Lightning Safety

Great article in Emergency Medicine, Vol. 43, No. 10 October 2011.

Emergency care:
1. CPR - Compression, Airway, Breathing - if victim unresponsive
2. As long as victim is breathing a care survey of the entire body must be done and a history from any witnesses must be taken.
3. Exam must include eyes, ears (ear drum rupture is common, bleeding in the ear), extremities (pulses, sensation, cold/clammy), abdomen, neurologic exam, look for burns.

"Lightning causes an estimated 50 to 300 deaths per year and approximately five times as many nonlethal injuries1,2; however, injuries and deaths due to lightning are believed to be underreported."

"Lightning generates intense heat around it, rapidly heating the air to 20,000°C, which is three times the  temperature of the surface of the sun. This rapid heating generates a supersonic shock wave that decays to an acoustic wave heard as thunder."

"Lightning produces injury and death by multiple mechanisms.6"
Electrical effect, direct strike, splash mechanism, contact injury, concussive force

"the victim of a lightning strike is unlikely to die since cardiac activity will resume spontaneously. Furthermore, when first examined, the patient may be in cardiac arrest with ventricular fibrillation."

"Telltale signs of lightning injury include an arborealtype burn (ie, Lichtenberg figures), tympanic membrane
rupture, and disheveled appearance of the patient (including clothing that is blasted apart). The patient is
also likely to be confused or amnestic to prior events."

"Recommended laboratory tests include electrolyte measurement, assessment of renal function, complete
blood count, and cardiac enzyme studies, including creatine kinase and troponin assays. ECG is mandatory,
as is cardiac monitoring. The decision to order radiologic evaluation depends on the patient’s presentation and the physician’s assessment. CT of the head may be warranted in patients with altered mental status. Further CT scans may be indicated."

Crossfit

I have been asked about Crossfit quite frequently, so here is my take: NO!

As with any trainer or training method, the problem is usually the trainer, not necessarily the method. In the Crossfit case it is both the method and the trainers with which I have a problem.


On the Crossfit website it states, 
"The CrossFit program is designed for universal scalability making it the perfect application for any committed individual regardless of experience. We’ve used our same routines for elderly individuals with heart disease and cage fighters one month out from televised bouts. We scale load and intensity; we don’t change programs."


Problem #1: Use of the same program regardless of experience. Since Crossfit uses not only standard lifts, but Olympic lifts, kettlebells and other training that is highly technique intensive, the same program CANNOT be used regardless of experience. This just sets the trainee up for injury.


Problem #2: Intensity. Every Crossfit workout I have ever seen in person has been high intensity for all comers and has not been scaled. The posted WOD (workout of the day) is not scaled for load and intensity either.

Problem #3: Injury rate. I have seen many injuries due to the lack of technique focus and high intensity of the workouts. When I have asked my patients to demonstrate the lifts they perform, I have NEVER seen a patient do a movement correctly. This is a BIG problem. Watch the video below...OUCH!

Problem #4: Cultish. Read this article in Men's Health magazine: Inside the Cult of Crossfit. The fact that a workout that caused rhabdomyolysis in a trainee was named for that trainee is beyond disgusting.


There you have it. Be careful. Learn technique. I have no problem with training hard and still train hard at 51 years old, but you must train in a thoughtful manner with regard to your goals. Even for professional and Olympic athletes, overtraining is a common problem.

AHA Recommendations for Preparticipation Cardiovascular Screening of Competitive Athletes

Washington State study: few doctors follow sudden cardiac death screening guidelines for athletes

TABLE. The 12-Element AHA Recommendations for Preparticipation Cardiovascular Screening of Competitive Athletes

*Parental verification is recommended for high school and middle school athletes.

†Judged not to be neurocardiogenic (vasovagal); of particular concern when related to exertion.

‡Auscultation should be performed in both supine and standing positions (or with Valsalva maneuver), specifically to identify murmurs of dynamic left ventricular outflow tract obstruction.

§Preferably taken in both arms.37

Medical history*

Personal history

1. Exertional chest pain/discomfort

2. Unexplained syncope/near-syncope†

3. Excessive exertional and unexplained dyspnea/fatigue, associated with exercise

4. Prior recognition of a heart murmur

5. Elevated systemic blood pressure

Family history

6. Premature death (sudden and unexpected, or otherwise) before age 50 years due to heart disease, in ≥1 relative

7. Disability from heart disease in a close relative <50 years of age

8. Specific knowledge of certain cardiac conditions in family members: hypertrophic or dilated cardiomyopathy, long-QT syndrome or other ion channelopathies, Marfan syndrome, or clinically important arrhythmias

Physical examination

9. Heart murmur‡

10. Femoral pulses to exclude aortic coarctation

11. Physical stigmata of Marfan syndrome

12. Brachial artery blood pressure (sitting position)§

Pre-Participation Physical Examinations

Heart Screenings:
"Symptoms that indicate the need for additional evaluation include an abnormal heart murmur, fainting or dizziness (especially during or immediately after exercise), skipping or racing heartbeats, excessive fatigue or shortness of breath associated with exercise, unusual chest pain or discomfort during exercise, high blood pressure, close relatives with heart conditions or the premature cardiovascular-related death of a close relative under the age of 50."

If you  or your child has one or more of the above mentioned symptoms, GET EXAMINED before you continue your sports participation.

Maryland Concussion Law

Please see this article on the new Maryland Concussion Law. Click here.

FREE HEAT INDEX APP FROM OSHA

Coaches, Parents, Athletes - Click here to download this great heat index app from OSHA

KIDS WHO SPECIALIZE IN ONE SPORT MAY HAVE HIGHER INJURY RISK, LOYOLA STUDY FINDS

MAYWOOD, Ill. -- Competitive young athletes are under increasing pressure to play only one sport year-round, but such specialization could increase the risk of injuries, a Loyola University Health System study has found.

Preliminary findings of the ongoing study included 154 athletes from all types of sports, with an average age of 13. They came to Loyola for sports physicals or treatment of injuries. The injured athletes had a significantly higher average score on a sports specialization scale than athletes who weren't injured.

"Young athletes who were injured tended to have more intense specialized training in one sport," said Dr. Neeru Jayanthi, medical director of primary-care sports medicine at Loyola and senior author of the study. "We should be cautious about intense specialization in one sport before and during adolescence. Parents should consider enrolling their children in multiple sports."

Jayanthi presented the findings May 2 at the annual meeting of the American Medical Society for Sports Medicine in Salt Lake City.

The current study is a follow-up to an earlier study of 519 junior tennis players, in which Jayanthi and colleagues found that players who specialized in tennis were more likely to be injured during tournaments than players who participated in several sports.

Jayanthi said findings from the studies provide new support for an American Academy of Pediatrics 2000 policy statement on intensive training and sports specialization in young athletes. The academy said kids should be discouraged from specializing in a single sport before adolescence. Young athletes "should be encouraged to participate in a variety of different activities and develop a wide range of skills," it said.

The current study included 85 young athletes who were treated for sports injuries and a comparison group of 69 non-injured athletes who came to Loyola for sports physicals.

Researchers graded athletes on a six-point sports-specialization score:

-- Trains more than 75 percent of the time in one sport.

-- Trains to improve skill or misses time with friends.

-- Has quit other sports to focus on one sport.

-- Considers one sport more important than other sports.

-- Regularly travels out of state.

-- Trains more than eight months a year, or competes more than six months.

On the six-point scale, the average sports-specialization score of uninjured athletes was 2.75, while the average score of injured athletes was 3.49.

The study found that 60.4 percent of the injured athletes specialized in sports, while only 31.3 percent of the uninjured athletes specialized. (Athletes who scored above 3 on the six-point scale were considered specialized.)

Uninjured athletes spent a total of 8.8 hours a week playing organized sports, while injured athletes spent 11 hours. However, this finding had a P value of 0.07, meaning that it fell just short of being considered statistically significant.

Jayanthi said results of the current study are preliminary. Researchers from Loyola and Children's Memorial Hospital in Chicago are enrolling additional athletes, and the athletes will be evaluated every six months for three years. This research will further assess the risk of intense training during growth spurts. The collaborative study has received a prestigious research grant from the American Medical Society for Sports Medicine.

Jayanthi said young athletes should be closely monitored for injuries, especially if they spend 11 or more hours a week in a single organized sport or more than 20 hours a week in all sports.

Injuries in young athletes include minor conditions such as muscle strains and knee cap pain, overuse injuries such as rotator cuff tendonitis and Osgood-Schlatter disease (painful lump below the kneecap) and severe injuries such abnormalities in knee cartilage and stress fractures in the spine.

While young athletes are specializing in all major sports, Jayanthi said the most intense specialization occurs in certain higher skill sports such as tennis, gymnastics and dance.

Jayanthi is an associate professor in the Departments of Family Medicine and Orthopaedic Surgery & Rehabilitation at Loyola University Chicago Stritch School of Medicine. Co-authors of the study are Amy Luke, PhD, assistant professor in the Department of Preventive Medicine & Epidemiology and Courtney Pinkham, a Stritch Medical student.

The study was supported by Loyola Stritch School of Medicine's Student Training in Approaches to Research (STAR) program.

For more information, or to enroll in the study, call 708-216-1071 or e-mail mhiggin@lumc.edu