CJSM Blog Journal Club — Can Cold IV Saline Mitigate the Effects of Exertional Heat Illness?

Can cooling this down prevent the sequelae of EHI? Photo courtesy of Wikimedia, NIAID

It’s November, and our sixth and final edition of 2018 has just published.  One of the original research articles in this edition is: Effects of Intravenous Cold Saline on Hyperthermic Athletes Representative of Large Football Players and Small Endurance Runners. 

Our Jr. Assoc. Editor Jason L Zaremski, MD  is today reprising his role as guest author for the CJSM blog journal club  and will take us through his read of the study.  Join in the conversation over this important new, original research by reading the article and the blog post below.  As ever, we love your comments:  you may give them here on the blog or Tweet them to us at @cjsmonline.

We’re nearing the end of 2018.  As the Journal publishing crew gets ready to celebrate Thanksgiving, we want to thank you for visiting us on this blog and reading and contributing to CJSM.

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Jason Zaremski, MD

Introduction:  The winter Journal Club commentary for the Clinical Journal of Sports Medicine (CJSM) will be a review of an original research manuscript highlighting an alternative method for treating exertional heat illness (EHI). As many of us in the sports medicine community are fully aware, EHI is a potentially devastating pathophysiological process that is treatable if timely and efficient action is taken.  Speed is of the essence. Heat stroke, a type of EHI where core body temperature is greater than 40°C/104°F, can result in significant central nervous system morbidity, and even death, if not treated immediately.

Morrison and colleagues performed a novel study assessing the effects of intravenous cold saline (IVCS) on hyperthermic collegiate football players and cross country runners. As the authors note, the use of cold saline infusion has not been studied for its effects on hyperthermic athletes, though it has been studied for rapid cooling for patients who have had cardiovascular and/or neurological insults in order to induce “therapeutic hypothermia.”

Purpose/Specific Aim(s):  To evaluate the cooling effects of IVCS (4°C/39°F) on hyperthermic athletes and compare to the effects of room temperature normal saline (RTNS) (22°C). A secondary aim was to assess if body composition had an effect on IVCS cooling rates.

Methods/Design: Read more of this post

Musings Post Sports Medicine New Zealand 2018 Conference

Dr. Hamish Osborne (standing, far left) at Pan Pacific Masters Games

Our Associate Editor Hamish Osborne MB ChB FACSP is a member of the Australasian College of Sport and Exercise Physicians (ACSEP).  CJSM relies on Dr. Osborne for a lot!  He has been a lead author on important studies CJSM has published, been a guest on our podcast series, and plays an invaluable role keeping the journal and its readers abreast of sport medicine developments in New Zealand and Australia.

We asked him to share his thoughts about the recent Sports Medicine New Zealand Conference that took place at the end of October.  He would have filed this report sooner, we’re sure, except for the fact he had to jet off right after the conference to participate in the Pan Pacific Masters Games which just wrapped.

So, we share with you our ever-intrepid editor, physician, athlete and Tweeter, Dr. Hamish Osborne:

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So I’m sitting @DunedinAirport in the @FlyAirNZ lounge on my way to the Gold Coast for the @PanPacMasters Games to put into action some of the swim skills @Karlynswim Pipes taught me in Kona a few weeks ago at the @IRONMANtri Sports Medicine Conference. My wife Jules Osborne, who coaches @HPSportNZ Allied health medical staff in motivational interviewing, is already there playing basketball with @ACSEP_ CEO Kate SImkovic (@hoover22). Hoove is great on the rebounds hence the handle. They are 2/2 so far so keep going team.

This morning I got to use what we learned at last week’s @Sportsmednz Conference. It has been a challenge for several years counselling young athletes with fresh ACL tears – you know the stuff – only 60% actually return to pivoting sport and the operation is no better than no operation just we don’t know how to decide whether you should have an operation – the consultation all goes well and they come back next time saying their coach/friend/sister/dog walker had an ACL recon and so they want one. Well – I had never heard of Prof Lynn Snyder-Mackler @doclsmack or her work. A decade of worldwide literature shows the return to sport rates after ACLR are not much better than the chance of predicting a US election* really no matter what sport, what level or country it’s from. Lynn’s research is more than 10% better than that AND she has published it. Not only does she have a pre op pathway that improves outcomes, she has a post op pathway that smashes everyone else’s results and makes us look like amateurs. I got to use it this morning and I must say it made for a much better consultation than what I used pre conference. #Loveaconferencethatchangesmypractice!!

It was also great to see my Canadian friend Dr Alan Vernec again.  I met him for the first time (but felt like I knew him from Prof David Gerrard talking about him) at Mt Tremblant @CASEMACMSE Conference in 2017. What a debate we had with him, David ( who is chair @wada_ama TUE Committee), A/Prof @LynleyAnderson  (author @ACSEP_ code of conduct) and Dr Peter Burt who is doing his PhD on the ethically challenging situations sports docs end up in @Otago University.

So back to my preparations; I stopped cramming my fitness Monday and tapered this morning. I’m rehydrating on a small glass of world famous New Zealand Sauvignon Blanc and they just called my flight.

Hope to see you all #DownUnder in New Zealand next year. You have a great choice – the ACSEP_ conference is in Queenstown in February 2019 and the next Sports Medicine New Zealand Conference is in Dunedin 1-2 November 2019 to coincide with the 150th Anniversary Celebrations  of Otago University

Swim fast, advise well, don’t dope and vote!

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Thank you Dr. Osborne.  Regarding several of the important points you brought up:

  1. Definitely circle the ACSEP conference on your calendars for 8 -10 February 2019 in Queenstown!
  2. Dr. Lynne-Sackler’s work on post-ACL injury rehab (for conservative or surgical treatment) is among the programs evaluated in this review of ACL Rehab Programs.
  3. * And regarding this point:  the quoted ‘odds’ of the Democrats’ winning the 2016 USA election were 85%, those facing an NFL goal-kicker kicking from the 37-yard line. Did anyone else watch Mason Crosby’s cringe-worthy kicking performance a few weeks ago?  As a Packers’ fan, I, for one, will never again take a 37 yard field goal for granted (or, for that matter, put much stock in election predictions!).

Dr. John Orchard on pain management in elite athletes: The CJSM Podcast

Dr. John Orchard, Chief Medical Officer of Cricket Australia (and so much more)

The September 2018 CJSM is a thematic issue on an issue of central importance in sport and exercise medicine:  the management of pain in the athletes we serve.

Many authors contributed to this special issue, with only a few more prolific than our guest on today’s podcast: John Orchard MBBS BA PhD MD.  Dr. Orchard was a contributing author on three of the original articles included in this issue:

Dr. Orchard is a wonderful interview, and so I hope you get to listen in — as ever you can go to our journal website to find all of our podcasts or to iTunes. We covered a lot of ground in a short time during our conversation.  Among the stories Dr. Orchard shared with me was one of immediate relevance:  that of Cooper Cronk, rugby league player in the NRL played in that league’s Grand Finale with a fractured scapula (and a local anesthetic injection).

The readers of this blog and the listeners of the podcast should all know that Dr. Orchard is also a wonderful tweeter — one of our profession’s most important ‘follows’ I think. I you don’t already have him on your Twitter list, please find him @DrJohnOrchard and remedy that situation!

Thanks for following us here on the blog, on the podcast, and on our journal’s website.  As ever we appreciate your feedback, and we’d ask you specifically to comment on the podcast on iTunes if you are willing.  We are always interested in improving our content.

Marijuana and Athletic Performance: Help or Hindrance? The CJSM Podcast

In our newest CJSM podcast we tackle the controversial issue of marijuana in sports.

The September 2018 thematic issue, on the management of pain in athletes, includes many unique contributions to this important body of literature.  Indeed, it almost goes without saying that almost all patients I see in my clinic on a daily basis have, as part of their presenting condition, a complaint of pain.  I suspect this is true for you, too. Pain management is one of the most common issues we deal with as sports medicine clinicians.

One of those newly published studies is Cannabis and the health and performance of the elite athlete — it is an excellent discussion about many dimensions of this drug and its varied uses among elite athletes.  Among the conclusions the authors make: “The potential beneficial effects of cannabis as part of a pain management protocol, including reducing concussion-related symptoms, deserve further attention.”

A logical question, when considering use of this drug in the athlete, might be:  what are the potential negative side effects?  Or, for that matter, are there ergogenic effects with which we must be concerned?

In our July 2018 journal, a group of authors tackled these issues in a systematic review on marijuana and its effects on athletic performance.

Mr. Dion Diep, McMaster University

The corresponding author of the study, Dion Diep, is a medical student at McMaster University in Hamilton University.  He was able to join us for a podcast discussion of what his team found.  Mr. Diep is our first medical student guest on the podcast, and based on his erudite performance I would say he has a stellar career ahead, as a clinician and a researcher.

We cover a lot of ground in a short time in this podcast.  Can marijuana enhance athletic performance?  What negative effects does it have?  May it show promise as a targeted treatment of various athletic maladies, such as anxiety?  What is the rational for having marijuana on the WADA banned substances list?

As ever you can find this podcast, and all our podcasts, on our journal website as well as iTunes, where you are invited to subscribe to the podcast and ensure you get direct delivery of every new edition of this growing audio library.

When you’re done listening to the podcast and reading the studies, take the time to take the poll and consider leaving a comment here on the blog or on the iTunes link. We’re always looking to hear from you — your contribution to the global conversation on clinical sports medicine is invaluable, and your feedback will help us continuously improve what we share with you.

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Marijuana and Its Effects on Athletic Performance: A Systematic Review

Cannabis and the Health and Performance of the Elite Athlete

 

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