Collapsed during the 400 metres

A 15-year-old runner collapsed mid-race and came round within a minute. Her coach says she 'just fainted'. She has fainted once before, in a swimming pool.

Age15 yearsWeight52.0 kgVitals read against the adolescent band

Pediatrics

15 years old· adolescent52.0 kggirl, Pediatric emergency, room 1Fictitious educational patient

Caregiver: Father: 'She has always been fit. She fainted in the pool two summers ago and they said it was the heat. Today she went down at 300 metres, no warning. My brother died suddenly at 34, they said his heart.'
Immunizations: Up to date.

Previously wellCompetitive athlete

Day 0 · 15:50

Awake and embarrassed

She is sitting up, apologetic, wanting to go home. No injury. She remembers running, then the ground.

Vitals

HR 58RR 14SpO2 99Adolescent band · HR 60 to 100 · RR 12 to 20

HR58low for ageBP108/66RR14SpO299%T36.8

Read against the adolescent band (12 to 17 years): HR 60 to 100 awake, RR 12 to 20, hypotension below 90 systolic at the youngest age in the band. Fever, crying and pain move these numbers.

History

Any warning?: 'None. One second I was running, then I was on the track.'
Palpitations or chest pain?: 'No.'
The pool episode?: 'I was swimming lengths and woke up on the side. They said I got too hot.'
Family history?: 'Dad's brother died suddenly at 34. They never really found out why.'
Medications, substances, eating?: Asked privately: no medications, no substances, eating well, periods regular.

What separates this syncope from the benign faint?

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