A runner may present to the medical tent with altered mental status for a variety of reasons.  Using systematic approach will allow you to provide optimal care and making it less likely to miss a serious problem.

If a runner arrives unresponsive:

• Begin with a C – A – B assessment.  Begin BLS and call for the code team.
• Check vital signs (HR, BP, O2 sat)
• Check the back of the BIB for medical information (if completed beforehand)
• Obtain a rectal temperature
  • If > 104 degrees begin immediate cooling measures.  See Exertional Heat Illness page.
• Obtain IV access
• Check I-stat sodium and blood glucose
  • Sodium
    • If abnormal (<135 ) see Exercise Associated Hyponatremia page
    • If normal (Na >135)  give 1 L D5 0.9NS over 30 minutes
  • Glucose
    • If blood sugar < 55 mg/dl and unconscious give Glucagon 1 mg IM and start D5NS.  See Hypoglycemia page.
• Prepare for transport if not responding to treatment

If the runner is conscious but has altered mental status, bring them to the Main Medical Tent via wheelchair or gurney.  Do not attempt to have the patient stand back up and walk them to the medical tent.

• Elevate legs 12 inches above their core (Trendelenburg)
• Obtain complete vitals (HR, BP, O2 sat)
• Obtain rectal temperature (may be in the lucid interval of hyperthermia)
  • If > 104 degrees Fahrenheit begin immediate cooling measures.  See Exertional Heat Illness page.
• Review patient history for previous cardiac history and for risk factors
• Obtain IV access
• Check I-stat sodium and blood glucose
  • Sodium
    • If abnormal (<135 ) see Exercise Associated Hyponatremia page
    • If normal (Na >135)  give 1 L D5 0.9NS over 30 minutes
  • Glucose
    • If blood sugar < 55 give 1 ampule of D50W and start D5NS.  See Hypoglycemia page.
• Encourage oral fluid intake once the nausea resolves
• Runner should have normal mental status and be able to sit-up, stand and walk without symptoms prior to discharge
• Runner must urinate prior to discharge if received IV fluids

Consider alternative etiologies if the patient continues to be unresponsive to medical treatment.