Common Medical Problems
of the Ultra-Runner
and Bill Ohlson RN, of
EAC usually occurs when a person stops running after a long distance. Ever had that feeling of dizziness or lightheadedness when you stop running? EAC happens frequently at sporting events. Legs are often referred to as the second heart. While you are running, the blood in your legs is being returned passively to your heart by muscle contraction. When you stop running, it begins to pool in your legs and does not return to your heart to be pumped to your brain and other organs. This is why a lot of athletes collapse after the finish. EAC can be treated easily by just laying flat with your legs and hips elevated. This will return blood to your heart by gravity. Also, when you cross the finish it is wise to continue walking around rather than standing or sitting in one place. If you sit down directly after finishing, the next time you stand up you could find yourself in a frightening predicament! Many runners like to wade or sit in the river at our finish. This is also acceptable for people experiencing EAC. The cool water will cause your veins and arteries to constrict, therefore the core of your body such as heart lungs and brain will receive a healthy supply of blood. However, the collapse of an athlete can also be caused by more serious conditions such as:
hypothermia are common in races such as this one. In this race you could find
yourself in snow at high elevations, or very hot conditions in the canyon. Hypothermia
and hyperthermia, in their mild forms are relatively easy to prevent and treat.
Wearing the proper clothing and paying close attention to the weather can
prevent you from developing hypo/hyperthermia. More severe cases need to be
Dehydration is not usually a cause of serious problems as one might think. The body can lose up to 10% body weight before serious problems occur. However, if a person gains >2% body weight, serious life-threatening problems can develop. Likewise, Hypoglycemia has a low percentage of serious problems at sporting events. It can usually be treated easily by drinking or eating something sweet.
Hyponatremia is a condition where the serum sodium (amount of sodium in the blood) is low. In the past, medical personnel were taught to treat more common conditions such as hypo/hyperthermia, dehydration and hypoglycemia. These conditions are common, but research has begun to show that in long distance events, hyponatremia could be to blame for life-threating problems as well. Symptoms include:
Physical signs of Hyponatremia include:
Life-threatening problems developing from Hyponatremia are caused by cerebral edema (swelling of the brain), and pulmonary edema (fluid in the lungs). Both of these conditions are very serious and could result in seizures, coma and death.
Hyponatremia can range from mild to severe. It usually occurs while exercising because of sweating. The body loses precious amounts of sodium through the skin. When sweat evaporates it leaves the white sediment on the skin mentioned above. Meanwhile, the body tries to compensate by retaining sodium and water from the kidneys. Urine output decreases and in severe cases will stop entirely. While more water is being consumed and no urine is being made, swelling and weight gain occurs. Mild cases can be treated easily by just eating something salty. If it has developed to a serious stage, treatment at the hospital is necessary.
Treatment of hyponatremia seems simple, replace the sodium. But it’s not that easy. First and foremost the medical crew needs to lay the runner flat with their hips and legs elevated. If EAC is the culprit, this may be all it takes. If the symptoms continue, then they will need to rule out hyper/hypothermia, dehydration, hyponatremia and hypoglycemia. This is done by assessing the following:
When other diagnoses are ruled out and hyponatremia is suspected, the first treatment would seem to be sodium replacement via an intravenous(IV) solution. The first choice of IV solution in an emergency situation is Normal Saline(NS) 0.9% Sodium. In most cases, NS is an appropriate choice. However, in hyponatremia cases the human body will stop making urine in attempt to retain sodium. By the time hyponatremia becomes an issue, all urine output will essentially cease. Giving the patient more fluid will result in fluid overload, or water intoxication. Hyponatremia can only be confirmed in a hospital setting where blood can be tested and watched closely while sodium replacement is being administered. Although intravenous access should be obtained immediately, it is advised that only anti-seizure medications be administered until the patient is received at the hospital. Then a solution with a high concentration of sodium (3.0% sodium) can be administered. It is very important not to correct the problem too quickly. Sodium replacement is done very slowly to prevent further problems.
Ankle and Knee injuries
Ankle and knee injuries are very common during ultra-runs due to the rugged trails and terrain encountered in the mountains. Most are sprains or tearing of ligaments, but some can be more serious such as fractures. Although, fractures are rare. Treatment for all ankle or knee injuries is rest, ice, compression and elevation of the effected extremity. If you suspect a fracture, splint the extremity and assess circulation. If you wrap the extremity, be sure not to wrap tightly and reassess circulation past the injury and/or wrap frequently as swelling may occur.
Snake Bites, and Stings
It is rare to
have a snake bite at an ultra-running event. Runners are rather noisy as they
hammer down the trail, and snakes are more afraid of humans than us of them. If
they strike they will do so in defense and will connect with the feet or ankles
in what is referred to as a “dry bite.” Always be aware of the
trail in front of you, most snake bites occur when someone is not paying
attention to where they step. Snakes are only seen in the lower stations and
canyon. In the
If you are stung and are allergic to bees, this could lead to serious complications. A condition called anaphylactic shock can occur where your airway could swell and inhibit breathing. Most runners are aware of their allergies and carry an epi-pen or medications to counteract the allergy. If you are stung and begin experiencing difficulty breathing, stop and sit on the side of the trail, keep calm and breathe slow and deeply. Remain where you are until another runner can get you help.
Scrapes, Lacerations and Blisters
Scrapes, lacerations and blisters are the most common injury at an ultra-running event. Control the bleeding first and foremost. Hold pressure on the wound until bleeding ceases. Then clean and dress the wound until you can get to medical attention. Runners usually have a preference for how they would like their blisters tended to. Some prefer to lance and drain, some prefer duct tape. The main idea with blisters is to reduce or ease the friction as much as you can with blister kits, duct tape and petroleum jelly, or whatever means necessary. Blister kits, Vaseline, and duct tape are available at all aid stations as well as sterile needles for lancing. Wear clean and dry socks and shoes whenever possible. Keep a change of socks and shoes in each drop bag.
Mountain Wild and Scenic Trail Runs are lucky to have a great Search and Rescue
team to watch over our participants. In 17 years we have had a number of people
run into problems. Each has had a happy ending. Just remember, they have been
doing this for a long time.
Runners, just remember to Run Smart and pay attention to how you feel, be aware of your body and your surroundings. Report anything unusual to the medical personnel and be prepared for all weather and trail conditions. Happy Trails!
Written from presentations provided by Dr. Addlesperger (2003)
and Bill Ohlson, RN(2009)
Written by Melanie Green, RN (June 16, 2009)
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