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Aim: The primary purpose of an avalanche airbag is to prevent burial during an avalanche. Approximately twenty percent of avalanche victims deploying airbags become critically buried, however. One avalanche airbag actively deflates three minutes after deployment, potentially creating an air pocket. Our objective was to evaluate this air pocket and its potential to prevent asphyxiation.Methods: Twelve participants were fitted with an airbag and placed prone on the snow. Participants deployed the airbag and were buried in 1.5 m of snow for 60 min with vital signs including oxygen saturation (SpO2) and end-tidal CO2 (ETCO2) measured every minute. Participants completed a post-burial survey to determine head movement within the air pocket.Results: Eleven of the 12 participants (92%) completed 60 min of burial. Preburial baseline SpO2 measurements did not change significantly over burial time (P > 0.05). Preburial baseline ETCO2 measurements increased over the burial time (P < 0.02); only one ETCO2 value was outside of the normal ETCO2 range (35-45 mmHg). Participants reported they could move their head forward 11.2 cm (SD 4.8 cm) and backward 6.6 cm (SD 5.1 cm) with the majority of participants stated that they had enough head movement to separate the oral cavity from opposing snow if necessary. Visual examination during extrication revealed a well-defined air pocket in all burials.Conclusion: The avalanche airbag under study creates an air pocket that appears to delay asphyxia, which could allow extra time for rescue and improve overall survival of avalanche victims. [ABSTRACT FROM AUTHOR]

Many popular tourist attractions and trekking routes in Bhutan and Nepal are situated between 3000 and 6000 m in elevation. High-altitude emergencies are becoming more common and medical providers must be aware of the practical and medical issues in managing these disorders. We reflect on the challenges in providing high-altitude emergency medical services in Bhutan and Nepal. [ABSTRACT FROM AUTHOR]

Abstract Ageism and negative attitudes are said to be institutionally embedded in healthcare during a time when there are unprecedented increases in older population numbers. As nurses' care for older people in a range of environments it is important to examine attitudes and perceptions of undergraduate nurses towards older people. A longitudinal mixed methods study in conjunction with a three-year undergraduate UK nursing programme 2009–2012 was conducted with 310 undergraduate nurses. A questionnaire incorporating Kogan's attitude towards older people scale and a drawing of a person aged 75 years was completed three times, once each year. Thurstone scale and photo elicitation were also employed. Comparisons were made between individual participant's attitude score and drawing. The study established 75% of participants had moderately positive attitudes towards older people when the programme began, at the programme end this had increased to 98%. Age, gender, educational qualifications, practice learning, nursing field and contact with older people influenced participants' overall attitude score. Drawings provided a visual narrative of participants' perceptions of older people, appearance was a dominant discourse and the images were socially constructed. The study established the undergraduate nursing programme influenced attitudes and perceptions towards older people and suggests nurse education can influence changing attitudes. To date there is no known study that has advanced this understanding. Highlights • Nurse education has the potential to foster positive attitudes towards older people. • Drawings provided a narrative of participants' perceptions of ageing. • Drawings can be used as an independent research method. • Undergraduate nurses viewed older people from a socially constructed phenomenon using signifiers to depict later life. • Further evidence is provided to develop Kogan's attitudes towards older person scale. [ABSTRACT FROM AUTHOR]

Statin intolerance (SI) has become controversial due to the publication of recent studies in which myalgias were as common in those taking a placebo (nocebo effect) as those taking a statin. Comparing statin prescriptions in patients with dyslipidemia with and without a statin listed as an allergy can help identify those patients who may not meet the criteria for SI, and perhaps benefit from another trial of a different type of statin. The overall objective of this study was to use University of Rochester (URMC) electronic health record data to start developing an algorithm to determine if patients have a true "statin allergy". Data were collected from patients who are taking or who have taken a statin across URMC since the initiation of EHR (Epic) in 2011. The EHR of all URMC patients >=18 years of age were queried to identify those who have hyperlipidemia. Of the patients who have a diagnosis of hyperlipidemia, those listed with a statin allergy were compared to patients who did not have any known statin allergy. Statin type, dose, and frequency were compared in these two groups. All variables were collected from the EHR at URMC using manual chart review and with the help of the URMC Clinical Translational Science Institute data request service. The outcomes of this study include the measurement of statins prescribed, drug allergies listed, and LDL cholesterol/non-HDL cholesterol. Demographic variables and clinical variables were also collected. Of patients with hyperlipidemia, patients who had statin listed as an "allergy" (n=7962) were compared with patients without a statin allergy (n=121184). Patients with a statin allergy were more likely to have been prescribed two different types of statins (n=4770, 60.0%) when compared with patients without a statin allergy (n=39581, 32.7%) (p<0.0001). When comparing high versus low intensity statin use according to statin allergy status, 1,731 (21.7%) of those with a statin allergy versus 42,033 (34.7%) of those without a statin allergy had been prescribed a high intensity statin (p<0.0001). Our pilot data show variability in the number of statins and intensity prescribed according to the presence of documentation of statin allergy. Utilizing an EHR-based algorithm to identify patients labeled with a statin allergy may help identify gaps in care and needs for further improvement in lipid treatment. No [ABSTRACT FROM AUTHOR]

Purpose: Biliary complications following liver transplantation are a significant source of morbidity, potentially leading to graft failure necessitating retransplantation. We sought to evaluate smoking as an independent risk factor for post-transplant biliary complications.Methods: The clinical course of all adult primary deceased donor liver transplants at our center from 1992 to 2012 was reviewed. Eligible patients were assigned to cohorts based on their lifetime tobacco exposure: never smokers indicating 0 pack-year exposure and all others were ever smokers. Biliary complications were defined as strictures, leaks, or bilomas requiring intervention. Complication rates were analyzed using univariate regression models correlated with donor and recipient characteristics. Associations found during univariate analysis were included in the final multivariate Cox model.Results: Eight hundred sixty-five subjects were followed for a median of 65 months; 482 (55.7%) of patients had a positive smoking history at the time of transplant. In univariate analysis, positive tobacco smoking history (HR = 1.36; p = 0.037) and increased time from quit date to transplantation (HR = 0.998; p = 0.011) were positive and negative predictors of biliary complication, respectively. Lifetime tobacco exposure remained a significant predictor of biliary complication on multivariate analysis (HR = 1.408; p = 0.023).Conclusions: Smoking status is an independent predictor of post-transplant biliary complications, and the data presented reinforces the importance of early smoking cessation in the pre-transplantation period. [ABSTRACT FROM AUTHOR]

To provide guidance to clinicians and avalanche professionals about best practices, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the prevention, rescue, and medical management of avalanche and nonavalanche snow burial victims. Recommendations are graded on the basis of quality of supporting evidence according to the classification scheme of the American College of Chest Physicians. [ABSTRACT FROM AUTHOR]

Objective: Hypobaric hypoxia decreases exercise capacity and causes hypoxic pulmonary vasoconstriction and pulmonary hypertension. The phosphodiesterase-5 inhibitor sildenafil is a pulmonary vasodilator that may improve exercise capacity at altitude. We aimed to determine whether sildenafil improves exercise capacity, measured as maximal oxygen consumption (peak V̇o2), at moderate altitude in adults 60 years or older.Methods: The design was a randomized, double-blind, placebo-controlled, crossover study. After baseline cardiopulmonary exercise testing at 1400 m, 12 healthy participants (4 women) aged 60 years or older, who reside permanently at approximately 1400 m and are regularly active in self-propelled mountain recreation above 2000 m, performed maximal cardiopulmonary cycle exercise tests in a hypobaric chamber at a simulated altitude of 2750 m after ingesting sildenafil and after ingesting a placebo.Results: After placebo, mean peak V̇o2 was significantly lower at 2750 m than 1400 m: 37.0 mL · kg(-1) · min(-1) (95% CI, 32.7 to 41.3) vs 39.1 mL · kg(-1) · min(-1) (95% CI, 33.5 to 44.7; P = .020). After placebo, there was no difference in heart rate (HR) or maximal workload at either altitude (z = 0.182; P = .668, respectively). There was no difference between sildenafil and placebo at 2750 m in peak V̇o2 (P = .668), O2 pulse (P = .476), cardiac index (P = .143), stroke volume index (z = 0.108), HR (z = 0.919), or maximal workload (P = .773). Transthoracic echocardiography immediately after peak exercise at 2750 m showed tricuspid annular plane systolic velocity was significantly higher after sildenafil than after placebo (P = .019), but showed no difference in tricuspid annular plane systolic excursion (P = .720).Conclusions: Sildenafil (50 mg) did not improve exercise capacity in adults 60 years or older at moderate altitude in our study. This might be explained by a "dosing effect" or insufficiently high altitude. [ABSTRACT FROM AUTHOR]

Climbing is a popular wilderness sport among a wide variety of professional athletes and amateur enthusiasts, and many styles are performed across many environments. Potential risks confront climbers, including personal health or exacerbation of a chronic condition, in addition to climbing-specific risks or injuries. Although it is not common to perform a preparticipation evaluation (PPE) for climbing, a climber or a guide agency may request such an evaluation before participation. Formats from traditional sports PPEs can be drawn upon, but often do not directly apply. The purpose of this article was to incorporate findings from expert opinion from professional societies in wilderness medicine and in sports medicine, with findings from the literature of both climbing epidemiology and traditional sports PPEs, into a general PPE that would be sufficient for the broad sport of climbing. The emphasis is on low altitude climbing, and an overview of different climbing styles is included. Knowledge of climbing morbidity and mortality, and a standardized approach to the PPE that involves adequate history taking and counseling have the potential for achieving risk reduction and will facilitate further study on the evaluation of the efficacy of PPEs. [ABSTRACT FROM AUTHOR]

High-altitude athletes and adventurers face a number of environmental and medical risks. Clinicians often advise participants or guiding agencies before or during these experiences. Preparticipation evaluation (PPE) has the potential to reduce risk of high-altitude illnesses in athletes and adventurers. Specific conditions susceptible to high-altitude exacerbation also important to evaluate include cardiovascular and lung diseases. Recommendations by which to counsel individuals before participation in altitude sports and adventures are few and of limited focus. We reviewed the literature, collected expert opinion, and augmented principles of a traditional sport PPE to accommodate the high-altitude wilderness athlete/adventurer. We present our findings with specific recommendations on risk stratification during a PPE for the high-altitude athlete/adventurer. [ABSTRACT FROM AUTHOR]

Objectives: Epinephrine is the first-line medical treatment for anaphylaxis, a life-threatening allergic syndrome. To treat anaphylaxis, backcountry recreationalists and guides commonly carry epinephrine autoinjectors. Epinephrine may be exposed to cold temperatures and freezing during expeditions. An epinephrine solution must contain 90% to 115% of the labeled epinephrine amount to meet United States Pharmacopeia standards. The purpose of this study was to determine whether freeze-thaw cycles alter epinephrine concentrations in autoinjectors labeled to contain 1.0 mg/mL epinephrine. A further objective was to determine whether samples continued to meet United States Pharmacopeia concentration standards after freeze-thaw cycles.Methods: Epinephrine from 6 autoinjectors was extracted and divided into experimental and control samples. The experimental samples underwent 7 consecutive 12-hour freeze cycles followed by 7 12-hour thaw cycles. The control samples remained at an average temperature of 23.1°C for the duration of the study. After the seventh thaw cycle, epinephrine concentrations were measured using a high-performance liquid chromatography assay with mass spectrometry detection.Results: The mean epinephrine concentration of the freeze-thaw samples demonstrated a statistically significant increase compared with the control samples: 1.07 mg/mL (SD ± 8.78; 95% CI, 1.04 to 1.11) versus 0.96 mg/mL (SD ± 6.81; 95% CI, 0.94 to 0.99), respectively. The maximal mean epinephrine concentration in the experimental freeze-thaw group was 1.12 mg/mL, which still fell within the range of United States Pharmacopeia standards for injectables (0.90 to 1.15 mg/mL).Conclusions: Although every attempt should be made to prevent freezing of autoinjectors, this preliminary study demonstrates that epinephrine concentrations remain within 90% to 115% of 1.0 mg/mL after multiple freeze-thaw cycles. [ABSTRACT FROM AUTHOR]

Objective Backcountry travelers should carry a standard set of safety gear (transceiver, shovel, and probe) to improve rescue chances and reduce mortality risk. Many backcountry enthusiasts are using other advanced equipment such as an artificial air pocket (eg, the AvaLung) or an avalanche air bag. Our goal was to determine the numbers of backcountry users carrying advanced equipment and their perceptions of mortality and morbidity benefit while carrying this gear. Methods A convenience sample of backcountry skiers, snowboarders, snowshoers, and snowmobilers was surveyed between February and April 2014. Participants of this study were backcountry mountain users recruited at trailheads in the Wasatch and Teton mountain ranges of Utah and Wyoming, respectively. Questions included prior avalanche education, equipment carried, and perceived safety benefit derived from advanced equipment. Results In all, 193 surveys were collected. Skiers and snowboarders were likely to have taken an avalanche safety course, whereas snowshoers and snowmobilers were less likely to have taken a course. Most backcountry users (149, 77.2%), predominantly skiers and snowboarders, carried standard safety equipment. The AvaLung was carried more often (47 users) than an avalanche air bag (10 users). The avalanche air bag had a more favorable perceived safety benefit. A majority of participants reported cost as the barrier to obtaining advanced equipment. Conclusions Standard avalanche safety practices, including taking an avalanche safety course and carrying standard equipment, remain the most common safety practices among backcountry users in the Wasatch and Tetons. Snowshoers remain an ideal target for outreach to increase avalanche awareness and safety. [ABSTRACT FROM AUTHOR]

Objectives Avalanche victims are subjected to a number of physiological stressors during burial. We simulated avalanche burial to monitor physiological data and determine whether wearing head and face insulation slows cooling rate during snow burial. In addition, we sought to compare 3 different types of temperature measurement methods. Methods Nine subjects underwent 2 burials each, 1 with head and face insulation and 1 without. Burials consisted of a 60-minute burial phase followed by a 60-minute rewarming phase. Temperature was measured via 3 methods: esophageal probe, ingestible capsule, and rectal probe. Results Cooling and rewarming rates were not statistically different between the 2 testing conditions when measured by the 3 measurement methods. All temperature measurement methods correlated significantly. Conclusions Head and face insulation did not protect the simulated avalanche victim from faster cooling or rewarming. Because the 3 temperature measurement methods correlated, the ingestible capsule may provide an advantageous noninvasive method for snow burial and future hypothermia studies if interruptions in data transmission can be minimized. [ABSTRACT FROM AUTHOR]

Objectives As the highest peak on the planet, Mt Everest provides a truly austere environment in which to practice medicine. We examined records of all visits to the Everest Base Camp Medical Clinic (Everest ER) to characterize the medical problems that occur in these patients. Methods A retrospective analysis of medical records from the first 10 years of operation (2003 to 2012) was performed. Results Medical reasons accounted for 85.3% (3045) of diagnoses, whereas 14.0% (500) were for trauma. The most common medical diagnoses were pulmonary causes such as high altitude cough and upper respiratory infection, comprising more than 38% of medical diagnoses. For traumatic diagnoses, 56% were for dermatologic causes, most commonly for frostbite and lacerations. Pulmonary and dermatologic diagnoses were also the most frequent causes for evacuation from Everest Base Camp, most commonly for high altitude pulmonary edema and frostbite, respectively. Conclusions Medical professionals treating patients at extreme altitude should have a broad scope of practice and be well prepared to deal with serious trauma from falls, cold exposure injuries, and altitude illness. [ABSTRACT FROM AUTHOR]

To narrow the gap in our understanding of potential oxidative properties associated with Electronic Nicotine Delivery Systems (ENDS) i.e. e-cigarettes, we employed semi-quantitative methods to detect oxidant reactivity in disposable components of ENDS/e-cigarettes (batteries and cartomizers) using a fluorescein indicator. These components exhibit oxidants/reactive oxygen species reactivity similar to used conventional cigarette filters. Oxidants/reactive oxygen species reactivity in e-cigarette aerosols was also similar to oxidant reactivity in cigarette smoke. A cascade particle impactor allowed sieving of a range of particle size distributions between 0.450 and 2.02 μm in aerosols from an e-cigarette. Copper, being among these particles, is 6.1 times higher per puff than reported previously for conventional cigarette smoke. The detection of a potentially cytotoxic metal as well as oxidants from e-cigarette and its components raises concern regarding the safety of e-cigarettes use and the disposal of e-cigarette waste products into the environment. [ABSTRACT FROM AUTHOR]

To provide guidance to clinicians, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of accidental hypothermia. The guidelines present the main diagnostic and therapeutic modalities and provide recommendations for the management of hypothermic patients. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according the criteria published by the American College of Chest Physicians. The guidelines also provide suggested general approaches to the evaluation and treatment of accidental hypothermia that incorporate specific recommendations. [ABSTRACT FROM AUTHOR]

Reports of overdue persons are common for search and rescue personnel. Search incidents for missing persons are conducted following established industry standard practices, which are continuously refined through experience and the analysis of previous search operations. Throughout this process, elements of uncertainty exist, and the knowledge and experience of the searchers and search managers may influence the outcome significantly. A sound knowledge of current search tactics will help search and rescue medical providers function more effectively during search operations. Initial actions during a search incident include 3 primary tasks that must be accomplished on any search: investigation, containment, and then hasty search efforts. Concurrent with these initial actions are the establishment of the search area and a formal US National Incident Management System incident command system. That is essential for an efficient operation and will lay the groundwork for expanding the operation past the initial operational period. The goal of applying these standard search management practices is to allow searchers to maximize their efforts, reduce some of the inherent uncertainty, and most importantly, place searchers in a position to detect the missing person. [Copyright &y& Elsevier]

Objective: Exposure to altitude may lead to acute mountain sickness (AMS) in nonacclimatized individuals. We surveyed AMS prevalence and potential risk factors in trekkers crossing a 5400-m pass in Nepal and compared the results with those of 2 similar studies conducted 12 and 24 years earlier. Methods: In April 2010, 500 surveys were distributed to English-speaking trekkers at 3500 m on their way to 5400 m, of which 332 (66%) surveys were returned complete. Acute mountain sickness was quantified with the Lake Louise Scoring System (LLSS, cutoff ≥3 and ≥5) and the Environmental Statistical Questionnaire III AMS-C score (ESQ-III, cutoff ≥0.7). We surveyed demographics, body mass index (BMI), smoking habit, rate of ascent, awareness of AMS, and acetazolamide use. Results: Prevalence of AMS was 22%, 23%, and 48% (ESQ-III ≥0.7, LLSS ≥5, and LLSS ≥3, respectively) lower when compared with earlier studies. Risk factors for AMS were younger age, female sex, higher BMI, and smoking habit. Forty-two percent had elementary knowledge about the risk and prevention of AMS. Forty-four percent used acetazolamide. Trekkers took longer to climb from 3500 to 5400 m than in earlier studies. Conclusions: Prevalence of AMS continued to decline over a period of 24 years, likely as a result of slower ascent and increased use of acetazolamide. The AMS risk factors of younger age, female sex, and high BMI are consistent with prior studies. Awareness of risk and prevention of AMS remains low, indicating an opportunity to better educate trekkers and potentially further reduce AMS prevalence. [Copyright &y& Elsevier]

The Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the management of pain in austere environments. Recommendations are graded based on the quality of supporting evidence as defined by criteria put forth by the American College of Chest Physicians. [ABSTRACT FROM AUTHOR]

Background: Minimal data exist regarding the activity, membership, training, and medical oversight of search and rescue (SAR) teams. Objective: Our objective was to describe these characteristics in the Intermountain West SAR organizations. Methods: A contact list was generated and electronic surveys were sent to SAR officials in each Intermountain West county. Results were descriptively analyzed. Results: Of the contacted jurisdictions, 56% (156) responded to the survey. The annual average call volume was 29 missions (range, 5 to 152). Multiple levels of medical training were represented on SAR teams, ranging from first aid/cardiopulmonary resuscitation providers to the physician level, and 79% of teams provided some medical training to their membership. Of the SAR medical professionals, 23% had formal wilderness medical training. Local emergency medical services provided 60% of the medical care on SAR missions rather than SAR personnel. Formal physician medical oversight was present in 41% of the SAR teams. These physicians participated in a range of SAR activities including medical protocol drafting (including expanded scope of practice), medical trainings, mission participation, medical consultation, and prescribing medications for field use. The majority (69%) of those physicians were trained in emergency medicine, and 45% of the active medical directors had protocols allowing for an expanded scope of practice due to the remote nature of SAR medical care. Conclusions: Intermountain West SAR teams vary in their activity, composition, training, and level of medical oversight. This study confirms that opportunities exist for physician integration with SAR teams in the studied states and likely throughout the United States. [ABSTRACT FROM AUTHOR]

Frostbite is a well-known occurrence in outdoor winter activity and exploration. We report the first documented case of frostbite associated with kite skiing. Kite skiing is an emerging sport that uses a kite to harness wind power for recreation and to travel long distances on skis. Certain characteristics of this sport may predispose athletes to frostbite injury. The stance required to resist and redirect the force created by the wind and kite puts constant pressure and repetitive trauma on the downwind great toe. This can compromise blood flow and increase risk of cold injury. Future kite skier expeditions should focus on specific prevention methods including properly fitting boots, adequate boot insulation, and frequent rest periods to inspect and warm toes. [ABSTRACT FROM AUTHOR]

Objective: Ultraviolet (UV) keratitis is a self-limited, inflammatory condition resulting in pain and temporary visual disturbance following acute UV radiation exposure. It may afflict mountaineers and other outdoor recreationalists because snow, water, and sand reflect a high percentage of UV radiation reaching the earth''s surface. We examined the cases of UV keratitis that have occurred on National Outdoor Leadership School (NOLS) courses in order to better understand its epidemiology and to help prevent this affliction on wilderness expeditions. Methods: We retrospectively reviewed all cases of UV keratitis that occurred on NOLS courses from 1984–2009. Subject demographics and contributing factors were recorded and descriptive information reported. Results: Fifteen cases of UV keratitis occurred during the study period with an overall incidence of 0.06% in those exposed. All cases occurred in mountainous or snowy terrain except one case which occurred while boating on a river. Thirteen of the 15 (87%) cases occurred in participants who were not wearing sunglasses. Two cases (13%) occurred in participants who were wearing sunglasses without side shields. Ten cases (71%) occurred in sunny conditions, and 4 cases (29%) occurred in cloudy or low visibility conditions. In all cases, symptoms resolved within 36 hours after cessation of UV exposure. Conclusion: Appropriate eye protection, including adequate lenses with appropriate side shields, should be worn in mountain or water environments in order to prevent UV keratitis. This data supports the conventional conception of UV keratitis as a relatively mild and self-limited condition, if treated appropriately. [Copyright &y& Elsevier]

The Wilderness Medical Society convened an expert panel to develop a set of evidence-based guidelines for the prevention and treatment of frostbite. We present a review of pertinent pathophysiology. We then discuss primary and secondary prevention measures and therapeutic management. Recommendations are made regarding each treatment and its role in management. These recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks/burdens for each modality according to methodology stipulated by the American College of Chest Physicians. [ABSTRACT FROM AUTHOR]

Introduction: The medical problems of the incarcerated population often require emergent transport to medical facilities via air or ground. The transport of this population, however, can be logistically challenging because of the potentially dangerous nature of the patients and requirements for accompanying security personnel. Methods: A retrospective chart review was conducted of prisoners transported by our air medical service from January 1, 2000 to December 31, 2008. We examined demographics, reason for call, type of patient, procedures performed by air medical crews during transport, and disposition from the emergency department. Results: Twenty-nine patients (0.3%) of the 11,448 helicopter transports during the study period were transported from correctional facilities, 17 of which were medical in nature and 12 of which had a traumatic mechanism. Fifteen (51.7%) were admitted to the operating room or intensive care unit after emergency treatment. The median scene time for these transports was 20.7 minutes and was significantly different from that of both scene and interfacility transports (median scene times of 13.7 and 31.0 minutes, respectively). Conclusion: Medical and traumatic problems of this transported population spanned a large variety of emergency complaints. Scene times reflected the nature of these transports and were not excessively long. Air medical programs should be aware of the medical problems of these patients and take measures to protect their crew when transporting this population. [Copyright &y& Elsevier]

Others have examined hypercapnia with air pockets ranging from zero to 4 L,[[2]] but to our knowledge no study has examined air pockets of moderate size. These densities were measured near the surface of the snow pack to avoid disrupting the integrity of the air pocket and may be slightly different than the actual snow density close to the participant and air pocket. [Extracted from the article]

Abstract: Air in the spinal canal after trauma is uncommon. We report a case of a motor vehicle accident resulting in a thoracic fracture-dislocation. Air was discovered within the spinal canal on a computed tomography (CT) scan. This injury pattern proved to be a diagnostic dilemma because multiple etiologies existed. Pneumothorax, ruptured esophagus, facial sinus fractures, and herniated vertebral discs can result in this entity. [Copyright &y& Elsevier]

To provide guidance to clinicians about best practices, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for prevention and treatment of acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema. These guidelines present the main prophylactic and therapeutic modalities for each disorder and provide recommendations about their role in disease management. Recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks/burdens according to criteria put forth by the American College of Chest Physicians. The guidelines also provide suggested approaches to prevention and management of each disorder that incorporate these recommendations. This is an updated version of the original WMS Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness published in Wilderness & Environmental Medicine 2010;21(2):146–155. [ABSTRACT FROM AUTHOR]

To provide guidance to clinicians about best practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the treatment and prevention of lightning injuries. These guidelines include a review of the epidemiology of lightning and recommendations for the prevention of lightning strikes, along with treatment recommendations organized by organ system. Recommendations are graded on the basis of the quality of supporting evidence according to criteria put forth by the American College of Chest Physicians. This is an updated version of the original WMS Practice Guidelines for Prevention and Treatment of Lightning Injuries published in Wilderness & Environmental Medicine 2012;23(3):260–269. [ABSTRACT FROM AUTHOR]

The Wilderness Medical Society convened an expert panel to develop a set of evidence-based guidelines for the prevention and treatment of frostbite. We present a review of pertinent pathophysiology. We then discuss primary and secondary prevention measures and therapeutic management. Recommendations are made regarding each treatment and its role in management. These recommendations are graded on the basis of the quality of supporting evidence and balance between the benefits and risks or burdens for each modality according to methodology stipulated by the American College of Chest Physicians. This is an updated version of the original guidelines published in Wilderness & Environmental Medicine 2011;22(2):156–166. [ABSTRACT FROM AUTHOR]