rectally) is below 104°F, and athletes generally con-
tinue to sweat to dissipate heat. Management includes
removal from participation, removal of helmet and
padding, external cooling measures (cool water immer-
sion, fanning), and intravenous(IV) fluids. Resolution
of associated symptoms, normal hydration status, and
restoration of baseline body weight are necessary prior
to resumption of physical activity.- Heat stroke is defined as core body temperature in
excess of 104°F coupled with central nervous system
dysfunction characterized by disorientation, confu-
sion, personality change, and even coma. Although
the pathophysiology of classic heat stroke includes
absence of sweating, athletes with exertional heat
stroke may sweat profusely, an important fact to be
remembered by care providers. - Heat stroke is a medical emergency requiring immedi-
ate cooling measures such as ice bath immersion and
immediate activation of the emergency medical system
for rapid transport to a hospital setting where additional
aggressive cooling measures may be employed.
Consequences of heat stroke may include irreversible
brain damage, renal failure, rhabdomyolysis, and death. - Stimulant supplements such as ephedra and ma huang
have been implicated in precipitating heat stroke and
death in highly competitive athletes. Their detrimental
effects are the result of sympathomimetic activity and
resultant vasoconstriction during activities which
require vasodilation for appropriate heat management. - Football players must have free access to water.
Sixteen to twenty ounces of fluid should be con-
sumed 20–30 min prior to activity, and access to
water should be ensured throughout the sporting
activity. Thirst is a poor measure of hydration status,
so athletes must consume fluids regularly during
activity regardless of their sense of need to drink.
Diet can be utilized to ensure adequate salt and elec-
trolyte replacement, which will aid in overall water
balance. Daily weights should be monitored to screen
for subclinical dehydration, and participation should
be precluded for athletes who are greater than 1–2%
below their preexercise baseline weight. Appropriate
guidelines for practice duration and attire should be
based on wet bulb globe temperature(WBGT), which
accounts for the heating effects of temperature,
humidity, and intensity of sunlight exposure.
SUDDEN CARDIAC DEATH
- Sudden cardiac death in football players is a rare but
devastating occurrence. The primary causes of non-
traumatic death in athletes include hypertrophic car-
diomyopathy, malignant cardiac arrhythmias, heat
stroke, asthma, and complications of sickle cell
anemia. Screening measures should focus on the iden-
tification of such potential conditions or a familial
predisposition to them, accepting that such screening
methods at present are limited in their yield.CREATINE- Creatine is a natural product of muscle metabolism.
Its use as a supplement for aiding muscle mass and
power development has become widespread, particu-
larly in football athletes. At present, it is generally
considered to be safe. - Studies in collegiate football players have shown that
low and high dose creatine supplementation results in
significant positive changes in strength, body weight,
body composition, lean body mass, and anaerobic
muscle endurance and power versus placebo (Wilder
et al, 2002; Bemben et al, 2001). There were no differ-
ences between the high and low dose creatine groups. - Creatine use at the high school level is widespread,
estimated at up to 50% in the athlete population
(McGuine, Sullivan, and Bernhardt, 2001). Use was
highest in smaller schools and at higher grade levels.
Enhanced recovery following a workout was the most
common reason cited for use.
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Sports Med 28(5):643–650, 2000.496 SECTION 6 • SPORTS-SPECIFIC CONSIDERATIONS