1) Environmental Factors a) Thermoregulation i) Conduction-two objects are in contact (heat transfers from warmer to cooler) (1) Ex.

Heat pack ii) Convection-heat is transferred from body to surrounding moving fluids (including air) (1) Ex. Whirlpool, icebath iii) Evaporation-heat is transferred via vaporization of sweat; most efficient means for heat loss b) Factors affecting sweat i) Environment (heat, humidity) ii) Intensity of action iii) Duration of session iv) Equipment worn v) Genetics (sickle cell) vi) Physical condition vii) Acclimatization c) Acclimatization i) Allows body adapt to exercising in the heat ii) Effects (1) Higher sweat rate (2) Earlier sweating (3) More of the body sweats (4) Lower core body temp (5) Lower HR d) Factors that effect EHI rates i) WBGT ii) Acclimatization iii) Intensity of activity iv) Length of session v) Size/type of athlete vi) Environmental risk factors (1) Ambient air temp (2) Relative humidity (3) Air motion (wind) (4) Radiant heat from other sources e) Types of EHIs i) Heat Cramps-muscle spasms with associated dehydration, thirst, sweating, and fatigue (1) Si/sx (a) Skin: moist and cool; sweating (b) Pulse: slightly elevated (c) Respiration: slightly elevated (d) Body temp: normal (2) Tx (a) Drink

(b) Stretch muscle (c) Ice massage ii) Heat Syncope-occurs from exposure to hot environment and attributed to peripheral vasodilatation, posture, pooling of blood, and diminished venous return (1) Si/sx (a) Dehydration (b) Fatigue (c) Tunnel vision (d) Skin: pale and sweaty (e) Heart rate: decreased (f) Dizzy and lightheaded iii) Heat Exhaustion-usually occurs to unacclimatized individuals during the first few intense exercise sessions on a hot day (1) Si/sx (a) Skin: pale and sweaty; ashen/grey (b) Dizziness (c) Pulse: rapid (d) Repiration: fast (e) Syncope (f) Body temp: Normal to slightly elevated (g) Mild anxiety (h) Headache, nausea, dec urine output, cramping (sometimes) (2) Tx (a) Seek medical attn (not emergency) (b) IV fluid (c) Remove from activity (d) Cool body iv) Heat Stroke (1) Si/sx (a) Skin: hot, red, dry (b) Pulse: rapid and strong (c) Respiration: shallow breathing (d) Core temp: 104+ (e) Dizzy, drowsy, confused, irritable, LOC (2) Tx (a) Remove from environment (b) Activate EMS (c) Cool body (i) Cold tub (d) IV fluid (e) TREAT first TRANSPORT second f) Prevention of EHIs i) Factors increasing risk of EHI (1) Past history (2) Inadequate acclimatization

(3) Lower fitness status (4) Higher % body fat (5) Dehydration (6) Fever (7) GI illness (8) Salt deficiency (9) Motivation to push oneself (10) Reluctance to report problems ii) WUT (1) Weight-amt lost from activity (a) 1% deficit-performance declines (b) 2% deficit-monitor (c) 4% deficit-hold (2) Urine-volume and concentration (3) Thirst-indicatory of hydration g) NCAA guidelines i) 5 days acclimatization period for all football athletes (1) Only one on field practice/day for the first 5 days (2) Days 1&2-helmets (3) Days 3&4-helmets and shoulder pads (4) Day 5-full pads (5) Days 6+-full pads but must alternate one and two/day h) Environmental concerns i) WBGT ii) Acclimatization iii) Intensity of activity iv) Length of activity v) Size/type of athlete vi) Ambient air temp vii) Relative humidity viii) Air motion (wind) ix) Radiant heat 2) Pharmacological Definitions a) FDA i) Promotes and protects public health by helping safe and effect products reach the Markey b) DEA i) Enforces controlled substances c) Pregnancy categories i) Category A-no risk to fetus in any trimester and fetal harm is probably remote ii) Category B-studies in animals may have shown risk, but not in humans; iii) Category C- adverse effect demonstrated in animals, but insufficient data in humans; benefits>risk iv) Category D-human fetal risk has been demonstrated v) Category X-human fetal risk has been clearly documented; avoid using in those pregnant/may become pregnant

d) Schedule i) Schedule I-potential for abuse is so high its unacceptable (1) LSD, marijuana, heroin ii) Schedule II-high potential for abuse and extreme liability or physical/psychological dependence (1) Codeine, morphine, methadone iii) Schedule III-immediate potential for abuse (1) Anabolic steroids iv) Schedule IV-less abuse than C-III and minimal liability for dependence (1) Valium v) Schedule V-minimal abuse potential (1) Cough suppressant with codeine e) Route of Administration i) Topical-applied for local therapy of skin (1) Targets specific area (2) Can cause skin irritation ii) Oral-taken through mouth (1) Easy, convenient, inexpensive (2) Variability in absorption iii) Sublingual-drug enters bloodstream thru cells of capillary wall (1) Absorbed rapidly (2) Uncomfortable, expensive iv) Rectal (1) Quick acting, doesnt interfere with digestive system (2) Cant control absorption rate v) Intravenous-puts drug directly into blood (1) No barriers, rapid onset (2) Cost and risk of infection vi) Intramuscular-drug injected into muscles (1) Can be used for poorly soluble drugs (2) Discomfort, inconvenient f) Terminology i) Generic name-official name of drug ii) Trade/brand name-name under which drug is marketed iii) Loading dose-larger initial dose of drug so high level can quickly be established iv) Maintenance dose-allows meds to plateau/maintain a certain level g) Pharmokinetics i) Indication-usefulness of drug for a certain condition ii) Contraindication- reason a drug shouldnt be given for a certain condition iii) Distribution-after absorption, drugs are distributed to various tissues and fluids iv) Metabolism/excretion-drug leaves body after action, usually converted by liver to be excreted h) Time/Action Profile i) Onset-how long it takes before the drug begins to have an effect

ii) Peak effect-length of time for max effect iii) Duration of activity-length of time before drug no longer has an effect iv) Half life-amt of time before the drug level decreases by half 3) Management of Pharmaceutical Products in the AT room a) Terms i) Drug-articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease ii) Administration-giving out a single does of med iii) Dispensing-giving out multiple doses (1) Only those licensed by the state can dispense iv) Pharmacy-1)multiple patient sources 2)multiple physician sources 3)licensure b) Discretionary tasks i) Assessment ii) Evaluation iii) Diagnosis iv) Prescription v) Dispense/administer c) Non-discretionary tasks i) Forwarding order on behalf of MD ii) Receiving/stocking inventory iii) Acquisition and disposition of inventory iv) Disposal v) Audit/reconciliation 4) Pharmacokinetics a) First Order Kinetics i) Pharmacokinetics-what the drug does to the body; bodys ability to use drug to cause a specific reaction ii) Pharmacodynamics-what the drug does to the body iii) First pass metabolism-constant fraction of the drug in the body thats eliminated per unit time iv) Half life-time it takes for plasma concentration to be reduced by 50% (1) After 4 half lives elimination is 94% complete b) Drug Excretion i) Main route=kidneys 5) Analgesics a) Pain i) Pain is subjective ii) Use pain scales (1) Rating (2) Color (3) Visual (4) McGill Pain Q iii) Management (1) Should be individualized based on (a) Cause (b) Severity

(c) Chronicity iv) Common Analgesics (1) Narcotic (i) Addictive (ii) No antipyretic effects (iii) Common error=overestimation of drug needed (iv)Adverse Effects 1. nausea 2. vomiting 3. dizziness 4. addiction 5. constipation (b) Morphine (c) Codeine (d) Propoxyphene (e) Oxycodone (i) #1 ABUSED DRUG; biggest black market potential (2) Non-Narcotic (a) Aspirin (b) Acetaminophen (i) Antipyretic and analgesic effects (ii) Minimal anti-inflammatory activity (iii) Minimal side effects (iv)Inhibits synthesis of prostaglandin v) Anesthetics (1) General (a) CNS depression (2) Local (a) Only in the area of injection