Marathon Medical Care

Aka: Marathon Medical Care, Running Event Medical Tent

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II. Management: Musculoskeletal Cramps

  1. Single Muscle group (e.g. unilateral calf cramping)
    1. Encourage independent walking
    2. Assisted walking may be offered (but runner will not receive a marathon time)
  2. Repeated and progressive single Muscle cramping (recurs multiple times along course)
    1. Oral rehydration with Electrolytes
    2. Calorie replacement
    3. Independent walking or assisted walking as above
  3. Diffuse Muscle involvement or unable to ambulate
    1. Intravenous Fluid rehydration
    2. Intravenous Magnesium Sulfate if available
    3. Consider Benzodiazepines if available
    4. Consider transport to Emergency Department if Intravenous Access or fluids not available
    5. Runners should not return to the race after initiating Intravenous Fluid

III. Management: Chafing or Blisters (e.g. inner thighs, nipples)

  1. Apply vaseline to chafed areas
  2. Mole-skin (or similar) may be applied to areas of Blisters (esp. on foot)
  3. Band aids may be applied over raw nipples

IV. Management: Collapsed runner

  1. Precautions
    1. Troponin and Creatine Kinase markers are frequently increased in healthy marathon participants
  2. Cardiac Arrest
    1. Initiate CPR
    2. Mobilize Paramedics with Defibrillator to collapsed runner
  3. Body Temperature extremes
    1. Obtain a Rectal Temperature in all collapsed runners
    2. Hypothermia
      1. Expose, dry off, wrap in warm blankets and protect from elements
    3. Hyperthermia (esp. Heat Stroke)
      1. Expose the patient and remove wet clothing
      2. Ice packs to axilla and groin (or immerse in ice water, or spray with tepid water)
  4. Electrolyte abnormalities
    1. Check a Glucose in all collapsed runners
    2. Hyponatremia (see below)

V. Management: Hyponatremia

  1. See Exercise Associated Hyponatremia
  2. Mechanism
    1. Water Intoxication due to overhydration
  3. Presentations
    1. Asymptomatic Hyponatremia occurs in up to 50% of endurance event athletes
    2. Mild: Light headed, Nausea
    3. Severe: Headaches, Vomiting, Dyspnea, Seizure
  4. Evaluation
    1. Serum Sodium as soon as possible
  5. Management
    1. See Isovolemic Hypoosmolar Hyponatremia
    2. See Hyponatremia Management
    3. Mild cases
      1. Consider 3-4 bouillon cubes in 1/2 to 1 cup of water at medical tent
      2. Athletes should not participate until asymptomatic and urinating
    4. Severe cases
      1. Emergency department evaluation and management
      2. See Hyponatremia Management for acute severe Hyponatremia Management protocol
  6. Prevention
    1. Athletes should drink to thirst, not on schedule
    2. Electrolyte tablets or solutions may slow Hyponatremia development
    3. Athletes should be aware of overhydration and Hyponatremia risk
      1. Sports Drinks are hypotonic and carry the same risks of overhydration as water
  7. References
    1. Orman and Anderson in Herbert (2016) EM:Rap 16(9): 13-4

VI. Management: Gastrointestinal symptoms

  1. Vomiting
    1. Occurs in up to 80% of marathon runners along the course
  2. Cecal Volvulus
    1. True emergency requiring immediate surgical care
    2. Presents as acute Bowel Obstruction with Vomiting, distention and ill appearance
    3. Typically occurs in endurance athletes ages 25 to 35 years old
  3. Rectal Bleeding
    1. Occurs in up to 16% of runners within 48 hours of the marathon
    2. Most runners (85%) are guaiac positive after the marathon
    3. Consider Ischemic Colitis in ill runners with acute abdominal findings

VII. References

  1. Swadron, Roepke and Knox in Herbert (2015) EM:Rap 15(3): 11-12

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