Adventure Race Medicine

Devika Raj

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.

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

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]

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

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

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

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

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

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

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

Rhabdomyolysis

• Injury to skeletal muscle causing leakage of toxic intracellular contents into plasma

• Exercise associated hyponatremia (EAH) often presents simultaneously

• Treatment for hypervolemic hyponatremia = free water restriction

• Treatment for rhabdomyolysis is aggressive IV isotonic fluid administration

• Important to balance aggressive fluid resuscitation with mindful fluid restriction

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

Preparation and Risk Reduction

• Skin and soft tissue injuries bandages, 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

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 Ultraendurance TriathlonErik L. O. Seedhouse, PhD; Michael L. Walsh, PhD; Andrew P. Blaber, PhD