Post-exercise Body Cooling: Skin Blood Flow, Venous Pooling, and Orthostatic Intolerance

Athletes and certain occupations (e.g., military, firefighters) must navigate unique heat challenges as they perform physical tasks during prolonged heat stress, at times while wearing protective clothing that hinders heat dissipation. Such environments and activities elicit physiological adjustments that prioritize thermoregulatory skin perfusion at the expense of arterial blood pressure and may result in decreases in cerebral blood flow. High levels of skin blood flow combined with an upright body position augment venous pooling and transcapillary fluid shifts in the lower extremities. Combined with sweat-driven reductions in plasma volume, these cardiovascular alterations result in levels of cardiac output that do not meet requirements for brain blood flow, which can lead to orthostatic intolerance and occasionally syncope. Skin surface cooling countermeasures appear to be a promising means of improving orthostatic tolerance via autonomic mechanisms. Increases in transduction of sympathetic activity into vascular resistance, and an increased baroreflex set-point have been shown to be induced by surface cooling implemented after passive heating and other arterial pressure challenges. Considering the further contribution of exercise thermogenesis to orthostatic intolerance risk, our goal in this review is to provide an overview of post-exercise cooling strategies as they are capable of improving autonomic control of the circulation to optimize orthostatic tolerance. We aim to synthesize both basic and applied physiology knowledge available regarding real-world application of cooling strategies to reduce the likelihood of experiencing symptomatic orthostatic intolerance after exercise in the heat.

Suspension syndrome

Suspension syndrome is a potentially fatal event of unknown incidence that can be caused by motionless hanging in the rope during rope-secured activities. During prolonged hanging, generalized hypoperfusion with reduced cerebral blood flow and consecutive loss of consciousness occurs. Two mechanisms are discussed as the cause leading to loss of consciousness: venous pooling in the legs and a sudden reduction of heart rate and blood pressure, similar to a neurocardiogenic syncope. The most important preventive measure is the activation of the muscle pump during hanging. In principle, the treatment follows standard <C>ABCDE care. The patient should be rescued from the hanging position as fast as possible and airway obstruction caused by hyperflexion of the head during unconscious hanging has to be reversed. There is an increased risk of hyperkalemia. Therefore, ECG monitoring should be established as soon as possible to recognize cardiac arrhythmias. Pulmonary embolism should be considered as a potentially reversible cause of cardiac arrest. Hypothermia prophylaxis and treatment have high priority. For suspension longer than two hours, a medical treatment facility able to provide continuous renal replacement therapy should be chosen. There is no evidence that laying a patient flat immediately after rescue is harmful. Key Words: Neurocardiac Syncope, Venous Pooling, Rescue Death, Generalized Hypoperfusion, Standard <C>ABCDE Care

Effect of Leech application in Prolapsed Thrombosed Hemorrhoid: A case study

ABSTRACT: Prolapsed hemorrhoid is an emergency condition. The condition becomes worse after thrombosis and strangulation of the pile mass. Urgent surgical intervention is required in all the cases. Venous return of strangulated pile mass become very low and severe edema takes place along with serious painful condition. Hemorrhoidal mass is not able to reduce further in anal canal. Patient struck in serious woe and seeks urgent surgical attention. Leeches can be used as a successful tool in this situation by relieving venous pooling of blood and also by liquefying the clotted blood in pile mass. In present case study, a patient of grade IV hemorrhoid was cured by leech application.                            Key Words: Leech therapy, Prolapsed hemorrhoid, jalaukavacharana, Arsha Chikitsa.