Transcript AHSAA Medical Issues

AHSAA
Middle/Junior High School
Conference
Sept 24, 2014
Marshall Smith Med, ATC, LAT
Sports Medicine Director
Southern Bone & Joint Specialist
Dothan Al
Athletic Health Related Issues
Emergency Action Plans
Heat Illness
Concussions
Hyponatremia
Emergency Action Plans
When an Emergency occurs it affects
more than just the people on the field or in
the school.
Emergency Action Plans
Required by the State of Alabama.
Required by AHSAA
Emergency Action Plans
Review Annually
New Building Additions
New Buildings
Office Relocations/Staff/Classrooms
Redesigned Fields/Stadiums
Gate Locations
Emergency Action Plans
AED’s
Know Locations
Boxes? Locked/ Alarms off-on
Batteries - need to be checked frequently
Pads- Check dates and proper sizes
Emergency Action Plans
Practice, Practice, Practice!!!
Who should be involved
Coaches
ATC’s
Student Athletic Trainers
EMS
School Administrators
Emergency Action Plans
Scenarios for Practice
Injured athlete on Game field
Injured athlete on Practice field
Injured athlete in Gym/ Basement
Injured Student in school/ classroom
Every scenario will have different issues
to overcome.
Emergency Action plans
Encourage your staff to introduce
themselves to the EMS staff at your
games.
New staff on EMS units
May never have worked an athletic event!
Athletic events are different than MVA’s
Heat Illness
Dehydration
Heat Cramps
Heat Exhaustion
Heat stroke
Dangerous Conditions
Heat Index – Know Temperature and
Humidity Level
Test Air with WBGT Heat Index Monitor
65-73
Moderate Risk
73-82 High Risk
82+
Very High Risk
Weather Bug App- Very Good
NOAA’s National Weather Service
Heat Index
Courtesy of NOAA’s National Weather Service www.nws.noaa.gov
Signs of Dehydration
Dry mouth
Thirst
Irritable or cranky
Headache
Bored or disinterested
Dizziness
Cramps
Excessive fatigue
Not able to keep up
Dark yellow urine
Other factors for Illness from
Heat
Low fitness levels
High body fat
Sickness
Previous dehydration or heat illnesses
Inadequate heat acclimatization
Salt deficiency
Medications/Dietary supplements
Serious Health Risks

1.
2.
3.

Dehydration Can Result In:
Heat Cramps
Heat Exhaustion
Heat Stroke
Recognize Warning Signs of Heat Illness
Heat Cramps
Are a mild heat illness that can be treated
easily.
Intense muscle spasms can develop after
exercising and losing large amounts of
fluid and salt from sweating.
Athletes who sweat a lot or have a high
concentration of salt may be more likely to
get heat cramps.
Heat Cramps

Signs/Symptoms



Intense pain
Persistent muscle contractions
Treatment



Hydration (sports drink and/or water)
Possibly extra sodium
Stretching, relaxation, massage
Heat Cramps
When can the athlete play again?
As soon as they are symptom free.
Important to continue to monitor.
May need to change eating and drinking
habits, become more fit, or get better
adjusted to the heat.
Heat Exhaustion
Is a moderate Heat Illness that occurs
when an athlete continues to be physically
active even after suffering from ill effects of
the heat.
The body struggles to keep up with the
demands, leading to heat exhaustion.
Heat Exhaustion

Signs/Symptoms






Loss of coordination, dizziness or fainting
Dehydration
Profuse sweating or pale skin
Headache, nausea, vomiting or diarrhea
Stomach/Intestinal cramps or muscle cramps
Treatment





Shade or air conditioned area
Remove excess clothing and equipment
Lie comfortably with feet above heart level
If not nauseous, rehydrate with water or sports drink
Monitor heart rate, blood pressure, CNS status and core
temperature
Heat Exhaustion
When can the athlete play again?
Should not be allowed to return until all
symptoms are gone.
Avoid intense practice in heat for a few
days.
If received medical treatment, not until
doctor approves and gives specific return
to play instructions.
Heat Stroke
Is a severe heat illness that occurs when
an athlete’s body creates more heat than it
can release, due to the strain of exercising
in the heat.
Results in rapid increase in core body
temperature.
Can lead to permanent disability or death.
Heat Stroke

Signs/Symptoms









Core body temperature 104°F+
CNS dysfunction
Nausea, vomiting or diarrhea
Headache, dizziness or weakness
Hot & wet or dry skin
Increased heart rate, decreased blood pressure or fast
breathing
Dehydration
Combativeness
Treatment



911
Aggressive whole-body cooling (cold water immersion)
Fans/ice/cold towels over much of the body if immersion is
not available.
Heat Stroke
When can an athlete play again?
When the doctor approves and gives
specific return to play instructions.
Parents should work with doctors to rule
out or treat other conditions that may
cause continued problems.
Should return very slowly under the
supervision of health care professional.
Prevention
Meet with prospective players and parents
to educate them.
Discuss pre-season conditioning program
Avoid mid-day heat
Take regular breaks in shade
Slowly increase practice time and intensity
Pre-participation physical
Emergency action plan
ATC on site if possible.
Activity Guidelines
A.
B.
C.
D.
5-10 minute rest & fluid break after 25-30 minutes of activity
5-10 minute rest & fluid break after 25-30 minutes of
activity/should be in shorts & t-shirt with helmet & should pads.
5-10 minute rest & fluid break after every 15-20 minutes of
activity/shorts & t-shirt only.
Cancel or postpone all outdoor practices. Practice in air
conditioned space.
Acclimation to Heat
Promote conditioning
Usually takes 10-14 days
Carefully observe athletes
Hydration
Encourage athletes to drink before, during and
after exercise
Take regular drink breaks in shade
Helpful Beverages: water and sports drinks with
adequate electrolytes
Harmful Beverages: fruit juice, CHO gels, soda,
sports drinks 8%+CHO, caffeinated drinks
Monitor Weight Loss
Athletes should weigh before and after
practice
Check weight charts
Up to 3 percent weight loss through
sweating is normal
Heat Illness
Prevention
Teach Nutrition
Teach Hydration
Instruction in Proper Pre-Game Meal
Education and Support
Korey Stringer Institute
CDC
What is a Concussion?
A traumatic injury that alters normal
brain function
It is a problem with function, not
structure: can’t see it or x-ray it
Any force applied to the body that
causes the brain to shift or rotate,
causing damage to brain cells that
results in chemical changes that
renders the brain vulnerable to
subsequent injury and may take
weeks to heal
What is a Concussion?
A common problem in ALL sports
Potential for serious complications including
death
Can even occur with a mild jolt or hit; Do not
have to lose consciousness- <10%
Occurs at all levels of play, but risk of serious
injury is more significant in adolescents
Trained medical personnel are not always
available to evaluate these injuries
Definition of Concussion
“Concussion is a brain
injury defined as a
complex pathological
process affecting the
brain…Featuring
pathologic and
biomechanical injury.”
Zurich,2012
Concussions
International Conferences on Concussions
in Sport:
Vienna 2001
Prague 2004
Zurich 2008
Zurich 2012
State Focus
AHSAA – Point of emphasis rule for 2010 for all
sports
“Any player who shows signs, symptoms or
behaviors of a concussion must be removed
from the game and shall not return to play until
cleared by an appropriate health care
professional (a medical doctor under AHSAA
rules)”
Previous rule stated athlete had to be
unconscious or apparently unconscious
State Focus Continued:
2011
Alabama Concussion Law
Any athlete who receives a concussion must
immediately be removed from play and not
be allowed to return until a doctor says its
safe and gives written permission
All youth sports programs and recreational
organizations must distribute information
sheets detailing the symptoms and risks of
concussion and other forms of traumatic
brain injury
State Focus Continued:
2011
Alabama Concussion Law
Athletes and their parents or guardians
must sign the information sheets
acknowledging they have read and
understand the material
Coaches must also receive annual training
on how to recognize concussion
symptoms and how to treat an athlete with
a concussion
Why Such a Concern in High
Schools
Adolescents are more vulnerable to
sustaining concussions and their brain
takes longer to heal after sustaining an
injury
Most high schools in Alabama do not have
a licensed certified athletic trainer or
physician available at all practices or
games so coaches are responsible for the
health and safety of their team
Common Signs and Symptoms
Physical







Headache
Nausea/Vomiting
Dizziness
Balance Problems
Visual Problems
Fatigue/Feeling Tired
Light & Noise
Sensitivity
 Numbness/Tingling
Cognitive
 Feeling mentally
foggy
 Feeling slowed down
 Difficulty
remembering
 Difficulty
concentrating
Common Signs and Symptoms
Emotional
Sleep
 Irritability
 Drowsiness
 Sadness
 Sleeping less than
 More emotional
usual
 Sleeping more than
usual
 Trouble falling asleep
 Nervousness
Using Concussion Clinical Trajectories to
Inform Targeted Treatment Pathways
Risk Factors
Concussion
Concussion
Clinical
Trajectories
Vestibular
Previous
Concussions
Migraine
Treatment and
Rehab
Pathways
Ocular
LD/ADHD
Cognitive
Sex
Migraine
Age
Anxiety/
Mood
Motion sensitivity,
Ocular Hx?
Cervical
New Advances in Concussion
Treatment
Vestibular and Ocular Motor Assessment
Balance Assessment
Recognize Balance Problems
BESS Test
(Balance Error Scoring
System)
University of North Carolina Sports Medicine Research
Laboratory Chapel Hill, NC 27599-8700
Vestibular and Ocular Motor
Assessment
Smooth Pursuits- H test
Saccades- Horizontal (eyes only)
Saccades – Vertical ( eyes only)
Convergence (near point) less than 8cm
VOR- Horizontal ( head with eyes)
VOR- Vertical ( head with eyes)
VMR- Horizontal ( body, head and eyes)
Headache, dizziness, nausea, fogginess
Comprehensive Assessment and
treatment Approach
NeuroCognitive
Physical
Exertion
Vestibular
Concussion
OcularMotor
Symptoms
Hyponatremia
Commonly referred to as a low level of
sodium in the blood.
Water Intoxication-without Na replacement
during strenuous exercise.
Can result from excess fluid in the body
relative to the normal amount of sodium,
or it may be due to a loss of sodium and
body fluid.
Hyponatremia
Symptoms may consist of:
Mental Changes- Confusion
Headache
Nausea
Tiredness
Muscle Spasms
Seizures
Vomiting
Hyponatremia
Mechanics of Hyponatremia
When the sodium levels in the blood are
low, water tends to enter cells causing
them to swell.
When this occurs in the brain it causes
Cerebral Edema. (Swelling in the Brain)
Causes increased pressure in the brain.
Only occurs in Severe cases
Hyponatremia
Treatment and Prevention
Treated with IV fluids and Electrolyte
replacements.
Gradual replacement of fluids during
exercise and following exercise.
Monitor diet and lifestyle
Gradual Hydration and Food intake prior to
athletic event and exercise to increase
sodium levels.
Thank You
Marshall Smith Med, ATC,LAT
Southern Bone & Joint Specialist
Dothan Al
[email protected]
Heat Stress and Athletic Participation. National Federation of State High School Associations.16
July 2008.
http:www.nfhs.org/web/2005/03/sports_medicine_heat_stress_and_athletic_participation.asp
How to Recognize, Prevent & Treat Exertional Heat Illnesses. National Athletic Trainers’
Association. 16 July 2008 http://www.nata.org/newsrelease/archives/000056.htm
Kendrick Fincher Memorial Foundation. 16 July 2008. http://www.kendrickfincher.org/index.htm
National Oceanic and Atmospheric Administration’s National Weather Service Heat Index. United
States Department of Commerce. Chart. 23 July 2008.
http://www.weather.gov/os/heat/index.shtml
Parents’and Coaches’ Guide to Dehydration and Other Heat Illnessess in Children. National
Athletic Trainers’ Association. June 2003.
http://www.nata.org/industryresources/heatillnessconcensusstatement.pdf.
Preseason Heat-Acclimatization Guidelines for Secondary School Athletics. Journal of Athletic
Training Volume 44 Number 3 June 2009. National Athletic Trainers Association
http://www.nata.org/jat
Recommendations for Hydration to Prevent Heat Illness. National Federation of State High
School Associations. 16 July 2008.
http://www.nfhs.org/core/contentmanager/uploads/heatstressflyers.pdf