20 Yards From The Finish Line - Page #1

Author: David Liddle, MD
Co Author #1: Andrew Gregory, MD
Editor: Daniel Parker, MD, MPH

Patient Presentation:
A 54 y/o female runner collapsed 20 yards from the finish line during a half-marathon.

This was one of many endurance events in which she had participated. When medical staff arrived at her side shortly after her collapse, she responded only to noxious stimuli. She was breathing slowly through frothy sputum but had a pulse. Because of sporadic limb movements, the bystanders who had initially attended to her were concerned about a seizure. Her friends, who ran with her, stated that she had no history of seizures but did have “a heart condition.” They also reported that she had complained of chest pain at mile 10 but chose to keep running since she was “so close to the finish.” Soon after initial assessment, she stopped breathing and became pulseless. Her PMH was later discovered to include angina treated with sublingual nitroglycerine PRN.
Race conditions: Temperature 67-72 F, 50-73% humidity, heat index 67-71 F

Physical Exam:
VS: RR 12, HR 120 but BP and SatO2% unknown.

General: Ill appearing with ashen color and dry mucous membranes. GCS 6. Cool clammy skin. No Trauma.
HEENT: ATNC, JVP 5 cm when lying flat. Pupils minimally responsive.
CV: Initially had rapid palpable carotid pulse but soon became pulseless.
Resp.: Labored bradypnea with course breath sounds bilaterally that became agonal.

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