HYPERTHERMIA MALIGNANT EFFORT OR HEAT STROKE
The first reflex when you are not well is to take your temperature in order to get an idea of the seriousness of the problem. Everyone is familiar with this indicator which, beyond 40 °, worries us a lot and prompts us to urgently call his doctor. On the other hand, heat stroke on exertion (or malignant hyperthermia of exertion) is much less known to the athlete or the active in general by tinkering, gardening ...
Its consequences are severe because this sudden increase in temperature during exercise can lead to death from cardiac arrest. Malignant exertional hyperthermia is a medical emergency that should be known to everyone, since it is life-threatening.
(1) DEFINITION
Extreme and sudden elevation in core temperature after intense muscular activity or work which causes a mismatch control systems s of the organism with altered cellular metabolism and suffering multi visceral.
(2) WHAT TYPES OF SPORTS ARE CONCERNED?
It is most often a long-term effort : half-marathon, marathon, endurance or orienteering race , raid, and sports requiring special equipment using hot and waterproof protective suits are also concerned: motorcycle, rally, car, etc ...
The practice of a sport at altitude can promote the occurrence of hyperthermia which is then confused with altitude sickness.
The sports unwary practicing their shirtless sports are also more exposed to hyperthermia effort than those wearing a T-shirt in cotton or breathable textiles.
Wearing a cap or hat protects against the heat and the sun, but it is unrealistic to believe that this is sufficient in the event of extreme heat. Seeking shade and spraying water on the face or body are effective means associated with reducing the intensity of exertion.
All sports and outdoor activities are ultimately affected by hyperthermia, but we must remain vigilant because even in a gym the temperature under the roof and the lack of ventilation are all the more dangerous.
(3) IMPORTANT: THE PREDISPOSING FACTORS
WEATHER CONDITIONS :
an abnormal temperature above 25 °, and above all an abnormal hot thermal environment.
a sport practiced during the hottest hours of the summer sun.
the presence of a hot wind or conversely the absence of wind to cool the body and the atmosphere. (Wind Chill)
the absence of shadow areas in the course, or on the contrary constant exposure to the sun during a long sporting practice.
the degree of hygrometry (humidity level in the air) plays a big role because the more humid heat there is, the less the body can evacuate its perspiration.
(A) FEEDING AND HYDRATION ERRORS
You must drink before you are thirsty. The occurrence of exertional malignant hyperthermia correlates with the state of dehydration. The necessary increase in the amount of drink depending on the temperature is a reality.
Do not "skip" the refreshments and if necessary sprinkle fresh water during the effort .
(B) POOR PHYSICAL CONDITION OR ABNORMAL FATIGUE
Fatigue, lack of sleep, anxiety, the presence or not of a small nasopharyngitis in addition, cause fatigability which can cause an adaptation dysfunction of the organism.
(C) TAKING DRUGS AND DOPING
Taking medication can also mask our good survival reflexes by masking warning signs such as sweating or simply vigilance. Doping by pushing back the physiological limits is a source of hyperthermia.
(D) A FEVERISH STATE OR ILLNESS
You should never make an effort or participate in a competition if you have a temperature or if you come out of a viral state (rest for at least 8 days).
(E) A POORLY ADAPTED PRACTICE
Unsuitable equipment, clothes that are too heavy and not ventilated, sports equipment poorly adjusted, effort too long, backpack creating an anti-ventilation screen, rest and hydration not respected, etc.
(4) T HE FIRST WORRYING SIGNS
Daze
Brutal fatigue
Vomiting
Intense thirst
Cramps
Unusual behavior (aggressiveness, disorientation, etc.)
Tense muscle compartments
Hyperthermia in mass competition: the Chicago Marathon, October 2007
The temperature of the day in Chicago: +/- 25 ° to 30 °
Humidity rate: 86%
36,000 participants
Winner's time: 2h11min11 sec
Order to stop the event at the halfway point, but many participants continued (25,000 out of 36,000).
Result: 1 death from exertional hyperthermia and 350 runners hospitalized, despite 200,000 units of water distributed and the opening of fire hydrants.
It is undoubtedly the only race in the history of this importance which was partially interrupted due to heat and risk of hyperthermia of effort.
(5) WHAT TO DO IF A HEAT STROKE OCCURS
Above all, one of the members of the group, or yourself if you are alone, must take a mobile phone, not forgetting that the international emergency number is 112. In France, we can also alert 15 or on 18.
1) Cooling
In the absence of the presence of doctors, first-aiders or competent medical or paramedical personnel, the athlete must be cooled immediately. We sprinkle it with water, put it in the shade, and try to ventilate it, even causing it to draft.
2) No medication
It would be dangerous to use antipyretic drugs like paracetamol.
3) Call for help
The emergency services are immediately alerted, in France on the 15th and 18th and by GSM on 112, clearly specifying the exact reason for the call, so that the care is easier and better adapted as soon as the emergency services arrive. .
4) Monitoring
During this time, we continue to try to cool the athlete according to all the possibilities that we have on the ground or in nature.
We talk to the victim. If he starts to vomit, we put him in a safety position on his side, we try to make him drink, we calm him, we put him in the shade and we remove all the curious who will already aggravate the situation. very disturbing.
5) help the emergency services
In all cases, hospitalization for assessment and monitoring is necessary.
(6) CONCLUSION
Malignant exertional hyperthermia occurs most often in endurance sports or long-term physical activities, with somewhat exceptional weather conditions.
Preventive measures are essential: this is why if you plan to participate this summer in a nature raid, a particular hike, in climatic conditions which will be difficult (heat, altitude, desert, country with a high degree of humidity) , consult your doctor first to find out your possibilities of adaptation and prepare yourself by gradually training yourself to accept this type of effort.
In any case, always take with you both the necessary quantities of water, but also instant cold pocket cooling compresses, which allow you to immediately fight against the effects of heat stroke, or malignant exertional hyperthermia.
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