By Dr. Stefano Casali
The assessment of the collapsed athlete in the field begins with a rapid analysis of the conscious level: if the athlete is alert and alert, the causes of the collapse are probably benign. When the level of consciousness decreases, timely cardiac assistance becomes necessary. Controlling the airways, breathing and circulation becomes of primary importance. It is necessary to examine the athlete's general conditions as soon as possible, ie rectal temperature, heart rate and blood pressure. Even the moment when the athlete has lost consciousness can be a sign of further concern: if it happened after the end of the race it is certainly less worrying than the possibility that the collapse occurred during the race.
History
Coaches, athletic trainers, friends and other observers can provide valuable information. Here are some basic questions to ask them too:
1. How many liquids and what kind of drinks did the athlete take during the race? The answer to this question is an important indication to understand the level of dehydration, hyponatremia or hypoglycemia.
3. Did vomiting or diarrhea occur during the competition? If so, it is a further contribution to dehydration.
4. How many carbohydrates were taken before and during the race? An insufficient supply of carbohydrates can cause a lowering of the sugar level (hypoglycemia), especially in people with diabetes.
5. Has the athlete had any diseases or interventions that may have reduced the tolerance to heat or the balance of liquids?
6. Was the athlete trained enough and ready for the competition? Inadequate preparation facilitates the incidence of collapse.
7. Does the athlete have symptoms such as chest pains, palpitations, nausea or wheezing that can be a wake-up call for an inadequate physical condition?
NB Long term races are meant
Drugs and substances that negatively affect thermoregulation
- Anticholinergic
- Antihistamines
- Beta blockers
- Diuretics
- Alfa-methyldopa
- phenothiazines
- Tricyclic antidepressants
- Drug abuse
- Alcohol
Exam
The examination of the athlete who suffered a collapse should be based on continuous monitoring of the patient's general condition. Heart rate and pressure should be measured both in a supine and upright position. When the athlete is in an upright position, if the heart rate increases by 20 beats per minute or the systolic pressure drops by 20 mm Hg and the diastolic pressure by 10 mm Hg, then we can speak of gradual exhaustion of blood volume and probable dehydration . The majority of endurance athletes have a very low resting heart rate and a value of 80 beats per minute at rest can, for them, represent tachycardia. It is necessary to measure the rectal temperature to those athletes who have reduced mental function to eventually establish the presence of heat stroke. (Measuring the temperature in the ear and in the mouth is not sufficient to establish the exact body temperature). A rectal temperature of about 40 ° C requires immediate cooling operations.
State of hydration
The athlete's hydration status can be established based on the amount of liquid ingested and the ability to produce saliva. Dehydrated athletes are very thirsty and will have difficulty producing enough saliva to spit. Furthermore, the turgidity of the skin decreases considerably in heavily dehydrated athletes, the skin seems soft, flaccid and takes the form of a newly planted tent (precisely the "tent" phenomenon). On the contrary, hyperhydrated athletes may seem swollen. And therefore rings, bracelets, shoes and cuffs seem to be narrower than they were before the competition. In many severe cases of hyperhydration, there may also be plastic edema (swelling) in the legs and this is generally associated with the lowering of sodium levels in the blood (hyponatremia). Controlling body weight before and after the competition can help to understand the level of fluids. A weight loss of 2-5% signals dehydration where weight gain is synonymous with excess fluid.
Lab test
The most effective laboratory tests for a collapsed athlete are those that measure the concentration of glucose and sodium in the blood.
Hyponatremia is the major cause of severe collapse for the endurance athlete. Timeliness in measuring sodium levels is essential in order to diagnose this condition and provide adequate treatment. Hypoglycaemia, although less common, can lead to severe alterations of the conscious level and even to coma, which can be readily corrected by administering oral or intravenous glucose.
