Emergency Assessment and Management of the Athlete
Core concepts
Master primary survey (ABCs), sudden cardiac arrest management (early CPR, AED), heat illness (heat stroke vs heat exhaustion), exertional hyponatremia, anaphylaxis, cervical spine precautions, and concussion on-field assessment. Know that sudden cardiac arrest is the leading cause of death in young athletes during sport; early defibrillation is the key intervention. Understand heat stroke: core temp typically >40°C with CNS dysfunction, requiring immediate cooling (cold water immersion). Exertional hyponatremia presents with confusion, nausea, and often overhydration with hypotonic fluids-treat with fluid restriction and hypertonic saline if severe.
Traps
A frequent trap is treating heat stroke with antipyretics or delayed cooling-cool first, transport second. Another is confusing heat exhaustion (sweating, weakness, normal mental status) with heat stroke (altered mental status). Cervical spine injury: do not remove equipment hastily; stabilize and follow spinal motion restriction protocols. Anaphylaxis requires epinephrine IM, not antihistamines alone.
Rule of thumb
"Cool first, transport second" for heat stroke. For suspected cardiac arrest, start compressions and get the AED immediately. For suspected anaphylaxis, epinephrine IM to the lateral thigh without delay.
Worked example
A football player collapses in August with confusion, hot skin, and a core temp of 41°C. This is exertional heat stroke: initiate immediate cold-water immersion and call EMS simultaneously; do not wait for transport to begin cooling.