Monitoring and evaluation of the athlete affected by collapse on the field

Edited by Dr. Stefano Casali

Classify the severity of the collapse in the athlete

The vast majority of collapses in athletes are benign in origin. The conditions that suggest a benign cause of collapse are the following:

The athlete is conscious and alert;

The rectal temperature is greater than 35 ° C and less than 40 ° C;

Systolic blood pressure is greater than 100 mmHg and heart rate less than 100 beats per minute;

The concentration of glucose in the blood is 70-180 mg / dl and that of sodium is equal to 135-148 mEq / L;

The percentage of weight loss is less than 5%.

The most common causes of severe collapse in athletes include hyponatremia, hypoglycemia, heat stroke, cardiac arrest, and other serious medical conditions, including stroke, brain haemorrhage, and diabetic coma. They have been identified as leading causes for the more severe forms of collapse the following situations:

State of unconsciousness or mental confusion (disorientation, aggression);

Rectal temperature above 40 ° C or below 35 ° C;

Systolic blood pressure below 100 mm Hg and heart rate above 100 beats per minute;

Blood glucose concentration less than 70 mg / dl or greater than 180 mg / dl; plasma sodium concentration less than 130 mEq / L or greater than 148 mEq / L;

Weight loss or gain greater than 5% of body weight. (Weight loss indicates dehydration and weight gain suggests excessive fluid load which presupposes hyponatremia).

Collapse in endurance athletes

It is very common to see athletes collapse during endurance competitions, especially in hot and humid conditions. If the athlete collapses just after the competition and remains conscious with regular heart rate, blood pressure, breathing and mental state , the situation is not serious and is probably a cause of excessive fatigue, of a slight dehydration that contributes to the drop in blood pressure when the athlete is in an upright position, and to the onset of cramps. A certainly more serious case is the collapse that occurs during competition or training, especially when the athlete exhibits unstable vital signs and / or loses consciousness or behaves in a bizarre way.

Causes of Collapse in the Endurance Athlete

Position hypotension (heat exhaustion or syncope):

Position hypotension (low blood pressure when standing) has been defined as heat exhaustion or heat syncope and is a major cause of collapse. Collapse generally occurs at the finish of the race and is rarely serious. to the point of requiring hospitalization. It is probably caused by the flow of blood into the dilated vessels of the skin and limbs, especially the legs, and by the loss of the pumping action of the muscle in the lower limbs after the cessation of activity. Dehydration and the resulting decrease in circulating blood volume increases the risk of standing hypotension, but there is no evidence that this type of hypotension will degenerate into heatstroke. Hypotension from standing is likely to be responsible if rectal temperature is less than 40 ° C, heart rate is less than 100 beats per minute and systolic blood pressure is greater than 100 mm Hg once the athlete is in the supine position .

Common causes of collapse during activity

Non-serious causes:

Exhaustion

Dehydration

Lowering of blood pressure when standing

Muscle cramps

Serious causes

Low blood sodium level (hyponatremia)

Heat stroke

Low blood sugar level (hypoglycemia)

Low body temperature (hypothermia)

Cardiac arrest

Other clinical situations such as stroke, cerebral haemorrhage and diabetic coma

As a treatment, the feet and pelvis should be raised for 10-20 minutes until normal circulation is restored. Athletes should be given fluids to take up to maximum tolerance. Oral rehydrating solutions or sports drinks capable of restoring mineral salts and carbohydrates are always preferable to water. There may also be those who need intravenous fluids if there are serious signs of dehydration.