chapter 6. The collapsed player
B M Devitt and KD Carson
COLLAPSE WITH NO TRAUMA
This is a very serious event. Call for help immediately!
Red Zone
More likely to occur during a game.
• Cardiac arrest
• Stroke
• Diabetes – insulin reaction or diabetic coma
• Severe asthma attack
Amber Zone
More likely to occur after a game.
• Faint
• Exhaustion
• Dehydration
Green zone
• Muscle or joint problems
A collapsed player should be treated as a Red Zone or Amber Zone injury until proven otherwise. Remove them from the field of play and ensure they are assessed by trained medical personnel.
An athlete with collapse related to a muscle of joint problem can return to play only if they perform the necessary skills – see Chapter 9.
What do I check for?
If the player is unconscious and does not come around quickly, go immediately to the ABC chapter (p. 21)!
With any head injury, be aware of possible neck injury and protect the neck.
Speak to the player
• ‘Hello, hello, can you hear me?’
• ‘Open your eyes’
• ‘What is your name?’
• ‘Do you know where you are?’
• ‘Are you in pain?’
• ‘Can you tell me what happened?’
• ‘Do you have any medical conditions?’
• ‘Are you taking any drugs?’
If the player is drowsy – Ask anybody who saw the incident what happened?
Find out if they are on medication or have a medical condition
Problem identification
Always assume the worst-case scenario.
Did the collapse happen during or after the game?
| Common causes of collapse during the game |
| Heart causes |
| Lethal arrhythmia (conduction problem) |
| Heart attack |
| Major vessel rupture (aortic dissection, aortic aneurysm) |
| Metabolic emergencies |
| Symptomatic Hyponatraemia (low salt) |
| Diabetic emergencies — Insulin Reaction (low blood sugar) or Diabetic Coma |
| Brain conditions |
| Stroke |
| Brain haemorrhage (Subarachnoid bleeding) |
| Seizure |
| Extremes of body temperature |
| Hyperthermia (overheating) |
| Hypothermia (Low body temperature) |
| Gasping for air |
| Extreme asthma attack |
| Anaphylactic reaction allergy |
| Aspirated a foreign body: Chunk of a sports bar, chewing gum or mouth guard |
| Severe cramping and other orthopaedic conditions |
| Common causes of collapse after the game |
| Exercise-associated collapse |
| Faint — Temporary Drop In Blood Pressure |
| Over heating |
| Dehydration |
| Severe cramping or other orthopaedic conditions |
Is the player making sense?
Yes. Encouraging sign, less likely to be a serious head injury. Quiz the player about what happened.
• Do you know why you collapsed?
• Has this happened before?
• Do you have any medical problems?
• Do you have chest pain? If yes, go to ‘I have chest pain – nobody hit me!’ (p. 127)
• Do you have any allergies?
No. Could indicate serious head injury or metabolic disturbance
– low blood sugar.
Close observation is necessary
– Do not leave the player alone!
Observe
Use your instincts! Does the player look very sick? Are they pale, Sweaty, or Clammy?
If the player looks sick or you are unsure in any way, seek medical assistance immediately.
Here are a few things to observe for
Airway
Look in the player’s mouth and make sure nothing is blocking the airway. Remove anything in the mouth and make sure the player can breathe.
Breathing
Has the player difficulty breathing? Is the player asthmatic?
Watch the movement of the chest and feel the rib cage moving in and out equally on both sides. If this is not happening or the player is in great distress, go to the ABC chapter (p. 21).
Circulation
Feel for the player’s pulse. The best pulse to feel is the carotid pulse in the neck (Fig. 6.1).
 |
| Fig. 6.1 |
Level of consciousness
Check if the player is alert by observing them. Are their eyes open?
Do they seem very sleepy? If they are drifting in and out of consciousness, talk to them and keep them awake.
A player may have lost consciousness briefly as a result of a faint (see Faint, p. 43) Seek immediate medical attention and urgent transfer to hospital.
Eye movement
Stand in front of the player and ask them to look at you.
• Watch to see if they can focus their eyes on you
• If their eyes are rolling in their head or unable to stay in one spot, this may indicate a head injury or concussion
• Ask them to follow your finger as you draw out an imaginary ‘H’ in front of them
• Observe to ensure that the eyes follow in all directions
• Any lack of movement in one direction or blurred vision when doing this suggests a head injury
• Tell the player to cover one eye with their hand. Hold up a number of fingers and ask ‘How many fingers do you see?’
• The wrong answer a number of times suggests a head injury
Feeling for a player’s pulse
You can feel the pulse by running the first two fingers of your right hand (index and middle finger) alongside the outer edge of your trachea (windpipe). Press your fingers in and move them outwards about two finger breadths – you should be able to feel the pulsation of the artery. It is sometime difficult to feel in a heavy person, so you may have to press a bit deeper. Since the carotid arteries supply a lot of the blood to the brain, it’s important not to press on both of them at the same time!
If the person has no pulse, check the other side. Look at the colour of the player. A person with no pulse will be unconscious and very pale; go immediately to the ABC chapter (p. ••) (check airway and breathing), start chest compressions and transfer to hospital as soon as possible.
A person exercising is likely to have a fast pulse! What is most worrying is a very slow or absent pulse or a pulse that doesn’t slow down when exercise has ceased. Seek medical assistance in these cases.
Verbal response
Ask the player the following questions.
• ‘What day is it?’ (Time)
• ‘What’s your name?’ (Person)
• ‘Where are you?’ (Place)
Movement
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