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Nye NS, Kasper K, Madsen CM, Szczepanik M, Covey CJ, Oh R, Kane S, Beutler AI, Leggit JC, Deuster PA, O'Connor FG. Clinical Practice Guidelines for Exertional Rhabdomyolysis: A Military Medicine Perspective. Curr Sports Med Rep 2021; 20:169-178. [PMID: 33655999 DOI: 10.1249/jsr.0000000000000822] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
ABSTRACT Exertional rhabdomyolysis (ER) is an uncommon condition with a paucity of evidence-based guidance for diagnosis, management, and return to duty or play. Recently, a clinical practice guideline for diagnosis and management of ER in warfighters was updated by a team of military and civilian physicians and researchers using current scientific literature and decades of experience within the military population. The revision concentrated on challenging and controversial clinical questions with applicability to providers in the military and those in the greater sports medicine community. Specific topics addressed: 1) diagnostic criteria for ER; 2) clinical decision making for outpatient versus inpatient treatment; 3) optimal strategies for inpatient management; 4) discharge criteria; 5) identification and assessment of warfighters/athletes at risk for recurrent ER; 6) an appropriate rehabilitative plan; and finally, 7) key clinical questions warranting future research.
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Affiliation(s)
| | - Korey Kasper
- 559th Trainee Health Squadron, JBSA-Lackland, TX
| | | | | | | | - Robert Oh
- Madigan Army Medical Center, Tacoma, WA
| | - Shawn Kane
- The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Anthony I Beutler
- Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Jeffrey C Leggit
- Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Patricia A Deuster
- Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Francis G O'Connor
- Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Bethesda, MD
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Incidence of Recurrent Exertional Heat Stroke in a Warm-Weather Road Race. ACTA ACUST UNITED AC 2020; 56:medicina56120720. [PMID: 33371206 PMCID: PMC7766530 DOI: 10.3390/medicina56120720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 12/27/2022]
Abstract
Background and Objectives: Exertional heat stroke (EHS) survivors may be more susceptible to subsequent EHS; however, the occurrence of survivors with subsequent EHS episodes is limited. Therefore, the purpose of this study was to evaluate the incidence of participants with repeated EHS (EHS-2+) cases in a warm-weather road race across participation years compared to those who experienced 1 EHS (EHS-1). Materials and Methods: A retrospective observational case series design was utilized. Medical record data from 17-years at the Falmouth Road Race between 2003–2019 were examined for EHS cases. Incidence of EHS-2+ cases per race and average EHS cases per EHS-2+ participant were calculated (mean ± SD) and descriptive factors (rectal temperature (TRE), finish time (FT), Wet Bulb Globe Temperature (WBGT), age, race year) for each EHS was collected. Results: A total of 333 EHS patients from 174,853 finishers were identified. Sixteen EHS-2+ participants (11 males, 5 females, age = 39 ± 16 year) accounted for 11% of the total EHS cases (n = 37/333). EHS-2+ participants had an average of 2.3 EHS cases per person (range = 2–4) and had an incidence rate of 2.6 EHS per 10 races. EHS-2+ participants finished 93 races following initial EHS, with 72 of the races (77%) completed without EHS incident. Initial EHS TRE was not statistically different than subsequent EHS initial TRE (+0.3 ± 0.9 °C, p > 0.050). Initial EHS-2+ participant FT was not statistically different than subsequent EHS FT (−4.2 ± 7.0 min, p > 0.050). The years between first and second EHS was 3.6 ± 3.5 year (Mode: 1, Range: 1–12). Relative risk ratios revealed that EHS patients were at a significantly elevated risk for subsequent EHS episodes 2 years following their initial EHS (relative risk ratio = 3.32, p = 0.050); however, the risk from 3–5 years post initial EHS was not statistically elevated, though the relative risk ratio values remained above 1.26. Conclusions: These results demonstrate that 11% of all EHS cases at the Falmouth Road Race are EHS-2+ cases and that future risk for a second EHS episode at this race is most likely to occur within the first 2 years following the initial EHS incident. After this initial 2-year period, risk for another EHS episode is not significantly elevated. Future research should examine factors to explain individuals who are susceptible to multiple EHS cases, incidence at other races and corresponding prevention strategies both before and after initial EHS.
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van den Bersselaar LR, Snoeck MMJ, Gubbels M, Riazi S, Kamsteeg EJ, Jungbluth H, Voermans NC. Anaesthesia and neuromuscular disorders: what a neurologist needs to know. Pract Neurol 2020:practneurol-2020-002633. [PMID: 33109742 PMCID: PMC8172077 DOI: 10.1136/practneurol-2020-002633] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2020] [Indexed: 11/04/2022]
Abstract
Neurologists are often asked for specific advice regarding patients with neuromuscular disease who require general anaesthesia. However, guidelines on specific neuromuscular disorders do not usually include specific guidelines or pragmatic advice regarding (regional and/or general) anaesthesia or procedural sedation. Furthermore, the medical literature on this subject is mostly limited to publications in anaesthesiology journals. We therefore summarise general recommendations and specific advice for anaesthesia in different neuromuscular disorders to provide a comprehensive and accessible overview of the knowledge on this topic essential for clinical neurologists. A preoperative multidisciplinary approach involving anaesthesiologists, cardiologists, chest physicians, surgeons and neurologists is crucial. Depolarising muscle relaxants (succinylcholine) should be avoided at all times. The dose of non-depolarising muscle relaxants must be reduced and their effect monitored. Patients with specific mutations in RYR1 (ryanodine receptor 1) and less frequently in CACNA1S (calcium channel, voltage-dependent, L type, alpha 1S subunit) and STAC3 (SH3 and cysteine rich domain 3) are at risk of developing a life-threatening malignant hyperthermia reaction.
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Affiliation(s)
- Luuk R van den Bersselaar
- Anaesthesiology, Malignant Hyperthermia Investigation Unit, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
- Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, Netherlands
| | - Marc M J Snoeck
- Anaesthesiology, Malignant Hyperthermia Investigation Unit, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Madelief Gubbels
- Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, Netherlands
| | - Sheila Riazi
- Anesthesiology and Pain Medicine, Malignant Hyperthermia Investigation Unit, University of Toronto, Toronto, Canada
| | | | - Heinz Jungbluth
- Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
- Department of Basic and Clinical Neuroscience, IoPPN, King's College, London, UK
- Randall Division for Cell and Molecular Biophysics, Muscle Signalling Section, King's College, London, UK
| | - Nicol C Voermans
- Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, Netherlands
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Wang HJ, Lee CS, Yee RSZ, Groom L, Friedman I, Babcock L, Georgiou DK, Hong J, Hanna AD, Recio J, Choi JM, Chang T, Agha NH, Romero J, Sarkar P, Voermans N, Gaber MW, Jung SY, Baker ML, Pautler RG, Dirksen RT, Riazi S, Hamilton SL. Adaptive thermogenesis enhances the life-threatening response to heat in mice with an Ryr1 mutation. Nat Commun 2020; 11:5099. [PMID: 33037202 PMCID: PMC7547078 DOI: 10.1038/s41467-020-18865-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 09/18/2020] [Indexed: 11/17/2022] Open
Abstract
Mutations in the skeletal muscle Ca2+ release channel, the type 1 ryanodine receptor (RYR1), cause malignant hyperthermia susceptibility (MHS) and a life-threatening sensitivity to heat, which is most severe in children. Mice with an MHS-associated mutation in Ryr1 (Y524S, YS) display lethal muscle contractures in response to heat. Here we show that the heat response in the YS mice is exacerbated by brown fat adaptive thermogenesis. In addition, the YS mice have more brown adipose tissue thermogenic capacity than their littermate controls. Blood lactate levels are elevated in both heat-sensitive MHS patients with RYR1 mutations and YS mice due to Ca2+ driven increases in muscle metabolism. Lactate increases brown adipogenesis in both mouse and human brown preadipocytes. This study suggests that simple lifestyle modifications such as avoiding extreme temperatures and maintaining thermoneutrality could decrease the risk of life-threatening responses to heat and exercise in individuals with RYR1 pathogenic variants.
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Affiliation(s)
- Hui J Wang
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
- Translational Biology and Molecular Medicine Graduate Program, Baylor College of Medicine, Houston, TX, USA
| | - Chang Seok Lee
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Rachel Sue Zhen Yee
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Linda Groom
- Department of Pharmacology and Physiology, University of Rochester Medical Center, Rochester, NY, USA
| | - Inbar Friedman
- Department of Anesthesiology, University of Toronto, Toronto, ON, Canada
| | - Lyle Babcock
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Dimitra K Georgiou
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Jin Hong
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Amy D Hanna
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Joseph Recio
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Jong Min Choi
- Advance Technology Core, Mass Spectrometry Proteomics Core, Baylor College of Medicine, Houston, TX, USA
| | - Ting Chang
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Nadia H Agha
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Jonathan Romero
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Poonam Sarkar
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Nicol Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, Netherlands
| | - M Waleed Gaber
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Sung Yun Jung
- Advance Technology Core, Mass Spectrometry Proteomics Core, Baylor College of Medicine, Houston, TX, USA
| | - Matthew L Baker
- Advance Technology Core, Mass Spectrometry Proteomics Core, Baylor College of Medicine, Houston, TX, USA
| | - Robia G Pautler
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Robert T Dirksen
- Department of Pharmacology and Physiology, University of Rochester Medical Center, Rochester, NY, USA
| | - Sheila Riazi
- Department of Anesthesiology, University of Toronto, Toronto, ON, Canada
| | - Susan L Hamilton
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA.
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Bosson C, Rendu J, Pelletier L, Abriat A, Chatagnon A, Brocard J, Brocard J, Figarella-Branger D, Ducreux S, van Coppenolle F, Sagui E, Marty I, Roux-Buisson N, Faure J. Variations in the TRPV1 gene are associated to exertional heat stroke. J Sci Med Sport 2020; 23:1021-1027. [PMID: 32471784 DOI: 10.1016/j.jsams.2020.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Exertional Heat Stroke (EHS) is one of the top three causes of sudden death in athletes. Extrinsic and intrinsic risk factors have been identified but the genetic causes still remain unclear. Our aim was to identify genes responsible for EHS, which is a necessary step to identify patients at risk and prevent crises. DESIGN Genetic and functional laboratory studies METHODS: Whole Exome Sequencing (WES) was performed to search for candidate genes in a cohort of 15 soldiers who had a documented EHS episode. In silico and in vitro functional studies were performed to evaluate the effect of mutations identified in the candidate gene TRPV1. RESULTS WES led to the identification of two missense variations in the TRPV1 gene. These variations were very rare or unreported in control databases and located in critical domains of the protein. In vitro functional studies revealed that both variations induce a strong modification of the channel response to one of its natural agonist, the capsaicin. CONCLUSIONS We evidenced mutations altering channel properties of the TRPV1 gene and demonstrated that TRPV1, which is involved in thermoregulation and nociception, is a new candidate gene for EHS. Our data provide the bases to explore genetic causes and molecular mechanisms governing the pathophysiology of EHS.
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Affiliation(s)
- Caroline Bosson
- CHU Grenoble Alpes IBP, Génétique Moléculaire : Maladies Héréditaires et Oncologie, France; Grenoble Institute of Neurosciences, Inserm U1216, Cellular Myology and Pathology, Grenoble Alpes, University, Grenoble, France
| | - John Rendu
- CHU Grenoble Alpes IBP, Génétique Moléculaire : Maladies Héréditaires et Oncologie, France; Grenoble Institute of Neurosciences, Inserm U1216, Cellular Myology and Pathology, Grenoble Alpes, University, Grenoble, France
| | - Laurent Pelletier
- Grenoble Institute of Neurosciences, Inserm U1216, Cellular Myology and Pathology, Grenoble Alpes, University, Grenoble, France
| | - Amandine Abriat
- Military Hospital Laveran, Service of Neurology, Marseille, France
| | - Amandine Chatagnon
- CHU Grenoble Alpes IBP, Génétique Moléculaire : Maladies Héréditaires et Oncologie, France
| | - Julie Brocard
- Grenoble Institute of Neurosciences, Inserm U1216, Cellular Myology and Pathology, Grenoble Alpes, University, Grenoble, France
| | - Jacques Brocard
- Grenoble Institute of Neurosciences, Inserm U1216, Cellular Myology and Pathology, Grenoble Alpes, University, Grenoble, France
| | - Dominique Figarella-Branger
- Aix-Marseille Univ, APHM, CNRS, INP, Inst Neurophysiopathol, Hôpital de la Timone, Service d'Anatomie Pathologique et de Neuropathologie, Marseille, France; Univ Aix-Marseille I, France
| | - Sylvie Ducreux
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA, Lyon, Université Claude Bernard, Bron, France
| | - Fabien van Coppenolle
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA, Lyon, Université Claude Bernard, Bron, France
| | | | - Isabelle Marty
- Grenoble Institute of Neurosciences, Inserm U1216, Cellular Myology and Pathology, Grenoble Alpes, University, Grenoble, France
| | - Nathalie Roux-Buisson
- CHU Grenoble Alpes IBP, Génétique Moléculaire : Maladies Héréditaires et Oncologie, France; Grenoble Institute of Neurosciences, Inserm U1216, Cellular Myology and Pathology, Grenoble Alpes, University, Grenoble, France.
| | - Julien Faure
- CHU Grenoble Alpes IBP, Génétique Moléculaire : Maladies Héréditaires et Oncologie, France; Grenoble Institute of Neurosciences, Inserm U1216, Cellular Myology and Pathology, Grenoble Alpes, University, Grenoble, France
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Bäcker HC, Busko M, Krause FG, Exadaktylos AK, Klukowska-Roetzler J, Deml MC. Exertional rhabdomyolysis and causes of elevation of creatine kinase. PHYSICIAN SPORTSMED 2020; 48:179-185. [PMID: 31532694 DOI: 10.1080/00913847.2019.1669410] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Rhabdomyolysis is a potentially fatal condition that can be triggered by a variety of inciting events, including excessive muscular exertion.The purpose of this study was to investigate the causes of creatine kinase elevation (CK≥1000U/L) to determine what percentage result from exRML, the etiology, and kinetics of CK levels, as well as the complications of exRML and comorbidities that may predispose an individual to this condition.Methods: We performed a cross-sectional analysis of the emergency department database for patients with CK≥1000U/L between 2012 and 2017. In total, there were 1957 cases of rhabdomyolysis diagnosed based on laboratory data and documentation. Trauma was the most common cause for rhabdomyolysis (n = 726/1957; 37.1%, respectively).Results: ExRML was identified in 2.1% (n = 42/1957) of the total cases. Patients with ExRML were significantly younger (30.1 ± 10.6 years) with a significantly higher maximal level of CK compared to the non-exertional causes of rhabdomyolysis, (CK = 16,884.4 ± 41,645.6U/L; both p < 0.005). The far majority of cases were sport or exercise related (n = 35/42; 83.3%), with strength training at the gym making up the largest group of athletes (n = 16/42; 38.1%). The main complication amongst the ExRML group was acute kidney insufficiency, which was observed in 42.9% of patients. The CK levels of the patients in the ExRML cohort steadily decreased after initiation of aggressive hydration.Conclusion: ExRML may be more prevalent than the current literature predicts, which is important to recognize as it has the potential to cause kidney failure, irregular heart rhythm, and death. Therefore, physicians and active individuals should be sensitized to the signs and symptoms that may lead to earlier recognition and proper treatment in exercising individuals.
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Affiliation(s)
- Henrik Constantin Bäcker
- Department of Orthopaedics and Trauma Surgery, Inselspital Bern, University Hospital Bern, University Bern, Bern, Switzerland.,Department of Orthopaedic Surgery, Columbia University Medical Center - Presbyterian Hospital, New York, NY, USA
| | - Morgan Busko
- Department of Orthopaedic Surgery, Columbia University Medical Center - Presbyterian Hospital, New York, NY, USA
| | - Fabian Götz Krause
- Department of Orthopaedics and Trauma Surgery, Inselspital Bern, University Hospital Bern, University Bern, Bern, Switzerland
| | | | - Jolanta Klukowska-Roetzler
- Department of Emergency Medicine, Inselspital Bern, University Hospital Bern, University Bern, Bern, Switzerland
| | - Moritz Caspar Deml
- Department of Orthopaedics and Trauma Surgery, Inselspital Bern, University Hospital Bern, University Bern, Bern, Switzerland
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Current paradigms in the prehospital care of exertional heat illness: A review. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Hosokawa Y, Casa DJ, Trtanj JM, Belval LN, Deuster PA, Giltz SM, Grundstein AJ, Hawkins MD, Huggins RA, Jacklitsch B, Jardine JF, Jones H, Kazman JB, Reynolds ME, Stearns RL, Vanos JK, Williams AL, Williams WJ. Activity modification in heat: critical assessment of guidelines across athletic, occupational, and military settings in the USA. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2019; 63:405-427. [PMID: 30710251 PMCID: PMC10041407 DOI: 10.1007/s00484-019-01673-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 01/13/2019] [Accepted: 01/15/2019] [Indexed: 05/04/2023]
Abstract
Exertional heat illness (EHI) risk is a serious concern among athletes, laborers, and warfighters. US Governing organizations have established various activity modification guidelines (AMGs) and other risk mitigation plans to help ensure the health and safety of their workers. The extent of metabolic heat production and heat gain that ensue from their work are the core reasons for EHI in the aforementioned population. Therefore, the major focus of AMGs in all settings is to modulate the work intensity and duration with additional modification in adjustable extrinsic risk factors (e.g., clothing, equipment) and intrinsic risk factors (e.g., heat acclimatization, fitness, hydration status). Future studies should continue to integrate more physiological (e.g., valid body fluid balance, internal body temperature) and biometeorological factors (e.g., cumulative heat stress) to the existing heat risk assessment models to reduce the assumptions and limitations in them. Future interagency collaboration to advance heat mitigation plans among physically active population is desired to maximize the existing resources and data to facilitate advancement in AMGs for environmental heat.
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Affiliation(s)
- Yuri Hosokawa
- Korey Stringer Institute, University of Connecticut, Storrs, CT, USA.
- College of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga, Japan.
| | - Douglas J Casa
- Korey Stringer Institute, University of Connecticut, Storrs, CT, USA
| | - Juli M Trtanj
- National Oceanic and Atmospheric Administration, Washington DC, USA
| | - Luke N Belval
- Korey Stringer Institute, University of Connecticut, Storrs, CT, USA
| | - Patricia A Deuster
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Sarah M Giltz
- National Oceanic and Atmospheric Administration, Washington DC, USA
- Louisiana Sea Grant, Louisiana State University, Baton Rouge, LA, USA
| | | | | | - Robert A Huggins
- Korey Stringer Institute, University of Connecticut, Storrs, CT, USA
| | - Brenda Jacklitsch
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - John F Jardine
- Korey Stringer Institute, University of Connecticut, Storrs, CT, USA
| | - Hunter Jones
- National Oceanic and Atmospheric Administration, Washington DC, USA
- University Corporation for Atmospheric Research, Boulder, CO, USA
| | - Josh B Kazman
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Mark E Reynolds
- U.S. Army Public Health Center, Aberdeen Proving Ground, Aberdeen, MD, USA
| | - Rebecca L Stearns
- Korey Stringer Institute, University of Connecticut, Storrs, CT, USA
| | - Jennifer K Vanos
- Scripps Institution of Oceanography Department, University of California San Diego, La Jolla, CA, USA
| | - Alan L Williams
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - W Jon Williams
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
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10
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Belval LN, Casa DJ, Adams WM, Chiampas GT, Holschen JC, Hosokawa Y, Jardine J, Kane SF, Labotz M, Lemieux RS, McClaine KB, Nye NS, O'Connor FG, Prine B, Raukar NP, Smith MS, Stearns RL. Consensus Statement- Prehospital Care of Exertional Heat Stroke. PREHOSP EMERG CARE 2018; 22:392-397. [PMID: 29336710 DOI: 10.1080/10903127.2017.1392666] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Exertional heat stroke (EHS) is one of the most common causes of sudden death in athletes. It also represents a unique medical challenge to the prehospital healthcare provider due to the time sensitive nature of treatment. In cases of EHS, when cooling is delayed, there is a significant increase in organ damage, morbidity, and mortality after 30 minutes, faster than the average EMS transport and ED evaluation window. The purpose of this document is to present a paradigm for prehospital healthcare systems to minimize the risk of morbidity and mortality for EHS patients. With proper planning, EHS can be managed successfully by the prehospital healthcare provider.
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Katch RK, Scarneo SE, Adams WM, Armstrong LE, Belval LN, Stamm JM, Casa DJ. Top 10 Research Questions Related to Preventing Sudden Death in Sport and Physical Activity. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2017; 88:251-268. [PMID: 28805553 DOI: 10.1080/02701367.2017.1342201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Participation in organized sport and recreational activities presents an innate risk for serious morbidity and mortality. Although death during sport or physical activity has many causes, advancements in sports medicine and evidence-based standards of care have allowed clinicians to prevent, recognize, and treat potentially fatal injuries more effectively. With the continual progress of research and technology, current standards of care are evolving to enhance patient outcomes. In this article, we provided 10 key questions related to the leading causes and treatment of sudden death in sport and physical activity, where future research will support safer participation for athletes and recreational enthusiasts. The current evidence indicates that most deaths can be avoided when proper strategies are in place to prevent occurrence or provide optimal care.
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