You are working at an aid station during the marathon section of a major a swim, bike, run triathlon; the station is six miles into the running section. The day is clear with a light wind; the temperature is 84º F. You have just finished attending to a heat exhausted runner when another runner staggers up. He initially complains of a headache and says he feels sick. As you are getting his history, he vomits. Bart says he feels better afterward. Digging into "What happened," you find out he fell off his bike towards the end of bike section. He can't remember what caused the fall and thinks he blacked-out for a moment. When he came to, he got back on his bike and finished the race. His headache started after the fall and has been getting worse. He said he noticed his bike helmet was cracked when he took it off during the event change. During your physical exam you notice the bruising on Bart's head and it is mildly tender. He is wearing a two liter hydration pack that is partially empty. He says he exchanged an empty pack for a full one at the event switchover. The pack contains a watered-down sports drink. Although sick, he is alert and cooperative with no spine pain or tenderness and normal motor and sensory exams. In addition to the bruising on his head he has a few minor abrasions on his right arm, shoulder, and leg. The remainder of Bart's SAMPLE history is unremarkable.
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