Exertional Heat Stroke in Athletes
Keywords:exertional heat stroke, heat illness, heat stress, thermoregulation, hyperthermia.
AbstractExercising in hot and especially humid environment can cause rise in body core temperature to such a critical level that it does not only reduce performance, but also may ultimately lead to exertional heat stroke (EHS). This illness is true medical emergency that can result in significant morbidity and mortality, if not early recognized and promptly treated. Diagnostic criteria for EHS are body core temperature above 40ÂºC and central nerve system dysfunction. Any athlete experiencing such symptoms should be immediately exposed to aggressive cooling treatment aimed to lower the elevated core temperature to near normal as quickly as possible. Ice water immersion is highly recommended as a cooling method because it provides the fastest cooling rates and is associated with lowest mortality rates. Athletes cooled rapidly soon after the onset of EHS usually recover without complications and are able to return to normal training in hot environment within a few weeks. EHS is also a preventable condition, and its occurrence can be minimized by implementing a few simple measures.
Casa DJ, Armstrong LE. Exertional heatstroke: a medical emergency. In: Armstrong LE, editor. Exertional Heat Illnesses. Champaign, IL: Human Kinetics. 2003:29â€“56.
Simon HB. Hyperthermia. N Engl J Med. 1993;329(7):483-7.
Armstrong LE, Casa DJ, Millard-Stafford M, Moran DS, Pyne SW, Roberts WO. American College of Sports Medicine position stand. Exertional heat illness during training and competition. Med Sci Sports Exerc. 2007;39(3):556-72.
Binkley HM, Beckett J, Casa DJ, Kleiner DM, Plummer PE. National Athletic Trainers' Association Position Statement: Exertional Heat Illnesses. J Athl Train. 2002;37(3):329-343.
Casa DJ, Armstrong LE, Kenny GP, O'Connor FG, Huggins RA. Exertional heat stroke: new concepts regarding cause and care. Curr Sports Med Rep. 2012;11(3):115-23.
Roberts WO. Exertional heat stroke: life-saving recognition and onsite treatment in athletic settings. Rev Bras Med Esporte. 2005;11(6):329-31.
Howe AS, Boden BP. Heat-related illness in athletes. Am J Sports Med. 2007;35(8):1384-95.
Barrow MW, Clark KA. Heat-related illnesses. Am Fam Physician. 1998;58(3):749-56.
Coris EE, Ramirez AM, Van Durme DJ. Heat illness in athletes: the dangerous combination of heat, humidity and exercise. Sports Med. 2004;34(1):9-16.
Lugo-Amador NM, Rothenhaus T, Moyer P. Heat-related illness. Emerg Med Clin North Am. 2004;22(2):315-27.
Hubbard RW, Armstrong LE. The heat illness: biochemical, ultrastructural, and fluid-electrolyte considerations. In: Pandolf KB, Sawka MN, Gonzalez RR, editors. Human Performance Physiology and Environment Medicine at Terrestrial Extremes. Indianapolis. Benchmark Press; 1988:305-359.
Bergeron MF. Heat cramps during tennis: a case report. Int J Sport Nutr. 1996;6(1):62-8.
Knochel JP. Heat stroke and related heat stress disorders. Dis Mon. 1989;35(5):301-77.
Bouchama A, Knochel JP. Heat stroke. N Engl J Med. 2002;346(25):1978-88.
Yeo TP. Heat stroke: a comprehensive review. AACN Clin Issues. 2004;15(2):280-93.
Yaqub B, Al Deeb S. Heat stroke: aetiopathogenesis, neurological characteristics, treatment and outcome. J Neurol Sci. 1998;156(2):144-51.
Brewster SJ, Oâ€™Connor FG, Lillegard WA. Exercise-induced heat injury: diagnosis and management. Sports Med Arthrosc. 1995;3(4):260-6.
Cleary M. Predisposing risk factors on susceptibility to exertional heat illness: clinical decision-making considerations. J Sport Rehabil. 2007;16(3):204-14.
Epstein Y. Heat intolerance: predisposing factor or residual injury? Med Sci Sports Exerc. 1990;22(1):29-35.
Epstein Y, Moran DS, Shapiro Y, Sohar E, Shemer J. Exertional heat stroke: a case series. Med Sci Sports Exerc. 1999;31(2):224-8.
Armstrong LE, De Luca JP, Hubbard RW. Time course of recovery and heat acclimation ability of prior exertional heatstroke patients. Med Sci Sports Exerc. 1990;22(1):36-48.
Seth P, Juliana P. Exertional heat stroke in a marathon runner with extensive healed deep burns: a case report. Int J Emerg Med. 2011;4:12.
Casa DJ. Donâ€™t gamble: complex considerations regarding return to play following exertional heat stroke. J Sport Rehabil. 2007;16(3):161-2.
McDermott BP, Casa DJ, Yeargin SW, Ganio MS, Armstrong LE, Maresh CM. Recovery and return to activity following exertional heat stroke: considerations for the sports medicine staff. J Sport Rehabil. 2007;16(3):163-81.
Oh RC, Henning JS. Exertional heatstroke in an infantry soldier taking ephedra-containing dietary supplements. Mil Med. 2003;168(6):429-30.
Roberts WO. Managing heatstroke: on-site cooling. Phys Sportsmed. 1992;20(5):17â€“28.
Sandor RP. Heat illness: on-site diagnosis and cooling. Phys Sportsmed. 1997;25(6):35â€“40.
Shapiro Y, Seidman DS. Field and clinical observations of exertional heat stroke patients. Med Sci Sports Exerc. 1990;22(1):6-14.
Casa DJ, Becker SM, Ganio MS, Brown CM, Yeargin SW, Roti MW, Siegler J, Blowers JA, Glaviano NR, Huggins RA, Armstrong LE, Maresh CM. Validity of devices that assess body temperature during outdoor exercise in the heat. J Athl Train. 2007;42(3):333-42.
Roth RN, Verdile VP, Grollman LJ, Stone DA. Agreement between rectal and tympanic membrane temperatures in marathon runners. Ann Emerg Med. 1996;28(4):414-7.
Holtzhausen LM, Noakes TD. Collapsed ultraendurance athlete: proposed mechanisms and an approach to management. Clin J Sport Med. 1997;7(4):292-301.
Blue JG, Pecci MA. The collapsed athlete. Orthop Clin North Am. 2002;33(3):471-8.
Garigan TP, Ristedt DE. Death from hyponatremia as a result of acute water intoxication in an Army basic trainee. Mil Med. 1999;164(3):234-8.
Armstrong LE. Exertional hyponatremia. In: Armstrong LE, editor. Exertional Heat Illnesses. Champaign, IL: Human Kinetics; 2003:103â€“135.
Assia E, Epstein Y, Shapiro Y. Fatal heatstroke after a short march at night: a case report. Aviat Space Environ Med. 1985;56(5):441-2.
Hadad E, Rav-Acha M, Heled Y, Epstein Y, Moran DS. Heat stroke: a review of cooling methods. Sports Med. 2004;34(8):501-11.
Shapiro Y, Rosenthal T, Sohar E. Experimental heatstroke. A model in dogs. Arch Intern Med. 1973;131(5):688-92.
Harker J, Gibson P. Heat-stroke: a review of rapid cooling techniques. Intensive Crit Care Nurs. 1995;11(4):198-202.
Costrini A. Emergency treatment of exertional heatstroke and comparison of whole body cooling techniques. Med Sci Sports Exerc. 1990;22(1):15-8.
Roberts WO. Tub cooling for exertional heatstroke. Phys Sportsmed. 1998;26(5):111-2.
Armstrong LE, Crago AE, Adams R, Roberts WO, Maresh CM. Whole-body cooling of hyperthermic runners: comparison of two field therapies. Am J Emerg Med. 1996;14(4):355-8.
Hadad E, Moran DS, Epstein Y. Cooling heat stroke patients by available field measures. Intensive Care Med. 2004;30(2):338.
Moran DS, Erlich T, Epstein Y. The heat tolerance test: an efficient screening tool for evaluating susceptibility to heat. J Sport Rehabil. 2007;16(3):215-21.
Hargreaves M, Febbraio M. Limits to exercise performance in the heat. Int J Sports Med. 1998;19 Suppl 2:S115-6.
Hargreaves M. Physiological limits to exercise performance in the heat. J Sci Med Sport. 2008;11(1):66-71.
Hasegawa H, Takatori T, Komura T, Yamasaki M. Combined effects of pre-cooling and water ingestion on thermoregulation and physical capacity during exercise in a hot environment. J Sports Sci. 2006;24(1):3-9.
How to Cite
All rights reserved.