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Key Terms

Agonal respirations


Automated external defibrillator


Commotio cordis


Incident Stress






Exercise-related SCA



Postictal state

Pulseless electrical activity

Sudden cardiac arrest

Sudden cardiac death


Ventricular fibrillation


It is a cool but sunny afternoon at the Newton North High School football stadium where the Newts are taking on the Laketon Blue Devils. After a hard-fought first half, the Newts begin their first play from scrimmage of the second half. You, the athletic trainer for the Laketon team, see the referee suddenly collapse in the backfield. You watch for a second as you hear the whistle blow to end the play but do not see the referee move or attempt to get up. You rush onto the field, and when you call his name or shake him, he does not answer. You observe a brief, deep gasp but cannot feel a carotid pulse with your cold hands.


Sudden death in athletes has an ancient legacy. Perhaps the first reported case was Pheidippides. He was the Greek soldier who ran 24 miles from Marathon to Athens to announce victory over the Persians. On arrival, legend has it, he dropped dead.

Unfortunately, sudden death in athletes is not just of historic interest and remains a very real problem, as evidenced by the sudden death of these more modern athletes: Hank Gathers (22 years old), Loyola Marymount University basketball player, at the free throw line; John McSherry (51), Major League Baseball umpire, behind home plate; Reggie Lewis (27), during an NBA playoff game; Louis Acompora (14), while playing lacrosse; Mindy Alpeter (16), while performing on stage; and Thomas Herrion (23), Minnesota Vikings football player, immediately after a preseason game.

Sudden cardiac arrest (SCA) is the sudden and unexpected cessation of the heart’s pumping activity. The resultant lack of blood flow to the brain leads to unconsciousness in about 20 to 30 seconds. If flow is not resumed, permanent brain damage will begin to occur in 4 to 6 minutes, and the condition is generally fatal if not treated in 10 minutes.1-4 When the heart is not pumping blood, there is no delivery of oxygen or glucose to any of the body’s tissue—including the heart itself because the heart tissue is perfused by blood flowing from the aorta into the coronary arteries. When sudden cardiac arrest results in death, it is termed sudden cardiac death.

The survival rate from SCA varies widely dependent ...

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