Version June 2024
| ECAST | Exertional Heat Stroke | Acute cardiac event | Asthma/respiratory collapse | Exercise-associated hyponatremia | Anaphylaxis | Hypoglycemia | |
| Mental status | May be conscious initially and able to converse | Altered mental status | Unconscious if cardiac arrest | Anxious | May be conscious but confused or lethargic; may be comatose | Variable; may be unconscious | Altered mental status; can range from anxious to comatose |
| HPI and acute presentation | Slumps to ground; may occur early after onset of exercise | CNS dysfunction – variable presentation (eg, disorientation, bizarre behavior, irritability, confusion, ataxia); occurs late in practice; risk factors include: dehydration; poor fitness; obesity; use of supplements, stimulants, and some other medications (eg, psychotropics); acute infectious illness | Sudden collapse, possibly preceded by chest pain, lightheadedness, difficulty breathing | Typically occurs after intense exercise; dyspnea, wheezing, dry hacking cough | Prolonged effort (eg, slow marathoner) in hot environment; frequent water breaks; weakness, headache, facial pallor, edematous hands; seizure may precede collapse | Rapid onset without warning; itching, hives, swollen lips/tongue, chest tightness/wheezing, vomiting/diarrhea/abdominal pain; possible trigger (sting, bite, food) | Gradual to rapid onset; tremor, palpitations, sweating, lightheadedness; during or after prolonged or intense exercise; poor food intake prior to or during event |
| Past history (check medic alert bracelet, racing bib) | Sickle cell trait | Possible history of exertional heat illness | History of cardiovascular disease or risk factors | History of asthma or episodes of respiratory difficulty | Prior testing shows high salt content in sweat ("salty" sweater) | History of anaphylactic reactions | History of diabetes mellitus |
| Vital signs | Temp <40°C (104°F) | Temp ≥40°C (104°F); tachycardia, hypotension | Often normothermic | Tachypnea, tachycardia | Temp <40°C (104°F) | Hypotension; normothermia | Tachycardia |
| Key examination findings | Other findings variable (eg, hyperventilation, vomiting, diarrhea, thirst, profuse sweating) | Abnormal pulse | Auscultation: poor air movement, wheezing; retractions, excessive use of respiratory muscles | Worsening dyspnea | Excessive sweating; pallor; insulin pump | ||
| Muscle findings | Cramp-like pain and weakness, most often in legs, buttocks, low back; no visible twitching (as seen with cramping) | May have muscle cramping or flaccidity; muscle rigidity raises concern for malignant hyperthermia | Muscles normal | Weakness; muscle cramping common, which may include upper and lower body | Possible muscle cramps | Possible muscle cramping | |
| Other distinguishing features | Abnormal findings on cardiac/AED monitor or ECG | Low peak flow measurements | Low serum sodium* | Low finger stick or serum glucose* | |||
| Seizure activity | No seizure activity | May have seizure activity | May have seizure activity | May have seizure activity | May have seizure activity | May have seizure activity | May have seizure activity |
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