The collapsed athlete

Blue, Jeffrey G; Pecci, Matthew

doi:10.1016/s0030-5898(02)00008-1

Cited by 6 publications

(4 citation statements)

References 29 publications

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“…The two most important criteria when considering the athletes for the trial were: (1) a normal level of consciousness and (2) collapse that occurred after finishing the race. It has been well documented that athletes who are confused or collapse during the race are more likely to have any of a number of serious medical conditions 2 4 17 19 21 22 32…”

Section: Discussionmentioning

confidence: 99%

A comparison of two treatment protocols in the management of exercise-associated postural hypotension: a randomised clinical trial

et al. 2010

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Objective To investigate which of two commonly used treatment protocols for exercise-associated postural hypotension (EAPH) resulted in earlier discharge from the medical facility. Methods This randomised clinical fi eld trial was undertaken at two Ironman Triathlon competitions and one ultra-distance footrace. All collapsed athletes admitted to the medical facilities were considered for the trial. Following clinical assessment and special investigations to confi rm the diagnosis of EAPH, 28 athletes were randomly assigned to an oral fl uid and Trendelenburg position (OT=14) or an intravenous fl uid (IV=14) treatment group. Following admission fl uid intake was recorded, and all athletes were assessed clinically (blood pressure, heart rate, level of consciousness) every 15 min until discharge criteria were met. The main measure of outcome was the time to discharge (min). Results On admission, subjects in the OT and IV groups were similar with respect to age, systolic blood pressure, heart rate and serum sodium concentration. There were no signifi cant differences in heart rate, systolic and diastolic blood pressure between groups and over time until discharge. The fl uid intake during the treatment period was signifi cantly greater in the IV group (IV 1045±185 ml, OT 204±149 ml; p<0.001). The average time to discharge for the OT group (58±23 min) was similar to that of the IV group (52.5±18 min; p=0.47). Conclusion Endurance athletes with EAPH can be treated effectively using the Trendelenburg position and oral fl uids and the administration of intravenous fl uids does not reduce the time to discharge. The fi ndings of this study support the hypothesis that EAPH is a result of venous pooling due to peripheral vasodilatation, rather than dehydration.Due to the strenuous nature of ultra-endurance events, participants in these events are at risk of developing various medical conditions. 1-7 One of the most common clinical presentations during and following an endurance event is that of the 'collapsed' athlete. Various medical conditions may lead to collapse in athletes, including cardiovascular, metabolic, neurological, musculoskeletal and respiratory causes. [1][2][3][4][5][6][7] The most common cause for collapse is a condition referred to as exercise-associated postural hypotension (EAPH). 3 8-10 The exact pathophysiology of EAPH is still widely debated in the literature, and currently two hypotheses have been proposed. The fi rst hypothesis is that a combination of dehydration and hyperthermia causes circulatory failure, resulting in the collapse of the athlete. 3 5 11-14The second hypothesis is that pooling of blood occurs in the dilated venous system resulting in postural hypotension and thus collapse if generalised arterial vasoconstriction fails to occur immediately exercise terminates. 2 9 10 15-17As a result of this ongoing debate, there is no clarity on how best to treat athletes with EAPH. Instead two protocols are used to manage athletes with EAPH in race medical facilities. These are (1) intra...

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Section: Discussionmentioning

confidence: 99%

A comparison of two treatment protocols in the management of exercise-associated postural hypotension: a randomised clinical trial

et al. 2010

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“…Apart from EHS, there are a few other medical conditions ( Table 2) that can also cause athlete to collapse or present with changes in mental status [1,7,[26][27][28], but none of these are associated with extreme hyperthermia, and as such they can be distinguished from EHS by a rectal temperature <40ºC. For instance, one such condition that can be initially mistaken for EHS is hyponatremia of exercise [31][32][33], which is defined as a serum sodium concentration less than 130 mmol/L, and occurs most commonly during the marathon races and ultraendurance-type events [34]. Misdiagnosis of EHS will result in improper management, which in turn increases the likelihood of a tragic outcome [35].…”

Section: Recognition Of Ehsmentioning

confidence: 99%

Exertional Heat Stroke in Athletes

Kjertakov¹,

Epstein

2013

Open Access Maced J Med Sci

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Exercising in hot and especially humid environment can cause rise in body core temperature to such a critical level that it does not only reduce performance, but also may ultimately lead to exertional heat stroke (EHS). This illness is true medical emergency that can result in significant morbidity and mortality, if not early recognized and promptly treated. Diagnostic criteria for EHS are body core temperature above 40ºC and central nerve system dysfunction. Any athlete experiencing such symptoms should be immediately exposed to aggressive cooling treatment aimed to lower the elevated core temperature to near normal as quickly as possible. Ice water immersion is highly recommended as a cooling method because it provides the fastest cooling rates and is associated with lowest mortality rates. Athletes cooled rapidly soon after the onset of EHS usually recover without complications and are able to return to normal training in hot environment within a few weeks. EHS is also a preventable condition, and its occurrence can be minimized by implementing a few simple measures.

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“…Apart from EHS, there are a few other medical conditions (Table 2) that can also cause athlete to collapse or present with changes in mental status [1,7,[26][27][28], but none of these are associated with extreme hyperthermia, and as such they can be distinguished from EHS by a rectal temperature <40ºC. For instance, one such condition that can be initially mistaken for EHS is hyponatremia of exercise [31][32][33], which is defined as a serum sodium concentration less than 130 mmol/L, and occurs most commonly during the marathon races and ultraendurance-type events [34]. Misdiagnosis of EHS will result in improper management, which in turn increases the likelihood of a tragic outcome [35].…”

Section: Recognition Of Ehsmentioning

confidence: 99%