Exercise Associated Collapse (EAC) is a condition seen in endurance events. A runner is unable to stand or walk unaided as a result of lightheadedness, faintness, dizziness, or syncope. During exercise the skeletal muscles act to pump blood back into the heart. Syncope may ensue if the pump action of the skeletal muscles is lost with persistence vasodilation. The most common scenario is when a runner abruptly ceases activity after crossing the finish line. Symptoms include nausea, emesis, lightheadedness, unsteady gait, and syncope.
If the runner “collapses” in the runner’s chute, they should be scooped to the side to avoid the runner and volunteer being stepped on by other participants. A BLS Survey should be immediately conducted as the legs are elevated to assist in venous return.
If absent pulse or breathing, perform high quality CPR per the AHA guidelines until the “code team” arrives. See Cardiac Care page.
If altered mental status but normal breathing and pulse, take the runner via wheelchair or gurney to the Heat Pod in the Medical Tent for core temperature assessment. See Altered Mental Status page or Exertional Heat Illness page.
If stable (normal mental status, breathing, and pulse present) take the runner via wheelchair or gurney to the Triage area of 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. The patient may feel nauseated so have the red bags/buckets at the ready should the runner vomit.
- 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
- If abnormal (<135 ) see Exercise Associated Hyponatremia page
- If normal (Na >135) give 1 L D5 0.9NS over 30 minutes
- 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.