Microsoft powerpoint - 2006 sports medicine in open water swimming.ppt

Sports Medicine in Open Family Practice and Sports Medicine Richmond, Virginia National Team Physician 1996 – present Chair Asthma and Diabetes Task Forces Member IAQ Task Force Doping Control Officer Chair, FINA Medical Congress 2004

Open Water – the Challenges • Water – "It's alive!" • "Things are swimming in • Water – "It's too cold!" • Water – "It's too hot!" • "Something touched me!" • Water – "It's moving!" • "Feeding? What is that?" • Water – "I cannot see • "What kind of food?" • "I cannot see the finish • Water – "Something is • "I got sand on me!"

• Convection – The transfer of heat from the movement of air or water across the body when the temperature of the water/air is cooler or warmer than the • Evaporation – the conversion of liquid to gas, as best demonstrated by sweating.
• Radiation – The heat transfer from electromagnetic waves either to or from the body to an object that is not in direct contact with the body, e.g. sunshine.
• Conduction – The transfer of heat from a warmer to a cooler object that are in direct Note that many of these are often in combination increasing the impact on the athlete.
Hypothermia – Mild (Two Levels of Severity) • Shivering and impairment • Shaking, shivering, mild to perform coordinated impairment of central nervous system with slow • Basic treatment: Simple thinking and speech re-warming by blankets (solar) and removal from • Basic Treatment: Same the exposure (can wrap as prior but will take in towels and cover with longer to reverse. sand if removal is not Consider warm shower and watch closely.
Hypothermia – Moderate • Shivering slows down and • Prevention of further heat stops, with profound slowing of mental maneuvers as prior. No function. Confusion may aggressive re-warming include hallucinations and attempts since this results paradoxical undressing. in shunting cold blood Muscle rigidity with jerky into the core and may motions, irregular heart further drop the core temperature. Evacuate, where warmed IV's, etc. will be considered.
Hypothermia – Severe • Coma, falling blood • Time is of the essence and this is a true threatening cardiac emergency. Evacuate and protect from further heat loss.
Hyperthermia – Heat Edema • Swelling of hands and • Resolves spontaneously over several days of acclimatization unless there are problems with renal function or there are medications being used for underlying • See ‘Acclimatization' Hyperthermia – Heat Syncope • Dizziness to the point • Supine position with of fainting in the legs elevated, cool (not iced) liquids and athlete. This shows resting in a cool up typically when the athlete stands up • See ‘Acclimatization' quickly, usually in a state of dehydration.
Hyperthermia – Heat Cramps • Painful muscle cramps • Rehydration and attention to electrolytes, and massage. If unsuccessful be attentive to sodium content in blood as well as other electrolytes.
• See ‘Acclimatization' Hyperthermia – Heat Exhaustion • Fatigue, weakness, • See prior recommendations uncoordination, mild • Protection from further confusion, agitation, headache, sweating, nausea, vomiting, • Spray with lukewarm water in diarrhea, muscle pain with a setting of cooling fans, cool oral rehydration.
• Body temp (core) is less than • Removal to an emergency facility where advanced treatment is available and hyponatremia can also be Hyperthermia – Heat Stroke • Dry – Skin is dry and very • Medical emergency warm with profound confusion, necessitating immediate loss of coordination and other transfer to an emergency CNS symptoms including facility. There gradual central seizures, coma, hallucinations.
cooling will be conducted with • Wet – Less common with attention to potential damage profuse sweating – otherwise to cardiac, CNS, renal, gastrointestinal, hematological, Hyponatremic Collapse • Long distance events • Medical emergency that typically with loss of cannot be evaluated or central nervous system treated at the site – function, ranging from transport immediately! decreased coordination • Water intoxication and and verbal capacity to acclimatization are frequently at the center of this medical event, though other underlying medical conditions have to be considered.
All athletes vary in their ability to tolerate cold or heat; thus their duration of accommodation varies. This can also be affected by medications or underlying medical issues.
• Layered swim caps (competition rules) • Lanolin and other coating (helps impact but does not change heat loss) • Temperature of liquids consumed before and during the competition/training • Exposure to high salinity – nausea, vomiting (electrolytes), swelling of face and tongue • Prevention: Use SPF of 40 or more (debate re: how much difference there is above 40) applied every 4 hours with some exception of Bullfrog and Zinc Oxide (attention to PABA sensitivity) • Basic Treatment: Avoidance of further injury via sunscreens and application of lubricants including 100% Aloe and Lanolin. True sun poisoning results in needing oral steroids and will eliminate the athlete from competition.
• Not uncommon due to the intensity of the sun as well as reflection off of the water with frequent sighting.
• Symptoms: Tearing and burning• Avoidance: Mirrored goggles• Basic Treatment: Liquid tears without Chafing is set up by prolonged exposure to water, salt, and the variable stroke patterns caused by wave action. Variances in stroke inherent with the athlete can be an underlying risk. It is a true laceration, prone to infections with all the complications.
• Common sites: suit lines, • Prevention: Lubricants shoulder (caused by such as lanolin, Vaseline, breathing patterns), arm Body Glide, Bag Balm, pit, inner thighs, back of etc. (Applied by staff, • Basic Treatment: Topical antibiotics that have anti- Staph activity and further protection (avoid NeoSporin, try Bactroban) Critters that Bite and Sting! Things that Float Examples: Jelly fish, Portuguese Man-O-War, Sea lice • Symptoms: Localized pain, • Basic Treatment: Spray with searing in nature, potentially White Vinegar as soon as producing a neuropathy, possible. Also may consider nausea, vomiting, hives, Adolph's meat tenderizer. Do localized red spots (Sea lice not rub the site, since this will are not imbedded!).
release more of the contents of the imbedded darts.
• Sea lice: Lightly apply rubbing • Severe life threatening allergic reactions: Epi Pen, which will result in disqualification of the Critters that Bite and Sting • Consider the expected (sharks, rays, and turtles) but also anything that is brightly colored ex. Lion Fish • Cardinal Rule #1 If it swims up to you, it is not afraid of you! That is a bad thing!! • Cardinal Rule #2 If it is brightly colored, it has no reason to hide! This is also a Critters that Bite and Sting ……….and one more to worry about……….
Critters that Bite and Sting Things that Slither and Crawl Ex. Sea snakes, venomous shells, octopus (spotted) • Cardinal Rule #3 – If it is pretty – Do not • Cardinal Rule #4 – If it is a shell - Somebody is probably at home.
• Basic Treatment: All bites from anything in this category requires emergency treatment at a medical facility.
Critters that Bite and Sting Things that Sit Still • Symptoms: Burning and stinging with a localized rash and hives • Basic Treatment: Like jellyfish stings, the mechanism of injected barbs is similar, thus treatment with sprayed white vinegar and avoidance of rubbing The topic of feeding during races can raise medical issues such s what, when, and how often. There are as many theories as to the best approach as there are athletes and coaches but some basic principles apply to all.
• Rule #1 – The longer the race, the more frequently the athlete should feed to sustain ‘fuel in the tank'. Frequencies of every 15 – 20 minutes are not uncommon.
• Rule #2 – The longer the race, the earlier the athlete should feed.
• Rule #3 – Plan the feeding what, where and how, remembering the 3 G's.
• Rule #4 – Use timed intervals for feeding not demand intervals. Once the athlete knows that they need food or water it is too late.
• Rule #5 – The fuel that you consume will not be available immediately. Thus, plan the sequence of feedings i.e. carbs early in the race with more water later. Some athletes prefer their carbs in gel or solid forms.
• Rule #6 – Practice feeding! The athlete needs to be accustomed to taking in nutrition during practice/races as well as working with feeding techniques with a feeding extension device. The feeding station may be a dock or boat (stationary • Rule #7 The athlete selects the flavors and brings them to the competition.
• Rule #8 The temperature of the fluids is a mirror image of the environmental temperature. • Rule #9 Nothing replaces proper hydration and nutrition prior to the start of the race. If the fuel tank is low prior to the start you cannot catch up to your needs during the race.
• Rule #10 - Coaches may not consume the nutrients until the athlete is finished! Thank you for your attention! I would like to thank all of the trainers and coaches that I have traveled with over the years. A considerable amount of this presentation is from all that I have learned fro them. Every trip has been a give and take of information that is constantly changing as open water swimming moves to the forefront as a new Olympic event.



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