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A Life Changing Run: When The Finish Line Isn’t The End - Page #1
 

Author: Dylan Wood, MD
Co Author #1: Jonathan Paul
Co Author #2: Sean Goldman
Co Author #3: Nicole Pontee and Timothy Tiu
Senior Editor: Drew Duerson, MD
Editor: Brett Bentley, MD

Patient Presentation:
A 37-year-old male with a past medical history of obesity (body mass index 38 kg/m²) initially presented to the emergency department via emergency medical services with altered mental status that developed while participating in a marathon. The patient collapsed at the finish line and had no recollection of the event.

History:
Emergency medical services personnel initiated cooling measures during transport, including wet blankets, cooling fans, ice packs, and 2 liters of chilled intravenous fluid.

Upon arrival to the emergency department, the patient was combative, tachycardic, and tachypneic, requiring lorazepam and midazolam for agitation. Despite aggressive intravenous fluid resuscitation and cooling measures over the subsequent 24 hours, his condition continued to deteriorate with worsening laboratory abnormalities, prompting transfer to the intensive care unit for higher-level care

Physical Exam:
Somnolent and intermittently moaning
Eyes closed and not opening to verbal commands or noxious stimuli
Bilateral dilated pupils that were briskly reactive to light, without blink-to-threat response; roving eye movements present
Dry mucous membranes
Normal muscle tone throughout the upper and lower extremities
Spontaneous movement of all extremities in the plane of the bed; withdrawal to noxious stimuli
Diffuse swelling of the right upper extremity involving all compartments
Deep tendon reflexes symmetric and normal
No clonus

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

UPCOMING EVENTS


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11/19-11/22/2026
2026 AMSSM/OHSU Introductory &/or Diagnostic/Interventional Sports US Course

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12/04-12/06/2026
2026 Advanced Team Physician Course

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4/16-4/21/2027
2027 AMSSM Annual Meeting

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4000 W. 114th Street, Suite 100
Leawood, KS 66211
Phone: 913.327.1415


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