Environment Dependent Sports Injuries
By Nick Pacis

Good health is achieved not only by exercise and a healthy diet but also by engaging in activities that renew the sagging vitality in a person. One such activity is mountaineering. Mountaineering is an outdoor sport that exposes participants to inclement weather and unnatural conditions that are unfit to today's normal living conditions. As participants to this outdoor sport increase astronomically, the frequency of environmentally related illnesses is most likely to speed up if proper care and prevention are not observed. Hypothermia, heat related illnesses, and high altitude illnesses are multi-system emergencies that require immediate, specific therapeutic maneuvers. As a mountaineer, you must be able to prevent and recognize the signs and symptoms of these emergencies and institute definitive care. Hympothermia is defined as a core body temperature less than 35 degrees centigrade. Development of hypothermia is a risk in multiple outdoor activities, including mounatineering, spelunking, hiking, scuba diving, river rafting, skiing, and swimming. Before accidental hypothermia can occur, two conditions must be met. First, the surrounding temperature must be less than the core body temperature (lower than 37.3 degrees centigrade). Second, the body's endogenous heat production must be less than its loss. The human body loses heat through four mechanisms; conduction, convection, radiation, and evaporation, which can affect in the formation of hypothermia. Hypothermia is often categorized in three stages based on core body temperature. The first stage is mild hypothermia, which corresponds to core body temperature of 32 to 35 degrees centigrade. It presents shivering, fast heart beat, rapid respiration, diuresis, cyanosis, and amnesia. The second stage is modertate hypothermia, which corresponds to a core body temperature of 28 to 32 degrees centigrade. Symptoms inlcude loss of shivering reflex, confusion, muscle rigidity, paradoxic undressing and delirium. The last stage is severe hypothermia, which corresponds to a core body temperature of less than 28 degrees centigrade. It presents loss of reflexes, stupor or coma, and dilated pupils. The person may even look like dead. To manage hypothermia, rapid core rewarming, airway control, and prolonged cardiopulmonary resuscitation are used. Rewarming therapies are divided into passive external rewarming, active external rewarming, and core rewarming. Passive external rewarming techniques include placing the hypothermic patient in a warm, sheltered environment, covered with dry blankets. Active external rewarming methods include warm blankets, hot packs and radiant heat such as heat lamps, and hot bath immersion. Carried out in a hospital setting, core rewarming techniques include warmed intraveneous fluids, and colonic, peritoneal bladder lavage. To prevent hypothermia, education regarding proper clothing and shelter is vital. Layering clothes and having linings that keep moisture away from the body are important. Proper nutrition and abstinence from alcohol are required. Requiring each member to look out for signs of hypothermia in others is also a useful preventive measure. Heat illnesses include heat cramps, heat stress, heat exhaustion, and heat stroke. Heat stress is characterized by increased heart rate, increased blood pressure, dizziness, restlessness, fatigue, emotional liability, and mild changes in mentation. Heat cramps are secondary to whole body salt deficiency. Its symptoms include muscle spasm, weakness, fatigue, nausea, vomitting and thirst. To treat heat illnesses, rest, cooling, and rehydration are necessary. For minor heat cramps, sport beverage or salt solution prepared by adding two 10 grain of salt tablets to 1 liter of water is prescribed. Behavior modification is the key to prevention. Gradual physical conditioning early in the training season, acclimatizing to local weather conditions, and frequent fluid intake during hot weather are good preventive measures. The American College of Sports Medicine has recommended runners and hikers to consume at least 100ml to 200ml of water for every 2 to 3 kilometers. They suggest that fluid intake should depend on exertional effort and amount of sweet produced. They recommend 630ml to 1300ml of fluid intake per hour of exertion.

High Altitude Illness can be defined as the constellation of symptoms resulting from exposure to the stressful environment of high altitude. And also, it occurs when an indiividual's rate of ascent exceeds the rate of acclimatization. Exposure to harsh environment may cause not only high altitude illness, but also hypothermia, ultra viloet exposure, dehydration, and exhaustion. The most prevalent form of high altitude illness is Acute Mountain Sickness (AMS). The most frequent symptom of AMS is bilateral, frontal, and throbbing headache which is severe in the morning and during exercise. Other manifestations include anorexia, nausea, vomitting, irritability, difficulty in concentrating and sleeping, and decrease in level of performance. Early recognition is important to effect therapy. The basis for treatment involves three strategies: removal from the harsh environment (i.e. descent), correction of the underlying condition responsible for the symptoms (i.e. administration of supplemental oxygen), and rest. To avoid high altitude illness, gradual ascent must be observed. Staging, as this is called, gives an individual time to acclimatize to the environment at a high altitude, which generally is enough to avoid the symptoms of AMS. Smoking should be avoided because it decreases oxygen available to the lungs. Alcohol, a respiratory depressant, interferes with the adaptive response to hypoxia. Furthermore, the symptoms of AMS resembles those of an alcoholic hangover, which can delay recognition. For these reasons, alcohol should be avoided at high altitude. If not, alcohol must be avoided at least during the initial phase of acclimatization. Increased fluid intake and a carbohydrate-rich diet are recommended beginning 24 hours before ascent and continuing throughout one's stay at high altitude. Most of all, education, careful planning, wise judgement, and early recognition of signs and symptoms of these illnesses are vital for prevention.