Adventure Race Medicine

1. Adventure Race Medicine Devika Raj

2. What is Adventure Racing? • Aka ‘wilderness multi-sport endurance race’ • Prolonged, competitive, multi-disciplinary sport in ardous terrain • Running, trekking, kayaking, climbing, mountain biking, caving etc. • Often >36hrs necessitating decisions regarding pace, sleep, navigation etc.

3. Pre-race Health • Injury and ill health is more common in athletes with previous injury • Inadequate recovery between injury/races  increased risk of illness • ‘Over-reaching’ and ‘over-training’  decreased performance, altered immune function and mood changes

4. Types of Illness and Injury • Emotional complications [mood, stress, sleep] • Musculoskeletal • Soft tissue [blisters, open wounds, infections] • Respiratory [SOB, respiratory distress etc.] • Cardiovascular [hypotension, tachycardia, secondary dysarrhythmia] • Temperature dysregulation [hypo/hyper-thermia] • Dehydration [hyponatremia, hypotension] • GI complications [infected water, dehydration]

5. Sleep Deprivation • Consequence of adventure racing • ‘post-race blues’ (depression, anger, confusion) most common around the 3rd day of recovery • Mood changes, immune suppression, impaired thermoregulation are common consequences • Severe fatigue can be a catalyst to infectious mononucleosis

6. Soft-Tissue Injuries • Blisters are easily prevented by comfortable footwear and dry feet • Blister tape and petroleum jelly are easy solutions • Open skin wounds should be cleansed and covered to prevent injury • Prophylactic antibiotics are advised if the wound is exposed/deep

7. Musculoskeletal Injuries • Stress fracture: crescendo pain, shaft of metatarsal, pain on pressure/weight baring • Runner’s knee: pain in kneecap on running/extending leg • Muscle pulls/tears  rest • P-protect; R-rest; I-ice; C-compress; E-elevate; S-stabilize

8. Respiratory Complications • Mucosal immune system protects body from URTI’s negatively affected by exercise and stress • Reactive airway disease and exercise induced bronchospasm is common • Decline in FEV1 and FVC • Treatment: Oxygen, B2 agonist, adrenaline, fluids, hospital

9. Cardiovascular Complications • Well trained competitors are in some cases able to sustain a relative maximum oxygen consumptions [VO2 max] • respiratory distress along with complications of dehydration, hyperthermia, hypothermia and hypovolemia can cause cardiac complications such as dysarrhythmia’s treat cause

10. Hypothermia • Symptoms include confusion, dizziness, chills, mood changes, slurred speech, ataxia, cardiac arrest • Treat by preventing further heat loss, avoid VF • If severe: Bretylium (5mg/kg) • Heat packs in the axillae/groin

11. Dehydration and Hyponatremia • Pre-race fluid replaces lost body water, reduces heat storage capacity, maintains serum osmolality, and maintains blood glucose • Fluids w/ carbohydrates = ideal for events >90mins • Hyponatremia disorientation, nausea, headache, muscle cramps, chills, seizures  isotonic saline

12. Rhabdomyolysis • Injury to skeletal muscle causing leakage of toxic intracellular contents into plasma • Exercise associated hyponatremia (EAH) often presents simultaneously • Treatment for hypervolemichyponatremia=free water restriction • Treatment for rhabdomyolysis is aggressive IV isotonic fluid administration • Important to balance aggressive fluid resuscitation with mindful fluid restriction

13. Hyperthermia/Heat Stroke • Heat exhaustion is characterized by worsening symptoms of weakness, dizziness, mental confusion and dehydration • Heat stroke is when the body loses its ability to sweat due to profound dehydration, and body temperature continues to rise, above 40 degrees • Remove restrictive clothing, spray body with water, cover with ice-water soaked sheets, place cooling packs in axillae and groin

14. Preparation and Risk Reduction • Skin and soft tissue injuriesbandages, topical antiseptic, blister tape etc. • Be prepared for hypothermia, water aspiration, drowning/near drowning, cardiovascular arrest, minor abrasions/contusions, hypothermia, nausea/vomiting, and minor trauma • Monitor weather, water temperatures and conditions prior to and during event • Enforce safety measures and advise competitors about healthy racing

15. Resources • Mood, Illness and Injury Responses and Recovery with Adventure Racing- Nat Anglem, MBChB, FACSP; Samuel J.E. Lucas, BPhED (Hons), BSc; Elaine A. Rose, PhD; James D. Cotter, PhD • EVENT MEDICINE: INJURY AND ILLNESS DURING AN EXPEDITION-LENGTH ADVENTURE RACE- David A. Townes, MD, MPH, FACEP,* Timothy S. Talbot, MD,† Ian S. Wedmore, MD, FACEP,‡ and Robert Billingsly, MD† • Pattern of Injury and Illness During Expedition-Length Adventure Races- Kyle A. McLaughlin, MD; David A. Townes, MD, MPH, FACEP; Ian S. Wedmore, MD; Robert T. Billingsley, MD; Chad D. Listrom, MD; Leslie D. Iverson, ARNP, MPH • Injury and illness in a wilderness multisport endurance event -MEREDITH L. BORLAND, MBBS, FRACGP, and IAN R. ROGERS*, MBBS, FACEM • Pre-race health status and medical events during the 2005 World Adventure Racing ChampionshipsRichard J. Newsham-West a,c,∗, Joanne Marley a, Anthony G. Schneiders a, Andrew Gray b • Rhabdomyolysis and Hyponatremia: A Cluster of Five Cases at the 161-km 2009 Western States Endurance RunJessica Rose Bruso, DO; Martin D. Hoffman, MD; Ian R. Rogers, MBBS; Linda Lee, MS, FNP; Gary Towle, MD; Tamara Hew-Butler, DPM, PhD • Heart Rate, Mean Arterial Blood Pressure, and Pulmonary Function Changes Associated With an UltraenduranceTriathlonErik L. O. Seedhouse, PhD; Michael L. Walsh, PhD; Andrew P. Blaber, PhD