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Carter AJ, Hall EJ, Bradbury J, Beard S, Gilbert S, Barfield D, O'Neill DG. Post-exercise management of exertional hyperthermia in dogs participating in dog sport (canicross) events in the UK. J Therm Biol 2024; 121:103827. [PMID: 38518416 DOI: 10.1016/j.jtherbio.2024.103827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/27/2024] [Accepted: 02/27/2024] [Indexed: 03/24/2024]
Abstract
Exercise is a common trigger of heat-related illness (HRI) events in dogs, accounting for 74% of canine HRI cases treated under primary veterinary care in the United Kingdom. However, few empirical studies have evaluated the effectiveness of differing cooling methods for dogs with exertional hyperthermia or HRI. This study aimed to prospectively evaluate effects of ambient conditions and post-exercise management practices (cooling methods and vehicular confinement) on the post-exercise temperature change of dogs participating in UK canicross events. Canine temperature was recorded at three intervals post-exercise: as close as possible to 0- (immediately post-exercise), 5-, and 15-min post-exercise. Ambient conditions and post-exercise management were recorded for 115 cooling profiles from 52 dogs. In 28/115 (24.4%) profiles, the dog's temperature increased during the first 5-min post-exercise. Overall, 68/115 (59.1%) profiles included passive cooling (stood or walked outside), 35 (30.4%) active cooling (cold-water immersion or application of a cooling coat), and 12 (10.4%) involved no cooling and were immediately housed in vehicles. No dogs developed hypothermia during the study and no adverse effects were observed from any cooling method. In hyperthermic dogs, overall post-exercise body temperature change was significantly negatively associated (i.e. the dogs cooled more) with 0-min post-exercise body temperature (β = -0.93, p < 0.001), and not being housed in a vehicle (β = -0.43, p = 0.013). This study provides evidence cold-water immersion (in water at 0.1-15.0 °C) can be used to effectively and safely cool dogs with exertional hyperthermia. Progressive temperature increases in many dogs - even after exercise has terminated - supports the message to "cool first, transport second" when managing dogs with HRI. When transporting dogs post-exercise or with HRI even after active cooling, care should be taken to cool the vehicle before entry and promote air movement around the dog during transport to facilitate ongoing cooling and prevent worsening of hyperthermia during travel.
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Affiliation(s)
- Anne J Carter
- Veterinary and Animal Sciences, Barony Campus, Scotland's Rural College, Parkgate, Dumfries, DG1 3NE, UK.
| | - Emily J Hall
- Department of Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
| | - Jude Bradbury
- Department of Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
| | - Sian Beard
- Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
| | - Sophie Gilbert
- Vets Now, Penguin House, Castle Riggs, Dunfermline, KY11 8SG, UK
| | - Dominic Barfield
- Department of Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
| | - Dan G O'Neill
- Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
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Hintz CN, Butler CR. Wearable and ingestible technology to evaluate and prevent exertional heat illness: A narrative review. PM R 2024; 16:398-403. [PMID: 38501700 DOI: 10.1002/pmrj.13155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 03/20/2024]
Abstract
Exertional heat illness remains a constant threat to the athlete, military service member, and laborer. Recent increases in the number and intensity of environmental heat waves places these populations at an ever increasing risk and can be deadly if not recognized and treated rapidly. For this reason, it is extremely important for medical providers to guide athletes, service members, and laborers in the implementation of awareness, education, and measures to reduce or mitigate the risk of exertional heat illness. Within the past 2 decades, a variety of wearable technology options have become commercially available to track an estimation of core temperature, yet questions continue to emerge as to its use, effectiveness, and practicality in athletics, the military, and the workforce. There is a paucity of data on the accuracy of many of these newer devices in the setting of true heat stroke physiology, and it is important to avoid overreliance on new wearable technology. Further research and improvement of this technology are critical to identify accuracy in the diagnosis and prevention of EHI.
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Affiliation(s)
- Courtney N Hintz
- Special Warfare Human Performance Support Group, USAF, San Antonio, Texas, USA
| | - Cody R Butler
- Special Warfare Human Performance Support Group, USAF, San Antonio, Texas, USA
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Stearns RL, Hosokawa Y, Belval LN, Martin DG, Huggins RA, Jardine JF, Casa DJ. Exertional Heat Stroke Survival at the Falmouth Road Race: 180 New Cases With Expanded Analysis. J Athl Train 2024; 59:304-309. [PMID: 37655801 PMCID: PMC10976335 DOI: 10.4085/1062-6050-0065.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
CONTEXT A high number of exertional heat stroke (EHS) cases occur during the Falmouth Road Race. OBJECTIVES To extend previous analyses of EHS cases during the Falmouth Road Race by assessing or describing (1) EHS and heat exhaustion (HE) incidence rates, (2) EHS outcomes as they relate to survival, (3) the effect of the environment on these outcomes, and (4) how this influences medical provider planning and preparedness. DESIGN Descriptive epidemiologic study. SETTING Falmouth Road Race. PATIENTS OR OTHER PARTICIPANTS Patients with EHS or HE admitted to the medical tent. MAIN OUTCOME MEASURE(S) We obtained 8 years (2012 to 2019) of Falmouth Road Race anonymous EHS and HE medical records. Meteorologic data were collected and analyzed to evaluate the effect of environmental conditions on the heat illness incidence (exertional heat illness [EHI] = EHS + HE). The EHS treatment and outcomes (ie, cooling time, survival, and discharge outcome), number of HE patients, and wet bulb globe temperature (WBGT) for each race were analyzed. RESULTS A total of 180 EHS and 239 HE cases were identified. Overall incidence rates per 1000 participants were 2.07 for EHS and 2.76 for HE. The EHI incidence rate was 4.83 per 1000 participants. Of the 180 EHS cases, 100% survived, and 20% were transported to the emergency department. The WBGT was strongly correlated with the incidence of both EHS (r2 = 0.904, P = .026) and EHI (r2 = 0.912, P = .023). CONCLUSIONS This is the second-largest civilian database of EHS cases reported. When combined with the previous dataset of EHS survivors from this race, it amounts to 454 EHS cases resulting in 100% survival. The WBGT remained a strong predictor of EHS and EHI cases. These findings support 100% survival from EHS when patients over a wide range of ages and sexes are treated with cold-water immersion.
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Affiliation(s)
- Rebecca L. Stearns
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | | | | | - David G. Martin
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - Robert A. Huggins
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - John F. Jardine
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - Douglas J. Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
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Eifling KP, Gaudio FG, Dumke C, Lipman GS, Otten EM, Martin AD, Grissom CK. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2024 Update. Wilderness Environ Med 2024; 35:112S-127S. [PMID: 38425235 DOI: 10.1177/10806032241227924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
The Wilderness Medical Society (WMS) convened an expert panel in 2011 to develop a set of evidence-based guidelines for the recognition, prevention, and treatment of heat illness. The current panel retained 5 original members and welcomed 2 new members, all of whom collaborated remotely to provide an updated review of the classifications, pathophysiology, evidence-based guidelines for planning and preventive measures, and recommendations for field- and hospital-based therapeutic management of heat illness. These recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks or burdens for each modality. This is an updated version of the WMS clinical practice guidelines for the prevention and treatment of heat illness published in Wilderness & Environmental Medicine. 2019;30(4):S33-S46.
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Affiliation(s)
- Kurt P Eifling
- Department of Emergency Medicine, University of Arkansas for Medical Sciences, Fayetteville, AR
| | - Flavio G Gaudio
- Department of Emergency Medicine, New York-Presbyterian Hospital / Weill Cornell Medical College, New York, NY
| | - Charles Dumke
- School of Integrative Physiology and Athletic Training, University of Montana, Missoula, MT
| | | | - Edward M Otten
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH
| | - August D Martin
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Fayetteville, AR
| | - Colin K Grissom
- Pulmonary and Critical Care Division, Intermountain Medical Center and the University of Utah, Salt Lake City, UT
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Hosokawa Y, Akama T. Navigating implementation barriers: a holistic approach to improving exertional heat stroke management. BMJ Open Sport Exerc Med 2024; 10:e001861. [PMID: 38420116 PMCID: PMC10900327 DOI: 10.1136/bmjsem-2023-001861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/02/2024] Open
Abstract
Objectives To assess the shift in medical volunteers' perception and practice surrounding exertional heat stroke (EHS) prehospital management after the Tokyo 2020 Olympic Games. Methods An online survey was sent to medical volunteers assigned to work at high EHS risk events during the Tokyo 2020 Olympic Games. Surveys were sent at the time of initial training, immediately after the Games, and one year after the Games. The survey investigated medical volunteers' perceptions and practices regarding the assessment of rectal temperature and the use of whole-body cold water immersion (CWI) as prehospital management of EHS. In addition, an open-ended question was prepared to examine barriers and facilitators of their chosen perception and/or behaviour. Results The lack of knowledge about rectal temperature assessment improved over time, but the actual implementation did not. Meanwhile, increased utilisation of CWI was observed 1 year after the Games. The lack of equipment, apprehension towards rectal temperature assessment, the perception of difficulty getting patient consent, concerns for hypothermic overshoot and the number of required medical providers were raised as barriers to implementation. Conclusion Some improvements were observed in perception and practice; however, further organisational and financial support is warranted for a broader skill transfer and implementation.
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Affiliation(s)
- Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Takao Akama
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
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Flouris AD, Notley SR, Stearns RL, Casa DJ, Kenny GP. Recommended water immersion duration for the field treatment of exertional heat stroke when rectal temperature is unavailable. Eur J Appl Physiol 2024; 124:479-490. [PMID: 37552243 DOI: 10.1007/s00421-023-05290-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/14/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION The recommended treatment for exertional heat stroke is immediate, whole-body immersion in < 10 °C water until rectal temperature (Tre) reaches ≤ 38.6 °C. However, real-time Tre assessment is not always feasible or available in field settings or emergency situations. We defined and validated immersion durations for water temperatures of 2-26 °C for treating exertional heat stroke. METHODS We compiled data for 54 men and 18 women from 7 previous laboratory studies and derived immersion durations for reaching 38.6 °C Tre. The resulting immersion durations were validated against the durations of cold-water immersion used to treat 162 (98 men; 64 women) exertional heat stroke cases at the Falmouth Road Race between 1984 and 2011. RESULTS Age, height, weight, body surface area, body fat, fat mass, lean body mass, and peak oxygen uptake were weakly associated with the cooling time to a safe Tre of 38.6 °C during immersions to 2-26 °C water (R2 range: 0.00-0.16). Using a specificity criterion of 0.9, receiver operating characteristics curve analysis showed that exertional heat stroke patients must be immersed for 11-12 min when water temperature is ≤ 9 °C, and for 18-19 min when water temperature is 10-26 °C (Cohen's Kappa: 0.32-0.75, p < 0.001; diagnostic odds ratio: 8.63-103.27). CONCLUSION The reported immersion durations are effective for > 90% of exertional heat stroke patients with pre-immersion Tre of 39.5-42.8 °C. When available, real-time Tre monitoring is the standard of care to accurately diagnose and treat exertional heat stroke, avoiding adverse health outcomes associated with under- or over-cooling, and for implementing cool-first transport second exertional heat stroke policies.
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Affiliation(s)
- Andreas D Flouris
- FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
- Human and Environmental Physiology Research Unit, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Sean R Notley
- Human and Environmental Physiology Research Unit, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Defence Science and Technology Group, Melbourne, VIC, Australia
| | - Rebecca L Stearns
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | - Douglas J Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | - Glen P Kenny
- Human and Environmental Physiology Research Unit, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Montpetit Hall, 125 University Private, Room 367, Ottawa, ON, K1N 6N5, Canada.
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Morrissey-Basler MC, Brewer GJ, Anderson T, Adams WM, Navarro JS, Marcelino M, Martin DG, Casa DJ. The effect of heat mitigation strategies on thermoregulation and productivity during simulated occupational work in the heat in physically active young men. Front Sports Act Living 2024; 5:1274141. [PMID: 38274034 PMCID: PMC10808760 DOI: 10.3389/fspor.2023.1274141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
Purpose To investigate heat stress mitigation strategies on productivity and thermoregulatory responses during simulated occupational work in the heat. Methods Thirteen physically active men (age, 25 ± 4 years; body mass,77.8 ± 14.7 kg; VO2peak, 44.5 ± 9.2 ml·kg-1·min-1) completed five randomized-controlled trials in a hot environment (40°C, 40% relative humidity). Each trial was 4.5 h in duration to simulate an outdoor occupational shift. Thermoregulatory responses (heart rate, HR; rectal temperature, Trec; mean skin temperature, Tsk), perceptual responses (rating of perceived exertion, RPE; thermal sensation; thermal comfort; fatigue) and productivity outcomes (box lifting repetitions, time to exhaustion) were examined in the following heat mitigation strategy interventions: (1) simulated solar radiation with limited fluid intake [SUN]; (2) simulated solar radiation with no fluid restrictions [SUN + H2O]; (3) shade (no simulated solar radiation during trial) with no fluid restrictions [SHADE + H2O]; (4) shade and cooling towels during rest breaks with no fluid restrictions [COOL + H2O]; and (5) shade with cooling towels, cooling vest during activity with no fluid restrictions [COOL + VEST + H2O]. Results [COOL + VEST + H2O] had lower Trec compared to [SUN] [p = 0.004, effect size(ES) = 1.48], [SUN + H2O] (p < 0.001, ES = -1.87), and [SHADE + H2O] (p = 0.001, ES = 1.62). Average Tsk was lower during the treadmill and box lifting activities in the [COOL + VEST + H2O] compared to [SUN] (p < 0.001, ES = 7.92), [SUN + H2O] (p < 0.001,7.96), [SHADE + H2O] (p < 0.001), and [COOL + H2O] (p < 0.001, ES = 3.01). There were performance differences during the [COOL + VEST + H2O] (p = 0.033) and [COOL + H2O] (p = 0.023) conditions compared to [SUN] during phases of the experimental trial, however, there were no differences in total box lifting repetitions between trials (p > 0.05). Conclusion Our results suggest that during a simulated occupational shift in a laboratory setting, additional heat mitigation strategies ([COOL + VEST + H2O] and [COOL + H2O]) reduced physiological strain and improved box lifting performance to a greater degree than [SUN]. These differences may have been attributed to a larger core to skin temperature gradient or reduction in fatigue, thermal sensation, and RPE during [COOL + H2O] and [COOL + VEST + H2O]. These data suggest that body cooling, hydration, and "shade" (removal of simulated radiant heat) as heat stress mitigation strategies should be considered as it reduces physiological strain while producing no additional harm.
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Affiliation(s)
- Margaret C. Morrissey-Basler
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs, CT, United States
- Department of Health Sciences, Providence College, Providence, RI, United States
| | - Gabrielle J. Brewer
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs, CT, United States
| | - Travis Anderson
- Department of Sports Medicine, UnitedStates Olympic & Paralympic Committee, Colorado Springs, CO, United States
- UnitedStates Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, CO, United States
| | - William M. Adams
- Department of Sports Medicine, UnitedStates Olympic & Paralympic Committee, Colorado Springs, CO, United States
- UnitedStates Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, CO, United States
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, United Kingdom
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, United States
| | - John S. Navarro
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs, CT, United States
| | - Monique Marcelino
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs, CT, United States
| | - David G. Martin
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs, CT, United States
| | - Douglas J. Casa
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs, CT, United States
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Notley SR, Mitchell D, Taylor NAS. A century of exercise physiology: concepts that ignited the study of human thermoregulation. Part 3: Heat and cold tolerance during exercise. Eur J Appl Physiol 2024; 124:1-145. [PMID: 37796292 DOI: 10.1007/s00421-023-05276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/04/2023] [Indexed: 10/06/2023]
Abstract
In this third installment of our four-part historical series, we evaluate contributions that shaped our understanding of heat and cold stress during occupational and athletic pursuits. Our first topic concerns how we tolerate, and sometimes fail to tolerate, exercise-heat stress. By 1900, physical activity with clothing- and climate-induced evaporative impediments led to an extraordinarily high incidence of heat stroke within the military. Fortunately, deep-body temperatures > 40 °C were not always fatal. Thirty years later, water immersion and patient treatments mimicking sweat evaporation were found to be effective, with the adage of cool first, transport later being adopted. We gradually acquired an understanding of thermoeffector function during heat storage, and learned about challenges to other regulatory mechanisms. In our second topic, we explore cold tolerance and intolerance. By the 1930s, hypothermia was known to reduce cutaneous circulation, particularly at the extremities, conserving body heat. Cold-induced vasodilatation hindered heat conservation, but it was protective. Increased metabolic heat production followed, driven by shivering and non-shivering thermogenesis, even during exercise and work. Physical endurance and shivering could both be compromised by hypoglycaemia. Later, treatments for hypothermia and cold injuries were refined, and the thermal after-drop was explained. In our final topic, we critique the numerous indices developed in attempts to numerically rate hot and cold stresses. The criteria for an effective thermal stress index were established by the 1930s. However, few indices satisfied those requirements, either then or now, and the surviving indices, including the unvalidated Wet-Bulb Globe-Thermometer index, do not fully predict thermal strain.
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Affiliation(s)
- Sean R Notley
- Defence Science and Technology Group, Department of Defence, Melbourne, Australia
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Duncan Mitchell
- Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Sciences, University of Western Australia, Crawley, Australia
| | - Nigel A S Taylor
- Research Institute of Human Ecology, College of Human Ecology, Seoul National University, Seoul, Republic of Korea.
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Reed EL, Chapman CL, Whittman EK, Park TE, Larson EA, Kaiser BW, Comrada LN, Wiedenfeld Needham K, Halliwill JR, Minson CT. Cardiovascular and mood responses to an acute bout of cold water immersion. J Therm Biol 2023; 118:103727. [PMID: 37866096 PMCID: PMC10842018 DOI: 10.1016/j.jtherbio.2023.103727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/02/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023]
Abstract
Cold water immersion (CWI) may provide benefits for physical and mental health. Our purpose was to investigate the effects of an acute bout of CWI on vascular shear stress and affect (positive and negative). Sixteen healthy adults (age: 23 ± 4 y; (9 self-reported men and 7 self-reported women) completed one 15-min bout of CWI (10 °C). Self-reported affect (positive and negative) was assessed at pre-CWI (Pre), 30-min post-immersion, and 180-min post-immersion in all participants. Brachial artery diameter and blood velocity were measured (Doppler ultrasound) at Pre, after 1-min and 15-min of CWI, and 30-min post-immersion (n = 8). Total, antegrade, and retrograde shear stress, oscillatory shear index (OSI), and forearm vascular conductance (FVC) were calculated. Venous blood samples were collected at Pre, after 1-min and 15-min of CWI, 30-min post-immersion, and 180-min post-immersion (n = 8) to quantify serum β-endorphins and cortisol. Data were analyzed using a one-way ANOVA with Fisher's least significance difference and compared to Pre. Positive affect did not change (ANOVA p = 0.450) but negative affect was lower at 180-min post-immersion (p < 0.001). FVC was reduced at 15-min of CWI and 30-min post-immersion (p < 0.020). Total and antegrade shear and OSI were reduced at 30-min post-immersion (p < 0.040) but there were no differences in retrograde shear (ANOVA p = 0.134). β-endorphins did not change throughout the trial (ANOVA p = 0.321). Cortisol was lower at 180-min post-immersion (p = 0.014). An acute bout of CWI minimally affects shear stress patterns but may benefit mental health by reducing negative feelings and cortisol levels.
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Affiliation(s)
- Emma L Reed
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, OR, USA.
| | - Christopher L Chapman
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, OR, USA.
| | - Emma K Whittman
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, OR, USA.
| | - Talia E Park
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, OR, USA.
| | - Emily A Larson
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, OR, USA.
| | - Brendan W Kaiser
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, OR, USA.
| | - Lindan N Comrada
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, OR, USA.
| | - Karen Wiedenfeld Needham
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, OR, USA.
| | - John R Halliwill
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, OR, USA.
| | - Christopher T Minson
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, OR, USA.
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Pryor RR, Haboian K, Fitts T, Stooks JJ. Tarp-Assisted Cooling for Exertional Heat Stroke Treatment in Wildland Firefighting. Wilderness Environ Med 2023; 34:490-497. [PMID: 37748988 DOI: 10.1016/j.wem.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/26/2023] [Accepted: 08/08/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION Exertional heat stroke is a life-threatening emergency necessitating immediate treatment with rapid body cooling. A field-expedient alternative may be tarp-assisted cooling, requiring only water and a tarp. The objective of this study was to compare core temperature (Tc) cooling rates of tarp-assisted cooling using the limited resources available to a wildland firefighter and the current standard care provided in wilderness settings. METHODS This cross-over, randomized control trial of 17 healthy individuals consisted of exercise in a 42±1°C, 32±4% relative humidity environment while wearing wildland firefighter attire, followed by cooling. Body cooling consisted of either pouring 11 L of 25±1°C water over the torso while lying supine on a tarp configured to hold water close to the individual (Tarp) or dousing the water on the participant followed by lying supine with a light breeze, current standard care in the wilderness (Current Care). Cooling occurred until Tc reached 38°C. RESULTS Participants walked until a similar Tc was achieved in Tarp (39.59±0.04°C) and Current Care (39.55±0.22°C; P=0.36). Core temperature cooling rate was not different between Tarp (0.076±0.042°C·min-1) and Current Care (0.088±0.046°C·min-1; P=0.41). CONCLUSIONS In hyperthermic individuals, Tarp did not provide a faster cooling rate compared to the current exertional heat stroke care provided in the wilderness, and both provided a slower cooling rate than that provided by the traditional method of cold water immersion (>0.20°C·min-1) to treat exertional heat stroke patients.
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Affiliation(s)
- Riana R Pryor
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY.
| | - Kara Haboian
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY
| | - Triniti Fitts
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY
| | - Jocelyn J Stooks
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY
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Lavonas EJ, Akpunonu PD, Arens AM, Babu KM, Cao D, Hoffman RS, Hoyte CO, Mazer-Amirshahi ME, Stolbach A, St-Onge M, Thompson TM, Wang GS, Hoover AV, Drennan IR. 2023 American Heart Association Focused Update on the Management of Patients With Cardiac Arrest or Life-Threatening Toxicity Due to Poisoning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2023; 148:e149-e184. [PMID: 37721023 DOI: 10.1161/cir.0000000000001161] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
In this focused update, the American Heart Association provides updated guidance for resuscitation of patients with cardiac arrest, respiratory arrest, and refractory shock due to poisoning. Based on structured evidence reviews, guidelines are provided for the treatment of critical poisoning from benzodiazepines, β-adrenergic receptor antagonists (also known as β-blockers), L-type calcium channel antagonists (commonly called calcium channel blockers), cocaine, cyanide, digoxin and related cardiac glycosides, local anesthetics, methemoglobinemia, opioids, organophosphates and carbamates, sodium channel antagonists (also called sodium channel blockers), and sympathomimetics. Recommendations are also provided for the use of venoarterial extracorporeal membrane oxygenation. These guidelines discuss the role of atropine, benzodiazepines, calcium, digoxin-specific immune antibody fragments, electrical pacing, flumazenil, glucagon, hemodialysis, hydroxocobalamin, hyperbaric oxygen, insulin, intravenous lipid emulsion, lidocaine, methylene blue, naloxone, pralidoxime, sodium bicarbonate, sodium nitrite, sodium thiosulfate, vasodilators, and vasopressors for the management of specific critical poisonings.
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12
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McDermott BP, Atkins WC. Whole-body cooling effectiveness of cold intravenous saline following exercise hyperthermia: a randomized trial. Am J Emerg Med 2023; 72:188-192. [PMID: 37562177 DOI: 10.1016/j.ajem.2023.07.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION In some athletic, occupational, military and emergency settings, cold intravenous (IV) fluids are used to facilitate whole-body cooling in an effort to treat heat illness. This treatment has anecdotal support, but currently lacks evidence supporting it as a whole-body cooling modality. Other modalities may offer superior cooling rates, and thus, patient outcomes following treatment. We sought to evaluate cooling rates of cold-IV normal saline immediately following exercise-induced hyperthermia. METHODS Eight healthy participants (3 females; 25 ± 2y; 72.9 ± 10.9 kg) completed 2 trials in random order. Prior to exercise, participants provided a small urine sample to confirm hydration status via urine specific gravity. Wet bulb globe temperature (WBGT) was assessed throughout trials. In both trials, participants exercised outdoors until rectal temperature (Tre) reached ∼38.9 °C, or volitional exhaustion, and then were cooled. In cooling, participants received either cold-IV (∼5 °C 0.9% NaCl fluids) or no treatment (sat in the shade; passive). Throughout exercise and treatment, Tre and heart rate (HR) were monitored. During exercise and every 10 min throughout cooling, participants were asked to assess thermal sensation. RESULTS Hydration status (P = .847) was not significantly different prior to exercise between trials. WBGT throughout was not different between trials (P = .426). Maximum Tre reached was not different between cold-IV (38.88 ± 0.30 °C) and passive cooling (38.76 ± 0.28 °C) trials (P = .184). Mean cooling rate for cold-IV (0.039 ± 0.005 °C·min-1) was significantly greater than for passive cooling (0.028 ± 0.005 °C·min-1; P = .002). Tre throughout cooling was not different between trials (P = .707), but did decrease throughout (P = .008), regardless of trial. HR was decreased over time (P < .001), but cold-IV and passive cooling were not different throughout HR recovery (P = .141). Thermal sensation decreased throughout cooling (P < .001), but was not different between trials (p = .278). CONCLUSION Emergency medical personnel should adopt treatment protocols that employ documented effective treatments for exertional heat stroke. In isolation, our data casts significant doubt for the use of cold-IV saline infusion for whole-body cooling of hyperthermic individuals.
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Affiliation(s)
- Brendon P McDermott
- Exercise Science Research Center, University of Arkansas, Fayetteville, AR, USA.
| | - Whitley C Atkins
- Exercise Science Research Center, University of Arkansas, Fayetteville, AR, USA; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX, USA.
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Casa DJ, Szymanski MR, Jardine JF, Stearns RL, Adams WM, Eason CM, Hosokawa Y, Huggins RA, Lopez RM, McDermott BP, Miller KC, Nolan JK, Pryor RR, Scarneo-Miller SE, Vandermark LW. Letter on the 2023 ACSM Expert Consensus Statement on Exertional Heat Illness. Curr Sports Med Rep 2023; 22:336-337. [PMID: 37678353 DOI: 10.1249/jsr.0000000000001100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Affiliation(s)
- Douglas J Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT
| | - Michael R Szymanski
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT
| | - John F Jardine
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT
| | - Rebecca L Stearns
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT
| | | | - Christianne M Eason
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT
| | - Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University. Tokorozawa, Saitama, Japan
| | - Robert A Huggins
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT
| | - Rebecca M Lopez
- School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Brendon P McDermott
- Exercise Science Research Center, College of Education and Health Professions, University of Arkansas, Fayetteville, AR
| | - Kevin C Miller
- Texas State University, Department of Health and Human Performance, San Marcos, TX
| | - Julie K Nolan
- Athletic Training Education Program, Sacred Heart University, Fairfield, CT
| | - Riana R Pryor
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY
| | | | - Lesley W Vandermark
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY
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14
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Gasc T, Henrionnet A, Cazes N, Haus MA, Thefenne L, Aigle L, Jouvion AX, Lavenir B. Exertional Heatstroke Support at the Acute Phase: Assessment of Professional Practices in the French Military Forces. Mil Med 2023; 188:e2472-e2479. [PMID: 36004718 DOI: 10.1093/milmed/usac252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/28/2022] [Accepted: 08/08/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Exertional heatstroke (EHS) is defined as a disturbance in consciousness, ranging from confusion to coma, with hyperthermia typically higher than 40 °C that occurs during intense physical activity. It is a life-threatening pathology that has been observed in the military since antiquity. Recent research has changed the understanding of the pathophysiology of EHS and led to the development of gold-standard treatment, which includes intrarectal temperature monitoring and cooling the patient as quickly as possible. The objective of this study was to describe the theoretical knowledge of French military unit practitioners regarding the latest recommendations for the treatment of EHS and their management of this condition in practice. MATERIALS AND METHODS We conducted a web-based survey from August 2 to December 31, 2020, including all French military practitioners. The questionnaire, sent via email, aimed to describe practitioners' theoretical knowledge of EHS and its practical management. Practitioners who had a local management protocol were asked to include it with their responses to analyze and determine if protocols complied with the latest recommendations. The responses were collected by name, anonymized, and analyzed by a single investigator. This observational study was exempted from ethics board approval by the French Military Health Service's research department. RESULTS Of the questionnaires sent, 84 practitioners responded, describing their theoretical knowledge of EHS. Of the respondents, 42 had experience managing EHS and described their practical management of EHS in the field. In addition, 15 local protocols were analyzed. Intrarectal temperature measurement was recommended by 71 physicians (84.5%), and cooling was preferably achieved by immersion in cold water by 65 practitioners (77.4%). If this method was unavailable, only 36.9% (24/65) of practitioners submerged patients in water at room temperature. Nine practitioners (10.7%) had perfect theoretical knowledge, and 36 (42.9%) knew the optimal management of EHS. There was no difference in the frequency of perfect theoretical knowledge between practitioners who had experience with EHS (9/36) and those who did not (12/48; P = 1). Practitioners who had experience with EHS had better optimal management knowledge than those who did not (61.1% vs.29.1%; P = .03). In practice, 21 (50%) cases had intrarectal temperature monitoring, and only 6 (14.3%) were immersed in cold water. Logistical challenges prevented optimal cooling methods in 29 (90.6%) cases. Concerning the other aspects of management, four (26.7%) practitioners recommended tympanic temperature measurement, two (20%) did not indicate immersion for cooling, and one (6.7%) administered paracetamol. CONCLUSIONS French military practitioners' theoretical knowledge of EHS is insufficient for a lethal pathology that is common in the military. Thus, improvements must be made in training and disseminating up-to-date knowledge. In practice, a lack of adequate logistics and the fact that first responders are rarely practitioners increase the suboptimal care of EHS. First responders should be equipped with valid and adapted protocols and adequate logistical means to manage this condition. By establishing a cohort of well-treated patients, we will be able to develop evidence-based recommendations for when to cease cooling and identify intrinsic susceptibility to EHS.
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Affiliation(s)
- Thomas Gasc
- 13e Centre Médical des Armées, 109e Antenne Médicale, Saint-Maixent-L'Ecole 79404, France
| | - Alexandra Henrionnet
- Institut de Recherche Biomédicale des Armées, Département environnements opérationnels, Unité de l'exercice et des activités en conditions extrèmes, Brétigny-sur-Orge 91220, France
| | - Nicolas Cazes
- Bataillon de Marins-Pompiers de Marseille, Groupement Santé, Service Médical d'Urgence, Marseille 13013, France
| | - Marie-Anne Haus
- Hôpital d'Instruction des Armées Laveran, Service d'Accueil des Urgences, Marseille 13013, France
| | - Laurent Thefenne
- Hôpital d'Instruction des Armées Laveran, Service de Médecine Physique et Réadaptation, Marseille 13013, France
| | - Luc Aigle
- Ecole Militaire de Santé de Lyon-Bron, Direction des Etudes, Bron 69500, France
| | - Arnaud-Xavier Jouvion
- Hôpital d'Instruction des Armées Laveran, Service de Médecine Physique et Réadaptation, Marseille 13013, France
| | - Bertrand Lavenir
- Direction de la Médecine des Forces, Bureau cohérence-synthèse, Tours 37000, France
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Hall EJ, Carter AJ, Bradbury J, Beard S, Gilbert S, Barfield D, O'Neill DG. Cooling Methods Used to Manage Heat-Related Illness in Dogs Presented to Primary Care Veterinary Practices during 2016-2018 in the UK. Vet Sci 2023; 10:465. [PMID: 37505869 PMCID: PMC10385239 DOI: 10.3390/vetsci10070465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/29/2023] Open
Abstract
The management of heat-related illness (HRI) in dogs has received limited attention in the veterinary literature, especially regarding effective cooling methods. Guidelines published in 2016 for prehospital management of dogs with HRI advised "cool first, transport second", and recommended using cold-water immersion and evaporative cooling (water application with air movement) as the optimal approaches to reduce the patient's temperature. The current retrospective cross-sectional observation study analysed electronic patient records from the VetCompass programme to describe the cooling methods used in dogs with HRI presented to primary care veterinary practices during 2016-2018. Of 623 HRI events identified, 341 (54.74%, 95% CI 50.81-58.60%) included information on cooling in their clinical record. Of these, 74/341 (21.70%, 95% CI 17.65-26.38%) were cooled prior to transport for veterinary care. Overall, 23.97% (95% CI 19.24-29.44%) were cooled using one of the two recommended cooling methods, whilst the most common cooling method recorded was the application of wet towels (51.31%, 95% CI 45.34-57.24%). Canine cooling guidance and messaging in both the public and veterinary sectors requires urgent review to ensure that the most effective cooling methods are promoted because delays to canine temperature reduction worsen patient outcomes.
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Affiliation(s)
- Emily J Hall
- Department of Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts AL9 7TA, UK
| | - Anne J Carter
- Animal and Veterinary Sciences, Scottish Rural Colleges, West Mains Road, Edinburgh EH9 3JG, UK
| | - Jude Bradbury
- Department of Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts AL9 7TA, UK
| | - Sian Beard
- Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts AL9 7TA, UK
| | - Sophie Gilbert
- Vets Now, Penguin House, Castle Riggs, Dunfermline KY11 8SG, UK
| | - Dominic Barfield
- Department of Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts AL9 7TA, UK
| | - Dan G O'Neill
- Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts AL9 7TA, UK
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[Expert consensus on the prevention and treatment of heatstroke in children (2023)]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:551-559. [PMID: 37382122 DOI: 10.7499/j.issn.1008-8830.2212063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Due to the immature development of temperature regulation in the central nervous system, children have a weakened ability to regulate heat and are susceptible to heatstroke, which can lead to organ damage. Based on the evidence evaluation criteria of the Oxford Centre for Evidence-Based Medicine, this expert consensus group evaluated the current evidence on heatstroke in children, and formed this consensus through thorough discussion with the aim of providing reference for the prevention and treatment of heatstroke in children. This consensus includes classifications, pathogenesis, prevention measures, as well as pre-hospital and in-hospital treatment plans for heatstroke in children.
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Caraway JJ, Shepard J, Hintz C, Butler CR. Management of a Special Warfare Trainee With Repeat Exertional Heat Stroke: A Case Study. J Sport Rehabil 2023:1-6. [PMID: 37290772 DOI: 10.1123/jsr.2022-0324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 04/03/2023] [Accepted: 04/16/2023] [Indexed: 06/10/2023]
Abstract
CONTEXT Exertional heat stroke (EHS) is the most deadly form the exertional heat illness with a higher incidence among active duty US military members than in the general population. Current guidelines on EHS recovery timelines and return to duty vary among the military branches. In some cases, individuals experience prolonged heat and exercise intolerance with repeat exertional heat illness events, which can complicate the recovery process. Management and rehabilitation of such individuals is unclear. CASE PRESENTATION This manuscript addresses the case and management of a US Air Force Special Warfare trainee who experienced 2 episodes of EHS, despite early recognition, gold standard treatment, and undergoing 4 weeks of a stepwise recovery after an initial EHS. MANAGEMENT AND OUTCOMES After the second episode, a 3-step process was utilized, consisting of a prolonged and personalized recovery period, heat tolerance testing using Israeli Defense Force advanced modeling, and stepwise reacclimatization. This process allowed the trainee to successfully recover from repeat EHS and return to duty, and set a framework for future repeat EHS treatment guidelines. CONCLUSIONS In individuals with repeat EHS, a prolonged recovery period followed by heat tolerance testing can be used to demonstrate appropriate thermotolerance and safely clear an individual to begin stepwise reacclimatization. Overall, patient care and military readiness may be improved by unified Department of Defense guidelines for return to duty after EHS.
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Affiliation(s)
- J Joseph Caraway
- School of Medicine, Uniformed Services University, Bethesda, MD,USA
| | - Julius Shepard
- School of Medicine, Uniformed Services University, Bethesda, MD,USA
| | - Courtney Hintz
- Special Warfare Human Performance Support Group, Lackland, TX,USA
| | - Cody R Butler
- Special Warfare Human Performance Support Group, Lackland, TX,USA
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18
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Kang H, Zsoldos RR, Sole-Guitart A, Narayan E, Cawdell-Smith AJ, Gaughan JB. Heat stress in horses: a literature review. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2023; 67:957-973. [PMID: 37060454 DOI: 10.1007/s00484-023-02467-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/21/2023] [Accepted: 03/28/2023] [Indexed: 06/15/2023]
Abstract
Healthy adult horses can balance accumulation and dissipation of body heat to maintain their body temperature between 37.5 and 38.5 °C, when they are in their thermoneutral zone (5 to 25 °C). However, under some circumstances, such as following strenuous exercise under hot, or hot and humid conditions, the accumulation of body heat exceeds dissipation and horses can suffer from heat stress. Prolonged or severe heat stress can lead to anhidrosis, heat stroke, or brain damage in the horse. To ameliorate the negative effects of high heat load in the body, early detection of heat stress and immediate human intervention is required to reduce the horse's elevated body temperature in a timely manner. Body temperature measurement and deviations from the normal range are used to detect heat stress. Rectal temperature is the most commonly used method to monitor body temperature in horses, but other body temperature monitoring technologies, percutaneous thermal sensing microchips or infrared thermometry, are currently being studied for routine monitoring of the body temperature of horses as a more practical alternative. When heat stress is detected, horses can be cooled down by cool water application, air movement over the horse (e.g., fans), or a combination of these. The early detection of heat stress and the use of the most effective cooling methods is important to improve the welfare of heat stressed horses.
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Affiliation(s)
- Hyungsuk Kang
- School of Agriculture and Food Sciences, The University of Queensland, Gatton, QLD, 4343, Australia.
| | - Rebeka R Zsoldos
- School of Agriculture and Food Sciences, The University of Queensland, Gatton, QLD, 4343, Australia
| | - Albert Sole-Guitart
- School of Veterinary Science, The University of Queensland, Gatton, QLD, 4343, Australia
| | - Edward Narayan
- School of Agriculture and Food Sciences, The University of Queensland, Gatton, QLD, 4343, Australia
| | - A Judith Cawdell-Smith
- School of Agriculture and Food Sciences, The University of Queensland, Gatton, QLD, 4343, Australia
| | - John B Gaughan
- School of Agriculture and Food Sciences, The University of Queensland, Gatton, QLD, 4343, Australia
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Wang X, Shang X, Li X, Liu S, Lai B, Ma L, Sun Y, Ma L, Ning B, Li Y, Wang Q. Phase-change material cooling blanket: A feasible cooling choice during transport after exercise-induced hyperthermia. J Therm Biol 2023; 114:103576. [PMID: 37344017 DOI: 10.1016/j.jtherbio.2023.103576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 04/15/2023] [Accepted: 04/16/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Exercise-induced hyperthermia preceding the onset of exertional heatstroke requires a rapid reduction in the body core temperature (Tcore) to ensure safety. In recent years, phase-change material (PCM) cooling devices have been increasingly used for rapid cooling after hyperthermia due to their superior capacity for heat absorption. OBJECTIVES This study aimed to evaluate the cooling performance and effectiveness of a PCM cooling blanket on heart rate (HR) and heart rate variability (HRV) recovery after exercise-induced hyperthermia. DESIGN Randomized cross-over. METHODS The study participants were 12 male volunteers who were engaged in professional training and completed an endurance exercise for approximately 30 min in a hot and humid environment (temperature ≈ 30 °C; relative humidity ≈ 66%). The participants underwent a 30-min cooling trial after exercise, receiving either treatment with a PCM cooling blanket (PCM group) or natural cooling (CON group). The Tcore, HR, and HRV time-domain indices were used for analysis. RESULTS The Tcore values were significantly lower in the PCM group during cooling. Reductions in the Tcore from precooling to 20 min of cooling were significantly greater in the PCM group than in the CON group. The HR in the PCM group was lower than that recorded in the CON group at 10 and 20 min of cooling. The reduction in HR during cooling from precooling was also significantly greater in the PCM group. HRV time-domain indices during cooling in the PCM group were significantly lower compared with the CON group while elevations in some HRV time-domain indices from precooling to postcooling were significantly greater in the PCM group than in the CON group. CONCLUSIONS The PCM cooling blanket had good cooling performance and the ability to hasten recovery of both HR and HRV. It may serve as a feasible cooling choice during transport after exercise-induced hyperthermia.
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Affiliation(s)
- Xin Wang
- Department of Critical Care Medicine, The Fifth Medical Center of Chinese PLA General Hospital, No.8 of East Street, Beijing, 100071, China
| | - Xueyi Shang
- Department of Critical Care Medicine, The Fifth Medical Center of Chinese PLA General Hospital, No.8 of East Street, Beijing, 100071, China
| | - Xin Li
- Department of Emergency Medicine, The Third Medical Center of Chinese PLA General Hospital, No.69 of Yongding Road, Beijing, 100039, China
| | - Shuyuan Liu
- Emergency Department, The Sixth Medical Center of Chinese PLA General Hospital, No.6 of Fucheng Road, Beijing, 100048, China
| | - Bin Lai
- Department of Emergency Medicine, The Third Medical Center of Chinese PLA General Hospital, No.69 of Yongding Road, Beijing, 100039, China
| | - Lizhi Ma
- Department of Medical Risk Management, The Third Medical Center of Chinese PLA General Hospital, No. 69 of Yongding Road, Beijing, 100039, China
| | - Ying Sun
- Department of Emergency Medicine, The Third Medical Center of Chinese PLA General Hospital, No.69 of Yongding Road, Beijing, 100039, China
| | - Lan Ma
- Department of Emergency Medicine, The Third Medical Center of Chinese PLA General Hospital, No.69 of Yongding Road, Beijing, 100039, China
| | - Bo Ning
- Department of Intensive Care Unit, Air Force Medical Center of China, No.30 of Fucheng Road, Beijing, 100142, China
| | - Yan Li
- Department of Critical Care Medicine, The Fifth Medical Center of Chinese PLA General Hospital, No.8 of East Street, Beijing, 100071, China
| | - Qian Wang
- Department of Emergency Medicine, The Third Medical Center of Chinese PLA General Hospital, No.69 of Yongding Road, Beijing, 100039, China.
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20
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Young D, Everitt B, Fine B, Miramontes D. Immersive Cooling in the Prehospital Setting for Heat Stroke: A Case Report. PREHOSP EMERG CARE 2023; 27:838-840. [PMID: 37040305 DOI: 10.1080/10903127.2023.2201515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/15/2023] [Accepted: 03/23/2023] [Indexed: 04/12/2023]
Abstract
Non-exertional heat stroke is defined as exposure to high outdoor temperatures, core body temperature >40 °C, and alteration of mentation. Early identification and treatment are imperative to reduce morbidity and mortality in these patients. Cold water immersion therapy is the most efficient and efficacious modality in treating heat stroke, yet it is rarely initiated in the prehospital setting. We outline a case of an 82-year-old man found unconscious outside during a regional heat wave with a temperature >107 °F. He was treated with cold water immersion using a body bag in the back of the ambulance and cooled to 104.1 °F during transport. During the 9-minute transport, the patient regained consciousness, followed basic commands, and answered basic questions. This case highlights the novel use of body bag cold water immersion as early initiation of treatment for heat stroke patients.
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Affiliation(s)
- Douglas Young
- Department of Emergency Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Bryan Everitt
- Department of Emergency Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | | | - David Miramontes
- Emergency Health Sciences, University of Texas Health San Antonio, San Antonio, Texas
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21
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DeGroot DW, Henderson KN, O'Connor FG. Cooling Modality Effectiveness and Mortality Associate With Prehospital Care of Exertional Heat Stroke Casualities. J Emerg Med 2023; 64:175-180. [PMID: 36806435 DOI: 10.1016/j.jemermed.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 11/07/2022] [Accepted: 12/13/2022] [Indexed: 02/19/2023]
Abstract
BACKGROUND Cold-water immersion is the gold standard for field treatment of an exertional heat stroke (EHS) casualty. Practical limitations may preclude this method and ice sheets (bed linens soaked in ice water) have emerged as a viable alternative. Laboratory studies suggest that this is an inferior method; however, the magnitude of hyperthermia is limited and may underestimate the cooling rate in EHS casualties. OBJECTIVE Our aim was to determine the prehospital core cooling rate, need for continued cooling on arrival to the emergency department, and mortality rate associated with ice sheet use. METHODS De-identified retrospective data were obtained from emergency medical services (EMS) and included presence or absence of altered mental status, cooling measures applied prior to EMS arrival, and time and core temperature (Tc; rectal) on-scene and on hospital arrival. Cooling rate was calculated from time and temperature data. Mortality data were obtained from the U.S. Army Combat Readiness Center. RESULTS There were 462 casualties that met inclusion criteria. The cooling rate for the entire sample was 0.07°C ± 0.08°C · min-1. EHS casualties with an observed initial Tc < 39°C had an en route cooling rate of 0.03°C ± 0.04°C · min-1 vs. initial Tc ≥ 39°C cooling rate of 0.16°C ± 0.08°C · min-1. There was one fatality due to EHS, for a mortality rate of 0.20% (95% CI 0.01-1.20%). CONCLUSIONS The cooling rate in EHS casualties with initial Tc ≥ 39°C was approximately double that reported in laboratory studies. The observed mortality rate was comparable with casualties treated with cold-water immersion. Our data suggest that ice sheets provide a viable alternative when practical constraints preclude cold-water immersion.
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Affiliation(s)
- David W DeGroot
- The Army Heat Center, Martin Army Community Hospital, Fort Benning, Georgia
| | - Kaemmer N Henderson
- Oak Ridge Institute for Science and Engineering (in support of The Army Heat Center), Martin Army Community Hospital, Fort Benning, Georgia
| | - Francis G O'Connor
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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22
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Abstract
Heat tolerance testing (HTT) has been developed to assess readiness for work or exercise in the heat based on thermoregulation during exertion. Although the Israeli Defense Forces protocol has been the most widely used and referenced, other protocols and variables considered in the interpretation of the testing are emerging. Our purpose was to summarize the role of HTT after exertional heat stroke; assess the validity of HTT; and provide a review of best-practice recommendations to guide clinicians, coaches, and researchers in the performance, interpretation, and future direction of HTT. We also offer the strength of evidence for these recommendations using the Strength of Recommendation Taxonomy system.
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Affiliation(s)
- Cody Butler
- Special Warfare Human Performance Squadron, Lackland Air Force Base, Texas
| | | | - Michelle Bruneau
- Sports Optimization and Rehabilitation Laboratory, Department of Kinesiology, University of Connecticut, Storrs
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Takegawa R, Kanda J, Yaguchi A, Yokobori S, Hayashida K. A prehospital risk assessment tool predicts clinical outcomes in hospitalized patients with heat-related illness: a Japanese nationwide prospective observational study. Sci Rep 2023; 13:1189. [PMID: 36681704 PMCID: PMC9867691 DOI: 10.1038/s41598-023-28498-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 01/19/2023] [Indexed: 01/22/2023] Open
Abstract
We previously developed a risk assessment tool to predict outcomes after heat-related illness (J-ERATO score), which consists of six binary prehospital vital signs. We aimed to evaluate the ability of the score to predict clinical outcomes for hospitalized patients with heat-related illnesses. In a nationwide, prospective, observational study, adult patients hospitalized for heat-related illnesses were registered. A binary logistic regression model and receiver operating characteristic (ROC) curve analysis were used to assess the relationship between the J-ERATO and survival at hospital discharge as a primary outcome. Among eligible patients, 1244 (93.0%) survived to hospital discharge. Multivariable logistic regression analysis revealed that the J-ERATO was an independent predictor for survival to discharge (adjusted odds ratio [OR] 0.47; 95% confidence interval [CI] 0.37-0.59) and occurrence of disseminated intravascular coagulation (DIC) on day 1 (adjusted OR 2.07; 95% CI 1.73-2.49). ROC analyses revealed an optimal J-ERATO cut-off of 5 for prediction of mortality at discharge (area under the curve [AUC] 0.742; 95% CI 0.691-0.787) and DIC development on day 1 (AUC 0.723; 95% CI 0.684-0.758). The J-ERATO obtained before transportation could be helpful in predicting the severity and mortality of hospitalized patients with heat-related illnesses.
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Affiliation(s)
- Ryosuke Takegawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Jun Kanda
- Department of Emergency Medicine, Teikyo University Hospital, Tokyo, Japan
| | - Arino Yaguchi
- Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Kei Hayashida
- Department of Emergency and Critical Care Medicine, School of Medicine, Keio University, Tokyo, Japan.
- Department of Emergency Medicine, South Shore University Hospital, Northwell Health System, Bay Shore, NY, USA.
- The Feinstein Institutes for Medical Research, Northwell Health System, Manhasset, NY, USA.
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Efficacy of two intermittent cooling strategies during prolonged work-rest intervals in the heat with personal protective gear compared with a control condition. Eur J Appl Physiol 2023; 123:1125-1134. [PMID: 36651993 DOI: 10.1007/s00421-023-05139-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Personal protective equipment (PPE) inhibits heat dissipation and elevates heat strain. Impaired cooling with PPE warrants investigation into practical strategies to improve work capacity and mitigate exertional heat illness. PURPOSE Examine physiological and subjective effects of forearm immersion (FC), fan mist (MC), and passive cooling (PC) following three intermittent treadmill bouts while wearing PPE. METHODS Twelve males (27 ± 6 years; 57.6 ± 6.2 ml/kg/min; 78.3 ± 8.1 kg; 183.1 ± 7.2 cm) performed three 50-min (10 min of 40%, 70%, 40%, 60%, 50% vVO2max) treadmill bouts in the heat (36 °C, 30% relative humidity). Thirty minutes of cooling followed each bout, using one of the three strategies per trial. Rectal temperature (Tcore), skin temperature (Tsk), heart rate (HR), heart rate recovery (HRR), rating of perceived exertion (RPE), thirst, thermal sensation (TS), and fatigue were obtained. Repeated-measures analysis of variance (condition x time) detected differences between interventions. RESULTS Final Tcore was similar between trials (P > .05). Cooling rates were larger in FC and MC vs PC following bout one (P < .05). HRR was greatest in FC following bouts two (P = .013) and three (P < .001). Tsk, fluid consumption, and sweat rate were similar between all trials (P > .05). TS and fatigue during bout three were lower in MC, despite similar Tcore and HR. CONCLUSION Utilizing FC and MC during intermittent work in the heat with PPE yields some thermoregulatory and cardiovascular benefit, but military health and safety personnel should explore new and novel strategies to mitigate risk and maximize performance under hot conditions while wearing PPE.
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Hutchins KP, Minett GM, Stewart IB. Treating exertional heat stroke: Limited understanding of the female response to cold water immersion. Front Physiol 2022; 13:1055810. [PMID: 36505067 PMCID: PMC9732943 DOI: 10.3389/fphys.2022.1055810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/02/2022] [Indexed: 11/26/2022] Open
Abstract
According to an expansive body of research and best practice statements, whole-body cold water immersion is the gold standard treatment for exertional heat stroke. However, as this founding evidence was predominantly drawn from males, the current guidelines for treatment are being applied to women without validation. Given the recognised differences in thermal responses experienced by men and women, all-encompassing exertional heat stroke treatment advice may not effectively protect both sexes. In fact, recent evidence suggests that hyperthermic women cool faster than hyperthermic men during cold water immersion. This raises the question of whether overcooling is risked if the present guidelines are followed. The current mini-review examined the literature on women's response to cold water immersion as a treatment for exertional heat stroke and aimed to clarify whether the current guidelines have appropriately considered research investigating women. The potential implications of applying these guidelines to women were also discussed.
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Affiliation(s)
- Cecilia Sorensen
- From the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University (C.S.), and the Department of Emergency Medicine, Columbia Irving Medical Center (C.S.) - both in New York; and the Department of Emergency Medicine, School of Medicine (J.H.), the Department of Environmental and Occupational Health Sciences, School of Public Health (J.H.), and the Department of Global Health, Schools of Medicine and Public Health (J.H.), University of Washington, Seattle
| | - Jeremy Hess
- From the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University (C.S.), and the Department of Emergency Medicine, Columbia Irving Medical Center (C.S.) - both in New York; and the Department of Emergency Medicine, School of Medicine (J.H.), the Department of Environmental and Occupational Health Sciences, School of Public Health (J.H.), and the Department of Global Health, Schools of Medicine and Public Health (J.H.), University of Washington, Seattle
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Incidence, risk factors, characteristics and prognosis of exertional heat stroke and heat exhaustion in Reunion Island, 2014–2018: A retrospective multicentre study. Sci Sports 2022. [DOI: 10.1016/j.scispo.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wang G, Zhang T, Wang A, Hurr C. Topical Analgesic Containing Methyl Salicylate and L-Menthol Accelerates Heat Loss During Skin Cooling for Exercise-Induced Hyperthermia. Front Physiol 2022; 13:945969. [PMID: 35910580 PMCID: PMC9326359 DOI: 10.3389/fphys.2022.945969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022] Open
Abstract
Hyperthermia impairs physical performance and, when prolonged, results in heat stroke or other illnesses. While extensive research has investigated the effectiveness of various cooling strategies, including cold water immersion and ice-suit, there has been little work focused on overcoming the cutaneous vasoconstriction response to external cold stimulation, which can reduce the effectiveness of these treatments. Over-the-counter (OTC) topical analgesics have been utilized for the treatment of muscle pain for decades; however, to date no research has examined the possibility of taking advantage of their vasodilatory functions in the context of skin cooling. We tested whether an OTC analgesic cream containing 20% methyl salicylate and 6% L-menthol, known cutaneous vasodilators, applied to the skin during skin cooling accelerates heat loss in exercise-induced hyperthermia. Firstly, we found that cutaneous application of OTC topical analgesic cream can attenuate cold-induced vasoconstriction and enhance heat loss during local skin cooling. We also revealed that core body heat loss, as measured by an ingestible telemetry sensor, could be accelerated by cutaneous application of analgesic cream during ice-suit cooling in exercise-induced hyperthermia. A blunted blood pressure response was observed during cooling with the analgesic cream application. Given the safety profile and affordability of topical cutaneous analgesics containing vasodilatory agents, our results suggest that they can be an effective and practical tool for enhancing the cooling effects of skin cooling for hyperthermia.
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Affiliation(s)
- Gang Wang
- Integrative Exercise Physiology Laboratory, Department of Physical Education, Jeonbuk National University, Jeonju, South Korea
- Department of Physical Education, Xinyang Normal University, Xingang, China
| | - Tingran Zhang
- Integrative Exercise Physiology Laboratory, Department of Physical Education, Jeonbuk National University, Jeonju, South Korea
| | - Anjie Wang
- Integrative Exercise Physiology Laboratory, Department of Physical Education, Jeonbuk National University, Jeonju, South Korea
| | - Chansol Hurr
- Integrative Exercise Physiology Laboratory, Department of Physical Education, Jeonbuk National University, Jeonju, South Korea
- *Correspondence: Chansol Hurr,
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Klous L, van Diemen F, Ruijs S, Gerrett N, Daanen H, de Weerd M, Veenstra B, Levels K. Efficiency of three cooling methods for hyperthermic military personnel linked to water availability. APPLIED ERGONOMICS 2022; 102:103700. [PMID: 35231652 DOI: 10.1016/j.apergo.2022.103700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 01/16/2022] [Accepted: 01/24/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE Three feasible cooling methods for treatment of hyperthermic individuals in the military, that differed considerably in water volume needed (none to ~80 L), were evaluated. METHODS Ten male soldiers were cooled following exercise-induced hyperthermia (rectal temperature (Tre) ∼39.5 °C) using ventilation by fanning (1.7 m s-1), ventilation by fanning (1.7 m s-1) while wearing a wet t-shirt (250 mL-27 °C water) and tarp assisted cooling with oscillations (80 L of 27.2 ± 0.5 °C water; TACO). RESULTS Cooling rates were higher using TACO (0.116 ± 0.032 °C min-1) compared to ventilation (0.065 ± 0.011 °C min-1, P<0.001) and ventilation in combination with a wet t-shirt (0.074 ± 0.020 °C min-1, P=0.002). Time to cool (TTC) to Tre=38.2 °C for TACO was shorter (14 ± 4 min) compared to ventilation only (20 ± 5 min; P=0.018), but not to ventilation while wearing a wet t-shirt (18 ± 6 min; P=0.090). CONCLUSIONS TACO may be an acceptable, efficient and feasible cooling method in case of exertional heat stroke. However, in case of limited water availability, transportat should be prioritized, and cooling of any form should be implemented while waiting for and during transport.
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Affiliation(s)
- Lisa Klous
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Netherlands Organization for Applied Scientific Research (TNO), Department of Human Performance, Unit Defence, Safety and Security, Soesterberg, The Netherlands
| | - Femke van Diemen
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Silke Ruijs
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Nicola Gerrett
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Gentherm Inc., Michigan, USA
| | - Hein Daanen
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Marijne de Weerd
- Institute of Training Medicine and Training Physiology, TGTF, Royal Netherlands Army, the Netherlands
| | - Bertil Veenstra
- Institute of Training Medicine and Training Physiology, TGTF, Royal Netherlands Army, the Netherlands
| | - Koen Levels
- Institute of Training Medicine and Training Physiology, TGTF, Royal Netherlands Army, the Netherlands.
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Garrett B, Lopez RM, Szymanski MR, Eidt D. Proper Recognition and Management of Exertional Heat Stroke in a High School Cross-Country Runner: A Validation Clinical Case Report. J Athl Train 2022; 57:586-591. [PMID: 35969664 DOI: 10.4085/1062-6050-0462.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A 14-year-old female high school cross- country runner (height = 154 cm, mass = 48.1 kg) with no history of exertional heat stroke (EHS) collapsed at the end of a race. An athletic trainer assessed the patient, who presented with difficulty breathing and then other signs of EHS (eg, confusion and agitation). The patient was taken to the medical area and draped with a towel, and a rectal temperature (Tre) of 106.9°F (41.6°C) was obtained. The emergency action plan was activated, and emergency medical services was called. The patient was submerged in a cold-water immersion tub until emergency medical services arrived (∼15 minutes; Tre = 100.1°F; cooling rate: 0.41°F.min-1[0.25°C.min-1]). At the hospital, the patient received intravenous fluids, and urine and blood tests were normal. She was not admitted and returned to running without sequelae. Following best practices, secondary school athletic trainers can prevent deaths from EHS by properly recognizing the condition and providing rapid cooling before transport.
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Affiliation(s)
- Bryanna Garrett
- School of Physical Therapy & Rehabilitation Sciences; Department of Orthopaedics & Sports Medicine; Morsani College of Medicine, University of South Florida, Tampa
| | - Rebecca M Lopez
- School of Physical Therapy & Rehabilitation Sciences; Department of Orthopaedics & Sports Medicine; Morsani College of Medicine, University of South Florida, Tampa
| | | | - Drew Eidt
- School of Physical Therapy & Rehabilitation Sciences; Department of Orthopaedics & Sports Medicine; Morsani College of Medicine, University of South Florida, Tampa
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Hosokawa Y, Adami PE, Stephenson BT, Blauwet C, Bermon S, Webborn N, Racinais S, Derman W, Goosey-Tolfrey VL. Prehospital management of exertional heat stroke at sports competitions for Paralympic athletes. Br J Sports Med 2022; 56:599-604. [PMID: 34620604 PMCID: PMC9120375 DOI: 10.1136/bjsports-2021-104786] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To adapt key components of exertional heat stroke (EHS) prehospital management proposed by the Intenational Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020 so that it is applicable for the Paralympic athletes. METHODS An expert working group representing members with research, clinical and lived sports experience from a Para sports perspective reviewed and revised the IOC consensus document of current best practice regarding the prehospital management of EHS. RESULTS Similar to Olympic competitions, Paralympic competitions are also scheduled under high environmental heat stress; thus, policies and procedures for EHS prehospital management should also be established and followed. For Olympic athletes, the basic principles of EHS prehospital care are: early recognition, early diagnosis, rapid, on-site cooling and advanced clinical care. Although these principles also apply for Paralympic athletes, slight differences related to athlete physiology (eg, autonomic dysfunction) and mechanisms for hands-on management (eg, transferring the collapsed athlete or techniques for whole-body cooling) may require adaptation for care of the Paralympic athlete. CONCLUSIONS Prehospital management of EHS in the Paralympic setting employs the same procedures as for Olympic athletes with some important alterations.
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Affiliation(s)
- Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | | | - Ben Thomas Stephenson
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- English Institute of Sport, Loughborough University, Loughborough, UK
| | - Cheri Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation; Spaulding Hospital/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Medical Committee, International Paralympic Committee, Bonn, Germany
| | - Stephane Bermon
- Health and Science Department, World Athletics, Monaco
- LAHMESS, Universite Cote d'Azur, Nice, Provence-Alpes-Cote d'Azu, France
| | - Nick Webborn
- Medical Committee, International Paralympic Committee, Bonn, Germany
- Centre for Sport and Exercise Science and Medicine (SESAME), School of Sport and Service Management, University of Brighton, Brighton, UK
| | - Sebastien Racinais
- Research Education Centre, ASPETAR - Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- IOC Research Center, University of Stellenbosch, Cape Town, South Africa
| | - Victoria L Goosey-Tolfrey
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- IOC Research Center, The National Centre for Sports Exercise and Medicine, Loughborough University, Loughborough, UK
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Kang H, Zsoldos RR, Skinner JE, Gaughan JB, Mellor VA, Sole-Guitart A. The Use of Percutaneous Thermal Sensing Microchips to Measure Body Temperature in Horses during and after Exercise Using Three Different Cool-Down Methods. Animals (Basel) 2022; 12:ani12101267. [PMID: 35625113 PMCID: PMC9137820 DOI: 10.3390/ani12101267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/05/2022] [Accepted: 05/13/2022] [Indexed: 01/27/2023] Open
Abstract
The frequent monitoring of a horse’s body temperature post strenuous exercise is critical to prevent or alleviate exertional heat illness (EHI) from occurring. Percutaneous thermal sensing microchip (PTSM) technology has the potential to be used as a means of monitoring a horse’s body temperature during and post-exercise. However, the accuracy of the temperature readings obtained, and their relationship to core body temperature are dependent on where they are implanted. This study aimed to document the relationship between core body temperature, and temperature readings obtained using PTSM implanted in different muscles, during exercise and post application of different cool-down methods. PTSMs were implanted into the right pectoral, right gluteal, right splenius muscles, and nuchal ligament. The temperatures were monitored during treadmill exercise, and post application of three different cool-down methods: no water application (Wno), water application only (Wonly), and water application following scraping (Wscraping). Central venous temperature (TCV) and PTSM temperatures from each region were obtained to investigate the optimal body site for microchip implantation. In this study, PTSM technology provided a practical, safe, and quick means of measuring body temperature in horses. However, its temperature readings varied depending on the implantation site. All muscle temperature readings exhibited strong relationships with TCV (r = 0.85~0.92, p < 0.05) after treadmill exercise without human intervention (water application), while the nuchal ligament temperature showed poor relationship with TCV. The relationships between TCV and PTSM temperatures became weaker with water application. Overall, however the pectoral muscle temperature measured by PTSM technology had the most constant relationships with TCV and showed the best potential to act as an alternate means of monitoring body temperature in horses for 50 min post-exercise, when there was no human intervention with cold water application.
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Affiliation(s)
- Hyungsuk Kang
- School of Agriculture and Food Sciences, The University of Queensland, Gatton, QLD 4343, Australia; (H.K.); (R.R.Z.); (J.E.S.); (J.B.G.); (V.A.M.)
| | - Rebeka R. Zsoldos
- School of Agriculture and Food Sciences, The University of Queensland, Gatton, QLD 4343, Australia; (H.K.); (R.R.Z.); (J.E.S.); (J.B.G.); (V.A.M.)
| | - Jazmine E. Skinner
- School of Agriculture and Food Sciences, The University of Queensland, Gatton, QLD 4343, Australia; (H.K.); (R.R.Z.); (J.E.S.); (J.B.G.); (V.A.M.)
- School of Agriculture and Environment, University of Southern Queensland, Toowoomba, QLD 4350, Australia
| | - John B. Gaughan
- School of Agriculture and Food Sciences, The University of Queensland, Gatton, QLD 4343, Australia; (H.K.); (R.R.Z.); (J.E.S.); (J.B.G.); (V.A.M.)
| | - Vincent A. Mellor
- School of Agriculture and Food Sciences, The University of Queensland, Gatton, QLD 4343, Australia; (H.K.); (R.R.Z.); (J.E.S.); (J.B.G.); (V.A.M.)
| | - Albert Sole-Guitart
- School of Veterinary Science, The University of Queensland, Gatton, QLD 4343, Australia
- Correspondence:
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Daguerre C, Marx T, Desmettre T. Coup de chaleur ou sepsis ? Une bactériémie à méningocoque chez un ouvrier du bâtiment en période caniculaire. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Caldwell AR, Saillant MM, Pitsas D, Johnson A, Bradbury KE, Charkoudian N. The Effectiveness of a Standardized Ice-Sheet Cooling Method Following Exertional Hyperthermia. Mil Med 2022; 187:e1017-e1023. [PMID: 35294018 DOI: 10.1093/milmed/usac047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/26/2022] [Accepted: 02/14/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Exertional heat illnesses remain a major threat to military service members in the United States and around the world. Exertional heat stroke (EHS) is the most severe heat illness, characterized by core hyperthermia and central nervous system dysfunction. Per current Army regulations, iced-sheet cooling (ISC) is the recommended immediate treatment for heat casualties in the field, but concerns have been raised regarding the efficacy of this approach. Thus, the purpose of this study was to quantify the cooling rate of ISC following exertional hyperthermia. MATERIALS AND METHODS We utilized a randomized crossover design with 2 experimental trials. In both trials, exertional hyperthermia was induced by walking (3.5 mph at 5% grade) on a treadmill in an environmental chamber (40 °C, 30% RH) for up to 3 hours or until core body temperature reached 39.2 °C. After the walking portion, individuals either received ISC (experimental trial) or cooling and rested supine in the same environmental conditions for 30 minutes with no ISC (control trial). For ISC, bed sheets soaked in ice water were applied (per Army guidance) at the neck, chest, and groin with another sheet covering the body. Sheets were rotated and resoaked every 3 minutes until core temperature decreased to <38.0 °C. RESULTS By design, participants finished exercise with increased core temperature (38.8 ± 0.39 °C vs. 38.90 ± 0.34 °C, ISC and control trials, P = 1.00). The ISC trial provided significantly (P = .023) greater cooling rates, 0.068 °C/min 95% confidence interval [CI; 0.053, 0.086], compared to the control trial, 0.047 °C/min 95% CI [0.038, 0.056]. Additionally, the time to decrease to less than 38.0 °C was significantly (P = .018) faster in the ISC trial (median = 9.3 minutes) compared to the control trial (median = 26.6 minutes). CONCLUSION ISC increases the cooling rate of those recovering from exertional hyperthermia. With the observed cooling rate, we can extrapolate that ISC would reduce core temperature by ∼2 °C within 30 minutes during a case of EHS. We conclude that ISC provides a safe and effective alternative for the field where cold water immersion resources may not be readily available.
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Affiliation(s)
- Aaron R Caldwell
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, MA 01760, USA.,Oak Ridge Institute of Science and Education, Belcamp, MD 21017, USA
| | - Michelle M Saillant
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, MA 01760, USA.,Oak Ridge Institute of Science and Education, Belcamp, MD 21017, USA
| | - Dina Pitsas
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, MA 01760, USA.,Oak Ridge Institute of Science and Education, Belcamp, MD 21017, USA
| | - Audrey Johnson
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Karleigh E Bradbury
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Nisha Charkoudian
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
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Koenig FS, Miller KC, O'Connor P, Amaria N. Body Anthropometrics and Rectal Temperature Cooling Rates in Women With Hyperthermia. J Athl Train 2022; 57:464-469. [PMID: 35230443 PMCID: PMC9205556 DOI: 10.4085/1062-6050-225-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Cold-water immersion (CWI) is the best treatment for exertional heat stroke (EHS), and rectal temperature (Trec) cooling rates may differ between sexes. Previous authors have suggested body surface area (BSA) to lean body mass (LBM) ratio is the largest factor affecting CWI Trec cooling rates in men with hyperthermia; this has never been confirmed in women with hyperthermia. OBJECTIVE To examine whether the BSA:LBM ratio and other anthropometrics affect Trec cooling rates in women with hyperthermia. DESIGN Cross-sectional study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Sixteen women were placed in either a low BSA:LBM ratio (LOW; n = 8; age = 22 ± 1 years, height = 166.8 ± 6.0 cm, mass = 64.1 ± 4.5 kg, BSA:LBM ratio = 3.759 ± 0.214 m2/kg·102) or high BSA:LBM ratio group (HIGH; n = 8; age = 22 ± 2 years, height = 162.7 ± 8.9 cm, mass = 65.8 ± 12.7 kg, BSA:LBM ratio = 4.161 ± 0.232 m2/kg·102). INTERVENTION(S) On day 1, we measured physical characteristics using dual-energy x-ray absorptiometry, and participants completed a maximal oxygen consumption test. On day 2, participants walked at 4.8 km/h for 3 minutes and then ran at 80% of their predetermined maximal oxygen consumption for 2 minutes in the heat (temperature = ~40°C, relative humidity = 40%). This sequence was repeated until Trec reached 39.5°C. Then, they completed CWI (temperature = ~10°C) until Trec was 38°C. MAIN OUTCOME MEASURE(S) Rectal temperature and CWI cooling rates. RESULTS Groups had different BSA:LBM ratios (P = .001), body fat percentages (LOW: 25.7% ± 5.0%; HIGH: 33.7% ± 6.3%; P = .007), and LBM (LOW: 45.8 ± 3.0 kg; HIGH: 41.0 ± 5.1 kg; P = .02) but not different BSA (LOW: 1.72 ± 0.08 m2; HIGH: 1.70 ± 0.16 m2; P = .40) or BMI (LOW: 23.1 ± 2.1; HIGH: 24.9 ± 4.7; P = .17). Despite differences in several physical characteristics, Trec cooling rates were excellent but comparable (LOW: 0.26°C/min ± 0.09°C/min; HIGH: 0.27°C/min ± 0.07°C/min; P = .39). The BSA:LBM ratio (r = 0.14, P = .59), body fat percentage (r = 0.29, P = .28), LBM (r = -0.10, P = .70), BSA (r = -0.01, P = .97), and BMI (r = 0.37, P = .16) were not correlated with Trec cooling rates. CONCLUSIONS Body anthropometrics did not affect CWI Trec cooling rates in women with hyperthermia. Clinicians need not worry about anthropometric characteristics slowing the treatment of severe hyperthermia in women using CWI.
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Affiliation(s)
- Fallon S Koenig
- *School of Health Sciences, Central Michigan University, Mount Pleasant
| | - Kevin C Miller
- †School of Rehabilitation and Medical Sciences, Central Michigan University, Mount Pleasant
| | - Paul O'Connor
- *School of Health Sciences, Central Michigan University, Mount Pleasant
| | - Noshir Amaria
- ‡College of Medicine, Central Michigan University, Mount Pleasant
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Bouchama A, Abuyassin B, Lehe C, Laitano O, Jay O, O'Connor FG, Leon LR. Classic and exertional heatstroke. Nat Rev Dis Primers 2022; 8:8. [PMID: 35115565 DOI: 10.1038/s41572-021-00334-6] [Citation(s) in RCA: 111] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 12/28/2022]
Abstract
In the past two decades, record-breaking heatwaves have caused an increasing number of heat-related deaths, including heatstroke, globally. Heatstroke is a heat illness characterized by the rapid rise of core body temperature above 40 °C and central nervous system dysfunction. It is categorized as classic when it results from passive exposure to extreme environmental heat and as exertional when it develops during strenuous exercise. Classic heatstroke occurs in epidemic form and contributes to 9-37% of heat-related fatalities during heatwaves. Exertional heatstroke sporadically affects predominantly young and healthy individuals. Under intensive care, mortality reaches 26.5% and 63.2% in exertional and classic heatstroke, respectively. Pathological studies disclose endothelial cell injury, inflammation, widespread thrombosis and bleeding in most organs. Survivors of heatstroke may experience long-term neurological and cardiovascular complications with a persistent risk of death. No specific therapy other than rapid cooling is available. Physiological and morphological factors contribute to the susceptibility to heatstroke. Future research should identify genetic factors that further describe individual heat illness risk and form the basis of precision-based public health response. Prioritizing research towards fundamental mechanism and diagnostic biomarker discovery is crucial for the design of specific management approaches.
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Affiliation(s)
- Abderrezak Bouchama
- King Abdullah International Medical Research Center, Experimental Medicine Department, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.
| | - Bisher Abuyassin
- King Abdullah International Medical Research Center, Experimental Medicine Department, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Cynthia Lehe
- King Abdullah International Medical Research Center, Experimental Medicine Department, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Orlando Laitano
- Department of Nutrition & Integrative Physiology, College of Health and Human Sciences, Florida State University, Tallahassee, FL, USA
| | - Ollie Jay
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Francis G O'Connor
- Military and Emergency Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Lisa R Leon
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
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Monseau AJ, Hurlburt GA, Balcik BJ, Oppenlander KE, Chill NM, Martin PS. Status of US Emergency Medical Service Protocols Regarding Pre-Transfer Cooling for Exertional Heat Stroke. Cureus 2021; 13:e19505. [PMID: 34912642 PMCID: PMC8666133 DOI: 10.7759/cureus.19505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: Exertional heat stroke (EHS) is a significant cause of morbidity and mortality in athletes and active individuals. In the field, initial management of exertional heat illness is based on rapid whole-body cooling. Cold-water immersion (CWI) is considered the superior cooling modality for EHS treatment. However, there often is a disconnect between the sports medicine community and the emergency medical service (EMS) community. Well-written emergency action plans may fail if EMS protocols do not allow for CWI in initial management. This is the first study to look at the current national EMS protocols regarding prehospital management of EHS. The purpose of our study was to assess the status of heat illness protocols regarding CWI for EHS in all 50 states plus Washington, DC. Methods: An internet search was performed to find EHS protocols. Statewide protocols were preferred. Several parameters were recorded for each protocol including whether: 1) CWI was the recommended cooling treatment for EHS and 2) CWI was explicitly permitted to be completed prior to transportation. Results: We found nine of the 51 protocols, or 17.6%, explicitly recommended CWI and 11 of the 51, or 21.6%, specifically instructed EMS personnel to complete CWI or cooling methods prior to transport. However, six protocols, or 11.8%, provided the recommendation instructing some variation of the phrase “do not delay transport to cool the patient.” Conclusion: Despite the medical literature endorsing CWI as the most effective treatment modality in a prehospital setting for exertional heat illness, EMS protocols largely fail to reflect this which leads to mismanagement and inadequate care of EHS patients. While CWI is not always available, all EMS protocols should include a systematic practical guideline for a heat illness patient when employing cooling treatment with an emphasis on CWI when available as the preferred treatment technique for EHS and the concept of “cool first, transport second.”
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Affiliation(s)
- Aaron J Monseau
- Emergency Medicine/Sports Medicine, West Virginia University, Morgantown, USA
| | - Gage A Hurlburt
- Medicine, West Virginia School of Osteopathic Medicine, Lewisburg, USA
| | - Brenden J Balcik
- Emergency Medicine/Sports Medicine, West Virginia University, Morgantown, USA
| | | | - Nicholas M Chill
- Emergency Medicine/Sports Medicine, West Virginia University, Morgantown, USA
| | - Peter S Martin
- Emergency Medicine, West Virginia University School of Medicine, Morgantown, USA
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Kanda J, Nakahara S, Nakamura S, Miyake Y, Shimizu K, Yokobori S, Yaguchi A, Sakamoto T. Association between active cooling and lower mortality among patients with heat stroke and heat exhaustion. PLoS One 2021; 16:e0259441. [PMID: 34788312 PMCID: PMC8598059 DOI: 10.1371/journal.pone.0259441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022] Open
Abstract
Body cooling is recommended for patients with heat stroke and heat exhaustion. However, differences in the outcomes of patients who do or do not receive active cooling therapy have not been determined. The best available evidence supporting active cooling is based on a case series without comparison groups; thus, the effectiveness of this method in improving patient prognoses cannot be appropriately quantified. Therefore, we compared the outcomes of heat stroke patients receiving active cooling with those of patients receiving rehydration-only therapy. This prospective observational multicenter registry-based study of heat stroke and heat exhaustion patients was conducted in Japan from 2010 to 2019. The patients were stratified into the "severe" group or the "mild-to-moderate" group, per clinical findings on admission. After conducting multivariate logistic regression analyses, we compared the prognoses between patients who received "active cooling + rehydration" and patients who received "rehydration only," with in-hospital death as the endpoint. Sex, age, onset situation (i.e., exertional or non-exertional), core body temperature, liver damage, renal dysfunction, and disseminated intravascular coagulation were considered potential covariates. Among those who received active cooling and rehydration-only therapy, the in-hospital mortality rates were 21.5% and 35.5%, respectively, for severe patients (n = 231) and 3.9% and 5.7%, respectively, for mild-to-moderate patients (n = 578). Rehydration-only therapy was associated with a higher in-hospital mortality in patients with severe heat illness (adjusted odds ratio [aOR], 3.29; 95% confidence interval [CI], 1.21-8.90), whereas the cooling methods were not associated with lower in-hospital mortality in patients with mild-to-moderate heat illness (aOR, 2.22; 95% CI, 0.92-5.84). Active cooling was associated with lower in-hospital mortality only in the severe group. Our results indicated that active cooling should be recommended as an adjunct to rehydration-only therapy for patients with severe heat illness.
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Affiliation(s)
- Jun Kanda
- Japanese Association for Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Shinji Nakahara
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
- Graduate School of Health Innovation, Kanagawa University of Human Services, Kanagawa, Japan
| | | | - Yasufumi Miyake
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Keiki Shimizu
- Emergency and Critical Care Center, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Shoji Yokobori
- Japanese Association for Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Arino Yaguchi
- Japanese Association for Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan
- Department of Critical Care and Emergency Medicine, Tokyo Women’s Medical University, Tokyo, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
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Marchand M, Gin K. The Cardiovascular System in Heat Stroke. CJC Open 2021; 4:158-163. [PMID: 35198932 PMCID: PMC8843991 DOI: 10.1016/j.cjco.2021.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
In June 2021, western Canada experienced an unprecedented heat wave, breaking dozens of temperature records. As a result, the region had a significant uptick in sudden deaths, emergency department visits, and hospital admissions. Under thermal stress, the human body achieves heat dissipation through evaporation of sweat and increased cutaneous blood flow. When these mechanisms are overwhelmed, the core body temperature rises, which leads to heat stroke, a life-threatening syndrome of hyperthermia and central nervous system dysfunction in the setting of an environmental thermal load. Heat dissipation relies on an intact cardiovascular system to dilate cutaneous vasculature and increase cardiac output. Individuals with impaired cardiovascular function have a limited ability to increase stroke volume, cardiac output, and blood flow to the skin, increasing the risk of heat stroke. In turn, these patients, whose cardiac condition is already compromised, are susceptible to cardiovascular complications of heat stroke, including arrhythmias, myocardial ischemia, heart failure, shock, and sudden death. Indeed, the majority of excess deaths during heat waves are cardiovascular in origin, highlighting the impact the cardiovascular system has on the development of heat stroke, and vice versa. This review summarizes the current understanding of the interaction between the cardiovascular system and heat stroke, including the pathophysiology, cardiovascular complications, and treatment.
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Affiliation(s)
- Miles Marchand
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
- Corresponding author: Dr Miles Marchand, Gordon & Leslie Diamond Health Care Centre, DHCC 9th Floor, 2775 Laurel St, Vancouver, British Columbia V5Z 1M9, Canada. Tel.: +1-604-875-4111.
| | - Kenneth Gin
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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Tripp BL, Winkelmann ZK, Eberman LE, Smith MS. Factors Affecting Incidence Rate of Exertional Heat Illnesses: Analysis of 6 Years of High School Football Practices in North Central Florida. Orthop J Sports Med 2021; 9:23259671211026627. [PMID: 34568503 PMCID: PMC8461130 DOI: 10.1177/23259671211026627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background Although experts have advocated for regionally specific heat safety guidelines for decades, guidelines have not been universally adopted. Purpose To describe the rate and risk factors associated with exertional heat illness (EHI). Study Design Descriptive epidemiology study. Methods For a 3-month period (August-October) over 6 years (2013-2018), athletic trainers at 13 high schools in North Central Florida recorded varsity football practice time and length, wet-bulb globe temperature (WBGT), and incidences of EHI, including heat stroke, heat exhaustion, and heat syncope. Results Athletes sustained 54 total EHIs during 163,254 athlete-exposures (AEs) for the 3-month data collection periods over 6 years (incidence rate [IR], 3.31 /10,000 AEs). Heat exhaustion accounted for 59.3% (32/54), heat syncope 38.9% (21/54), and heat stroke 1.9% (1/54) of all EHIs recorded. Of the EHIs, 94.4% (51/54) were experienced within the first 19 practices. The first 19 practices had an IR of 7.48 of 10,000 AEs, and the remaining 44 practices had an IR of 0.32 of 10,000 AEs, demonstrating that the risk of EHI for practices 1 to 19 was 23.7 times that of the remaining practices. When comparing morning to afternoon practices, 35.2% (19/54) EHI incidents occurred during morning practices. The risk of EHI during practices with WBGT >82°F (27.8°C) was 3.5 times that of practices with WBGT <82°F. Conclusion In the current study, the risk of EHI was greatest in the first 19 practices of the season and during practices with WBGT >82°F. As modifiable risk factors for EHI, increased vigilance and empowerment to adhere to acclimatization guidelines can mitigate EHI risk. Health care providers must continue to advocate for implementation of regulations and the authority to make decisions to ensure patient safety.
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Affiliation(s)
- Brady L Tripp
- Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, Florida, USA
| | - Zachary K Winkelmann
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, USA
| | - Lindsey E Eberman
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, Indiana, USA
| | - Michael Seth Smith
- Department of Orthopedics, University of Florida, Gainesville, Florida, USA
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Verdegaal ELJMM, Howarth GS, McWhorter TJ, Boshuizen B, Franklin SH, Vidal Moreno de Vega C, Jonas SE, Folwell LE, Delesalle CJG. Continuous Monitoring of the Thermoregulatory Response in Endurance Horses and Trotter Horses During Field Exercise: Baselining for Future Hot Weather Studies. Front Physiol 2021; 12:708737. [PMID: 34512382 PMCID: PMC8427666 DOI: 10.3389/fphys.2021.708737] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/29/2021] [Indexed: 11/15/2022] Open
Abstract
Establishing proper policies regarding the recognition and prevention of equine heat stress becomes increasingly important, especially in the face of global warming. To assist this, a detailed view of the variability of equine thermoregulation during field exercise and recovery is essential. 13 endurance horses and 12 trotter horses were equipped with continuous monitoring devices [gastrointestinal (GI) pill, heartrate (HR) monitor, and global positioning system] and monitored under cool weather conditions during four endurance rides over a total of 80 km (40 km loops) and intense trotter track-based exercise over 1,540 m. Recordings included GI temperature (T c ), speed, HR and pre- and post-exercise blood values. A temperature time profile curve of T c was constructed, and a net area under the curve was calculated using the trapezoidal method. Metabolic heat production and oxygen cost of transport were also calculated in endurance horses. Maximum T c was compared using an independent samples t-test. Endurance horses (mean speed 14.1 ± 1.7 km h-1) reached mean maximum T c (39.0 ± 0.4°C; 2 × 40 km in 8 horses) during exercise at 75% of completion of T c exercise and T c returned to baseline within 60 min into recovery. However, the mean T c was still 38.8 ± 0.4°C at a HR of 60 bpm which currently governs "fit to continue" competition decisions. Trotters (40.0 ± 2.9 km h-1) reached a comparable mean max T c (38.8 ± 0.5°C; 12 horses) always during recovery. In 30% of trotters, T c was still >39°C at the end of recovery (40 ± 32 min). The study shows that horses are individuals and thermoregulation monitoring should reflect this, no matter what type of exercise is performed. Caution is advised when using HR cut-off values to monitor thermal welfare in horses since we have demonstrated how T c can peak quite some time after finishing exercise. These findings have implications for training and management of performance horses to safeguard equine welfare and to maximize performance.
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Affiliation(s)
- Elisabeth-Lidwien J. M. M. Verdegaal
- Equine Health and Performance Centre, University of Adelaide, Adelaide, SA, Australia
- School of Animal and Veterinary Sciences, Roseworthy Campus, University of Adelaide, Adelaide, SA, Australia
- Research Group of Comparative Physiology, Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Gordon S. Howarth
- School of Animal and Veterinary Sciences, Roseworthy Campus, University of Adelaide, Adelaide, SA, Australia
| | - Todd J. McWhorter
- School of Animal and Veterinary Sciences, Roseworthy Campus, University of Adelaide, Adelaide, SA, Australia
| | - Berit Boshuizen
- Research Group of Comparative Physiology, Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Samantha H. Franklin
- Equine Health and Performance Centre, University of Adelaide, Adelaide, SA, Australia
- School of Animal and Veterinary Sciences, Roseworthy Campus, University of Adelaide, Adelaide, SA, Australia
| | - Carmen Vidal Moreno de Vega
- Research Group of Comparative Physiology, Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Stacey E. Jonas
- School of Animal and Veterinary Sciences, Roseworthy Campus, University of Adelaide, Adelaide, SA, Australia
| | - Louise E. Folwell
- School of Animal and Veterinary Sciences, Roseworthy Campus, University of Adelaide, Adelaide, SA, Australia
| | - Catherine J. G. Delesalle
- Research Group of Comparative Physiology, Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
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Yamanaka MS, Hosokawa Y, Ayusawa M, Hirose N, Kaneoka K. Epidemiology of sports-related fatalities during organized school sports in Japanese high schools between 2009 and 2018. PLoS One 2021; 16:e0256383. [PMID: 34415923 PMCID: PMC8378710 DOI: 10.1371/journal.pone.0256383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/06/2021] [Indexed: 11/18/2022] Open
Abstract
Limited literature has investigated epidemiology of sports-related fatalities during high school organizes sports in Japan. Therefore, the purposes of this study are to determine the frequency and incidence rate of sports-related fatalities in Japanese high schools by cause and sports, and to examine the type of on-site first responder. Insurance claim data of sports-related fatalities in Japanese high schools reported to Japan Sports Council Injury and Accident Mutual Aid Benefit System between 2009 and 2018 were retrieved as the primary data source. All fatalities were classified into direct or indirect type by the reported etiology and further categorized into cardiac-related, head and neck injury, exertional heat stroke (EHS), or other. Frequency and incidence rate were calculated by cause of death and sports, and incidence rates were expressed per 100,000 athlete-years (AY) with 95% confidence interval (CI). Information regarding first responder to the incident was also retrieved and examined by frequency. A total of 63 sports-related fatalities were analyzed. The overall incidence rate was 0.45 (95%CI = 0.25–0.65) per 100,000AY. The incidence rates of direct and indirect fatalities declined from 0.36 and 0.50 per 100,000AY to 0.28 and 0.00 per 100,000AY, respectively. The leading cause of deaths was cardiac-related (n = 30/63, 47.6%), followed by head and neck injury (n = 15/63, 23.8%) and EHS (n = 14/63, 22.2%). The number of fatalities was highest in male baseball (n = 12/63, 19.0%) and the incidence rate was highest in male judo (4.79 per 100,000 AY, 95%CI: 0.68–8.15). Coach was the most frequently reported first responder onsite (n = 52/63, 82.5%). Medically trained personnel were involved in onsite care in two cases (3.2%). In conclusion, the occurrence of sports-related fatalities has declined over time from 2009 to 2018. To deliver appropriate medical care onsite for better survival, employment of medically trained personnel should be promoted in high school sports setting in Japan.
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Affiliation(s)
| | - Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Mamoru Ayusawa
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Norikazu Hirose
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Koji Kaneoka
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
- * E-mail:
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Stone GL, Sanchez LD. Hypothermia following cold-water immersion treatment for exertional heat illness. Res Sports Med 2021; 31:255-259. [PMID: 34383570 DOI: 10.1080/15438627.2021.1966007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cold-water immersion (CWI) is the gold standard therapy for exertional heat illness (EHS), and it is critical to perform CWI expeditiously when the core temperature exceeds 40°C; however, the treatment comes with risks, most notably hypothermia. Following a major marathon, three runners presented to our emergency department (ED) with symptomatic mild hypothermia requiring re-warming. Prior to developing hypothermia, all three were treated at the racecourse with CWI for EHS. During CWI, there are monitoring methods to determine appropriate cessation: continuous temperature measurement, regular temperature checks, using an equation to predict immersion time, and symptom observation. There is no consensus on the best system, but a monitoring method should be used to prevent over-cooling. This case series illustrates the importance of proper CWI execution in order to avoid harm.
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Affiliation(s)
- Genevra L Stone
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women's Faulkner Hospital, Boston, MA, USA
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Kruijt N, den Bersselaar LV, Snoeck M, Kramers K, Riazi S, Bongers C, Treves S, Jungbluth H, Voermans N. RYR1-related rhabdomyolysis: a spectrum of hypermetabolic states due to ryanodine receptor dysfunction. Curr Pharm Des 2021; 28:2-14. [PMID: 34348614 DOI: 10.2174/1381612827666210804095300] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/10/2021] [Indexed: 11/22/2022]
Abstract
Variants in the ryanodine receptor-1 gene (RYR1) have been associated with a wide range of neuromuscular conditions, including various congenital myopathies and malignant hyperthermia (MH). More recently, a number of RYR1 variants, mostly MH-associated, have been demonstrated to contribute to rhabdomyolysis events not directly related to anesthesia in otherwise healthy individuals. This review focuses on RYR1-related rhabdomyolysis, in the context of several clinical presentations (i.e., exertional rhabdomyolysis, exertional heat illnesses and MH), and conditions involving a similar hypermetabolic state, in which RYR1 variants may be present (i.e., neuroleptic malignant syndrome and serotonin syndrome). The variety of triggers that can evoke rhabdomyolysis, on their own or in combination, as well as the number of potentially associated complications, illustrates that this is a condition relevant to several medical disciplines. External triggers include but are not limited to strenuous physical exercise, especially if unaccustomed or performed under challenging environmental conditions (e.g., high ambient temperature or humidity), alcohol/illicit drugs, prescription medication (in particular statins, other anti-lipid agents, antipsychotics and antidepressants) infection, or heat. Amongst all patients presenting with rhabdomyolysis, a genetic susceptibility is present in a proportion, with RYR1 being one of the most common genetic causes. Clinical clues for a genetic susceptibility include recurrent rhabdomyolysis, creatine kinase (CK) levels above 50 times the upper limit of normal, hyperCKemia lasting for 8 weeks or longer, drug/medication doses insufficient to explain the rhabdomyolysis event, and a positive family history. For the treatment or prevention of RYR1-related rhabdomyolysis, the RYR1 antagonist dantrolene can be administered, both in the acute phase, or prophylactically in patients with a history of muscle cramps and/or recurrent rhabdomyolysis events. Aside from dantrolene, several other drugs are being investigated for their potential therapeutic use in RYR1-related disorders. These findings offer further therapeutic perspectives for humans, suggesting an important area for future research.
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Affiliation(s)
- Nick Kruijt
- Department of Neurology, Radboud University Medical Centre, Nijmegen. Netherlands
| | | | - Marc Snoeck
- Malignant Hyperthermia Investigation Unit, Canisius Wilhelmina Hospital, Nijmegen. Netherlands
| | - Kees Kramers
- Department of Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen. Netherlands
| | - Sheila Riazi
- Department of Anesthesiology and Pain Medicine, University Health Network, University of Toronto, Toronto, ON. Canada
| | - Coen Bongers
- Department of Physiology, Radboudumc, Nijmegen. Netherlands
| | - Susan Treves
- Department of Biomedicine, University Hospital Basel. Switzerland
| | - Heinz Jungbluth
- Department of Paediatric Neurology - Neuromuscular Service, Evelina Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London. United Kingdom
| | - Nicol Voermans
- Department of Neurology, Radboud University Medical Centre, Nijmegen. Netherlands
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Morrissey MC, Casa DJ, Brewer GJ, Adams WM, Hosokawa Y, Benjamin CL, Grundstein AJ, Hostler D, McDermott BP, McQuerry ML, Stearns RL, Filep EM, DeGroot DW, Fulcher J, Flouris AD, Huggins RA, Jacklitsch BL, Jardine JF, Lopez RM, McCarthy RB, Pitisladis Y, Pryor RR, Schlader ZJ, Smith CJ, Smith DL, Spector JT, Vanos JK, Williams WJ, Vargas NT, Yeargin SW. Heat Safety in the Workplace: Modified Delphi Consensus to Establish Strategies and Resources to Protect the US Workers. GEOHEALTH 2021; 5:e2021GH000443. [PMID: 34471788 PMCID: PMC8388206 DOI: 10.1029/2021gh000443] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 06/04/2023]
Abstract
The purpose of this consensus document was to develop feasible, evidence-based occupational heat safety recommendations to protect the US workers that experience heat stress. Heat safety recommendations were created to protect worker health and to avoid productivity losses associated with occupational heat stress. Recommendations were tailored to be utilized by safety managers, industrial hygienists, and the employers who bear responsibility for implementing heat safety plans. An interdisciplinary roundtable comprised of 51 experts was assembled to create a narrative review summarizing current data and gaps in knowledge within eight heat safety topics: (a) heat hygiene, (b) hydration, (c) heat acclimatization, (d) environmental monitoring, (e) physiological monitoring, (f) body cooling, (g) textiles and personal protective gear, and (h) emergency action plan implementation. The consensus-based recommendations for each topic were created using the Delphi method and evaluated based on scientific evidence, feasibility, and clarity. The current document presents 40 occupational heat safety recommendations across all eight topics. Establishing these recommendations will help organizations and employers create effective heat safety plans for their workplaces, address factors that limit the implementation of heat safety best-practices and protect worker health and productivity.
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Affiliation(s)
- Margaret C. Morrissey
- Department of KinesiologyKorey Stringer InstituteUniversity of ConnecticutMansfieldCTUSA
| | - Douglas J. Casa
- Department of KinesiologyKorey Stringer InstituteUniversity of ConnecticutMansfieldCTUSA
| | - Gabrielle J. Brewer
- Department of KinesiologyKorey Stringer InstituteUniversity of ConnecticutMansfieldCTUSA
| | - William M. Adams
- Department of KinesiologyUniversity of North Carolina at GreensboroGreensboroNCUSA
| | - Yuri Hosokawa
- Faculty of Sports SciencesWaseda UniversitySaitamaJapan
| | | | | | - David Hostler
- Department of Exercise and Nutrition SciencesCenter for Research and Education in Special EnvironmentsBuffaloNYUSA
| | - Brendon P. McDermott
- Department of Health, Human Performance and RecreationUniversity of ArkansasFayettevilleARUSA
| | | | - Rebecca L. Stearns
- Department of KinesiologyKorey Stringer InstituteUniversity of ConnecticutMansfieldCTUSA
| | - Erica M. Filep
- Department of KinesiologyKorey Stringer InstituteUniversity of ConnecticutMansfieldCTUSA
| | - David W. DeGroot
- Fort Benning Heat CenterMartin Army Community HospitalFort BenningGAUSA
| | | | - Andreas D. Flouris
- Department of Exercise ScienceFAME LaboratoryUniversity of ThessalyTrikalaGreece
| | - Robert A. Huggins
- Department of KinesiologyKorey Stringer InstituteUniversity of ConnecticutMansfieldCTUSA
| | | | - John F. Jardine
- Department of KinesiologyKorey Stringer InstituteUniversity of ConnecticutMansfieldCTUSA
| | - Rebecca M. Lopez
- School of Physical Therapy & Rehabilitation SciencesMorsani College of MedicineUniversity of South FloridaTampaFLUSA
| | | | - Yannis Pitisladis
- Collaborating Centre of Sports MedicineUniversity of BrightonBrightonUK
| | - Riana R. Pryor
- Department of Exercise and Nutrition SciencesCenter for Research and Education in Special EnvironmentsBuffaloNYUSA
| | - Zachary J. Schlader
- Department of KinesiologySchool of Public HealthIndiana UniversityBloomingtonIAUSA
| | - Caroline J. Smith
- Department of Health and Exercise ScienceAppalachian State UniversityBooneNCUSA
| | - Denise L. Smith
- Department of Health and Human Physiological SciencesFirst Responder Health and Safety LaboratorySkidmore CollegeSaratoga SpringsNYUSA
| | - June T. Spector
- Department of Environmental and Occupational Health SciencesSchool of Public HealthUniversity of WashingtonSeattleWAUSA
| | | | - W. Jon Williams
- Centers for Disease Control and Prevention (CDC)National Personal Protective Technology Laboratory (NPPTL)National Institute for Occupational Safety and Health (NIOSH)PittsburghPAUSA
| | - Nicole T. Vargas
- Faculty of Health SciencesUniversity of SydneySydneyNSWAustralia
| | - Susan W. Yeargin
- Department of Exercise ScienceArnold School of Public HealthUniversity of South CarolinaColumbiaSCUSA
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Miller KC, Casa DJ, Adams WM, Hosokawa Y, Cates J, Emrich C, Fitzpatrick T, Hopper M, Jardine JF, LaBotz M, Lopez RM, O'Connor F, Smith MS. Roundtable on Preseason Heat Safety in Secondary School Athletics: Prehospital Care of Patients With Exertional Heat Stroke. J Athl Train 2021; 56:372-382. [PMID: 33290540 PMCID: PMC8063668 DOI: 10.4085/1062-6050-0173.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE First, we will update recommendations for the prehospital management and care of patients with exertional heat stroke (EHS) in the secondary school setting. Second, we provide action items to aid clinicians in developing best-practice documents and policies for EHS. Third, we supply practical strategies clinicians can use to implement best practice for EHS in the secondary school setting. DATA SOURCES An interdisciplinary working group of scientists, physicians, and athletic trainers evaluated the current literature regarding the prehospital care of EHS patients in secondary schools and developed this narrative review. When published research was nonexistent, expert opinion and experience guided the development of recommendations for implementing life-saving strategies. The group evaluated and further refined the action-oriented recommendations using the Delphi method. CONCLUSIONS Exertional heat stroke continues to be a leading cause of sudden death in young athletes and the physically active. This may be partly due to the numerous barriers and misconceptions about the best practice for diagnosing and treating patients with EHS. Exertional heat stroke is survivable if it is recognized early and appropriate measures are taken before patients are transported to hospitals for advanced medical care. Specifically, best practice for EHS evaluation and treatment includes early recognition of athletes with potential EHS, a rectal temperature measurement to confirm EHS, and cold-water immersion before transport to a hospital. With planning, communication, and persistence, clinicians can adopt these best-practice recommendations to aid in the recognition and treatment of patients with EHS in the secondary school setting.
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Affiliation(s)
- Kevin C. Miller
- School of Rehabilitation and Medical Sciences, Central Michigan University, Mount Pleasant
| | - Douglas J. Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - William M. Adams
- Department of Kinesiology, University of North Carolina at Greensboro
| | - Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | | | | | | | | | - John F. Jardine
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | | | - Rebecca M. Lopez
- Department of Orthopaedics and Sports Medicine, University of South Florida, Tampa
| | - Francis O'Connor
- Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, MD
| | - M. Seth Smith
- Department of Orthopedics and Rehabilitation, University of Florida, Gainesville
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Muniz-Pardos B, Angeloudis K, Guppy FM, Tanisawa K, Hosokawa Y, Ash GI, Schobersberger W, Grundstein AJ, Yamasawa F, Racinais S, Casa DJ, Pitsiladis YP. Ethical dilemmas and validity issues related to the use of new cooling technologies and early recognition of exertional heat illness in sport. BMJ Open Sport Exerc Med 2021; 7:e001041. [PMID: 33927884 PMCID: PMC8048013 DOI: 10.1136/bmjsem-2021-001041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 12/21/2022] Open
Abstract
The Tokyo 2020 Olympic Games is expected to be among the hottest Games in modern history, increasing the chances for exertional heat stroke (EHS) incidence, especially in non-acclimatised athletes/workers/spectators. The urgent need to recognise EHS symptoms to protect all attendees' health has considerably accelerated research examining the most effective cooling strategies and the development of wearable cooling technology and real-time temperature monitoring. While these technological advances will aid the early identification of EHS cases, there are several potential ethical considerations for governing bodies and sports organisers. For example, the impact of recently developed cooling wearables on health and performance is unknown. Concerning improving athletic performance in a hot environment, there is uncertainty about this technology's availability to all athletes. Furthermore, the real potential to obtain real-time core temperature data will oblige medical teams to make crucial decisions around their athletes continuing their competitions or withdraw. Therefore, the aim of this review is (1) to summarise the practical applications of the most novel cooling strategies/technologies for both safety (of athletes, spectators and workers) and performance purposes, and (2) to inform of the opportunities offered by recent technological developments for the early recognition and diagnosis of EHS. These opportunities are presented alongside several ethical dilemmas that require sports governing bodies to react by regulating the validity of recent technologies and their availability to all.
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Affiliation(s)
- Borja Muniz-Pardos
- GENUD Research Group, Faculty of Health and Sport Sciences, University of Zaragoza, Zaragoza, Spain
| | | | - Fergus M Guppy
- Centre for Stress and Age Related Disease, University of Brighton, Brighton, UK.,School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | - Kumpei Tanisawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Garrett I Ash
- Center for Medical Informatics, Yale School of Medicine, New Haven, Connecticut, USA.,Pain Research, Informatics, Multi-morbidities, and Education (PRIME), VA Connecticut Healthcare System, West haven, CT, USA
| | - Wolfgang Schobersberger
- Institute for Sports Medicine, Alpine Medicine and Health Tourism, Tirol Kliniken Innsbruck and UMIT Tirol, Hall, Austria
| | | | | | - Sebastien Racinais
- Athlete Health and Performance Research Centre, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Douglas J Casa
- Korey Stringer Institute, University of Connecticut, Storrs, Connecticut, USA
| | - Yannis P Pitsiladis
- Centre for Stress and Age Related Disease, University of Brighton, Brighton, UK.,Centre for Exercise Sciences and Sports Medicine, FIMS Collaborating Centre of Sports Medicine, Rome, Italy.,International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
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Effect of ice slurry ingestion on core temperature and blood pressure response after exercise in a hot environment. J Therm Biol 2021; 98:102922. [PMID: 34016346 DOI: 10.1016/j.jtherbio.2021.102922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/21/2021] [Accepted: 03/27/2021] [Indexed: 11/23/2022]
Abstract
Delays in the restoration of thermoregulation after exercise in a hot environment has been associated with post-exercise hypotension. This study tested the hypothesis that simultaneous internal cooling and rehydration by ingesting ice slurry prevents the excessive decrease in mean arterial pressure (MAP) and promotes recovery of core and skin temperatures in male athletes. Seven male athletes participated in this randomized controlled trial with a crossover design. The participants ran on a treadmill at 75% of their maximal oxygen uptake in the heat (35 °C, 60% relative humidity), up to exhaustion. Immediately after exercise, participants ingested either 4 g⋅kg -1 body weight of ice slurry (0.5 °C, ICE) or a control beverage (28 °C, CON). The participants then recovered by sitting for 20 min. We measured participants' rectal temperature (Tre), skin temperature (Tsk), mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), total peripheral resistance (TPR), and physiological strain index (PSI) before exercise (Pre), after running to exhaustion (PEx), and at 0 (P0), 10 (P10), and 20 (P20) minutes after ice slurry or control beverage ingestion. MAP, CO, HR, TPR, or PSI did not change significantly during the recovery period. At P10 and P20, Tre and Tsk significantly decreased in the ICE group compared to the CON group (p < 0.05). These results suggested that ingestion of ice slurry, post-exercise, promoted core and skin temperature recovery but did not affect the central and peripheral cardiovascular responses during the acute recovery period.
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Proposing the VetCompass clinical grading tool for heat-related illness in dogs. Sci Rep 2021; 11:6828. [PMID: 33767275 PMCID: PMC7994647 DOI: 10.1038/s41598-021-86235-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/11/2021] [Indexed: 01/31/2023] Open
Abstract
Heat-related illness is a potentially fatal condition in dogs. Rapid and accurate recognition of the severity can improve clinical management in affected dogs and lead to better outcomes. This study explored retrospective VetCompass veterinary clinical records to investigate the clinical signs recorded for dogs presenting with heat-related illness to primary-care veterinary practice from 2016 to 2018. The relative risk of death associated with these clinical signs was reported and used to develop a novel clinical grading tool. From the clinical records of 856 heat-related illness events, the most frequently recorded clinical signs were respiratory changes (68.73%) and lethargy (47.79%). The clinical signs with the highest relative risk of death were neurological dysfunction, gastrointestinal haemorrhage and bleeding disorders. The novel VetCompass Clinical Grading Tool for Heat-Related Illness in dogs defines three grades: mild (altered respiration, lethargy), moderate (gastrointestinal signs, a single seizure, episodic collapse) and severe (neurological dysfunction, gastrointestinal haemorrhage, bleeding disorders). This novel grading tool offers a simple, evidence-based device to improve recognition of heat-related illness in dogs and promote improved decision-making for earlier interventions such as cooling and hospitalisation. This could improve outcomes and protect the welfare of dogs in the face of rising global temperatures.
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50
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Brownlow MA, Mizzi JX. Exertional heat illness in Thoroughbred racehorses – Pathophysiology, case definition and treatment rationale. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
| | - J. X. Mizzi
- 315 Singles Ridge Road Yellow Rock New South Wales Australia
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