The collapsed athlete

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Background

Collapse in an athlete can mean many things. In this article, athletic collapse will refer to the sudden and temporary loss of consciousness and postural tone. An athlete may also collapse and lose postural tone but not lose consciousness. That condition will not be considered in this article.

Consciousness is dependent on the proper functioning of the reticular activating system and both cerebral hemispheres. Disruption of either or both of these systems will result in a loss of consciousness.

Epidemiology

The causes of athletic collapse depend upon the sport or activity involved, environmental conditions, and age and medical conditions of the participant. Traumatic causes of athletic collapse are common in contact sports. Head injuries are common in sports such as football and ice hockey. Noncontact high-speed sports can result in trauma when accidents or falls occur, such as during downhill skiing or biking. Prolonged aerobic activity in sports such as endurance running, triathlons, and

Fatal collapse

Fatal collapse of an athlete is very rare, and most physicians covering sporting events will not be a witness to such a tragic event during their career. Fatal collapse in athletes can be traumatic or nontraumatic. Fatal traumatic collapse is directly related to an injury sustained while participating in a particular event. Fatal nontraumatic collapse is often due to sudden cardiac death.

Traumatic nonfatal collapse

Traumatic collapse occurs most frequently with injury to the head and neck. Other less common causes include cardiac contusion, vascular disruption, and visceral organ disruption. Traumatic brain concussion is the most common cause of brain dysfunction in athletes competing in contact sports. In the management of traumatic collapse, basic CPR and advanced trauma life support (ATLS) protocols should be followed. Trauma to the head, neck, trachea, anterior chest wall, and vascular structures are

Management

It's important to have as much information about an athlete's collapse as possible. An initial, quick consideration should be whether the collapse was witnessed or not. Witnesses to an athletic collapse can provide clues as to the cause of the collapse. The etiology of traumatic events causing immediate collapse is fairly straightforward, but apparent nontraumatic athletic collapse may in fact be due to trauma in the recent past that was not witnessed. Such may be the case with a subdural

Summary

Athletic collapse is rare, but personnel caring for athletes at sporting events must be prepared for it. Most cases are nonfatal and, with proper management, can have good outcomes. Medical personnel should expect the typical causes of athletic collapse that occur at the events they are covering, but rare causes should also be anticipated.

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