On The Ball - Rapid Intervention On An Unconscious Athlete - Page #1

Author: Joseph Benert, MD
Co Author #1: Laura Henn, ATC
Co Author #2: Matthew Hofkens, DO
Senior Editor: Marc Hilgers, MD, PhD, FAMSSM
Editor: Marissa Vasquez Machuca, MD, MBA

Patient Presentation:
An 18-year-old high school football player with a history of asthma and two prior concussions (one and three years prior) presents after a nose tackle with decompensation on the sideline during a high school playoff game.

The athlete was participating in the second half of the game when he came off the field, sat immediately on the bench, and took off his helmet. Medical staff checked on him as they observed him rocking back and forth. There was no identifiable preceding injury or significant collision that was witnessed or described by the athlete or medical staff. The athlete initially reported symptoms of headache and neck pain that progressed while seated. Symptoms worsened with changing position from sitting to standing. Additional symptoms of hyperventilation, nausea and photophobia prompted removal of shoulder pads and further neurological evaluation. The emergency action plan was initiated by the onsite medical staff. Pupil dilation and projectile vomiting ensued. Prior to loss of consciousness the athlete lost bladder control; he then collapsed in the arms of the team physician. The athlete suffered a generalized tonic-clonic seizure.

Physical Exam:
Airway was maintained by the team physician during ongoing emesis and seizure activity, with the athlete demonstrating a strained, loud, snoring type breathing pattern. An AED demonstrated that no shock was needed. There was questionable decorticate posturing.

Initial emergency department evaluation revealed a Glasgow Coma Scale (GCS) of 3. Left pupil was dilated to 5 mm when compared to 2 mm on the right. He was intubated and hyperventilated in the trauma unit.

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.

© The American Medical Society for Sports Medicine
4000 W. 114th Street, Suite 100
Leawood, KS 66211
Phone: 913.327.1415

Website created by the computer geek