fatigue. These early symptoms sometimes are called heat exhaustion. If steps are not taken to reduce body temperature, heat exhaustion can worsen and become heat stroke.

Heat stroke is a serious, potentially life-threatening form of heat illness. The body temperature rises to 105° Fahrenheit or higher and you develop neurological changes, such as mental confusion or unconsciousness. At these high temperatures, body proteins and the membranes around the cells in the body, especially in the brain, begin to be destroyed or malfunction. The extreme heat can affect internal organs, causing breakdown of the heart muscle cells and blood vessels, damage to internal organs, and death. There are two main causes of heat stroke:

 Exertional heat stroke occurs when someone is vigorously active in a hot environment, such as playing sports on a hot summer day or participating in military training activities. It typically strikes young, otherwise healthy people, those least likely to be concerned about the effects of heat on their health. Because of the lack of concern, early symptoms may be dismissed or ignored.  Nonexertional heat stroke tends to occur in people who have a diminished ability to regulate body temperature, such as older people, very young children or people with chronic illnesses. High heat in the surrounding environment, without vigorous activity, can be enough to cause heat stroke in these people.

Factors that can contribute to heat stroke include:

 Dehydration from not drinking enough water  Wearing bulky or heavy clothing, such as firefighting gear, in the heat  Being overweight, which causes the body to generate more heat and reduces the body's ability to cool down  Sleep deprivation, which can decrease the rate of sweating  Being unaccustomed to the heat, such as moving from a cooler climate to a warmer climate  Some medications, most commonly antihistamines (taken for allergies), diuretics (taken for high blood pressure or leg swelling), laxatives (taken to relieve constipation), calcium channel blockers (one type of blood pressure or heart medicine), medicines for Parkinson's disease, some diarrhea treatments and tricyclic antidepressants  Being confined to a poorly ventilated or non-air-conditioned living space  Having had heat stroke in the past  Use of illicit drugs, including cocaine, heroin, amphetamines and ecstasy (MDMA)

Symptoms

Heat stroke can come on suddenly, but warning symptoms often appear first. They include:

GVGS Heat Illness 01/19/2012 11:28 AM Page 8 of 10  Abdominal cramps  Muscle cramps  Nausea  Vomiting  Headache  Dizziness  Weakness  Heavy sweat or a lack of sweat

When heat stroke starts, neurological symptoms can include:

 Odd or bizarre behavior  Irritability  Delusions  Hallucinations  Seizures  Coma

Diagnosis

A doctor will examine the person and do tests to check for other possible causes of the high temperature. Tests may include a computed tomography (CT) scan of the head, blood tests and a lumbar puncture (spinal tap).

The doctor also will do urine and blood tests to monitor how well the kidneys are functioning. Dehydration and heat stroke can be a major stress for the kidneys.

Expected Duration

It is standard for a person with heat stroke to stay in the hospital for one or more days so that any complications can be identified quickly. Complete recovery from heat stroke and its affects on body organs may take two months to a year.

Prevention

Most cases of heat stroke can be prevented. When the temperature outside is especially high:

 Drink lots of water throughout the day.  Stay indoors in an air-conditioned area whenever you feel too warm.  Wear lightweight, light-colored clothing, preferably with a loose-weave material that lets air get to your skin.  Avoid strenuous activity in the hottest part of the day (between 10 a.m. and 4 p.m.). If you must participate, take frequent breaks, limit the time that you wear a helmet by taking it off between activities, and avoid wearing heavy uniforms or equipment.  Drink less caffeine and alcohol, which can contribute to dehydration.

If you begin to feel tired, dizzy or nauseated, or if you develop a headache, get out of the heat immediately. Seek out an air-conditioned building. Drink water. If possible, take a cool shower or bath or use a hose to soak yourself.

GVGS Heat Illness 01/19/2012 11:28 AM Page 9 of 10 Treatment

The first step in treating heat stroke is to reduce body temperature by cooling the body from the outside. This can be done by removing tight or unnecessary clothing, spraying the person with water, blowing cool air on the person, or wrapping the person loosely in wet sheets. Alternatively, ice packs can be placed at the neck, groin and armpits to accelerate cooling.

If these methods do not lower body temperature enough, a doctor may try to lower temperature from the inside by flushing the stomach or rectum with cold water. Severe cases may require cardiopulmonary bypass, in which the person's blood is diverted from the heart and lungs into a collection machine, cooled, and then returned to the body.

In some cases, anti-seizure or muscle-relaxing medications may be given to control convulsions and shivering. Aspirin and acetaminophen (Tylenol) do not help lower body temperature a person has heat stroke, and these medications should be avoided if heat stroke is suspected.

People with heat stroke generally need to be hospitalized so they can be tested for complications that may appear after the first day. One common complication is muscle breakdown caused by the heat. In this condition, called rhabdomyolysis, byproducts of the muscle breakdown appear in the bloodstream and can damage the kidneys.

When To Call A Professional

Seek emergency help if you or someone else has been in the heat and experiences confusion, faintness, staggering, hallucinations (visions that are not real), unusual agitation or coma. Begin cooling the person immediately.

Prognosis

If medical help is sought quickly, heat stroke almost always is treated successfully. Having had heat stroke in the past increases your risk of heat stroke in the future, so you will have to take extra precautions in hot weather. Delaying treatment can have serious consequences, including kidney or liver damage, congestive heart failure or heart arrhythmias, coma or death.

Sources

1 www.nws.noaa.gov/os/heat/index.shtml

2 sportsmedicine.about.com/od/enviromentalissues

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