Long time listener first time caller…thanks for a great forum. I ran my usual trail run this weekend that includes a steep grade right in the middle of the run. I caught up to a couple of mountain bikers at the top as they were going pretty slow due to the steepness and heat. They were friendly and we started chatting at the top. After about 5 minutes of normal chit-chat one of the bikers complained of dizziness and shortly after proceeded into convulsions and lack of ability to speak/slack jaw/eyes glazed etc. Our first reaction was to lay him down in the shade but laying him down made it worse so we sat him back up and gave him some water and took off his helmet gloves etc. This seemed to work and he recovered after a short while. We finally went our separate ways but it made me think…many times people get sick when they start talking to me but this was worse than usual! I often ride/run with training partners and if this happens again I’d like to know more about what to do. My question after this long drawn out story is…have any of you experienced this kind of thing before or know generally what to do/tips in this situation? I don’t want to feel helpless again! Thanks in advance.
CPR and basic first aid might be a good call. You can get this training fairly inexpensively and it is really useful.
It’s hard to say what the mountain biker was suffering from. What was your altitude? How hot was it? Maybe there is a doctor on the forum that would have some ideas as to the specifics of what plagued him.
Not a doctor (give me 4 years… no joke) but I am a WEMT, for what that’s worth.
It could have been a lot of things, from purely environmental (altitude, heat, etc) to a precondition (diabetic, epilectic, etc.) to a combination of thereof (dehydration, hyponatremia).
There are a set of questions you can ask to narrow your choices (ie “do you feel cold?” is a sign of heat exhaustion/sunstroke), but training is necessary to make those questions valuable so don’t worry about that.
Really, it sounded like you did the right thing. In EMT circles we like to repeat the mantra “not by mouth” which means exactly what is says–don’t give them anything by mouth, as they could easily choke on it or worse. Water is often the exception. That said, clear cases of heat exhaustion, dehydration, hyponatremia (harder to guess), diabetic shock (his partners may know about this condition) have led EMTs to make the call and give other liquids and/or food. Tough one, even for veterans. There are state and federal laws to deal with, and thus liability issues.
I love the CPR advice. Take a class! So easy, and the statistics are amazing about how many lives are saved due to average citizens administering CPR. (The next level up is a First Responder class, up to a week long, and often what firemen and police officers have. Take a month and do it on nights–you won’t regret it).
Also, lean on 911. Better safe than sorry, though where you are on a trail is a big factor. Hopefully those mt. bikers went straight home in case it happened again…
Hey NewB, I’m an ER MD and am happy to pass along some advice. First of all I think the previous poster’s recommendation re: CPR and Basic first aid is excellent. While serious cardiac emergencies are fortunately rare in highly trained individuals, being ready to respond to such a situation can truly make the difference between life and death.
In regards to your specific situation, I’m still curious about what exactly you observed. Did the person lose consciousness? That is, did they just seem confused or were they completely unresponsive? Secondly, what do you mean by convulsions? Were they fairly dramatic movements or was it more like intense shivering? Did it involve one or both sides of the body? Did anyone happen to take this persons’ pulse during or after the event? I’ll be happy to give an explanation of several scenarios if you can give me some more detail.
This board is amazing…thanks everyone. Excellent advice regarding CPR/first responder courses. It is inexcusable I haven’t done this already! It was at Whiting Ranch in south Orange County, CA unfortunately recently in the news due to mountain lion attacks. It felt hot but probably wasn’t that hot maybe 85. The elevation should not be a factor either. I appreciate the not by mouth advice because I felt like an A-hole for telling the guy to spit out his gum. My fear was that all we needed when he laid back was to choke on top of what was going on already! He did mention being cold too and we checked his pulse but it felt normal. His shaking was pretty bad but not too violent, enough to make his partner and I give each other that look like oh shit! It seemed like he was trying to talk but couldn’t get the words out?? At this particular trail we are very fortunate in that at the top there is one of those highway style call boxes in case of emergency. I think you guys summed it up…invest the time and take some classes. Thanks again!
Hey NewB, I’m an ER MD and am happy to pass along some advice. First of all I think the previous poster’s recommendation re: CPR and Basic first aid is excellent. While serious cardiac emergencies are fortunately rare in highly trained individuals, being ready to respond to such a situation can truly make the difference between life and death.
In regards to your specific situation, I’m still curious about what exactly you observed. Did the person lose consciousness? That is, did they just seem confused or were they completely unresponsive? Secondly, what do you mean by convulsions? Were they fairly dramatic movements or was it more like intense shivering? Did it involve one or both sides of the body? Did anyone happen to take this persons’ pulse during or after the event? I’ll be happy to give an explanation of several scenarios if you can give me some more detail.
Sorry Stickman, I thought I replied to you but it didn’t post? Here are the details as i remember them: He didn’t lose consciousness in the way I would generalize like eyes closed etc. but he did become unresponsive in that it seemed like his brain shut down for a minute or so. The movements seemed more dramatic than intense shivering and it looked like both sides of his body were equally affected. His pulse afterward felt somewhat normal for the activity level we were enduring but I suppose it should have been lower since we had rested for a good 5 minutes. The guy was probably 30 years of age or so and later mentioned he hadn’t been drinking or anything the night before. I guess my worst fear was that he was having a stroke/aneurism of some sort. Thanks for any insight!
Thanks. Well, I won’t be able to say with complete certainty what was going on physiologically but I’ll take a stab at the most likely explanations.
My first guess would be “syncope” or “near syncope” (medical terms for loss of consciousness or near loss of consciousness) which is due to a sudden lowering of blood pressure such that the brain isn’t getting enough blood to work properly. This can be due to a wide variety of causes including structural and electrical heart abnormalities (which is why I had the pulse rate question-this information would be very helpful to other medical providers). In the case you described, a combination of mild dehydration, heat illness and redistribution of blood flow due to heavy exercise probably conspired to cause a brief fainting spell. This will typically resolve when the person is layed flat but it serves as a powerful warning that any training is done for the day. If symptoms persist a thorough medical evaluation is highly recommended.
A seizure is another possibility. These “usually” involve a loss of consciousness combined with fairly dramatic muscle contractions, abnormal breathing and eye deviation followed by a period of confusion or agitation lasting 15 minutes or longer-but there are many variations of seizure, I’ve just described a somewhat typical “generalized” seizure. Persons with a seizure disorder will usually wear a “med alert” bracelet which will obviously offer a big clue as to what is going on.
Other possibilities that were suggested: hyponatremia, hypoglycemia (low blood sugar) can certainly cause profound confusion and loss of consciousness but they will not get better without very specific treatment. The same goes for severe heat illness.
Bottom line. In the situation you described in a person who is breathing and has a pulse, a brief period of observation can be appropriate (5-10 min.) as long as they seem to be improving. If their condition is not getting better or worsening it’s time to activate the emergency medical system.
Thanks again! I would say your first scenario seems the most likely. Especially the nature of the trail as you go all out and once reach the top maybe stop a little too quickly and confuse your body. Great insights about what to do regarding getting help. It seems better to error on the side of calling help if in doubt. Thank you for your time!