Bodhi Brown iHuman Case Scenario
Patient Presentation
The patient is an 18-year-old male who arrived at the clinic with his father after collapsing during football practice. He experienced a brief loss of consciousness on the field. The patient reported various symptoms, including headache, nausea, lightheadedness, cramps, excessive sweating, and decreased urination. He admitted to not hydrating adequately. During the physical examination, the patient exhibited tachycardia, orthostatic hypotension, dry mucous membranes, and a capillary refill of 3 seconds. Risk factors for his condition include antihistamine use, alcohol consumption, wearing heavy equipment in high heat and humidity, and obesity.
Primary Diagnosis
Heat Exhaustion:
The most probable diagnosis is heat exhaustion due to the patient’s exposure to a heat index of 100°F, inadequate hydration, high-intensity exercise, and loss of consciousness. Heat exhaustion is differentiated from simple dehydration based on the heat index (Mayo Clinic, 2021). The patient’s sweating, normal mentation, and core body temperature below 104°F disqualify the possibility of heat stroke.
Other Possible Diagnoses
1. Bradycardia:
Bradycardia, a condition characterized by a slow heart rate, is a different diagnosis to consider. Symptoms of bradycardia include fatigue, fainting, lightheadedness, confusion or memory loss, and chest pain (O’Connor and Casa, 2021). The patient’s collapse and lightheadedness suggest the possibility of bradycardia, but the absence of chest pain and shortness of breath rules out this condition.
2. Syncope:
Syncope, another potential diagnosis, refers to fainting or passing out. The symptoms of syncope include blacking out, falling for no reason, feeling lightheaded, dizziness, grogginess, fainting, and changes in vision (O’Connor and Casa, 2021). The patient’s collapse, fainting, and subsequent awakening suggest the presence of syncope, but the absence of grogginess excludes this condition.
3. Dehydration:
Dehydration is another possible diagnosis for the patient. Dehydration occurs when an individual loses more fluids than they consume through sweat, tears, vomiting, urination, or diarrhea (O’Connor and Casa, 2021). The patient’s symptoms developed after exercising, indicating that he may have become dehydrated through sweating. Symptoms of dehydration include tiredness, headache, lightheadedness, dry mouth, and infrequent urination, all of which the patient experienced.
Pharmacological Care
1. No intervention is necessary if the patient is stable and asymptomatic, but continuous monitoring for patient safety and well-being is required.
2. Cardiac monitoring and IV access are necessary with regular assessment of vital signs every 5-15 minutes every 4-6 hours during the first 24 hours, including oxygen saturation when indicated.
3. Atropine 1 mg IV bolus can be administered, with a repeat every 3-5 minutes as needed, not exceeding a total dose of 3mg.
Supportive Care
1. The patient should refrain from returning to play or engaging in intense practice in heat for at least 24 hours.
2. An acclimatization plan should be developed, and the patient should be symptom-free before returning to play.
3. Regularly change wet clothes and sheets, as needed.
4. Stay hydrated with fluids high in electrolytes.
5. Maintain a moderate room temperature.
6. Loosen clothing.
Additional Ancillary Test Needed
A 12-lead electrocardiogram (ECG) is recommended.
Social Determinants of Health, Health Promotion, and Patient Risk Factors
1. The patient’s heavy fast-food diet may contribute to hyperglycemia.
2. Obesity is a risk factor for heat-related illnesses, as excess weight can hinder the body’s ability to regulate temperature effectively.
3. A nutritionist can provide assistance to the entire family.
Patient Education
1. Educate the patient about the signs and symptoms to recognize them early.
2. Encourage the patient to drink sports drinks (e.g., Gatorade) or water (Buttaro et al., 2021).
3. Provide education on diet to prevent weight gain.
4. Educate the patient about the signs and symptoms of low blood pressure.
Follow-Up/Disposition
1. Refer the patient to a cardiac consult.
2. Schedule a follow-up appointment in 1-2 weeks.
3. Advise the patient to call 911 if symptoms of bradycardia persist.
4. Allow activity as tolerated.
5. Excuse the patient from school sports workouts for 5 days. The patient may return to school after 5 days if no symptoms are present.
References
Buttaro, T. M., Trybulski, J., Polgar-Bailey, P., & Sandberg-Cook, J. (2021). Primary care: Interprofessional collaborative practice (6th ed.). Elsevier.
O’Connor F, Casa DJ. Exertion heat illness in Adolescents and adults: Epidemiology, thermoregulation, risk factors, and diagnosis. Updated. 2021.
Mayo Clinic (2021). Heat exhaustion. Retrieved November 2021, https://www.mayoclinic.org/diseases-conditions/heat-exhaustion/diagnosis-treatment/drc-20373253
