Heat illness, exertional collapse and sudden death prevention — formative SAQs

SAQ 1 (10 marks) — The sixteen-year-old runner who collapses confused at the eight-kilometre mark

Stem: A sixteen-year-old cross-country runner collapses at the eight-kilometre mark of an August race on a hot humid morning. At the field side she is confused and combative, her skin is hot, and a rectal thermistor reads 41.2 degrees Celsius. The athletic trainer has a cold-water immersion tub ready. Outline your assessment, immediate management, and the prevention that should have preceded the race. [1] [2]

Model answer

Assessment and diagnosis (2 marks). This athlete has exertional heat stroke, defined by a core (rectal) temperature of 40 degrees Celsius or higher accompanied by central nervous system dysfunction. The confusion and the combativeness are the central nervous system signs, the hot skin supports the diagnosis, and the rectal temperature of 41.2 degrees Celsius confirms it. The pulse was checked first because an athlete without a pulse has sudden cardiac arrest, and the rectal thermistor — not the tympanic, oral, or skin reading — is the only valid field measure of the core temperature. The diagnosis is made at the field side and the cooling begins at once. [1]

Immediate management (5 marks). The treatment of choice is cold-water immersion, begun before any transport is arranged, under the cool-first-transport-second rule. The athlete is immersed to the neck in a tub of cold water at 2 to 15 degrees Celsius, the water is stirred continuously to maintain the cooling gradient, and the rectal temperature is monitored throughout. The cold-water immersion achieves the fastest cooling rate of any field method, approximately 0.15 to 0.35 degrees Celsius per minute, and the goal is a rectal temperature below 39 degrees Celsius (around 102 degrees Fahrenheit) before the transport. The survival approaches one hundred per cent when the cooling begins within minutes, and the DeMartini Falmouth Road Race series anchors this near-complete survival. The airway is supported, the vomiting is anticipated, the shivering is suppressed because it generates heat, and the intravenous fluids are given for the hypotension. The transport is arranged only after the temperature is controlled. [2] [1]

Hospital and disposition (1 mark). The athlete is transported to the emergency department for the monitoring of the hepatic, renal, coagulation, and neurological complications, and the support is given as the multi-organ picture demands. The bloods include the electrolytes, the creatine kinase, the liver function tests, and the coagulation profile. [1]

Prevention that should have preceded the race (2 marks). The prevention rests on the four pillars: a fourteen-day heat-acclimatization protocol, the wet-bulb globe temperature activity modification, the hydration without overhydration, and the rehearsed emergency action plan. The wet-bulb globe temperature combines the heat, the humidity, the radiant heat, and the wind, and the intense activity is modified as it rises. The unrestricted access to fluids, the attentive supervision, and the empowered athletic trainer who removes the struggling athlete are the safeguards, and the cold-water immersion tub and the rehearsed team are the preparedness that this venue demonstrated. [1] [9]