ABEM Sports Medicine cheat sheet
ABEM Sports Medicine · Keep the key ideas within reach.
Emergency Medicine and Sports Medicine Clinical Practice
Commotio cordis: blunt precordial impact during ventricular repolarization; survival depends on immediate CPR and early defibrillation; survival falls roughly 10% per minute without defibrillation.
Exertional heat stroke: core temperature typically >40°C with CNS dysfunction; cold-water immersion is the standard cooling method; mortality rises with time to cooling below 40°C.
Suspected cervical spine injury: immobilize and maintain in-line stabilization; do not remove helmet/shoulder pads unless airway access requires it and trained personnel are present.
Anaphylaxis in the athlete: intramuscular epinephrine 0.3-0.5 mg (1:1000) into the lateral thigh; repeat every 5-15 minutes as needed; antihistamines are adjuncts only.
Sickle cell trait exertional collapse: presents with rhabdomyolysis, heat illness, or sudden collapse; management is aggressive hydration, cooling, and rapid transport.
Sudden cardiac arrest in athletes: shockable rhythms (VF/pulseless VT) get immediate defibrillation; CPR with minimal interruptions and high-quality compressions improves survival.
Concussion red flags: focal neurologic deficit, worsening headache, repeated vomiting, seizure, or GCS decline mandate urgent imaging and transport.
Open fracture or joint dislocation: assess neurovascular status before and after reduction; splint in position of comfort; document distal pulses and sensation.
Musculoskeletal Injury Evaluation and Management
Ottawa Ankle Rules: imaging indicated if pain in malleolar zone plus inability to bear weight 4 steps, or bony tenderness at posterior malleolus, distal fibula, or navicular/base of 5th metatarsal.
Ottawa Knee Rules: imaging if age >55, isolated patellar tenderness, fibular head tenderness, inability to flex to 90°, or inability to bear weight 4 steps.
Lachman test is the most sensitive examination for ACL integrity; anterior drawer and pivot shift are adjuncts.
Anterior shoulder dislocation: axillary nerve (deltoid sensation/contraction) is the most commonly injured nerve; document before reduction.
Compartment syndrome: pain out of proportion, pain with passive stretch, and tense compartment are early signs; pulselessness and paralysis are late.
Achilles tendon rupture: positive Thompson test (no plantar flexion with calf squeeze); palpable gap; management is surgical or functional rehabilitation.
Meniscal tear: joint line tenderness, positive McMurray and Thessaly tests; locking or true block suggests displaced fragment requiring orthopedic evaluation.
RICE is superseded by PEACE & LOVE: early protection, elevation, compression, and progressive loading rather than prolonged rest and ice.
Medical Conditions in the Athlete
Exercise-associated hyponatremia: presents with confusion, seizure, or collapse after endurance events; treat with hypertonic (3%) saline; do not give free water.
Sickle cell trait: universal screening recommended before participation; risk of exertional collapse is mitigated by hydration, acclimatization, and gradual conditioning.
Asthma and exercise-induced bronchoconstriction: warm-up and inhaled beta-2 agonist 15-20 minutes before exercise reduce symptoms; avoid cold dry air exposure.
Sudden cardiac death in young athletes is most commonly from hypertrophic cardiomyopathy (USA) or anomalous coronary arteries; screening relies on history and physical.
Marburg and other viral myocarditis: athletes with recent viral illness and chest pain or arrhythmia need ECG, troponin, and echo before return to play.
Diabetes in athletes: monitor glucose before, during, and after exercise; carry fast-acting carbohydrate; adjust insulin for prolonged activity.
Infectious mononucleosis: splenic rupture risk peaks 2-4 weeks after onset; return to contact sports typically delayed 4 weeks with clinical resolution.
Red flags for exertional rhabdomyolysis: dark urine, severe muscle pain, weakness, and elevated CK; aggressive IV fluids and monitoring for acute kidney injury.
Exercise Physiology and Performance
VO2max = cardiac output × arteriovenous oxygen difference; aerobic capacity is limited by oxygen delivery in most athletes.
Lactate threshold occurs at roughly 60-80% of VO2max in trained endurance athletes; training above threshold improves performance.
Energy systems: phosphagen (0-10 s), glycolytic (10 s-2 min), oxidative (>2 min); training specificity targets the dominant system.
Maximal heart rate estimate: 220 − age is a rough population estimate with wide individual variability (±10-12 bpm).
Karvonen formula: target HR = ((HRmax − HRrest) × intensity%) + HRrest.
Heat acclimatization requires 10-14 days; benefits include expanded plasma volume, earlier sweating, and lower core temperature at a given workload.
Muscle hypertrophy follows progressive overload with adequate protein intake (roughly 1.2-2.0 g/kg/day for strength athletes) and recovery.
Altitude: acute exposure lowers arterial oxygen saturation and VO2max; acclimatization over 2-3 weeks increases erythropoietin and hemoglobin.
Preparticipation Evaluation, Rehabilitation, and Return to Play
AHA 14-point screening: personal history, family history, physical exam; positive findings warrant ECG and cardiology referral.
A positive family history of sudden cardiac death before age 50 or known cardiomyopathy in a relative is a screening red flag.
Return-to-play after concussion follows graduated steps: symptom-limited activity, aerobic exercise, sport-specific drills, full contact, then competition.
Each concussion step requires 24 hours symptom-free before advancing; any symptom recurrence restarts the prior step.
Rehabilitation phases: acute protection, mobility, strength, power, sport-specific function, then return to play; criteria-based rather than time-based.
Strength testing asymmetry >10% between limbs is a common criterion to delay return to sport after lower extremity injury.
Psychological readiness (e.g., fear of reinjury) predicts return-to-play success and should be assessed alongside physical tests.
Disqualification decisions consider risk of injury, risk to other athletes, and whether the condition is treatable; guidelines vary by sport and level.
Preparticipation Evaluation, Rehabilitation, and Return to Play
Preparticipation exam should include cardiovascular, musculoskeletal, neurologic, and general medical history and exam components.
Screening for sickle cell trait, asthma, and prior concussion history is standard in the athlete history.
Rehabilitation progression uses the SAID principle: Specific Adaptation to Imposed Demands; overload must be sport-specific.
Return-to-play decisions require normalization of strength, range of motion, and functional testing, not just absence of pain.
Concussion return-to-learn precedes return-to-play: academic accommodations and graduated cognitive activity come first.
Post-ACL reconstruction return to sport typically occurs 9-12 months with functional testing; earlier return raises reinjury risk.
Cardiac clearance after myocarditis typically requires 3-6 months of restriction with repeat testing before return.
Shared decision-making with the athlete and family is documented for return-to-play decisions involving residual risk.
Exercise Physiology and Performance (Additional)
Overtraining syndrome: performance decrement, mood disturbance, and elevated resting heart rate; recovery requires rest and load reduction.
Female athlete triad (RED-S): low energy availability, menstrual dysfunction, and low bone density; screen for stress fractures and disordered eating.
Precooling (ice slurry, cooling vests) before exercise in heat improves endurance performance and lowers core temperature.
Carbohydrate loading increases muscle glycogen; typical protocol is 8-10 g/kg/day for 36-48 hours before endurance events.
Post-exercise recovery: protein 20-40 g and carbohydrate within 30-60 minutes supports glycogen resynthesis and muscle repair.
Static stretching before power activities can transiently reduce force output; dynamic warm-up is preferred before competition.
Blood flow restriction training can improve strength at low loads; contraindicated with vascular disease or history of DVT.
Sleep deprivation impairs reaction time, power, and injury risk; athletes should target 7-9 hours nightly.
Emergency Medicine and Sports Medicine Clinical Practice (Field Management)
Spine board and collar application: maintain manual in-line stabilization; log-roll with coordinated team to minimize movement.
Lightning safety: 30-30 rule - seek shelter when flash-to-bang is under 30 seconds; wait 30 minutes after last thunder.
Heat index and activity modification: cancel or modify outdoor activity when heat index exceeds safe thresholds per sport guidelines.
Cardiac arrest on field: initiate CPR immediately, apply AED as soon as available; do not delay for transport.
Eye injury: chemical burns require immediate copious irrigation; hyphema or penetrating injury needs urgent ophthalmology.
Dental avulsion: reimplant permanent tooth within 60 minutes if possible; store in milk or saline; do not handle root.
Splenic injury: left upper quadrant pain after contact; monitor for Kehr sign and hemodynamic instability; avoid contact until cleared.
Return-to-play after heat illness: no exercise until asymptomatic with normal labs; gradual reacclimatization over days to weeks.
Medical Conditions in the Athlete (Cardiopulmonary and Neurologic)
Hypertrophic cardiomyopathy: exertional syncope, family history of sudden death, and murmur that increases with Valsalva; ECG and echo are diagnostic.
Commotio cordis and blunt chest trauma: any athlete with chest impact and collapse requires immediate CPR and AED.
Exercise-induced anaphylaxis: triggered by exercise, often with food; treat with epinephrine and avoid triggers.
Seizure in athlete: protect airway, do not restrain; return to play after evaluation if no structural cause.
Concussion: no same-day return to play; graded symptom checklist and neurocognitive testing guide return.
Second impact syndrome: rare but catastrophic; never allow return while symptomatic from prior concussion.
Sickle cell trait and exertional collapse: maintain hydration, avoid extreme exertion in heat, and educate athletes on warning signs.
Asthma exacerbation: assess peak flow and oxygen saturation; treat with bronchodilator and systemic steroids if severe.
Musculoskeletal Injury Evaluation and Management (Special Tests and Imaging)
Shoulder: Neer and Hawkins tests for impingement; Speed and Yergason tests for biceps; apprehension test for instability.
Knee: McMurray for meniscus; Lachman for ACL; valgus/varus stress for collateral ligaments; patellar apprehension for instability.
Ankle: anterior drawer and talar tilt for ligamentous laxity; squeeze test for syndesmosis.
Hip: FADIR and FABER tests for labral pathology; log roll and Stinchfield for hip joint.
Wrist: Watson test for scaphoid instability; Phalen and Tinel for carpal tunnel.
Imaging: X-ray first for fracture; MRI for soft tissue; ultrasound for tendon and muscle; CT for complex fractures.
Stress fractures: MRI is most sensitive; bone scan is alternative; plain films may be normal early.
Pediatric considerations: physeal injuries (Salter-Harris) require careful exam; growth plate tenderness warrants imaging.
Preparticipation Evaluation (Screening Details)
History: prior injuries, surgeries, concussions, cardiac symptoms, medications, supplements, and menstrual history.
Physical exam: blood pressure, pulse, cardiac auscultation, musculoskeletal screening, and vision.
Cardiac red flags: chest pain with exertion, syncope, disproportionate dyspnea, and family history of sudden death.
ECG screening is debated; it improves detection of channelopathies but has false positives requiring cardiology follow-up.
Sickle cell trait screening is recommended for all athletes in some organizations; positive results guide hydration and acclimatization.
Immunizations and prior heat illness should be documented during preparticipation evaluation.
Clearance categories: cleared, cleared with restrictions, not cleared pending further evaluation, or permanently disqualified.
Documentation of shared decision-making is important when athletes compete with residual risk.
Rehabilitation and Return to Play (Concussion and Functional Testing)
Concussion return-to-play protocol: 24 hours per step, symptom-free before advancing; any recurrence restarts previous step.
Return-to-learn: reduce screen time, provide academic accommodations, and gradually reintroduce cognitive load.
Functional testing after lower extremity injury: single-leg hop, Y-balance, and strength symmetry within 10% of contralateral side.
Criterion-based return to sport reduces reinjury compared with time-based clearance.
Psychological readiness scales (e.g., fear of reinjury) should be assessed before full return.
Post-concussion syndrome: symptoms >4 weeks; requires multidisciplinary management and gradual return.
Rehabilitation after ACL reconstruction: restore quadriceps strength, neuromuscular control, and sport-specific movement before clearance.
Return-to-play after cardiac events: individualized cardiology clearance with exercise testing and rhythm monitoring.
Exercise Physiology and Performance (Training Principles)
Progressive overload: gradually increase training stimulus to drive adaptation; excessive load causes overtraining.
Specificity: training adaptations are specific to the mode, intensity, and duration of exercise.
Periodization: planned variation in volume and intensity to peak for competition and reduce injury.
Recovery: sleep, nutrition, and rest days are essential; inadequate recovery impairs performance.
Warm-up: dynamic movements increase muscle temperature and reduce injury risk before competition.
Cool-down: gradual reduction in intensity aids venous return and reduces dizziness.
Hydration: monitor body weight changes and urine color; replace fluids and electrolytes after exercise.
Ergogenic aids: caffeine improves endurance performance; creatine improves strength and power; both have evidence but require caution.
Emergency Medicine and Sports Medicine Clinical Practice (Cardiac and Environmental)
Cardiac arrest: high-quality CPR with minimal interruptions; early defibrillation for shockable rhythms improves survival.
Heat illness: exertional heat stroke requires immediate cooling (cold-water immersion) and transport; do not delay cooling.
Hypothermia: remove wet clothing, insulate, and use active rewarming; avoid rough handling to prevent arrhythmia.
Lightning: 30-30 rule; seek shelter when flash-to-bang <30 seconds; resume activity 30 minutes after last thunder.
Altitude illness: descend for severe symptoms; acetazolamide for prevention; supplemental oxygen if available.
Drowning: rescue breathing is priority; CPR with compressions; do not delay for spinal precautions if airway compromised.
Anaphylaxis: epinephrine IM first-line; adjuncts include antihistamines and steroids; observe for biphasic reaction.
Eye trauma: chemical injury requires immediate irrigation; penetrating injury needs eye shield and urgent ophthalmology.
Medical Conditions in the Athlete (Endocrine, Hematologic, Infectious)
Diabetes: monitor glucose before, during, and after exercise; adjust insulin and carbohydrate intake; carry glucagon.
Sickle cell trait: hydration, acclimatization, and gradual conditioning reduce exertional collapse risk.
Infectious mononucleosis: avoid contact sports for at least 4 weeks due to splenic rupture risk.
Iron deficiency: common in endurance athletes; screen with ferritin and treat with iron supplementation.
Female athlete triad/RED-S: low energy availability, menstrual dysfunction, and low bone density; screen and treat.
Thyroid disease: hyperthyroidism can cause palpitations and heat intolerance; hypothyroidism causes fatigue and weight gain.
HIV and other bloodborne pathogens: universal precautions; participation generally allowed with appropriate management.
Viral myocarditis: restrict exercise for 3-6 months and obtain cardiology clearance before return.
Musculoskeletal Injury Evaluation and Management (Fractures and Dislocations)
Open fracture: cover wound, splint, and give antibiotics and tetanus prophylaxis; urgent orthopedic consultation.
Dislocation: reduce promptly if neurovascular compromise; document pulses and sensation before and after.
Compartment syndrome: pain out of proportion, pain with passive stretch, and tense compartment; emergent fasciotomy.
Stress fracture: focal tenderness and pain with activity; MRI is most sensitive; rest and gradual return.
Salter-Harris fractures: growth plate involvement; types I-V; type I may have normal X-ray.
Shoulder dislocation: axillary nerve injury is common; assess deltoid function and sensation.
Ankle fracture: Ottawa rules guide imaging; syndesmotic injury requires stress testing.
Pediatric fractures: consider non-accidental trauma if inconsistent history; involve child protective services as needed.
Preparticipation Evaluation (Cardiac Screening and Clearance)
AHA 14-point screening includes personal and family history plus physical exam; positive findings warrant further evaluation.
ECG screening can detect channelopathies but has false positives; follow-up with cardiology is required.
Hypertrophic cardiomyopathy: murmur increases with Valsalva; ECG and echo are diagnostic; disqualification may be required.
Syncope with exertion: red flag for structural heart disease; evaluate before clearance.
Family history of sudden cardiac death before age 50: refer for evaluation.
Clearance categories: cleared, cleared with restrictions, not cleared pending evaluation, permanently disqualified.
Shared decision-making and documentation are essential when residual risk exists.
Athletes with pacemakers or ICDs require individualized cardiology clearance.
Rehabilitation and Return to Play (Strength and Conditioning)
Strength symmetry within 10% of contralateral limb is a common return-to-play criterion.
Functional testing: single-leg hop, Y-balance, and sport-specific drills assess readiness.
Criterion-based return to sport reduces reinjury compared with time-based clearance.
Psychological readiness (fear of reinjury) predicts successful return.
Progressive loading: increase volume and intensity gradually to avoid re-injury.
Neuromuscular training reduces ACL injury risk in athletes.
Return-to-play after concussion: graduated steps with 24 hours per step; symptom-free before advancing.
Cardiac clearance after myocarditis: 3-6 months restriction with repeat testing.
Exercise Physiology and Performance (Nutrition and Hydration)
Carbohydrate loading: 8-10 g/kg/day for 36-48 hours before endurance events.
Protein intake: 1.2-2.0 g/kg/day for strength athletes; 20-40 g post-exercise supports recovery.
Hydration: monitor body weight changes and urine color; replace fluids and electrolytes.
Exercise-associated hyponatremia: avoid excessive free water; treat with hypertonic saline if symptomatic.
Caffeine improves endurance performance; creatine improves strength and power.
Iron deficiency: screen with ferritin in endurance athletes; treat with supplementation.
Female athlete triad/RED-S: low energy availability, menstrual dysfunction, low bone density; screen and treat.
Precooling before exercise in heat improves endurance performance.
Emergency Medicine and Sports Medicine Clinical Practice (Airway and Trauma)
Cervical spine injury: maintain in-line stabilization; do not remove helmet/shoulder pads unless airway access requires it.
Airway management: use bag-valve-mask and advanced airway as needed; avoid excessive cervical movement.
Hemorrhage control: direct pressure, tourniquet for life-threatening extremity bleeding.
Tension pneumothorax: needle decompression followed by chest tube.
Fractures: splint in position of comfort; assess neurovascular status before and after.
Dislocations: reduce promptly if neurovascular compromise; document pulses and sensation.
Head injury: GCS decline, focal deficit, or repeated vomiting warrant urgent imaging.
Anaphylaxis: epinephrine IM first-line; observe for biphasic reaction.
Medical Conditions in the Athlete (Dermatologic and Environmental)
Skin infections: bacterial (impetigo), viral (herpes gladiatorum), fungal (tinea); return-to-play requires treatment and no active lesions.
Herpes gladiatorum: contagious; avoid contact until lesions crusted; antiviral treatment.
Tinea corporis: topical antifungal; avoid sharing equipment.
Heat rash: keep skin dry and cool; avoid occlusive clothing.
Frostbite: gradual rewarming; avoid rubbing; protect from refreezing.
Sunburn: prevent with sunscreen; treat with cooling and hydration.
Blister management: drain if large and painful; keep clean and covered.
Return-to-play after skin infection: no active lesions and appropriate treatment.
Preparticipation Evaluation (Musculoskeletal Screening)
History: prior injuries, surgeries, and current symptoms.
Physical exam: joint range of motion, strength, and stability testing.
Red flags: instability, locking, or neurovascular symptoms warrant imaging.
Screening for ligamentous laxity: assess with special tests.
Pediatric considerations: growth plate tenderness warrants imaging.
Clearance categories: cleared, cleared with restrictions, not cleared pending evaluation, permanently disqualified.
Documentation of findings and recommendations is essential.
Return-to-play criteria should be individualized based on sport and injury.
Rehabilitation and Return to Play (Concussion Management)
No same-day return to play after concussion.
Graduated return-to-play protocol: 24 hours per step; symptom-free before advancing.
Return-to-learn precedes return-to-play: academic accommodations and gradual cognitive activity.
Any symptom recurrence restarts the previous step.
Post-concussion syndrome: symptoms >4 weeks; multidisciplinary management.
Neurocognitive testing and symptom checklists guide return.
Second impact syndrome: rare but catastrophic; never allow return while symptomatic.
Psychological readiness should be assessed before full return.
Exercise Physiology and Performance (Environmental Physiology)
Heat acclimatization: 10-14 days; expanded plasma volume and earlier sweating.
Altitude: acute exposure lowers oxygen saturation and VO2max; acclimatization over 2-3 weeks.
Cold: hypothermia risk; insulate and use active rewarming.
Precooling before exercise in heat improves endurance performance.
Hydration: monitor body weight changes and urine color.
Exercise-associated hyponatremia: avoid excessive free water; treat with hypertonic saline.
Lightning: 30-30 rule; seek shelter when flash-to-bang <30 seconds.
Heat index and activity modification: cancel or modify outdoor activity when heat index exceeds safe thresholds.
Emergency Medicine and Sports Medicine Clinical Practice (Cardiac Emergencies)
Cardiac arrest: high-quality CPR with minimal interruptions; early defibrillation for shockable rhythms.
Commotio cordis: blunt precordial impact during repolarization; immediate CPR and AED.
Hypertrophic cardiomyopathy: exertional syncope, family history, murmur that increases with Valsalva.
Myocarditis: restrict exercise for 3-6 months; cardiology clearance before return.
Anomalous coronary artery: leading cause of sudden cardiac death in young athletes in some series.
Syncope with exertion: red flag for structural heart disease; evaluate before clearance.
AED use: apply as soon as available; do not delay for transport.
Return-to-play after cardiac events: individualized cardiology clearance with exercise testing.
Medical Conditions in the Athlete (Neurologic and Psychiatric)
Concussion: no same-day return to play; graded symptom checklist and neurocognitive testing guide return.
Seizure: protect airway, do not restrain; return to play after evaluation if no structural cause.
Second impact syndrome: rare but catastrophic; never allow return while symptomatic.
Post-concussion syndrome: symptoms >4 weeks; multidisciplinary management.
Psychological readiness (fear of reinjury) predicts return-to-play success.
Eating disorders: screen for disordered eating; treat with multidisciplinary team.
Overtraining syndrome: performance decrement, mood disturbance, elevated resting heart rate; rest and load reduction.
Sleep deprivation impairs reaction time, power, and injury risk; target 7-9 hours nightly.
Musculoskeletal Injury Evaluation and Management (Tendinopathy and Overuse)
Tendinopathy: degenerative rather than inflammatory; managed with progressive loading and eccentric exercise.
Patellar tendinopathy: eccentric decline squats are effective.
Achilles tendinopathy: eccentric heel drops; avoid complete rest.
Rotator cuff tendinopathy: strengthening and scapular stabilization.
Stress fracture: focal tenderness and pain with activity; MRI is most sensitive.
Overuse injuries: address training errors, footwear, and biomechanics.
Return-to-play: progressive loading and pain-guided activity.
Prevention: gradual increase in training volume and intensity.
Preparticipation Evaluation (Medical and Cardiac History)
Personal history: chest pain, syncope, disproportionate dyspnea with exertion.
Family history: sudden cardiac death before age 50, cardiomyopathy, channelopathy.
Physical exam: cardiac auscultation, blood pressure, pulse.
ECG screening: debated; improves detection but has false positives.
Sickle cell trait screening: recommended in some organizations.
Clearance categories: cleared, cleared with restrictions, not cleared pending evaluation, permanently disqualified.
Documentation of shared decision-making is important.
Immunizations and prior heat illness should be documented.
Rehabilitation and Return to Play (Postoperative Rehabilitation)
ACL reconstruction: return to sport typically 9-12 months with functional testing.
Strength symmetry within 10% of contralateral limb is a common criterion.
Criterion-based return to sport reduces reinjury compared with time-based clearance.
Psychological readiness should be assessed before full return.
Progressive loading: increase volume and intensity gradually.
Neuromuscular training reduces ACL injury risk.
Postoperative rehabilitation phases: protection, mobility, strength, power, sport-specific function.
Functional testing: single-leg hop, Y-balance, and sport-specific drills.
Exercise Physiology and Performance (Cardiovascular and Respiratory)
VO2max = cardiac output × arteriovenous oxygen difference.
Lactate threshold occurs at roughly 60-80% of VO2max in trained endurance athletes.
Maximal heart rate estimate: 220 − age is a rough population estimate with wide variability.
Karvonen formula: target HR = ((HRmax − HRrest) × intensity%) + HRrest.
Energy systems: phosphagen (0-10 s), glycolytic (10 s-2 min), oxidative (>2 min).
Altitude: acute exposure lowers arterial oxygen saturation and VO2max.
Heat acclimatization: 10-14 days; expanded plasma volume and earlier sweating.
Precooling before exercise in heat improves endurance performance.
Emergency Medicine and Sports Medicine Clinical Practice (Field Triage and Transport)
Primary survey: airway, breathing, circulation, disability, exposure.
Cervical spine precautions: maintain in-line stabilization; do not remove helmet/shoulder pads unless airway access requires it.
Hemorrhage control: direct pressure, tourniquet for life-threatening extremity bleeding.
Tension pneumothorax: needle decompression followed by chest tube.
Head injury: GCS decline, focal deficit, or repeated vomiting warrant urgent imaging.
Anaphylaxis: epinephrine IM first-line; observe for biphasic reaction.
Heat stroke: immediate cooling (cold-water immersion) and transport.
Lightning: 30-30 rule; seek shelter when flash-to-bang <30 seconds.
Medical Conditions in the Athlete (Renal and Gastrointestinal)
Exertional rhabdomyolysis: dark urine, severe muscle pain, weakness, elevated CK; aggressive IV fluids.
Hyponatremia: confusion, seizure, or collapse after endurance events; treat with hypertonic saline.
Hematuria after exercise: usually benign; evaluate if persistent.
Gastrointestinal distress during exercise: common; adjust hydration and nutrition.
Splenic injury: left upper quadrant pain after contact; monitor for Kehr sign and hemodynamic instability.
Liver injury: right upper quadrant pain; evaluate with imaging if severe.
Return-to-play after renal injury: normalize labs and hydration status.
Prevention: gradual acclimatization and hydration.