Skip to main content
SpringerLink
Log in

The Collapsed Athlete

  • Chapter
  • First Online:
Book cover Sports Cardiology

Abstract

Sideline management involves the ability to assess an athlete’s symptoms and sudden changes in health. Injuries can vary from musculoskeletal to cardiovascular to neurologic in nature. The collapsed athlete is defined as an athlete who experiences sudden loss of postural tone that results in the inability to continue with event participation (Blue and Pecci. Orthop Clin North Am. 33(3):471–478, 2002). Athletic collapse, while frequently benign, can result in significant harm to the athlete and therefore requires immediate medical attention. Overall, fatal events are rare. In the most recent 2017 Annual Report, the National Center for Catastrophic Sport Injury Research (NCCSIR) noted 862 nontraumatic catastrophic injuries since 1982, with 44 fatal injuries at the collegiate level over that time period (Reports – National Center for Catastrophic Sport Injury Research [Internet]. [cited 2019 Sept 17]. Available from: https://nccsir.unc.edu/reports/).

With the progression of sports medicine and expansion of sideline management, the quick assessment and early intervention in the collapsed athlete has become a crucial component of athlete care. While there can be many causes for athletic collapse, there is a limited differential for severe and potentially life-threatening conditions that should guide initial diagnosis and management. These main causes include cardiac arrest, hyponatremia, exertional heat stroke, hypothermia, respiratory distress, hypoglycemia, trauma, and exertional sickling. The evaluation and management of each topic will be reviewed in this chapter.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Blue JG, Pecci MA. The collapsed athlete. Orthop Clin North Am. 2002;33(3):471–8.

    Article  PubMed  Google Scholar 

  2. Reports – National Center for Catastrophic Sport Injury Research [Internet]. [cited 2019 Sept 17]. Available from: https://nccsir.unc.edu/reports/.

  3. Chiampas G, Jaworski C. Preparing for the surge: perspectives on marathon medical preparedness. Curr Sports Med Rep. 2009;8(3):131–5.

    Article  PubMed  Google Scholar 

  4. Harmon KG, Asif IM, David K, Drezner Jonathan A. Incidence of sudden cardiac death in national collegiate athletic association athletes. Circulation. 2011;123(15):1594–600.

    Article  PubMed  Google Scholar 

  5. Wasfy MM, Hutter AM, Weiner RB. Sudden cardiac death in athletes. Methodist Debakey Cardiovasc J. 2016;12(2):76–80.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Toresdahl B, Courson R, Börjesson M, Sharma S, Drezner J. Emergency cardiac care in the athletic setting: from schools to the Olympics. Br J Sports Med. 2012;46(Suppl 1):i85–9.

    Article  PubMed  Google Scholar 

  7. Drezner JA, Toresdahl BG, Rao AL, Huszti E, Harmon KG. Outcomes from sudden cardiac arrest in US high schools: a 2-year prospective study from the National Registry for AED use in sports. Br J Sports Med. 2013;47(18):1179–83.

    Article  PubMed  Google Scholar 

  8. Drezner JA, Rao AL, Justin H, Bloomingdale Megan K, Harmon Kimberly G. Effectiveness of emergency response planning for sudden cardiac arrest in United States high schools with automated external defibrillators. Circulation. 2009;120(6):518–25.

    Article  PubMed  Google Scholar 

  9. Neumar RW, Shuster M, Callaway CW, Gent LM, Atkins DL, Bhanji F, et al. 2015 American Heart Association Guidelines Update for CPR and ECC: executive summary. Circulation. 2015;132(Suppl 2):S315–67.

    Article  PubMed  Google Scholar 

  10. Rao AL, Standaert CJ, Drezner JA, Herring SA. Expert opinion and controversies in musculoskeletal and sports medicine: preventing sudden cardiac death in young athletes. Arch Phys Med Rehabil. 2010;91(6):958–62.

    Article  PubMed  Google Scholar 

  11. Rothmier JD, Drezner JA. The role of automated external defibrillators in athletics. Sports Health. 2009;1(1):16–20.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Noakes TD, Speedy DB. Case proven: exercise associated hyponatraemia is due to overdrinking. So why did it take 20 years before the original evidence was accepted? Br J Sports Med. 2006;40(7):567–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Urso C, Brucculeri S, Caimi G. Physiopathological, epidemiological, clinical and therapeutic aspects of exercise-associated hyponatremia. J Clin Med. 2014;3(4):1258–75.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Almond CSD, Shin AY, Fortescue EB, Mannix RC, Wypij D, Binstadt BA, et al. Hyponatremia among runners in the Boston Marathon. N Engl J Med. 2005;352(15):1550–6.

    Article  CAS  PubMed  Google Scholar 

  15. Hew-Butler T, Loi V, Pani A, Rosner MH. Exercise-Associated Hyponatremia: 2017 Update. Front Med [Internet]. 3 Mar 2017 [cited 2019 Sept 19];4. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5334560/.

  16. Hew-Butler T, Rosner M, Fowkes-Godek S, Dugas J, Hoffman M, Lewis D, et al. Statement of the third international exercise-associated hyponatremia consensus development conference, Carlsbad, California, 2015. Clin J Sport Med. 2015;25(4):303–20.

    Article  PubMed  Google Scholar 

  17. Rosner MH, Kirven J. Exercise-associated hyponatremia. Clin J Am Soc Nephrol. 2007;2(1):151–61.

    Article  PubMed  Google Scholar 

  18. Chang RG, Khan JJ. Hydration Issues in the Athlete and Exercise Associated Hyponatremia – PM&R KnowledgeNow [Internet]. PM&R Knowledge Now. 2016 [cited 2019 Oct 27]. Available from: https://now.aapmr.org/hydration-issues-in-the-athlete-and-exercise-associated-hyponatremia/.

  19. Howe AS, Boden BP. Heat-related illness in athletes. Am J Sports Med. 2007;35(8):1384–95.

    Article  PubMed  Google Scholar 

  20. Casa DJ, DeMartini JK, Bergeron MF, Csillan D, Eichner ER, Lopez RM, et al. National Athletic Trainers’ Association position statement: exertional heat illnesses. J Athl Train. 2015;50(9):986–1000.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Navarro C, Casa D, Belval L, Nye N. Exertional heat stroke. Curr Sports Med Rep. 2017;16(5):304–5.

    Article  PubMed  Google Scholar 

  22. Miyake Y. Pathophysiology of heat illness: thermoregulation, risk factors, and indicators of aggravation. Jpn Med Assoc J. 2013;56(3):167–73.

    Google Scholar 

  23. Armstrong L, Casa D, Millard-Stafford M, Moran D, Pyne S, Roberts W. Exertional heat illness during training and competition. Med Sci Sports Exerc. 2007;39(3):556–72.

    Article  PubMed  Google Scholar 

  24. Casa D, Armstrong L, Kenny G, O’Connor F, Huggins R. Exertional heat stroke: new concepts regarding cause and care. Curr Sports Med Rep. 2012;11(3):115–23.

    Article  PubMed  Google Scholar 

  25. Gaudio FG, Grissom CK. Cooling methods in heat stroke. J Emerg Med. 2016;50(4):607–16.

    Article  PubMed  Google Scholar 

  26. Zhang Y, Davis J-K, Casa D, Bishop P. Optimizing cold water immersion for exercise-induced hyperthermia: a meta-analysis. Med Sci Sports Exerc. 2015;47(11):2464–72.

    Article  CAS  PubMed  Google Scholar 

  27. Belval LN, Casa DJ, Adams WM, Chiampas GT, Holschen JC, Hosokawa Y, et al. Consensus statement- prehospital care of exertional heat stroke. Prehosp Emerg Care. 2018;22(3):392–7.

    Article  PubMed  Google Scholar 

  28. Proulx CI, Ducharme MB, Kenny GP. Safe cooling limits from exercise-induced hyperthermia. Eur J Appl Physiol. 2006;96(4):434–45.

    Article  CAS  PubMed  Google Scholar 

  29. Hosokawa Y, Adams WM, Belval LN, Davis RJ, Huggins RA, Jardine JF, et al. Exertional heat illness incidence and on-site medical team preparedness in warm weather. Int J Biometeorol. 2018;62(7):1147–53.

    Article  PubMed  Google Scholar 

  30. Environmental Conditions [Internet]. Recognize to Recover. [cited 2019 Oct 28]. Available from: http://www.recognizetorecover.org/environmental.

  31. Chiampas GT, Goyal AV. Innovative operations measures and nutritional support for mass endurance events. Sports Med Auckl Nz. 2015;45(Suppl 1):61–9.

    Article  Google Scholar 

  32. Castellani J, Young A, Ducharme M, Giesbrecht G, Glickman E, Sallis R. Prevention of cold injuries during exercise. Med Sci Sports Exerc. 2006;38(11):2012–29.

    Article  PubMed  Google Scholar 

  33. Fudge J. Exercise in the cold. Sports Health. 2016;8(2):133–9.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Malik S, Chiampas G, Roberts WO. The collapsed athlete. In: Sports cardiology in practice: evaluation, management, and case studies. New York: Springer-Verlag; 2011.

    Google Scholar 

  35. Taylor EE, Carroll JP, Lovitt MA, Petrey LB, Gray PE, Mastropieri CJ, et al. Active intravascular rewarming for hypothermia associated with traumatic injury: early experience with a new technique. Proc Bayl Univ Med Cent. 2008;21(2):120–6.

    Article  PubMed  PubMed Central  Google Scholar 

  36. McMahon J, Howe A. Cold weather issues in sideline and event management. Curr Sports Med Rep. 2012;11(3):135–41.

    Article  PubMed  Google Scholar 

  37. Darocha T, Kosiński S, Jarosz A, Drwila R. Extracorporeal rewarming from accidental hypothermia of patient with suspected trauma. Medicine (Baltimore). 2015;94(27)

    Google Scholar 

  38. Hilmo J, Naesheim T, Gilbert M. “Nobody is dead until warm and dead”: prolonged resuscitation is warranted in arrested hypothermic victims also in remote areas – a retrospective study from northern Norway. Resuscitation. 2014;85(9):1204–11.

    Google Scholar 

  39. Cappaert TA, Stone JA, Castellani JW, Krause BA, Smith D, Stephens BA. National Athletic Trainers’ Association Position Statement: Environmental Cold Injuries. J Athl Train. 2008;43(6):640–58.

    Google Scholar 

  40. Poowuttikul P, Saini S, Seth D. Anaphylaxis in children and adolescents. Pediatr Clin N Am. 2019;66(5):995–1005.

    Article  Google Scholar 

  41. Hull JH, Ansley L, Robson-Ansley P, Parsons JP. Managing respiratory problems in athletes. Clin Med. 2012;12(4):351–6.

    Article  Google Scholar 

  42. Bussotti M, Di Marco S, Marchese G. Respiratory disorders in endurance athletes – how much do they really have to endure? Open Access J Sports Med. 2014;5:47–63.

    Google Scholar 

  43. Weder MM, Truwit JD. Pulmonary disorders in athletes- ClinicalKey. Clin Sports Med. 2011;30:525–36.

    Google Scholar 

  44. Manwani D, Frenette PS. Vaso-occlusion in sickle cell disease: pathophysiology and novel targeted therapies. Blood. 2013;122(24):3892–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Blinder MA, Russel S. Exertional sickling: questions and controversy. Hematol Rep. 2014;6(4):66–70.

    Article  Google Scholar 

  46. Mitchell BL. Sickle cell trait and sudden death. Sports Med - Open. 2018;4(19)

    Google Scholar 

  47. Loosemore M, Walsh SB, Morris E, Stewart G, Porter JB, Montgomery H. Sudden exertional death in sickle cell trait. Br J Sports Med. 2012;46(5):312–4.

    Article  PubMed  Google Scholar 

  48. Casa DJ, Guskiewicz KM, Anderson SA, Courson RW, Heck JF, Jimenez CC, et al. National Athletic Trainers’ Association position statement: preventing sudden death in sports. J Athl Train. 2012;47(1):96–118.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Tarini BA, Brooks MA, Bundy DG. A policy impact analysis of the mandatory NCAA sickle cell trait screening program. Health Serv Res. 2012;47(1 Pt 2):446–61.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Eichner ER. Sickle cell considerations in athletes. Clin Sports Med. 2011;30:537–49.

    Article  PubMed  Google Scholar 

  51. Asplund CA, O’Connor FG, Noakes TD. Exercise-associated collapse: an evidence-based review and primer for clinicians. Br J Sports Med. 2011;45(14):1157–62.

    Article  PubMed  Google Scholar 

  52. Wen DY. Collapsed athlete – atraumatic. Curr Rev Musculoskelet Med. 2014;7(4):348–54.

    Google Scholar 

  53. Bromfield EB, Cavazos JE. Sirven JI. American Epilepsy Society: Basic mechanisms underlying seizures and epilepsy; 2006.

    Google Scholar 

  54. Zupanc ML, Otallah SJ, Goodkin HP. Sports and epilepsy. In: DeLee, Drez, & Miller’s Orthopaedic sports medicine. 5th ed. Philadephia: Elsevier; 2020. p. 230–4.

    Google Scholar 

  55. Silverman EC, Sporer KA, Lemieux JM, Brown JF, Koenig KL, Gausche-Hill M, et al. Prehospital care for the adult and pediatric seizure patient: current evidence-based recommendations. West J Emerg Med. 2017;18(3):419–36.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Josephson CB, Rahey S, Sadler RM. Neurocardiogenic syncope: frequency and consequences of its misdiagnosis as epilepsy. Can J Neurol Sci. 2007;34:221–4.

    Article  PubMed  Google Scholar 

  57. Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden deaths in young competitive athletes. Circulation. 2009;119(8):1085–92.

    Article  PubMed  Google Scholar 

  58. Drezner JA, Courson RW, Roberts WO, Mosesso VN, Link MS, Maron BJ. Inter-association task force recommendations on emergency preparedness and management of sudden cardiac arrest in high school and college athletic programs: a consensus statement. J Athl Train. 2007;42(1):143–58.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Justine S. Ko

  2. Departments of Emergency Medicine and Orthopedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    George Chiampas

Authors
  1. Justine S. Ko
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. George Chiampas
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA

    David J. Engel

  2. Sports Cardiology Center, Hypertrophic Cardiomyopathy Center Atrium Health Sanger Heart & Vascular Institute, Charlotte, NC, USA

    Dermot M. Phelan

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Ko, J.S., Chiampas, G. (2021). The Collapsed Athlete. In: Engel, D.J., Phelan, D.M. (eds) Sports Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-69384-8_20

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-69384-8_20

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-69383-1

  • Online ISBN: 978-3-030-69384-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation