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Stephanie M. Mazerolle, Susan W. Yeargin, Tutita M. Casa and Douglas J. Casa

Edited by Shane Caswell

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Douglas J. Casa, Yuri Hosokawa, Luke N. Belval, William M. Adams and Rebecca L. Stearns

Exertional heat stroke (EHS) is among the leading causes of sudden death during sport and physical activity. However, previous research has shown that EHS is 100% survivable when rapidly recognized and appropriate treatment is provided. Establishing policies to address issues related to the prevention and treatment of EHS, including heat acclimatization, environment-based activity modification, body temperature assessment using rectal thermometry, and immediate, onsite treatment using cold-water immersion attenuates the risk of EHS mortality and morbidity. This article provides an overview of the current evidence regarding EHS prevention and management. The transfer of scientific knowledge to clinical practice has shown great success for saving EHS patients. Further efforts are needed to implement evidence-based policies to not only mitigate EHS fatality but also to reduce the overall incidence of EHS.

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Craig A. Williams

In my 2015 editorial, I selected two research publications with a focus on an applied sports sciences perspective. This year I have chosen to focus on two publications from a methodological viewpoint, highlighting the importance of laboratory procedures and extraction of data through a systematic review respectively. The first publication by Leites and colleagues (J Appl Physiol) addresses questions in relation to thermoregulation and carbohydrate metabolism in young people. This topic is difficult to conduct due to additional ethical and safety concerns due to exercising in the heat. Nonetheless, there are important basic science questions to be answered. Using a range of measurement techniques including rectal thermometry, 13C-enriched carbohydrate isotopes and procedures to standardize the heat stress equally between a group of men and boys, this project demonstrates an exemplary range of experimental skills. In my second selected paper by Lesinski et al., (Brit J Sports Med), both a systematic review and a meta-analyses were conducted to investigate the dose-response relationships of resistance training on physical performance in youth athletes. As the requirement for more evidence based practice is demanded, the move away from a narrative review to a more methodological and rigorous approach is to be encouraged. It is, in my opinion, a skill that we should be encouraging all our early career pediatric researchers to learn from the outset, the outcome of which can only make our discipline stronger.

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William M. Adams, Yuri Hosokawa, Robert A. Huggins, Stephanie M. Mazerolle and Douglas J. Casa

Context:

Evidence-based best practices for the recognition and treatment of exertional heat stroke (EHS) indicate that rectal thermometry and immediate, aggressive cooling via cold-water immersion ensure survival from this medical condition. However, little is known about the recovery, medical follow-up, and return to activity after an athlete has suffered EHS.

Objective:

To highlight the transfer of evidenced-based research into clinical practice by chronicling the treatment, recovery, and return to activity of a runner who suffered an EHS during a warm-weather road race.

Design:

Case study.

Setting:

Warm-weather road race.

Participant:

53-y-old recreationally active man.

Intervention:

A runner’s treatment, recovery, and return to activity from EHS and 2014 Falmouth Road Race performance.

Main Outcomes:

Runner’s perceptions and experiences with EHS, body temperature, heart rate, hydration status, exercise intensity.

Results:

The runner successfully completed the 2014 Falmouth Road Race without incident of EHS. Four dominant themes emerged from the data: predisposing factors, ideal treatment, lack of medical follow-up, and patient education. The first theme identified 3 predisposing factors that contributed to the runner’s EHS: hydration, sleep loss, and lack of heat acclimatization. The runner received ideal treatment using evidence-based best practices. A lack of long-term medical care following the EHS with no guidance on the runner’s return to full activity was observed. The runner knew very little about EHS before the 2013 race, which drove him to seek knowledge as to why he suffered EHS. Using this newly learned information, he successfully completed the 2014 Falmouth Road Race without incident.

Conclusions:

This case supports prior literature examining the factors that predispose individuals to EHS. Although evidence-based best practices regarding prompt recognition and treatment of EHS ensure survival, this case highlights the lack of medical follow-up and physician-guided return to activity after EHS.

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David P. Looney, Mark J. Buller, Andrei V. Gribok, Jayme L. Leger, Adam W. Potter, William V. Rumpler, William J. Tharion, Alexander P. Welles, Karl E. Friedl and Reed W. Hoyt

CT and rise in CT over time has been and continues to be a keen interest within the research and clinical communities. Given the stable settings of traditional clinical care facilities, the ability to monitor core body temperature clinically has long been achievable (e.g., via stable rectal