Marathon Emergencies: From Muscle Cramps to Cardiac Arrest

Marathon Emergencies: From Muscle Cramps to Cardiac Arrest

In 2019, there have been 238 marathon competitions in Germany. Greater than 90% of the over 110,000 runners who began these races reached the end, in accordance with emergency and intensive care medics. Since operating is a well-liked sport for many individuals of varied age teams, threat teams, and levels of professionalism, emergency providers are confronted with a large spectrum of medical emergencies, in accordance with Simon-Richard Finke, MD, intensivist at College Hospital Cologne, Germany, and Daniel C. Schroeder, MD, intensivist at German Armed Forces Hospital in Koblenz, Germany. In a latest journal article, Finke, Schroeder, and colleagues defined which medical emergencies ought to be anticipated and the way they’re approached.

Train-Related Muscle Cramps

The authors write that muscular overload, electrolyte imbalances, and inadequate fluid consumption are mentioned as the reason for painful, involuntary skeletal muscle contractions. Older and untrained athletes, in addition to runners with joint displacement, are significantly affected.

Remedy: Muscle stretching and oral rehydration.


Tendinopathy is normally brought on by repetitive exercise, the consequence of which is progressive degeneration of the collagen fibers. Scientific signs embody ache and lack of operate. Websites affected are the Achilles tendon and plantar fascia.

Preclinical Remedy: Resting the affected limb, subsequently withdrawing from the competitors, and analgesia.


Doable causes of rhabdomyolysis (the speedy breakdown of broken skeletal muscle) are traumas, drugs, poisons, and pronounced thermal stress. Nonspecific preliminary signs embody ache, weak point, and motion limitations. They point out harm to the skeletal musculature, the extent of which should not be underestimated, warn the authors.

Preclinical Remedy: Analgesia and cooling. Within the occasion of an unclear analysis, referral to the hospital.


Microfractures and stress fractures can come up on account of exertion. The tibia, fibula, metatarsals, and the iliac crest are affected most of all.

Signs: Preexisting, rising ache on exertion, which could be localized by means of palpation and is accompanied by nonspecific signs similar to redness and swelling.

Preclinical Remedy: Relaxation, splinting, and analgesia.

Compartment Syndrome

Mostly affected in runners are the anterior muscular tissues of the shin. The signs are initially nonspecific (similar to cramps or muscle weak point), clarify the emergency medics. In a while, a scientific hardening of the muscle when in movement turns into obvious, with concomitant ache at relaxation, hypesthesia, and inadequate circulation.

Preclinical Remedy: Relaxation and analgesia. Remedy for superior compartment syndrome consists of immediate surgical intervention.

Sudden Cardiac Dying/Cardiac Arrest

Based on data from the authors, the incidence of cardiac arrest at operating occasions is between 1 in 15,000 and 1 in 150,000. Males are significantly affected (93%) with a mean age of 45-50 years. The affected sufferers typically have coronary coronary heart illness. For youthful athletes, the principle trigger is hypertrophic cardiomyopathy. Hyponatremia and warmth stroke are uncommon causes of cardiac arrest.


Collapse (orthostatic dysregulation) is the most typical complication in long-distance runners, the emergency medics continued. Nearly all of sufferers don’t require any medical care. If care is critical, that is thought-about a “critical collapse” (tachycardia, hyperthermia, metabolic acidosis, and hypernatremia).

Preclinical Measures: Safeguarding the very important features according to the ABCDE strategy (airway, respiration, circulation, incapacity, and publicity) as the principle focus. 

Train-Induced Hyponatremia

Hyponatremia is outlined as a serum sodium degree of

Causes: Elevated oral consumption of hypotonic fluid (or hypervolemic hyponatremia) and hyperthermia (hypovolemic hyponatremia).

It’s thought-about extreme (exercise-induced) hyponatremia if the serum sodium degree is

The scientific analysis of exercise-induced hyponatremia is extraordinarily tough, the authors write, as a result of it may be confused simply with warmth stroke or dehydration. An actual preclinical differentiation of the diploma of severity is unimaginable. Scientific examination as per the ABCDE strategy and cautious surveying of the neurologic standing are subsequently of nice significance for the preclinical estimation. By way of the differential analysis, hypoglycemia should be excluded preclinically.

For sufferers with delicate signs, hydration ought to be carried out orally. Critically unwell sufferers with extreme dehydration (lack of>7% of the physique weight, hypotension) or with restricted oral consumption (nausea, vomiting) ought to be hydrated intravenously. This remedy should be carried out underneath shut scientific monitoring.

Dehydration principally impacts quick marathon runners who don’t drink sufficient fluid in the course of the competitors, whereas with slower runners, “overdrinking” is extra generally noticed, in accordance with the authors. Quick runners are in better hazard of dehydration, whereas sluggish runners are in better hazard of hyponatremia.

Warmth Stroke

The emergency medics clarify that warmth stroke is characterised by a core physique temperature of>104° F (>40° C), seizures, impaired consciousness, and a number of organ failure. Regardless of the type of sport, exercise-related warmth stroke is the second most typical reason behind demise in younger athletes, with a mortality of 21%–63%.

Preclinical Remedy: Undressing and cooling (ice, towels), safeguarding the very important features. At increased physique temperatures and life-threatening scientific signs, speedy referral to a hospital.

Gastrointestinal Signs

Between 30% and 90% of endurance runners report growing gastrointestinal signs, proceed the authors. The severity of the signs correlates with the gap or the extent of bodily exertion. The particular high-protein, high-carbohydrate and high-fat weight loss program utilized by many runners encourages gastrointestinal signs. Mildly symptomatic sufferers have diarrhea, an urge to defecate, vomiting, flatulence, gastroesophageal reflux, nausea, cramps, and colic. It’s attainable to transition to extreme signs similar to stomach angina, bloody diarrhea, small intestinal infarction, hemorrhagic gastritis, ischemic colitis, and rectal (occult) bleeding.

Preclinical Remedy: Symptomatic and cautious rehydration.

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