Heat Illness in Athletes

As summer approaches, athletes, coaches and other individuals will need to be aware of heat-related illnesses. Heat illnesses include a spectrum of conditions ranging from heat syncope, heat cramps and heat exhaustion to the more severe heat stroke.

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Heat Syncope (fainting) is a form of orthostatic hypotension that is related to dehydration. It occurs due to inadequate cardiac output and hypotension. It also occurs with standing quickly after sitting or lying down for prolonged durations in the heat. Symptoms include fainting, dizziness and light-headedness. Treatment includes oral rehydration (water, juice or sports drinks) and placing the patient flat on the ground in a cool area with slight elevation of the legs to push the blood back to the vital organs such as the brain.

Heat Cramps are painful muscle cramps that occur due to decreased sodium heat2.pngconcentration in the blood. The patient’s core temperature is usually not elevated. Sodium may decrease when salts are lost in sweat or with excessive water intake that does not include electrolytes leading to a situation called dilutional hyponatremia. Symptoms include painful muscle cramps occurring commonly in the abdominal muscles, arms, legs and thighs. Treatment includes rest, cooling and IV fluids or oral rehydration with fluids rich in electrolytes (sports drinks and juices) to replenish the sodium stores. Prevention could be achieved by consumption of fluids high in electrolytes before strenuous activities.

heat3Heat Exhaustion is the most common heat illness. The body temperature becomes elevated but is less than 40°C. The core body temperature is best measured rectally. The signs and symptoms of heat exhaustion include profuse sweating, core body temperature lower than 40°C, weakness and fatigue, cramping, headaches, nausea and vomiting,  fainting, hypotension, increased heart rate, and fast shallow breathing. Treatment includes rest, IV fluids or oral rehydration and rapid cooling by whole-body immersion in an ice bath.

Heat Stroke is the most severe form of heat illness. It is a medical emergency that needs immediate attention. The patient should be transported to the hospital as soon as possible. Heat strokes occur due to failure of the body’s normal thermoregulatory mechanism. If treatment is not started promptly, end-organ failure and ultimately death may occur. Heat strokes have a high mortality rate and require quick reduction of the patient’s temperature. The three characteristic features of this condition are a lack of sweating, core body temperature above 40°C (best measured rectally) and an altered mental status. Additional signs and symptoms include hot, dry skin, disorientation, confusion and hallucinations, headache and slurred speech. This is a serious medical emergency that requires rapid core body temperature reduction. The patient should have close monitoring of airway, breathing and circulation. The physician should implement basic life support and ACLS protocols. Rapid cooling by whole-body immersion in an ice bath will be utilized as well as IV fluids.

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Bedside Surgery Can Treat Compartment Syndrome

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Compartment Syndrome
Image: webmd.com

Throughout his career, orthopedic surgeon Dr. Nabil Ebraheim has been credited with both encyclopedic knowledge of his field and contributions to its further advancement. Among these contributions is an improvement on the procedure known as fasciotomy, a surgery used to treat compartment syndrome, which in severe cases can cause irreversible muscle damage within a few hours of its occurrence. Fasciotomies are usually performed in operating rooms, but the difficulty in providing timely surgery for diagnosed patients led Dr. Nabil Ebraheim to develop the “bedside fasciotomy,” allowing a patient to receive critical treatment without the need for full surgical preparation.

Compartment syndrome is a situation in which blood flow expands muscle tissues during physical activity, but the fascia – the connective tissue binding the muscle fibers – doesn’t expand with them, creating pressure that can cut off blood flow and begin causing weakness and numbness as the muscle begins to die. The exact cause of compartment syndrome isn’t fully understood, but it is often associated with athletic exertion, and can frequently be confused with other painful athletic injuries, such as shin splints. Mild cases of compartment syndrome can be treated with therapy, but more serious cases require a fasciotomy, which treats the condition by cutting or removing the damaged fascia to relieve the pressure and restore normal blood flow.

The bedside fasciotomy simplifies the process as much as possible for the sake of expedience. Instead of a general anesthetic, the patient is given conscious sedation to prevent pain or reflexive movement while the patient remains awake, and a local anesthetic is administered at the site of the surgery. The surgery itself consists of a single long incision at one of several specific locations, allowing access to the muscle compartments of each limb, ensuring the doctor has ready access to the damaged fascia in need of removal.