HEALTH
Recently, I had the pleasure of volunteering in the medical tent at the Vermont City Marathon run by the University of Vermont Medical Center. The runners had a glorious day, with sunny skies, a cool breeze, and a high of 85°.
In our preparations for the event, led by an emergency medicine physician from the University of Vermont Medical Center, we reviewed common conditions that we might see while working the main tent at the finish line. The most critical of them all were cardiac complications related to the high heat index. Fortunately, we did not have many cases of heat exhaustion, but we did see other emergencies that I thought were relevant to share as people venture out in the hot summer sun.
Most every single condition we saw, triaged, and treated were related directly and indirectly, to lack of proper hydration. Not only are you at risk for heat exhaustion if not properly hydrated, but you also risk debilitating muscle strains and spasms which can lead to further injury.
Multiple runners limped across the finish line, grabbing at their calves and their quadriceps, a look of pain and agony as they attempted to massage out the involuntary, painful muscle contractions related to running 26.2 miles in high heat.
As the initial triage provider, I was responsible for negotiating which injury was most severe to enter the main medical tent, and which was less acute. These injuries were considered in the fast-track treatment area. Most people that came through the finish line were seeking shade, a place to sit, and water. While seeking shade is always a good idea to help cool the body down, after high exertion and increased oxygen demand, such as running a full marathon, we encouraged every single participant that came to the triage station to remain upright, keep walking, and provided them with Gatorade and an ice pack to use for cooling.
It is easy to want to sit down when your muscles are exhausted, but that can lead to further breakdown of lactic acid, a byproduct of muscular energy production, making muscular recovery longer (and more painful). The key to preventing any heat-related symptoms, especially the common muscle cramps associated with heat, is ingesting liquid with electrolytes, especially sodium.
When you sweat, you lose a large amount of bodily sodium that is necessary for our muscles, heart, and brain to function correctly and efficiently. While it is tempting to reach for a large icy bottle of water, opt for electrolyte-rich liquids. A few of my favorites are Nuun tablets, Liquid IV powder and Gatorade Zero. These solutions provide sodium replacement that is necessary to restore the lost sodium due to overexertion, which can lead to heat-related conditions.
Most people that we treated at the marathon were given electrolyte replacement beverages and a cool ice pack to place behind their neck to aid in rapid cooling. Almost all of them were able to quickly recover within 15 to 30 minutes of active recovery, shade, and replacing lost fluids. The heat cramps resolved as the runners stayed moving and slowly sipped their beverages.
And one of the ancillary medical tents on the course, the highest recorded field temperature reached 107.8°F. Fortunately, we only treated a small handful of runners for heat exhaustion, which requires immediate, active cooling by immersing these runners in ice baths and monitoring their core temperature under close physician supervision. While extreme, it is important to know the symptoms and rapidly identify them in order to prevent lethal brain and cardiac complications.
Below are symptoms to be on the lookout for while you, your friends, and loved ones are out enjoying the summer heat and sun.
If you notice any of the symptoms, it is necessary to call 911 and seek emergency care immediately.
For heat cramps, maintaining proper hydration is key prior to exerting yourself outside on a hot day—even if it is just working in the yard, or going for a walk. Consume at least 16 ounces of an electrolyte-rich beverage prior to going outside and have the solution readily available for consumption throughout the activity. One way to keep track of hydration status is to monitor your urine production. Are you going to the bathroom? No? time to drink more electrolytes!
You can prevent heat cramps by watching for symptoms such as excessive sweating during exertion and making modifications to rest or move to a shady or cool spot indoors. If you have a heat cramp that lasts longer than one hour, or develop worsening symptoms, such as those classified in the heat exhaustion list, it is wise to see emergency medical care.
Go out there and have fun! Just remember to pack your electrolytes!
