By Dev K. Mishra, M.D.
I am often asked this time of year about some strategies for coaches and parents to recognize heat illness, and for some strategies to manage theyoung athlete. With that in mind let’s review some basic principles.
“Heat Illness” is a broad term used for a range of problems such as dehydration, cramping, dizziness,heat exhaustion and a very serious problem called heat stroke.
Young athletes are at a higher risk than adults for developing heat illnesses. Children absorb heat faster than adults, they don’t sweat as much (sweat helps the body cool), they take longerto get conditioned to exercising in warmer weather and often they don’t feel the need to drink fluids before or during exercise.
Recognizing Possible Heat Illness
Most young athletes will first start to show signs of heat-related illness through dehydration. The athlete may come off the field complaining of being tired, having leg cramps or feelinglight-headed. On a hot day, be suspicious of the athletes with poor performance. They might not tell you anything — be alert.
You might see signs of decreased performance, more fatigue thantypical, they may be irritable. In more severe cases there may be nausea and headache. From the coach and parent’s perspective you’ll often need to be suspicious and watch for these signson a hot day.
Basic Sideline Management for Heat Illness
* Get the athlete off the field and let her lie down in a cool, shaded place.
• Elevate the legsabove the level of the head.
• Provide a sports drink (not carbonated, no caffeine).
• Loosen any tight-fitting clothing and remove socks.
• If the playerdoesn’t start to feel better within 10-15 minutes, seek medical help.
• Prevent future dehydration with a good fluid management strategy
Warning Signs
Young athletes should respond within 10-15 minutes from re-hydrating. You should see them “perk up” and get back toward their normal attitude and appearance. If an athlete does notimprove, it may signal more severe dehydration and they should be evaluated in the emergency department of the local hospital.
“Heat Stroke” is a medical emergency. In heat stroke,the athlete will have very hot skin that can be wet or dry, a change in normal behavior (confused, irritable), vomiting, and even seizures or loss of consciousness; the athlete will look in obvioustrouble. If you have any suspicion of this, call local emergency services or 911 immediately.
If you have called for emergency help, start cooling the athlete by applying ice packs to thearmpits, groin, or neck. If ice is not available, squirt cold water over the head and trunk.
Play or Sit Out?
Once the athlete suffering from dehydration and mild heatillness has started to re-hydrate with fluids, he should return to his normal appearance and attitude in 10-15 minutes and with proper fluids should be able to return to play later that day.
If the athlete has not fully recovered, it may signal a more significant problem and a physician should be consulted before the athlete returns to play.
KeyPoints
• A good hydration strategy will go a long way toward minimizing the chance of heat illness.
• A young athlete with suspected heat illness will typically respond tocooling and re-hydration in around 15 minutes.
• Beware of hot skin. This is a possible sign of heat stroke, and is a medical emergency.
(Dr. Dev K. Mishra, a Clinical Assistant Professor of orthopedic surgery at Stanford University, is thecreator of the SidelineSportsDoc.com online injury-recognition course, now a requirement for US Club Soccer coaches and staff members. Mishra writes about injury management at SidelineSportsDoc.com Blog, where this article first appeared. It has also previously appeared in the Youth SoccerInsider.)
Got this from Jim Gordon on 2009Hydration: Preparation and Warning SignsForget about every other question that you have about nutrition until you’vefigured out how to stay hydrated. Being smart about hydration can separategood performance from great performance.You are mostly water. In fact, if you took the water out of a 180-pound leanbody, there would be about 55 pounds left. Because your muscles, your brain,your blood and sweat are mostly water, your body doesn’t work like it shouldwhen it is not properly hydrated. You don’t think as clearly, your enduranceis compromised and your heart works harder.When you’re severely dehydrated, sweating stops and your body overheats. Theresult is fatigue, weakness, dizziness, and collapse, or worse. In fact,every year, deaths in young healthy athletes are linked to severe dehydration.Sweat It OutSometimes you don’t even see sweat, like when you swim. But you sweatwhenever your body heats up from working out. Sweat is your body’s coolingsystem. Evaporation of sweat from your skin cools you down.When you sweat, you lose fluid from your body. That fluid must be replaced,and replacing fluids takes a plan.Dehydration: A shortage of fluids in the body.Don’t Rely on ThirstYou might be thinking, “What’s the big deal? Won’t drinking when I’m thirstyguarantee that I’m hydrated?” Surprisingly, no. During exercise, for reasonsnot totally understood, humans don’t drink enough to prevent dehydration.You need to drink before you’re thirsty and keep drinking after you nolonger feel thirsty..
Part 2Drink It InForget about the old rule of drinking 8 glasses of water per day. Youprobably need more than that on most days. Counting how many glasses youdrink is only one way of keeping track of what you need. A better way ofmaking sure you’re hydrated is to check your body weight before and afterpractice. For accuracy, weigh yourself in minimal clothing if there’sprivacy, and afterwards, change out of the sweaty clothing before you weigh.The weight lost during practice or competition is not fat, it’s fluid loss.One pint of fluid weighs one pound. To replace the fluid, drink one pint offluid (Gatorade or water) for every pound you lost. (One pint = 16 ounces =500 ml = ½ liter). It is critical to replace this as quickly as possible.Before your next workout, your weight should be back up to normal.If you can’t check your weight, pay attention to your body for signs ofdehydration. Your mouth should not be dry. Your urine should belemon-colored most of the time.More than one episode of dark yellow urine is a warning sign that you don’thave much reserve. (Exception: Vitamin supplements can turn your urineyellow-orange, even if you are hydrated.) Loss of appetite, stomach aches,and muscle cramps can be other warning signals of dehydration.
Part 3When?Drink before, during and after working out. Drink a pint or so of fluid afew hours before exercise. This will help make sure you are hydrated andgive you enough time to urinate if you need to beforehand.Keep drinking during exercise. And don’t worry about getting too much fluid.If you’re sweating, your body needs a constant supply. Your stomach mightgurgle, but your body will absorb and use the fluid. Feeling sick andcramping have been blamed on too much water when in fact, stomachaches andmuscle cramps are usually signs of not drinking enough fluid.Drinking fluids after workouts is extremely important. Even when drinkingfluids during a workout, many athletes become dehydrated. Athletes workingout in the heat for several hours can lose 10 pounds. That’s more than agallon of water.Hydration Tip: Keep your hydration source full and in plain sight so youremember to drink it.
Part 4What Should I Drink?Your body needs water. But remember water comes in all sizes, shapes andcolors. Milk is 90% water. Juice and most soft drinks are 89% water, sportdrinks are 94% water, and even pizza is 50% water. And it all counts. Nearlyeverything that passes your lips provides water for your body, and in fact,research shows that most hydration happens at meals from the combination offood and beverages.Research also shows that we tend to drink more if the fluid is flavored andif a variety of fluids are available. Gatorade and water are two excellentsources for hydration.Keys to HydrationWhen you have figured out how to stay hydrated, especially when you sweatheavily, you have accomplished the single most importantperformance-enhancing aspect of nutrition.Water is your most important nutrient.
Part 5Outline for Heat IllnessesSource: USOC Sports Medicine DivisionHeat illnesses are common problems for both athletes and non-athletes inhot, humid weather. Heat Cramps, Heat Exhaustion, and Heat Stroke start fromsimilar circumstances: poor adjustment to hot weather and relativedehydration. These conditions can be severe and need emergency medicalattention. All are preventable if certain procedures, such as time to adjustto heat, adequate fluids, and normal dietary electrolyte intake, are followed.Heat CrampsCauseInadequate adjustment to hot weather, heavy sweating; decreased blood levelsof electrolytes; fluids and electrolytes not adequately replaced; unreplacedweight loss from previous workout/day.Clinical signs and symptomsMuscles in arms, legs, and/or abdomen spasm uncontrollably, accompanied byheavy sweating.
Part 6TreatmentDrink fluids; gently stretch and massage cramped muscles; rest in coolenvironment; apply ice to cramped area; watch for breathing or heart problems.PreventionMaintain adequate fluid intake by replacing sweat losses: 15-30 minutesbefore exercise, drink 16 oz. of fluid; during exercise, drink 8oz. every 15minutes; and after exercise drink 16 oz. of water/electrolyte drink (i.e.,PowerAde, Gatorade) for every pound of body weight loss; increase fitness;wear light colored and/or lightweight (i.e. mesh) clothing; do not usealcohol, coffee, caffienated drinks, or soda pop for fluid replacement.
Part 7Heat ExhaustionCauseLong exposure to hot and/or humid environment; heavy sweating; fluids andelectrolytes not replaced adequately; unreplaced weight loss from previousworkout/day.Clinical signs and symptomsSkin cool, pale and moist; heavy sweating; headache; dizziness; poorcoordination; mental dullness; enlarged pupils; nausea; vomiting; fatigue;weakness; thirsty; small urine volume (bright yellow color); possibility ofunconsciousness.TreatmentStop activity; rest in a cool area; sponge with cool water; drink water ifconscious (replace weight loss with 16 oz of fluid for each pound of bodyweight); watch for breathing or heart problems; refer to physician attentionif recovery does not occur quickly.PreventionMaintain adequate fluid intake by replacing sweat losses; 15-30 minutesbefore exercise drink 16 ounces of fluid, during exercise drink 8 ouncesevery 15 minutes, and after exercise drink 16 ounces of water-electrolytedrink (i.e. Powerade, Gatorade for every pound of body weight lost; increasefitness; wear light colored and/or lightweight (i.e. mesh) clothing; do notuse alcohol, coffee, caffeinated drinks, or soda pop for fluid replacement;allow time for rest and cool down.
Part 8 almost done :)HeatstrokeCauseBody’s temperature control system stops working.Clinical signs and symptomsHot, dry and red skin; no sweating; rapid pulse; confusion; dizziness;unconsciousness; rectal temperature as high as 104°-106° Fahrenheit.Treatment: Medical Emergency!Immediate emergency cooling (e.g. cool room, put body in tub of ice water,ice cloths with a fan blowing on skin) and transport immediately tohospital; check temperature; watch for breathing or heart problems (may needCPR)PreventionMaintain adequate fluid intake by replacing sweat losses; 15-30 minutesbefore exercise drink 16 ounces of fluid, during exercise drink 8 ouncesevery 15 minutes, and after exercise drink 16 ounces of water/electrolytedrink (i.e. mesh) clothing; do not use alcohol, coffee, caffeinated drinks,or soda pop for fluid replacement; allow time for rest and cool down.
Part 9 the endUSOC Medical Emergency ProceduresHeat Illness GuidelinesRecognitionHeat CrampsMusculature spasm of extremity and abdomenHeavy sweatingCore temperature normal or slightly elevatedHeat ExhaustionCool, moist, pale or flushed skinHeadache and dizzinessStrong, slow pulseWeakness, confusion, and fatigueNausea, vomitingHeat StrokeUsually, hot, dry, flushed skinHeadache and dizzinessStrong, slow pulseHeavy sweating, thirstFluid and electrolyte depletionEnlarged pupilsPossible unconsciousnessManagementHeat CrampsCease activity and remove from heatRest and drink cool fluidsMonitor for change in symptomsHeat ExhaustionCease activity and remove from heatSponge with cool waterSlowly administer cool fluids orally if consciousMonitor for change in symptomsHeat StrokeActivate EMSRemove wet clothing and sponge with cold waterMonitor symptomsRemove from heatReferralHeat Cramp/Heat ExhaustionContact consulting physician if complications occur or symptoms do not resolveHeat StrokeActivate EMSFollow UpHeat Cramp/Heat ExhaustionMaintain adequate fluid intake, adequate rest and cooling periods,acclimatize to environment, physician release if indicatedHeat StrokePhysician release to activityMaintain adequate fluid intakeAdequate rest and cooling periodsAcclimatize to environmentNotify Head ATC or designee and appraise of situationNotify the emergency contact of the patient if they are a minor
Can’t you just post a link?
I did not get a link. He sent it to me on an email. I saved it. The problem is a save things I like even if it is long. Take what you like discard what you don’t like.On hydration on hot days. Drink like crazy 3 days before a game in heat. In between games in tournament play find or make a place for them in the shade. Kid gets injured on a field. Have a medical kit that holds 6 bottles of water so everyone can get a drink. Give a bottle to keep in the back of the net. Heat stroke is serious it can kill you. Got to get used to playing in heat.
Should see what we did playing in cold. Adults we put Ben Gaye on their legs 🙂
Important topic. Thanks Dr. Mishra.