1. Special Considerations in Athletes
Chapter 25

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

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

19. 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

20. 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.

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

22. 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

24. 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

25. 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

26. 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

27. 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

28. 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.

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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 minutes
EMS must be activated

38. 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.

39. 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

40. 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.