Question

Scenario:
During preseason practice in August, a soccer player comes into the athletic training room complaining of fatigue and dizziness. He sits on a treatment table and promptly passes out. The certified athletic trainer (ATC) calls for help and starts his examination. He finds the athlete is breathing and has a strong carotid but weak radial pulse. The athlete sluggishly responds to questions and is confused. The skin is warm, moist, and flushed. Blood pressure (BP) is 80/50, pulse is 120, respiratory rate is 20, pulse oximetry is 99% on room air, and axillary temperature is 99.5 F. The athlete denies pain.

Questions:
1.What are your concerns for the patient, environment, and scenario?
2.Is this athlete in shock and if so, how did you determine that?
3.Can this athlete be treated effectively in the athletic training room? Explain your rationale.
4.What is your referral strategy?
5.How often should vital signs be monitored?

Answer 1

1.What are your concerns for the patient, environment, and scenario?

As per the data provided, the patient is developin a hypovolemic shock. His BP is falling , ie 80/50. The pulse is very thready and he developed tachycardia. His heart beat is 120 beats/ minutes. Which indicate that the cardiac system is trying hard to pump the blood throughout the body. Adequate fluid resuscitation measures to be done immedaitely for this patient to protect him from hypovelemia.Regarding his environment, its the  month of august, and he was during his practice session. The month of july to august remain, one of the hotest month, since practice during this time can lead to severe dehydration and associated hypovolemia.

2.Is this athlete in shock and if so, how did you determine that?

As per the clinical data provide the patient is developing a hypovolemic shock. Hypovolemic shock is a clinical condition characterized by excess loss of body fluid from the body, leads to organ failure and other associated problems. The hypovolemic shock can be identified with some of the clinical data such as BP, Heart rate, urine output, electrolyte studies etc. the patient also have a cool and clamy skin, paleness of the skin, dizziness, fatigue etc. Here also, the patients BP is falling, he developed tachycardia.The skin is flushed, he is having sluggish response to questions, and his peripheral pulses are week. All these symptoms suggestive of a hypovolemic shock.

3.Can this athlete be treated effectively in the athletic training room? Explain your rationale.

Since his BP is falling rapidly, he need to be resuscited with adequate fluids immediately. Oxygen administration also maintained immediately to avoid hypoxia. Oral fluids may not be effective here because, the patient is very week and tired. His response also sluggish. He need to shift to an emergency care, where continuous monitoring of cardiac activity, ECG monitoring, electrolyte monitoring etc are available. Hence this patient cannot managed effectively in the athletic training room.

4.What is your referral strategy?

Refer him to the near by emergency department. where facilities are availble for emergency intensive care such as oxygen administration, fluid resuscitation, ECG monitoring, ventilatory support etc are available.

5.How often should vital signs be monitored?

The vital signs to be monitored every 2 hourly for the first 4 hours after the symptoms of hypovolemia develops. Once fluid resuscitation measures begined and patient is clinically stable, then vitals can be repeated for a every 4 hours.