Bodhi Brown iHuman Case Scenario
Patient Presentation
An 18-year-old male arrives at the clinic with his father following an episode of exercise-associated collapse during football practice. The patient experienced a brief loss of consciousness on the field and complains of headache, nausea, lightheadedness, cramps, excessive sweating, and decreased urination. He admits to inadequate hydration. On physical examination, findings include tachycardia, orthostatic hypotension, dry mucous membranes, and a capillary refill time of 3 seconds. Risk factors identified encompass antihistamine use, alcohol consumption, wearing heavy equipment in high heat and humidity, and obesity.
Primary Diagnosis
Heat Exhaustion: The most likely diagnosis is heat exhaustion, given the patient’s heat index of 100°F, insufficient hydration, high-intensity exercise, and the loss of consciousness. It is differentiated from simple dehydration by the heat index. The presence of sweating, normal mentation, and a core body temperature below 104°F rules out heat stroke (Mayo Clinic, 2021).
Differential Diagnoses
Bradycardia:
- Signs: Fatigue, fainting, lightheadedness, confusion or memory loss, and chest pain.
- Ruling out: Absence of chest pain and shortness of breath.
Syncope:
- Signs: Blacking out, falling for no reason, feeling lightheaded, dizziness, grogginess, fainting, and change in vision.
- Ruling out: Absence of feeling groggy.
Dehydration:
- Signs: Tiredness, headache, lightheadedness, dry mouth, passing little urine infrequently.
- Ruling out: Presence of all dehydration symptoms.
Pharmacological Care
- If stable and asymptomatic, no intervention required.
- Continuous monitoring: VS every 5-15 minutes q 4-6 hours for the first 24 hours, including oxygen saturation if indicated.
- Atropine 1 mg IV bolus, repeat q3-5min prn, not exceeding 3 mg total dose.
Supportive Care
- No return to play or intense practice in heat for at least 24 hours.
- Develop an acclimatization plan before returning to play.
- Change wet clothes and sheets as needed.
- Stay hydrated with electrolyte-rich fluids.
- Maintain a moderate room temperature.
- Loosen clothing.
Additional Ancillary Test Needed
- 12-lead electrocardiograms (ECG).
Social Determinants of Health to Consider, Health Promotion, and Patient Risk Factors:
- Hyperglycemia may result from the patient’s heavy fast-food diet.
- Obesity is a risk factor for heat-related illnesses, hindering effective body temperature regulation.
- Involvement of a nutritionist to assist the entire family.
Patient Education
- Explain signs and symptoms for early recognition.
- Encourage the patient to consume sports drinks (e.g., Gatorade) or water (Buttaro et al., 2021).
- Educate the patient on a diet to prevent weight gain.
- Provide information on signs and symptoms of low blood pressure.
Follow-Up/Disposition
- Referral to cardiac consult.
- Follow-up in 1 to 2 weeks.
- Instruct to call 911 if symptoms of bradycardia persist.
- Encourage activity as tolerated.
- Excuse from school sports workouts for 5 days, with a return to school allowed after this period if no symptoms persist.
References
Buttaro, T. M., Trybulski, J., Polgar-Bailey, P., & Sandberg-Cook, J. (2021). Primary care: Interprofessional collaborative practice (6th ed.). Elsevier.
O’Connor F, Casa DJ. Exertion heat illness in Adolescents and adults: Epidemiology, thermoregulation, risk factors, and diagnosis. Updated. 2021.
Mayo Clinic (2021). Heat exhaustion. Retrieved November 2021, https://www.mayoclinic.org/diseases-conditions/heat-exhaustion/diagnosis-treatment/drc- 20373253 Bodhi Brown iHuman
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