Heat illness, exertional collapse and sudden death prevention — branching viva

Branching framework

Open with the field-side protocol and the pulse check. State the rule aloud: the collapsed athlete is run in the order of the life threat, and the first move is the pulse and the breathing check. The athlete without a pulse has sudden cardiac arrest and the immediate start of the cardiopulmonary resuscitation and the defibrillation. This athlete has a pulse, so the heat-illness assessment proceeds. The examiner is listening for whether you reach for the defibrillator when there is no pulse and the rectal thermistor when there is. [9] [1]

Branch to the diagnosis and the defining criteria. This is exertional heat stroke, defined as 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, and the rectal thermistor — never the tympanic, the oral, or the skin reading — is the only valid field measure of the core temperature. State the requirement for the rectal temperature aloud, because the reliance on the unreliable devices is the documented cause of the missed diagnosis. [1]

Branch to the immediate treatment and the cooling rule. The treatment of choice is the cold-water immersion, begun before any transport is arranged under the cool-first-transport-second rule. The athlete is immersed to the neck in cold water at 2 to 15 degrees Celsius, the water is stirred continuously, and the rectal temperature is monitored to the target below 39 degrees Celsius before the transport. The cooling rate of approximately 0.15 to 0.35 degrees Celsius per minute is the fastest of any field method, and the survival approaches one hundred per cent when the cooling begins within minutes. The dantrolene is not recommended, and the shivering is suppressed. [2] [1]

Branch to the runner who collapses pale and alert at the finish. This is exercise-associated collapse, the benign venous-pooling event that occurs when the calf-muscle pump stops. The preserved mental state, the normal rectal temperature, and the rapid recovery once supine distinguish it from the heat stroke, and the management is the rest with the legs elevated and the oral rehydration. Branch to the exercise-associated hyponatraemia: the endurance athlete who overhydrated, confused or seizing with a normal or low temperature, managed with the fluid restriction and the hypertonic saline, never the free-water rehydration. [5]

Close with the prevention and the emergency action plan. The prevention rests on the four pillars: the fourteen-day heat-acclimatization protocol, the wet-bulb globe temperature activity modification, the hydration without overhydration, and the rehearsed emergency action plan with an accessible defibrillator. The wet-bulb globe temperature combines the heat, the humidity, the radiant heat, and the wind, and the intense activity is suspended at the high values. The rehearsed emergency action plan is the single intervention that links the heat stroke and the cardiac arrest, because the prepared venue survives both and the unprepared venue loses both. [1] [9]