1. Environmental Concerns
Intro to Sports Medicine

2. Lightning THIRTY MINUTES MUST PASS SINCE LAST STRIKE BEFORE RTP
See lightning: you are in immediate danger and should seek shelter
Avoid standing under large trees, flagpoles, light poles, or on top of hills
Lightning Detectors
Hand-held instrument to detect lightning within 40 miles
Weather apps, ThorGuard, SkyScan, StrikeAlert
Flash to Bang Method
Count number of seconds from sighting of lightning to hearing thunder; divide by 5
THIRTY MINUTES MUST PASS SINCE LAST STRIKE BEFORE RTP

3. Thermoregulation Body heat is gained through:
Radiation – through space
Conduction – through touch
Convection – through wind/water
Metabolism
Excess body heat is lost through:
Radiation, Conduction, Convection
Evaporation – sweating

4. Acclimatization
Process in which the body adjusts to continuous and significant climate change
The more fit the athlete, the faster the acclimatization
↑ Exercise tolerance in heat
Strategies for Successful Acclimatization
↑ Sodium intake
Fluid replacement
Easily accessible, individual containers
Volume markers
Flavored to preference

5. Dehydration Mechanism Presentation
Acute change in fluid stores from euhydration → hypohydration
Factors leading to dehydration
Fluid loss (sweating, urinating, respiring)
Fluid intake < fluid losses
Presentation
Irritability, general discomfort
Headache
Weakness
Dizziness
Cramps
Chills
Nausea, vomiting
Head/neck heat sensations
Disorientation
↓ Performance

6. Dehydration Treating dehydration Move to cooler environment Rehydrate
Transport as needed
Developing individualized hydration protocol
Fluid intake = fluid losses

8. Heat Cramps Management Return to play Hydrate Replace sodium
Stretch, relax, massage
Ice
Return to play
Few hours or next day

9. Heat Exhaustion Mechanism Presentation
Inability to sustain adequate cardiac output with strenuous physical exercise, environmental heat stress
Presentation
Fatigue, dizziness
Profuse sweating
Pallor
Nausea, vomiting, diarrhea
CNS inhibition
Rectal temperature < 104°F (40°C)

10. Heat Exhaustion Management Move to cool area
Remove excess clothing and equipment
Cool to rectal temperature of 101°F (38.3°C)
Elevate legs above heart
Rehydrate
Monitor vital signs, core temperature, CNS
Transport as needed
Return to play
Physician clearance
Maintain cardiovascular status
Ensure adequate hydration
Resolve all symptoms

11. Exertional Heat Stroke
Mechanism
During intense exercise in warm/hot environment, body temperature ↑, exceeds physiologic capacity to dissipate heat
Figure 19.2:
thermistor

12. Exertional Heat Stroke
Presentation
Nausea, vomiting, diarrhea
Hot and wet or dry skin
CNS dysfunction
Rectal temperature > 104°F (40°C)
↑ Heart rate, respirations
↓ Blood pressure
Dehydration
Combativeness

13. Exertional Heat Stroke
Management
Cool first, transport later
Remove clothing, equipment
Immediate cold-water immersion
Constant temperature monitoring
IV hydration
Return to play
Physician clearance
R/O secondary injury to body’s organ systems
Ensure adequate hydration
Reacclimatization
Assure appropriate physical fitness

15. Hypothermia Core temperature < 98.6° F (37°C)
Cold, wet, windy weather
Endurance, long-duration events
Management
Remove wet, damp clothes
Wrap in dry, warm clothes/blanket
Gentle core heating
Warm fluids
Monitor vital signs
Presentation
Shivering
Slow breathing
Impaired motor control
Muscle rigidity
Bradycardia
↓ Blood pressure
Cyanosis
Dilated pupils
Return to play
Depends on episode severity, duration
Prevention
Acclimatization
Physician clearance

16. Frostbite Mechanism Skin, local tissues < 28° F
Cool, dry or moist environment
Frostnip a precursor
Presentation
Edema
Red, waxy, or mottled gray skin
Hardened peripheral tissue without rebound
Anesthesia
Management
Slow, immediate rewarming
Warm, dry or lukewarm, wet environment
Pain control
IV rehydration
Debridement
Infection control
Return to play
Depends on tissue damage
↑ Susceptibility to future cold injury
Prevention plan

18. WBGT Threat Level Activity <82.0°F (27.8°C) White (No Risk)
Table 1. WBGT Chart Recommendations
WBGT
Threat Level
Activity
<82.0°F (27.8°C)
White
(No Risk)
Normal activities: provide ≥3 separate rest breaks/h of minimum duration 3 min each during workout.
°F ( °C)
Green
(Low Risk)
Use discretion for intense or prolonged exercise. Watch at-risk players carefully. Provide ≥3 separate rest breaks/h of minimum duration 4 min each.
°F ( °C)
Yellow
(Moderate Risk)
Maximum practice time = 2h. For football: players restricted to helmet, shoulder pads, and shorts during practice. All protective equipment must be removed for conditioning activities. For all sports: provide ≥4 separate rest breaks/h of minimum duration 4 min each.
°F ( °C)
Red
(High Risk)
Maximum length of practice = 1h. No protective equipment may be worn during practice and there may be no conditioning activities. There must be 20 min of rest breaks provided during the hour of practice.
>92.1°F (33.4°C)
Black
(Extreme Risk)
No outdoor workouts, cancel exercise, delay practices until a cooler WBGT reading occurs.

19. 30°F and Below 25°F and Below 15°F and Below 0°F and Below
Be aware of the potential for cold injury and notify appropriate personnel of the potential
25°F and Below
Provide additional protective clothing, cover as much exposed skin as practical, and provide opportunities and facilities for rewarming
15°F and Below
Consider modifying activity to limit exposure or to allow more frequent chances to rewarm
0°F and Below
Consider Terminating or Rescheduling

20. Wet Bulb Globe Temperature

21. Sling Psychrometer