Quick Questions Heat-Related Illness Expert Advice in Sports Medicine

Acknowledgments

About the Editor

Contributing Authors

Preface

Introduction

Section I Prevention

Question 1 What Are the Basic Guidelines for Preventing Exertional Heat Illnesses,

Including Heat Cramps, Heat Syncope, Heat Exhaustion, and

Exertional Heat Stroke?

Riana R. Pryor, MS, ATC and Douglas J. Casa, PhD, ATC, FACSM, FNATA

Question 2 What Factors Lead to Exertional Heat Stroke?

Rebecca M. Lopez, PhD, ATC, CSCS

Question 3 What Are the Physiological Benefits of Heat Acclimatization?

Matthew S. Ganio, PhD

Question 4 What Are the Latest Guidelines for Becoming Heat Acclimatized and

Better Prepared When Exercising in a Warm Environment?

Michelle A. Cleary, PhD, ATC

Question 5 If an Athlete Lives in a Constantly Warm Environment

(eg, Southern Parts of the United States), Is Heat Acclimatization

Still an Issue in Athletic Participation?

Michele C. Benz, MS, ATC, CSCS and Rebecca M. Lopez, PhD, ATC, CSCS

Question 6 What Causes Heat Cramps and How Can They Be Prevented?

Rebecca L. Stearns, PhD, ATC and Deanna M. Dempsey, MS

Question 7 What Is the Best Way to Prevent an Athlete From Overheating

When Exercising in a Hot Environment?

Rebecca L. Stearns, PhD, ATC

Question 8 What Impact Does Protective Equipment (ie, Helmets, Padding)

Have on Heat Tolerance?

Michelle A. Cleary, PhD, ATC

Question 9 Should Athletes Still Take Rest Breaks Even if They Have Access to

Fluids Throughout Activity?

J. Luke Pryor, MS, ATC, CSCS and Riana R. Pryor, MS, ATC

Question 10 Do Exertional Heat Illnesses Occur in a Continuum

(ie, Heat Cramps ? Heat Exhaustion ? Exertional Heat Stroke) or

Can They Occur Independently of Each Other?

Rebecca M. Lopez, PhD, ATC, CSCS

Question 11 Is It Possible to Prevent Death From Exertional Heat Stroke?

Yuri Hosokawa, MAT, ATC, LAT and

Douglas J. Casa, PhD, ATC, FACSM, FNATA

Section II Diagnosis

Question 12 What Criteria Are Used to Differentiate Between Heat Exhaustion and Exertional Heat Stroke?

Rebecca M. Lopez, PhD, ATC, CSCS and Candi D. Ashley, PhD

Question 13 What Temperature Devices Are Valid When Measuring

Internal Body Temperature in an Exercising Individual?

Rebecca L. Stearns, PhD, ATC and Julie K. DeMartini, PhD, ATC

Question 14 Can Skin Temperature Be Used to Assess an Athlete's

Body Temperature When Exercising?

Luke N. Belval, ATC, CSCS and

Lesley W. Vandermark, MS, ATC, PES

Question 15 What Are the Steps to Correctly Use a Rectal Probe in Order to

Diagnose and Monitor a Possible Case of Exertional Heat Stroke?

Lesley W. Vandermark, MS, ATC, PES and

William M. Adams, MS, ATC

Question 16 How Does One Differentiate Between an Exertional Heat Illness and an Exertional Sickling Event?

Robert C. Oh, MD, MPH and Francis G. O'Connor, MD, MPH

Section III Emergency Management and Treatment

Question 17 What Is the Best Practice for the Treatment of Exertional Heat Illnesses

(Heat Cramps, Heat Syncope, Heat Exhaustion, and

Exertional Heat Stroke)?

Nicholas D. Peterkin, MD; Joseph S. Atkin, MD; and Eric E. Coris, MD

Question 18 If You Do Not Have a Rectal Probe for the Proper Assessment of

Body Temperature, What Should You Do if You Suspect an

Athlete Has Exertional Heat Stroke?

Riana R. Pryor, MS, ATC and J. Luke Pryor, MS, ATC, CSCS

Question 19 How Should a Clinician Deal With a Combative

Exertional Heat Stroke Victim?

Douglas J. Casa, PhD, ATC, FACSM, FNATA;

Luke N. Belval, ATC, CSCS; and Rebecca M. Lopez, PhD, ATC, CSCS

Question 20 How Do You Prepare for and Appropriately Implement the Use of

Cold-Water Immersion for the Emergency Management of

Exertional Heat Stroke?

William M. Adams, MS, ATC and Riana R. Pryor, MS, ATC

Question 21 What Are the Proper Steps for the Treatment and

Emergency Management of an Exertional Heat Stroke Victim

(Including Appropriate Duration of Cooling and Transport to the

Emergency Room)?

Julie K. DeMartini, PhD, ATC and Robert A. Huggins, PhD, ATC, LAT

Question 22 What Are the Most Effective Alternative Methods to Cooling an

Exertional Heat Stroke Victim if Cold-Water Immersion

Is Not Available?

Julie K. DeMartini, PhD, ATC

Question 23 Does Cold-Water Immersion Cause Shock or Other Adverse Events?

Lindsey E. Eberman, PhD, LAT, ATC

Section IV Special Considerations: Environmental Conditions and

Return to Play

Question 24 Can Exertional Heat Illnesses Occur in Cool or Cold Environments?

Rebecca L. Stearns, PhD, ATC

Question 25 What Are the Best Methods of Assessing Environmental Conditions and

What Modifications Should Be Made to Work-to-Rest Ratios,

Practices, and Games Based on the Environment?

Earl R. Bud Cooper, EdD, ATC, CSCS

Question 26 When Can an Athlete Return to Play Following an

Exertional Heat Illness?

Robert A. Huggins, PhD, ATC, LAT and Francis G. O'Connor, MD, MPH

Question 27 What Is the Proper Functional Progression for an Athlete

Returning to Play Following Exertional Heat Stroke?

Brendon P. McDermott, PhD, ATC

Section V Hydration

Question 28 What Are the Most Practical, Valid Methods of Measuring

Hydration Status in Athletes?

Michelle A. Cleary, PhD, ATC

Question 29 How Much and What Types of Fluid Should Be Consumed Before,

During, and After Exercise or Training?

Lindsey E. Eberman, PhD, LAT, ATC

Question 30 How Does One Calculate Sweat Rate and Sweat Sodium Losses in an

Athlete, and How Much of the Weight Loss Due to Sweating Should Be

Replaced Before the Next Practice or Event?

Nicole E. Moyen, MS, CSCS and Matthew S. Ganio, PhD

Question 31 Is Intravenous Fluid Superior to Oral Fluid Rehydration When

Replacing Fluid Losses Due to Exercise?

Brendon P. McDermott, PhD, ATC

Question 32 Should Sodium (via Foods, Salt Tablets, or Pickle Juice) Be Consumed

Prior to or During Endurance Activities for the Prevention of

Exertional Heat Illness?

J. Luke Pryor, MS, ATC, CSCS and Deanna M. Dempsey, MS

Question 33 How Long Should an Athletic Trainer Monitor Pre- and Post-Practice

Weigh-Ins?

Mike D. Ryan, PT, ATC, CES, PES

Question 34 Is It Possible for an Athlete to Become Overhydrated, and

Does This Help or Hinder the Athlete?

Dawn M. Emerson, MS, ATC

Question 35 What Is Hyponatremia, and How Can It Be Prevented, Diagnosed, and

Treated?

Dawn M. Emerson, MS, ATC

Question 36 Is Drinking a Sports Drink More Beneficial to Drinking Water for

Either Increased Performance or Preventing Exertional Heat Illness or Hyponatremia?

J. D. Adams, MS and Stavros A. Kavouras, PhD, FACSM, FECSS

Question 37 What Effect Does Hydration Status Have on Body Temperature

During Exercise?

Matthew A. Tucker, MA and Matthew S. Ganio, PhD

Question 38 Do Supplements (eg, Creatine and Caffeine) Cause Dehydration or

Exertional Heat Illness During Activity in Hot Environments?

Candi D. Ashley, PhD

Question 39 Is It Possible to Be Well Hydrated and Still Experience

Exertional Heat Illness?

Evan C. Johnson, PhD and Stavros A. Kavouras, PhD, FACSM, FECSS

Financial Disclosures

Index

Biography

Rebecca M. Lopez, PhD, ATC, CSCS graduated from Florida International University in 1998 with a Bachelor’s of Science in Health Education, Athletic Training Specialization. She returned to Florida International University and obtained her Master of Science in Advanced Athletic Training/Sports Medicine in 2004. She completed her PhD in Kinesiology from the University of Connecticut in 2010. Dr. Lopez is a Board-Certified Athletic Trainer, an American College of Sports Medicine Certified Health Fitness Specialist, and a Certified Strength and Conditioning Specialist through the National Strength and Conditioning Association. She worked as a certified athletic trainer in Miami-Dade Public Schools for several years and has volunteered in the medical tent at the Boston Marathon, Marine Corps Marathon, Falmouth Road Race, and others. Her research interests include exertional heat stroke and other exertional heat illnesses, cooling methods for hyperthermic athletes, ergogenic aids and thermoregulation, sickle cell trait in athletes, hydration and exercise performance, and preventing sudden death in sports. She has published numerous peer-reviewed articles and several chapters on exertional heat illness, hydration, and preventing sudden death in sports. Dr. Lopez is currently an Assistant Professor in the Department of Orthopaedics and Sports Medicine and the Director of the Post-Professional Graduate Athletic Training Program at the University of South Florida. She also serves on the medical and science advisory board for the Korey Stringer Institute.