Sports and the Environment

Sudden Death in Sport
	Donald Kuah

	Causes	Sudden and unexpected death is a rare event in sport. In snow skiing one death occurs per every million skier days (one million skiers on one day) (Fig.14). The causes are:     Trauma (males < 40 years)     Cardiac events (males > 40 years)     Hypothermia (children)
	Causes	Sudden Cardiac Death
		In young athletes (< 35 years) this is usually a myocardial event from an unknown cardiac problem: (hypertrophic cardiomyopathy, anomalous coronary arteries, coronary artery disease, conduction system problems). In older athletes (> 35 years) it is usually due to pre-existing coronary artery disease (known in up to 50% of cases). These cases should be preventable. In the old athlete (> 50 years) sudden death is from hyperthermia (hypothermia if in water). There may be a dietary deficiency.
	Causes	Traumatic Deaths These are due to injuries of the:         Head (Fig 16)         Neck ( Fig. 15)         Chest         Abdomen
		Head Injuries Intra Cranial
		These are not uncommon in contact/collision sports (Fig 16). They can be diffuse or focal.     Diffuse Mild: is where there is no loss of consciousness but a variable period of amnesia. Classic: where definite loss of consciousness. Diffuse: axonal where loss of consciousness > 6 hours with residual neurological and personality deficiencies.     Focal These are intracranial haematomas (cerebral contusion, intra-cerebral extradural/subdural haematomas diagnosed on CT head (Fig. 17).)
	Treatment	Treatment includes resuscitation and surgical evacuation of haematoma.
		Extracranial     Facio-maxillary injuries Extracranial injuries are common in contact and high speed sports (such as football and skiing). Whilst most are minor, there is a potential for major airways problems and disfigurement. Injuries include fractures of the facial skeleton, facial lacerations and dental injuries (Fig. 18). Mouth guards and helmets can prevent such injuries. Fractures may involve the mandible or maxilla (zygoma and orbits). (Fig. 19)
	Treatment	Treatment includes airways management, control of bleeding (nasal packing; intra cranial - surgical intervention), and surgical stabilisation within 3 weeks.
		Chest injuries An immediate threat to life is caused by: airway obstruction, tension/open pneumothorax, massive haemothorax, flail chest and cardiac tamponade. Potentially life threatening problems are: myocardial contusion, pulmonary contusion, disruption of aorta/airways/oesophagus and major hernia.
	Treatment	Accurate diagnosis and resuscitation (with chest tube for pneumothorax) is essential (Fig 20).
		Abdominal injuries Usually from blunt trauma in a multi-trauma patient. CT abdomen and peritoneal lavage may be necessary.
		Resuscitation Involves simultaneous prioritised evaluation and treatment ie. Primary survey, (Airways, Breathing, Circulation), Resuscitation, ventilation, fluids, electrical/support drugs and secondary survey for potential problems and need for surgery.