Emergency Conditions
Anaphylaxis
Anaphylaxis is a serious, potentially fatal allergic reaction and medical emergency that is rapid in onset and requires immediate medical attention regardless of the use of emergency medication on site. It typically causes more than one of the following: an itchy rash, throat closing due to swelling that can obstruct or stop breathing; severe tongue swelling that can also interfere with or stop breathing; shortness of breath, vomiting, lightheadedness, loss of consciousness, low blood pressure, and medical shock.
Asthma
Asthma is a long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wheezing, coughing, chest tightness, and shortness of breath. These may occur a few times a day or a few times per week. Depending on the person, asthma symptoms may become worse at night or with exercise.
Cervical Spine Injuries
Cervical spine injuries ranging from serious to catastrophic can be a cause of sudden death in athletes competing in both contact and non-contact sports. Although the incidence rate is low (0.07/100,000 for high school; 2.12/100,000 for college) this type of injury has a very high fatality rate. There are an estimated 12,000 new cases of cervical spine injury in the US each year, 42% of which are a result of vehicle crashes. Sports constitute about 8% of these cervical spine injuries (~1,000 cases). American football is associated with the highest spine injury among sports; however, rule changes have dramatically improved the incidence of spine injuries since the 1970s.
Commotio Cordis
Commotio Cordis refers to the sudden arrhythmic death caused by a low/mild chest wall impact. Commotio Cordis is seen mostly in athletes between the ages of 8 and 18 who are partaking in sports with projectiles such as baseballs, hockey pucks, or lacrosse balls. These projectiles can strike the athletes in the middle of the chest with a low impact but enough to cause the heart to enter an arrhythmia. Martial arts is a sport in which a strike of a hand can also cause the heart to change it’s rhythm. Without immediate CPR and defibrillation the prognosis of commotio cordis is not very good. This condition is extremely dangerous with rare survival.
Deep Vein Thrombosis
Because of advances in medicine/traumatic care, blunt force trauma and the injuries sustained are usually treated very rapidly, and morbidity directly from trauma has been seen to decrease. However, this may also explain an increase in morbidity indirectly, through Deep Vein Thrombosis and Pulmonary Embolism.
Exertional Sickling
Exertional sickling is a medical emergency occurring in athletes carrying the sickle cell trait. When the red blood cells(RBC) change shape or “sickle” this causes a build up of RBCs in small blood vessels, leading to decreased blood flow. The drop in blood flow leads to a breakdown of muscle tissue and cell death, known as fulminant rhabdomyolysis.
Heat Cramps
Heat cramps, while likely not caused by heat alone, are a subcategory of Exercise-Associated Muscle Cramps (EAMC). The exact mechanism of muscle cramps in warm environmental conditions is unknown, but can be caused acutely by extensive dehydration and sodium losses or chronically via inadequate electrolytes in the athlete’s diet. Although heat cramps are not a cause of sudden death, it can be confused with the more serious condition, exertional sickling.
Heat Exhaustion
Heat exhaustion is the most common heat-related condition observed in active populations ranging from athletes to recreational hikers. It is defined as the inability to continue exercise in the heat due to cardiovascular insufficiency (not enough blood pumped to the heart) and energy depletion that may or may not be associated with physical collapse. Cardiovascular insufficiency refers to when the heart has difficulty providing enough oxygenated blood to all the working organs and muscles and is exacerbated by dehydration via extreme sweating without replacing fluids during exercise. Heat exhaustion is one of the most common medical conditions reported to park rangers at the Grand Canyon and other recreational hiking areas.
Heat Stroke
Heat stroke or heatstroke, also known as sun-stroke, is a severe heat illness that results in a body temperature greater than 40.0 °C (104.0 °F), along with red skin, headache, dizziness, and confusion. Sweating is generally present in exertional heatstroke, but not in classic heatstroke. The start of heat stroke can be sudden or gradual.[3] Heatstroke is a life-threatening condition due to the potential for multi-organ dysfunction with typical complications including seizures, rhabdomyolysis, or kidney failure.
Heat Syncope
Heat Syncope is also known as orthostatic dizziness. This refers to a fainting episode that someone can experience in high environmental temperatures, usually during the initial days of heat exposure. Heat syncope occurs when an individual in a hot environment does not have adequate blood flow to the brain, causing the person to lose conciousness. This commonly occurs when someone is standing for long periods of time without movement or sudden rising from a sitting or lying position in the heat.
Hypo/Hyperglycemia
Type I Diabetes Mellitus, also known as insulin-dependent diabetes, is a condition where the pancreas does not produce any or enough insulin. Insulin is a hormone that lets glucose (sugar) enter cells to be used for energy. Type II Diabetes Mellitus occurs when the body becomes resistant to the effects of insulin or doesn’t make enough insulin to handle all the glucose in the blood. Type II Diabetes usually begins with insulin resistance. The pancreas can keep up with the resistance by producing more insulin, but in time will lose the ability to secrete insulin in effective doses.
Hyponatremia
Hyponatremia is a medical condition termed for a low concentration of sodium in the blood (serum). By definition, hyponatremia occurs when serum sodium levels in the plasma fall below <135mEq/L. Although previously considered to be more prevalent in endurance activities, hyponatremia cases are also now being reported in non-endurance sports and activities. Hyponatremia is mainly caused by hyperhydration, but can also be caused by intake of hypotonic fluids (including sport drinks) that exceed sweat and urine output, excessive sodium losses, or other hormonal dysfunctions that affect the maintenance of sodium stores in the body. The table below shows the risk factors associated with hyponatremia.
Kidney Injury
Kidneys are the third most common solid organ injury in blunt abdominal trauma. Even with significant renal injuries, patients can fully recover with conservative management alone. Kidney rupture is similar to splenic rupture in that it is usually caused by a direct blow to the abdomen, side, or mid-to-low back which causes damage or a tear to the organ. This is frequently seen with high-contact sports such as football, rugby, ice hockey, soccer, horseback riding, gymnastics, boxing, sledding, and skiing. Though it is very rarely possible to happen spontaneously.
Lightning
Aside from flooding, death from lightning is the highest storm related fatality. Death or injury from lightning occurs most often in the summer months (June-August) during athletic and outdoor activities with individuals who are alone, rather than in a large group, at the highest risk. The greatest form of preparation is becoming educated and aware of unsafe surroundings. People must be cognizant of the risks of lightning producing storms and the appropriate steps to reduce the risk of lightning related injury.
Pneumothorax
A pneumothorax (PTX) is defined as air that has leaked into the pleural space, either spontaneously or as a result of traumatic tears in the pleura following a chest injury. Chest trauma sustained in sporting occurs infrequently. It has been found that only 2% of adult thoracic injuries requiring medical treatment are sports related. Although uncommon in athletics, when they occur they can be life-threatening, requiring immediate diagnosis and treatment.
Pulmonary Contusion
A pulmonary contusion is caused by a very strong blunt force driving into the chest, causing disruption of the lung and pulmonary tissues (bruised lung). Unlike a pulmonary laceration, a contusion does not involve a tear of the lung.
Splenic Injury
Splenic rupture occurs when the spleen is placed under intense pressure/duress, strong enough to tear or separate the outer lining of the organ. A ruptured spleen accounts for 10% of all abdominal injuries. When a blunt abdominal trauma is present, the spleen is the most frequently and often the only injured organ. Often, an athlete returning to contact sports following infectious mononucleosis are at potential risk of splenic rupture secondary to abdominal trauma.
Sudden Cardiac Death
Sudden cardiac death (SCD) is the number one cause of exercise related death in young athletes and is due to a cardiovascular disorder. Age is a very significant factor in regards to SCD in athletes. For adults (individuals older than 35) coronary artery disease is the major cause of exercise related sudden cardiac death. For youth congenital cardiac conditions are the majority of causes for exercise related SCD. In the United States SCD is seen in all sports but mostly in basketball and football due to higher participation levels. Males are more likely to suffer from this condition as well as athletes of the African-American ethnicity.
Traumatic Brain Injury
It is estimated that approximately 1.6 to 3.8 million sports related traumatic brain injuries (TBI) occur every year, accounting for roughly 15% of all high school sport-related trauma reported. However, these numbers may be considered an underestimate due likely to failures in reporting of head injuries sustained or seeking medical attention. In fact, approximately 55% of pediatric athletes who sustained a concussion were not seen within a health care facility and approximately 42% of adults with a mild TBI (mTBI) did not seek medical care as well. The age group most vulnerable for sustaining a sports related concussion (SRC) is between ages 9-22 years old when team sports are most popular. Additionally, females have been diagnosed at higher rates of concussion susceptibility than males during both competition (1.46x) and practices (1.75x).