Special Considerations in Athletes Chapter 25

Special Considerations in Athletics Training staff needs to be aware of any medical condition an athlete has so they can be prepared if an emergency should arise Information could be found on physical and should be on emergency medical cards Environmental Considerations Skin Conditions Diabetes Seizure Disorders Insect Stings or Bites Female Athlete Triad

Heat Stress A condition that occurs when the body cannot maintain homeostasis and the body temperature begins to rise (hyperthermia). The hypothalamus of the brain is in control of regulating body temperature

Assessing the Risk There are certain risks that increase the chance of suffering from heat stress Athletes need to be well hydrated, rested and in good physical condition for temperature regulation work properly Poor condition causes the body to work harder, putting more strain on the hypothalamus The heat index combines temperature and humidity to provide a reference point for various levels of risk associated with exercise under hot and humid conditions The greater the head index, the more moisture in the air. The body progressively loses its ability to adequately evaporate moisture These risks can cause potentially dangerous increases to core temperature

National Oceanic and Atmospheric Administration Bright Yellow Zone – CAUTION: Normal practice for athletes, closely monitor new or unconditioned athletes or all athletes during extreme exertion. Schedule mandatory rest / water breaks. (5 min water / rest break every 25 min) Gold Zone – EXTREME CAUTION: New or unconditioned athletes should not practice. Well conditioned athletes should have more frequent rest breaks and hydration as well as cautious monitoring for symptoms of heat illness. Schedule frequent mandatory rest / water breaks. (5 min water / rest break every 20 min) Have immersion pool on site for practice. Orange Zone – DANGER: All athletes must be under constant observation and supervision. Remove pads and equipment. Schedule frequent mandatory rest / water breaks. (5 min water / rest break every 15 min) Have immersion pool on site for practice. Dark Red Zone – EXTREME DANGER: SUSPEND PRACTICE

Athletic Activity Guidelines Bright Yellow Zone CAUTION: Normal practice for athletes, closely monitor new or unconditioned athletes or all athletes during extreme exertion. Schedule mandatory rest / water breaks. (5 min water / rest break every 25 min) Gold Zone EXTREME CAUTION: New or unconditioned athletes should not practice. Well conditioned athletes should have more frequent rest breaks and hydration as well as cautious monitoring for symptoms of heat illness. Schedule frequent mandatory rest / water breaks. (5 min water / rest break every 20 min) Have immersion pool on site for practice. Orange Zone DANGER: All athletes must be under constant observation and supervision. Remove pads and equipment. Schedule frequent mandatory rest / water breaks. (5 min water / rest break every 15 min) Have immersion pool on site for practice. Dark Red Zone EXTREME DANGER: SUSPEND PRACTICE

General Care of Heat Illnesses There are varying degrees of heat-illnesses but even the milder ones can become life threatening if not properly treated or managed Methods of Treatment Reduce body temperature Moving victim to cool location, removing unnecessary clothing, pouring cool water over extremities Fanning the victim Increases air circulation and evaporation Immerse victim in cool water Extremities should be massaged to promote circulation of cool blood

Avoiding Heat-related Illnesses Keys to avoid heat-related illnesses Prevention Addressing the environment Acclimatization Proper Hydration Heat-related illness include Dehydration Sunburns Heat cramps Heat Syncope Heat Exhaustion Heat Stroke

Dehydration Dehydration in athletics is usually due to the increased demand for water during exercise, which can be lost by the body at a rate of 1 – 2 liters per hours during vigorous exercise. Symptoms are very subtle at first Light yellow urine Mild headache Fatigue Reduced endurance and oxygen uptake Feelings of thirst Serious dehydration Disorientation Irritability Rapid pulse Complete exhaustion

Dehydration (cont’d) There are 3 levels of dehydration Mild Moderate Mucous membranes drying out Normal Pulse Yellow Urine Mild Thirst Moderate Extremely dry mucous membranes Weak and rapid pulse Very dark urine (apple juice) Very thirsty feeling Severe Completely dry mucous membranes Disorientation Drowsiness No urine output Inability to form tears Beginning stages of shock Rapid weak pulse, Rapid breathing pale skin

Treatment for Dehydration The best treatment is prevention Athlete’s recommendations 17 to 20 oz. 2 – 3 hours before activity 7 to 10 oz. after warm-up 28-49 oz. every hour of play 20 to 24 oz afterward for every pound of body weight lost of sweat Water vs. Sports Drinks The use of sports drinks vs. water has been debated for a while Sports drinks do contain carbohydrates and electrolytes that the body may need Especially endurance athletes

Sunburns Caused by overexposure to UV light from the sun Can lead to premature aging and skin cancer Medical attention should be sought if the burn is severe enough to cause blistering Treatment Cold washcloth Use of over-the-counter pain medication Petroleum or products containing benzocaine should be avoided Moisturizing lotion or aloe vera gel can help relieve itching and provide moisture Prevention Use of sunscreen on exposed skin Sun Protection Factor (SPF) of 15 or greater

Heat Cramps Heat cramps are very common and should not be overlooked because they can be the first stage of heat illness Caused by rapid water and electrolyte loss through to perspiration Occur in various muscles Calf (most common) Quadriceps Hamstrings Abdominals Treatment Slow passive stretching with ice Immediate fluid and electrolyte replacement

Heat Syncope Occurs when the body tries to cool itself through the dilation of blood vessels Also called fainting Symptoms Lightheadedness Dizziness Headache Nausea Vomiting Treatment Drinking fluids Stop activity

Heat Exhaustion A condition of near-total body collapse, where the athlete experiences difficulty dissipating the heat. Symptoms Skin is cool, moist and pale Generalized weakness Dizziness Nausea Rapid breathing Pulse May progress to heat stroke if not treated Treatment Moving the athlete to the shade Immediate fluid replacement Cooling the body Use ice towels if necessary

Heat Stroke The most severe heat-related condition, where the body’s heat regulation breaks down Symptoms Dry, hot skin Strong, rapid pulse Possible mental confusion Unconsciousness Treatment Move the athlete to shade Cool immediately by removing unnecessary clothing Icing with towels with ice packs in axilla and groin areas Misting and fanning the skin Heatstroke is a medical emergency and requires immediate transport to an emergency room by EMS

Cold Stress There are 5 ways that the body loses heat Respiration Evaporation Conduction Radiation Convection Contributing factors Cold temperatures High or cold winds Dampness Cold water The body has to work harder to maintain its temperature

Evaporation Respiration Evaporation of perspiration and other moisture from skin causes body to lose heat Rids the body of heat with every expiration

Conduction When the body is in direct contact with a cooler object. Heat from the body flows to the cooler object Ex. Sitting on cool ground or standing/swimming in cool water

Radiation Transfer of head by infrared rays. Just as the body gains head from infrared rays of the sun, it can lose heat by infrared rays to a cooler environment.

Convection Occurs when heat near the body’s surface is removed by moving air Wind, cool breeze

Wind Chill Describes the rate of heat loss on the human body resulting from the combined effects of low temperature and wind Wind-chill temperature is a measure of relative discomfort due to combined cold and wind Developed in 1941 and revised in 2001 to make use of advances in science and technology The factors of wind chill Amount of clothing Other protection worn Age Health Body characteristics Wind-chill temperatures near or below 0 degrees F indicate a risk of frostbite to expose flesh

Hypothermia When heat from the body is lost (from being in a cold environment) faster than it can be replaced Symptoms Begin when body temp drops to 95 Shivering Stomping feet As body temp continues to drop Slurred speech Lack of coordination Memory loss Unconsciousness after body temp reaches 85 Death may occur around 78

Hypothermia (cont’d) People who have experienced trauma often go into shock and begin to shiver Warming sign for hypothermia Physical or mental trauma limits body’s capability to regulate its own temperature As a core body temperature decreases, severe hypothermia sets in

Frostbite When skin tissues and blood vessels are damaged from exposure to temperatures below 32 degrees F Commonly affects toes, fingers, earlobes, chin, cheeks, and nose

3 Stages of Frostbite Stage 1 – Frostnip pins-and-needles sensation skin turns very white and soft Stage 2 - Superficial frostbite May show blistering Skin is numb, waxy, and frozen Ice crystal form in the skin Stage 3 – Deep Frostbite Freezing of blood vessels, muscles, tendons, nerves, and bone. Can lead to permanent damage, blood clots, gangrene No feeling in the affected area Usually no blistering Serious infection and loss of limb is frequent Medical attention is needed as soon as possible

Treatment of Frostbite Emergency care should be provided. If it is not possible to immediately transport to a hospital, the following steps will help Bring the individual indoors as soon as possible Apply warm towels or immerse the area in circulating lukewarm water or 20 minutes. Leave any blisters Do not use hot water or hold the affected area near fire Offer warm fluids to the athlete, but never alcohol, which causes the blood to cool quickly Keep the affected areas raised.

Diabetes A disorder in which the body does not produce or properly use insulin Hormone that causes body cells to absorb sugar from the body for use within the cell 2 types of Diabetes Type I: Insulin dependant Affects 10-15% of people with this disorder Type II: Non-insulin dependant Affects 85-90% of people with this disorder

Types of Diabetes Type I Type II Results from the body’s failure to produce any insulin First appears in childhood to young adults Insulin is normally produced by beta cells within the pancreas Management Possible through frequent monitoring of blood sugar levels Insulin injections May require the use of a pump Type II Can usually be controlled with diet and exercise Body still produces insulin but in insufficient amounts or poorly functioning

Diabetic Emergencies Insulin reaction Happens when there is way too much insulin in the body, rapidly reducing the sugar level in the blood causing brain cells to suffer Causes Taking too much medication Failing to eat Heavy exercise Emotional factors Symptoms Fast breathing and pulse Dizziness Weakness Change in level of consciousness Vision difficulties Sweating Headache Numb hands or feet Hunger Treatment Giving the athlete sugar if conscious

Diabetic Coma Occurs when the sugar levels are too high and too little insulin in the blood Causes Eating too much sugar Not taking prescribed meds Stress Infection Symptoms Drowsiness Confusion Deep and fast breathing Thirst Dehydration Fever Change in the level of consciousness Peculiar, sweet-or-fruity smelling breath Monitor carefully and seek professional help

Seizure Disorders Seizures are caused by disruption of normal brain activity Epilepsy is a condition in which seizures occur regularly No clear cause Other causes Infection High fever Brain tumors Drugs Strokes Bleeding in the brain Trauma to the brain Low blood glucose, sodium, or calcium

Types of Epileptic Seizures Simple partial seizure When jerking beings in one area of the body, arm, leg, or face Victims may hear things that are not there, or feel unexplained fear, sadness, anger or joy No first aid is necessary, unless the seizure becomes convulsive Generalized tonic-clonic seizure Also called grand mal seizure Characterized by sudden cry, falling, and rigidity Followed by muscles jerks, shallow breathing, or temporarily suspended breathing, bluish skin, and possible loss of bladder or bowel control After a couple of minutes, normal breathing resumes, though there may be confusion and/or fatigue

Managing “grand mal” seizures Look for medical identification Protect the victim from nearby hazards Loosed ties or shirt collars Protect the head from injury Turn the victim on side, unless injury exists To keep airway clear If there are multiple seizures, or if they last more than 5 minutes, call 911

Insect Bites and Stings Severity and duration of the reaction can vary from person to person If multiple stings are received or if allergic reactions occur, the situation can be life threatening Local Reaction Characterized by pain, swelling, redness, itching, and a whelp surrounding the wound Systemic Reaction If it occurs, happens within a few minutes of a sting May include Skin flushing Itchy rash Chest wheezing Nausea Vomiting Abdominal pains Palpitations Faintness Falling blood pressure death

Treatment for Insect Bites/Stings Notifying a companion in cases assistance is necessary Immediately removing the sting apparatus by scraping it out of the skin Applying ice to reduce the pain and swelling Seeking medical assistance if a serious reaction is suspected For systemic reaction Epinephrine by injection is the only effective, immediate treatment Epipen is an automatically injecting syringe, designed to inject a premeasured, single dose of epinephrine. Its administered if the front part of the leg through the clothing. Effects will last 15-20 minutes EMS must be activated

Female Athlete Triad Involves a combination of 3 conditions Disordered Eating conditions such as anorexia and bulimia that result in malnutrition When muscles that lack sufficient and proper fuel, performance is impaired Amenorrhea The loss of menstrual periods A certain % of body fat in females is necessary for proper functioning of the menstrual cycle IF the body fat % gets too low, hormonal balance and the menstrual cycle are affected Osteoporosis The loss of bone, most commonly among women after menopause, whose menstrual cycle also stops functioning Amenorrhea can lead to osteoporosis in female athletes just like it can in postmenopausal women Stress fractures become more common and repair is slow.

Warning signs of Female Athlete Triad Frequent or unexplained injuries, stress fractures Excessive or compulsive exercise Change in performance Loss of endurance, speed and/or strength Impaired concentration Absent or irregular menstrual periods Restrictive eating masked as a “performance-enhancing” meal plan Use of weight loss products or supplements

Prevention of Female Athlete Triad Choosing an activity that complements an individuals natural body strengths. Realizing health is more important that competitive success. Avoiding frequent weigh-ins, weight comments and punitive consequences for weight gain. Appreciating a healthy, active body. Optimal weight for health and performance is different for everyone. Realizing that the thinnest athletes are not necessarily the fastest or the strongest. Thinking of fuel as the ultimate performance enhancer. Not starving the bones. Part of the fuel mix should include several servings of good calcium sources. Being a role model with words and actions. Take a positive attitude about fueling and enjoying foods.