Heatstroke, Jordan McNair, and Maryland

By Dr. Ankur Verma

 

Photo: Maryland GovPics

 

I was on the cusp of being a teenager in 2001 when news broke that Minnesota Vikings lineman Korey Stringer died of heatstroke during training camp.  At the time, the news rattled me; I had recently begun to take sports seriously and the realization that a prominent NFL player wasn’t immortal caused a change in my worldview.

You have probably heard by now the tragic news that befell the late Jordan McNair of the Maryland football program.  ESPN reported on the circumstances of McNair’s death and there is expected to be a report released by Dr. Rod Walters on September 15.  ESPN has also reported on the allegedly toxic football culture under Maryland head coach DJ Durkin.

Because there’s still a detailed report to be released on the circumstances surrounding McNair’s death, rather than speculate on how it happened, we’ll instead focus this post on heatstroke.  We’ll discuss what heatstroke exactly is and what should be done when presented with it.

The Collapsed Athlete

First, it should be clear that there can be many reasons that an athlete collapses.  Heatstroke is only one of them.  Other reasons include hyponatremia (low sodium), hypoglycemia (low blood sugar), cardiac arrest, epilepsy, and exercise-associated postural hypotension.

In an unconscious athlete, it is important to get a rectal temperature.  A rectal temperature, as opposed to an oral or axillary temperature, is recommended by national guidelines, and studies have shown that there is greater accuracy in rectal temperature measuring true body core temperature as compared to other routes of temperature measurement.

As your body temperature rises, symptoms may manifest.  These symptoms include nausea, headache, dizziness, confusion, and even coma.  If an athlete shows changes in mental functioning (such as coma or seizures) and has a rectal temperature greater than 106 degrees Fahrenheit, then the diagnosis is heatstroke.

Management of Heatstroke

The single most important factor in the treatment of heatstroke is immediate cooling, even more so than sending the collapsed athlete to the emergency department.  It is unclear from what we know about the McNair situation right now if prompt cooling was done; it has been reported that an hour lapsed before EMS was contacted, so what was done when McNair was reportedly collapsed (and/or seizing) is up to speculation as of now.

The quickest way to achieve this is immersing the athlete in an ice-water bath.  It is generally acknowledged that it is critical to reduce the rectal temperature to 100 degrees Fahrenheit as quickly as possibly so as to preserve the best possible prognosis for the athlete.  In an ice-water bath, this would take roughly 5-10 minutes.

Immersing a collapsed athlete in an ice bath is critical. (Photo: Weightlifter Karyn Marshall as photographed by Dr. Dennis Cronk.)

In fact, prompt cooling is so important that it is usual for athletes to be up and walking within 30-60 minutes if they had been cooled promptly (and did not have a pre-existing medical condition that may be a factor).  Per the sports medicine book, Brukner and Khan’s Clinical Sports Medicine, mortality should actually be zero in a collapsed athlete with no previous health issues who was cooled in a timely fashion.  Again, it is unclear what health issues McNair had.  And yet, regardless of any predisposing conditions he had, the promptness of the staff to treat him has come into question.  We’ll know more when the investigative report is released.

Intravenous fluids may be given and could help, but care must be taken not to overly hydrate the athlete given their compromised cardiac function.

After the athlete has been cooled appropriately, hospital admission may be indicated for further observation to ensure the rectal temperature does not increase again or to monitor mental status.  Of course, if the patient is still unconscious after cooling or is in shock (low blood pressure and a high heart rate), they would absolutely require hospital admission.

Complications

Heatstroke can damage multiple organs.  Please see the table below.

Heatstroke Complications

SystemComplicationExplanation
CardiovascularArrhythmiaAbnormal heartbeats
CardiovascularMyocardial infarctionHeart attack
NeurologicalComaProlonged unconsciousness
NeurologicalStrokeDeath of brain tissue
MuscleRhabdomyolysisMuscle breakdown that can cause renal failure and heart problems
RenalRenal failure
GastrointestinalLiver damage
This list in not exhaustive.

 

As you can see, heatstroke can have devastating consequences.  Since it’s not always clear whether the heatstroke was the direct cause of these issues in a collapsed athlete, larger systemic issues must be considered by the healthcare provider.  For instance, someone may be more susceptible to heatstroke due to genetic issues.  This may alter future plans when it comes to athletic participation.

It’s unclear exactly what happened in the interval between McNair showing symptoms and his ultimate death.  We will await the September report for perhaps further clarification.  Until then, like the news of Stringer’s death to a twelve-year-old me, it’s a sobering reminder that tragedies can happen even when you’re playing a game.

Thanks to Brukner and Khan’s Clinical Sports Medicine for information.