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

November 21, 2018 by 1 Comment

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

Filed under General Interest, Journal Club Tagged with ,

Hot child in the city

August 26, 2016 by

tami

Tamara Hew-Butler on TruTV’s “Adam Ruins Everything”

My topic for today is not that glorious piece of 70’s bubble gum pop from Nick Gilder — no, it is a topic much more directly related to sports medicine.

It’s August and it is hot indeed, with a day here in Ohio set to be one of those classic 90/90 days (>90 F and > 90% humidity).  And it’s the first day of high school Friday night football, with middle school and Pop Warner following this weekend.   These are days we need to do all we can to prevent exertional heat illness (EHI), most especially in our children and adolescents.

In our zeal to prevent EHI, we must be careful not to overhydrate.  A year ago CJSM published the Third International Consensus Statement on Exercise Associated Hyponatremia and followed this up with a blog post and a podcast where we discussed the risks of overhydration with lead author, Tamara Hew-Butler.

The hashtag that came out of those discussions — #Drink2Thirst — spread over social media last year.  The concept is an important one, and one which remains controversial.  There are still many proponents of mandatory water breaks, or of drinking to a certain color of urine.  Others argue that while both are potentially life-threatening, the risk of EHI outweighs the risks of the much rarer condition of EAH — better to err on the side of overhydration they say.  On the other side, some note that hydration is pushed on athletes as something of a panacea, touted as helping to prevent exercise associated muscle cramping (EAMC) when the science argues against that concept.

Now, Adam Ruins Everything, on TruTV, has weighed in on the issue of overhydration in sports, with hilarious effect. And I see Adam has recruited Dr. Hew-Butler herself to debunk some of the hydration mythology and spread the mantra of #Drink2Thirst

Watch the video, and laugh.  Then check out some of the links in this post that will take you to the consensus statement and podcast and you’ll get more of the hard science from Dr. Hew-Butler.  It might change your thinking, and you may start translating some of this science to how you approach the athletes you manage.

Stay cool out there and #Drink2Thirst!

Filed under General Interest, Youth Sport Tagged with , , , ,

Football. Texas style.

August 4, 2015 by 1 Comment

grand prairie texas weather

It’s big–and HOT–in Texas.

The Lone Start state, in August.  Grand Prairie, Texas–next to Arlington, within sight of Cowboy Stadium (alright, so it’s officially AT&T stadium).  Deep in the heart and soul of American Football, that’s where my month began.

In addition to being an Associate Editor of CJSM, one of the hats I wear is as a Director sitting on the Board of a non-profit youth sport safety advocacy group, MomsTeam Institute. Yesterday, I participated in the group’s outreach to a youth football organization in Texas:  the Grand Prairie Youth Football Assocation (GPYFA).  The Chief Executive of MomsTeam, Brooke deLench, has organized a week long session to address issues of football and cheerleading safety; this week is preparatory to longitudinal work including injury surveillance to determine if certain interventions can lower injury rates in the 1000+ youth athletes participating in GPYFA sports.  Brooke has coined the term “SmartTeams, PlaySafe” to emphasize the important role education, knowledge transfer, and implementation can play in the world of youth sports.

Yesterday, I was one of a few individuals speaking to the coaches and parents of GPYFA.  My charge was to talk about preventing and identifying heat illness and overuse injuries, and review the pre-participation evaluation (PPE) with the assembled crowd.

s grand prairie hs weight room

The weight room in South Grand Prairie High School It’s superior to a lot of college facilities I have seen.

The venue was South Grand Prairie High School, a magnificent structure with a beautiful, large auditorium, and just around the corner a magnificent and huge weight room and indoor turf facility. Boy, they do things big in Texas, they really do.

As I prepared for this talk, I found myself time and again dipping into the CJSM well–on the subject of youth overuse injury, I leaned heavily on the AMSSM position statement from Di Fiori et al. published in the January 2014 CJSM. When I touched on the topic of Exercise-Associated Hyponatremia, I turned to the 3rd International Consensus Statement and the podcast I just conducted with lead author, Dr. Tamara Hew. The PPE?  Of course, I would consult the joint ACSM/FIMS statement (CJSM Nov. 2014) and the podcast I conducted with its lead author, Dr. William Roberts.

It does indeed excite me to share with you all the resources this journal has.  As an educator and public health advocate, as well as a clinician, I use CJSM in a very real and practical sense.  Day in, day out.

My time in Texas was brief, but MomsTeam’s work will continue.  I am hopeful that our work will help these children and their families navigate some of the risks that are associated with the many, many benefits of youth sports such as football and cheer.  For one, I hope my talk helps prevent any cases of exertional heat illness (EHI) in this group. The forecast for  this week in Grand Prairie has the thermometer hitting 106F (41C)!!!  At least I think the humidity on an August day in Texas may be a little bit less than that seen in, say, Qatar, site of the 2022 World Cup.

As I flew home, I read the recent Sports Illustrated story on the 25 anniversary of the release of the iconic book,’ Friday Night Lights.’  I mused on the importance of youth football not just in Texas, but in the United States in general.  With 3.5 million players age 6 – 13 in this country (CJSM 2013), the sport keeps a LOT of kids active.  With the season now upon us, let’s all keep working on making this sport, and all sports, safer for our young athletes.  With the work done in this and other journals of sports medicine, we’ll continue to generate the evidence to support the decisions that will further this cause.

 

Filed under General Interest, Injury Prevention, Youth Sport Tagged with , , , , , , ,

CJSM Podcast 10: Exercise-associated Hyponatremia, the 2015 Consensus Statement

June 29, 2015 by 2 Comments

jsm-podcast-bg-1#DrinkToThirst is the hashtag that needs to trend in the sports medicine world!

Exercise-associated hyponatremia (EAH), a preventable and treatable but potentially life-threatening condition that can affect athletes under our care, is the topic of our tenth podcast.  And #DrinkToThirst is one of the chief themes to be found therein.

We’re proud to publish the 3rd international consensus statement on EAH in our July 2015 CJSM, and we’re delighted to have the lead author as our guest on the associated podcast.

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Dr. Hew-Butler and friend.

Dr Tamara Hew-Butler is an associate professor of Exercise Science at Oakland University in Rochester, MI. She obtained her: BS in Kinesiology at the University of California at Los Angeles, CA; Doctor of Podiatric Medicine (DPM) at Temple University in Philadelphia, PA; Residency and Fellowship at the Harris County Podiatric Surgical Residency Program, Houston, TX; and Philosophy Doctor (PhD) at the University of Cape Town, South Africa. Dr Hew-Butler is a Fellow of the American College of Sports Medicine (FACSM) and specializes in both sports medicine and exercise physiology. Her expertise is in exercise-associated hyponatremia and the endocrine regulation of fluid balance during exercise. She trained under Timothy D. Noakes MD, DSc and Joseph G. Verbalis MD and has published ~50 papers on the topic.

Join us in the rousing conversation, and learn i) why athletes should #DrinkToThirst; ii) why sidelines should have hypertonic saline as well as AEDs and access to cold-water immersion therapies; iii) and so much more.

Filed under CJSM Podcasts, General Interest, Injury Prevention, Patient Education, Public Health in Sports and Exercise Medicine, Safeguarding in Sport Tagged with , , , ,

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