Emergency Medicine and Sports Medicine Clinical Practice
Sports emergencies reward a systematic primary survey over pattern recognition. The candidate must know the field management of sudden cardiac arrest (immediate CPR, early AED, removing pads/gear that impede defibrillation), exertional heat stroke (core temp often >40°C with CNS dysfunction - cool first, transport second), and catastrophic cervical spine injury (in-line stabilization, no routine collar traction). Recognize commotio cordis as a blunt precordial blow during a narrow electrical window causing VF in a structurally normal heart; treatment is defibrillation, not precordial thump.
Traps: questions conflate heat exhaustion with heat stroke - the discriminator is CNS dysfunction, not a specific temperature. Exertional hyponatremia presents with confusion and seizures in an athlete who over-hydrated; do not assume heat stroke and give free water. Anaphylaxis from a sting or exercise-induced anaphylaxis requires IM epinephrine first-line. Sickle cell trait collapse is often mistaken for heat illness; it presents with rhabdomyolysis and exertional collapse, especially at altitude or in high-intensity field drills.
Rule of thumb: in any collapsed athlete, "ABC first, then cool or shock." A worked example: a football player collapses in August, is confused, skin hot and dry, temp 41°C - the answer is aggressive cold-water immersion with cooling initiated before transport, because time-to-cooling drives survival and neurologic outcome.
Also know return-to-play after concussion is not a same-day decision, and that exertional sickling prevention (gradual acclimatization, hydration, rest breaks) is a preventive answer choice.