Guide Altitude Illness: Prevention & Treatment (Mountaineers Outdoor Expert): Prevention and Treatment

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Published: Ann Intern Med. DOI: See Also. View More View Less.

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Getting High: An Update In Altitude Medicine - HPS

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Getting High: An Update In Altitude Medicine

View More. Brand New!. Seller Inventory Book Description Mountaineers Books. Seller Inventory ZZN.

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Book Description Condition: New. Seller Inventory n. Paperback or Softback. Seller Inventory BBS Stephen Bezruchka. Publisher: Mountaineers Books , This specific ISBN edition is currently not available. View all copies of this ISBN edition:. Review : A wise purchase for someone planning a climbing trip or a backpacking trip in the mountains if they're going to reach high altitude.

Buy New Learn more about this copy. Trauma is a common cause of wilderness morbidity. A leading cause of trauma mortality is head injury after a fall from height during hiking, rock climbing, mountain biking, and snow-related activities. Although most traumatic injuries are "minor" and involve the lower extremities, they often end outdoor activities and extended trips. In rare events, trauma involves multiple systems and becomes life-threatening.

This category of wilderness medicine includes injuries sustained in motor vehicle crashes that occur during travel to and within remote areas. Advances in cervical spine management and immobilization, opiate-based pain control, and invasive procedures are being discussed. Heat exposure and heat stress can cause a spectrum of illness, ranging from benign heat cramps to lifethreatening heatstroke.

Heatstroke is a complex process that involves cellular dysfunction, cardiac conduction dysfunction, release of pro-inflammatory cytokines, concomitant intravascular depletion, and subsequent circulatory collapse. In contrast to classic heatstroke, exertional heatstroke can occur even in moderate temperatures, especially among endurance wilderness athletes. Removal from the heat stress and rapid whole body cooling are essential to mitigate encephalopathy, coagulopathy, and multi-organ failure. Under these circumstances, skin wetting and aggressive fanning can be used in an attempt to lower the patient's temperature.

This technique might induce shivering, but there is no evidence suggesting that the concomitant heat production conflicts with the attempt to lower the core temperature. Accidental hypothermia is a common concern in wilderness medicine both as a primary condition and as a complication of illness or trauma. Interestingly, hypothermia can even occur in temperate climates. Multiple physiologic and behavioral mechanisms work together to maintain euthermia; however, they can fail when certain temperature thresholds are reached.

The basics of hypothermia resuscitation include prevention of further heat loss, rewarming, and support of physiologic processes. Improvised and commercial methods for preventing further body heat loss are being developed. Resuscitation protocols for hypothermia and cardiac arrest have long engendered controversy, because of the resources that are required and the dismal recovery statistics.

In some cases, prolonged resuscitation will be successful in achieving a positive neurologic outcome. But, in remote settings, the required resources are usually not available. Frostbite is a complex process in which tissue cooling causes vasoconstriction, ischemia, and intracellular and extracellular ice crystal formation, leading to cell lysis and cell death. Reperfusion-ischemia injury is possible, and repeated thawing and refreezing is particularly damaging. Recent practice guidelines from the Wilderness Medical Society discuss the dichotomy between intentional field rewarming of a frozen body part, with maintenance of thawed tissue, and keeping the tissue frozen when the risk of re-freezing is significant.

Basic field care includes administration of antiprostaglandins, pain control, and placement of protective dressings in addition to treating concomitant hypothermia and injuries. Debridement of nonhemorrhagic blisters might be beneficial, but evidence is lacking. In the past, a "wait-and-see" approach was used to determine demarcation of the frozen area; now, tissue viability can be determined rapidly with advanced imaging such as magnetic resonance angiography or bone scintigraphy.

Victims caught in an avalanche are subjected to tremendous traumatic forces and are at risk of suffocation and, eventually, hypothermia. The severity of avalanche injury is generally based on several factors: depth of burial, length of burial, airway obstruction, and concurrent trauma. Military medicine.

Topic Overview

Significant advances have been achieved in hemorrhage control with tourniquets and hemostatic agents, surgical cricothyroidotomy, intraosseous access, needle decompression, pain management, prophylactic antibiotics, and low-volume field resuscitation. These advances are now crossing over to civilian EMS systems, tactical units, and wilderness medicine. Wilderness medicine epidemiology is a rapidly growing field that describes the incidence of morbidity and mortality in the wilderness.

Detailed information is still being collected, but general trends can be described.

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The most common injuries are soft-tissue lesions e. Search and rescue. Search and rescue operations are conducted under many organizational structures, typically citizen volunteer groups, law enforcement agencies, or, in many localities, a blend of the two. Search and rescue missions are often used for missing children, recreationalists, and individuals with developmental delay, autism, Alzheimer's disease, or dementia.


Travel medicine. Travel medicine involves the epidemiology of travelers' diseases, education, and vaccination. Disaster medicine. Disaster medicine and wilderness medicine have significant overlap. Both are practiced under sudden, unexpected, difficult, and austere conditions and have an inherent delay in emergency response and evacuation.

Disaster conditions can be created in urban, suburban, and rural locations and are all associated with delays in emergency response, extraction, and evacuation to medical resources. Diseases that are typical in wilderness or remote settings can emerge in the aftermath of disasters. Although dramatic scenarios such as crush injuries and amputations grab news media attention, the basics of hygiene and water sanitation are just as critical in disaster management as is the deployment of trained response personnel into devastated areas. Small, portable ultrasound machines are being used as an extension of the physical examination of patients with a number of clinical conditions: trauma Focused Assessment with Sonography in Trauma [FAST] and pneumothorax examination , HAPE pulmonary examination , HACE determination of the diameter of the optic nerve sheath , and obstetric emergencies determination of the age of the fetus.

Real-time ultrasound images have even been transmitted from the International Space Station.

Altitude Illness

WMS practice guidelines. Formal recommendations for clinical care and decision-making were lacking until , when Forgey published Wilderness Medicine.

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Over the past several years, the evidence-based Wilderness Medical Society Practice Guidelines have been developed and published in several areas of wilderness medicine. The topics addressed in these guidelines include: high-altitude illness, [16] frostbite, [81] lightning, [] eye injuries , [] epinephrine, [] use of extrication devices in crevasse rescue, [] exercise-associated hyponatremia, [] spine trauma management, [51] heat-related illness, [] anesthesia and pain management in press , wound management pending , hypothermia pending , drowning and immersion injuries pending.

They are based on case series and expert consensus, because, for many topics, research studies using randomized controls have not yet been conducted. The guidelines were developed in accordance with the templates suggested by the American College of Chest Physicians. Professional organizations. The Wilderness Medical Society WMS is the primary professional organization representing wilderness medicine physicians and other health care providers. It sponsors a variety of meetings in North America: an annual summer meeting, an annual winter meeting, and a fall specialty meeting organized around themes such as travel medicine, desert medicine, or environmental health.

The World Congress in Wilderness Medicine has met every 10 years since , providing a forum for the exchange of current ideas and concepts related to wilderness medicine. Several other professional societies play important roles in wilderness medicine. The International Society of Travel Medicine www. ISTM is involved in global monitoring of infectious diseases. Together with the Centers for Disease Control and Prevention CDC , ISTM manages Geosentinel, a global surveillance network for infectious diseases that provides nearly realtime data for analysis of evolving disease patterns.

The International Commission for Alpine Rescue www. ICAR publishes recommendations on both medical and technical issues for a variety of issues facing mountain rescue teams. The purpose of wilderness medicine fellowships is to develop academic leaders in the specialty. Multiple postgraduate fellowships are based in emergency medicine and family medicine graduate medical education programs. Generally, they have a research component, a teaching component, and a field component. A typical pattern is 1 year of training, with part-time clinical attending duties and part-time wilderness medicine training.

The program at the University of California, Fresno, has an optional 1-year extension to obtain a master's degree in public health. The program at George Washington University also offers the opportunity to complete a master of science or a master of public health degree. The original and best known wilderness medicine fellowship is based at Stanford University in Palo Alto, California. The Society for Academic Emergency Medicine lists eight other wilderness medicine fellowships associated with emergency medicine residency programs.

Several family medicine programs also host wilderness medicine fellowships: the Montana Family Medicine Program www. Academy of wilderness medicine. Under the auspices of the Wilderness Medical Society, the Academy of Wilderness Medicine offers a fellowship that provides rigorous education through a hour core curriculum as well as requirements for service, teaching, research, and experience.

Wilderness Medicine: Acute Mountain Sickness - High Altitude Illness

As of June , the Academy recognizes more than fellows as well as more than fellowship candidates. Master's degree. This program offers advanced, post-fellow certification in the participant's chosen sub-discipline within the scope of wilderness medicine. The master's program is developed by the student and a mentor and must meet requirements in education, scholarly activity, and experimental activity.