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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 highaltitude 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]

Background: Traditionally, physicians have identified which outcome factors are important to measure in order to determine the success or failure of treatment without any input from patients. The purpose of the present study was to ascertain the five outcome factors that are most important to the patient and the impact that age and sex have on these factors. These five most important patient-derived outcome factors were then compared with factors within two of the most commonly used outcome instruments for the foot and ankle. Methods: Informant interviews, pre-testing, consistency analysis, and pilot testing led to the construction of a twenty-item survey of outcome factors that patients identified as being important in the treatment of their foot or ankle problem. Subjects selected the top five factors and rank ordered them from 1 to 5 (with 1 representing extreme importance and 5 representing least importance). One thousand computer simulations identified the top five factors, and these were subsequently stratified for sex and age. Wilcoxon rank-sum and Benjamini-Hochberg tests were used to compare the data between groups. Results: The survey was completed by 783 subjects. The five most important factors were limited walking (p < 0.05), activity-related pain (p < 0.05), constant pain (p < 0.05), difficulty with prolonged standing (p = 0.754), and inability to do one's job or housework (p = 0.995). Shoe-related issues and foot and ankle weakness were significantly different between the sexes. Constant pain, inability to play sports, inability to participate in a job or housework, and recurrent foot or ankle skin sores or infections were significantly different between age groups. Between 38% and 50% of the outcome points found on two commonly used foot and ankle instruments included factors not of primary importance to the patient. Conclusions: There are sex and age-related differences regarding outcome factors following the treatment of disorders affecting the foot and ankle. As many as 50% of the factors in currently used foot and ankle outcome instruments are not of primary importance to patients. [ABSTRACT FROM AUTHOR]

Background: Injuries sustained while skiing or snowboarding are commonly encountered in emergency departments near winter resorts. The purpose of this study is to identify and compare the types of injuries likely to be found in the skier or snowboarder patient. An additional goal of this study is to provide a description of the demographics and hospitalizations for these patients., Methods: A retrospective cohort study consisting of patients treated for skiing- or snowboarding-related injuries was performed at the University of Utah Medical center. All emergency department visits were captured: walk-ins and emergency medical service transports (ground and air). Seven hundred ninety-four skiing and 348 snowboarding-related cases were identified for a total of 1,142. Cases that occurred within 2001/2002 to 2005/2006 seasons were included in the study. Injuries were classified according to the International Classification of Diseases-9th Revision system and categorized by body location and specific type of injury. Outputs for this study include the chi test using the skiers as the control group due to size, with risk odds ratios comparing snowboarders to skiers. A p value of <0.05 was considered significant., Results: Patients injured while skiing and snowboarding were predominantly men, representing 70.0% of injured skiers and 87.6% of injured snowboarders. The mean age for skiers was 41 (SD = 16), whereas the mean age for snowboarders was 23 (SD = 8). High percentages of patients among both groups had suffered injury to the head, which was more common in snowboarders when compared with skiers (27.3% vs. 20.4%, p = 0.010). Despite this fact, skiers tended to have slightly higher percentages of Glasgow Coma Scores in the moderate to severe range and accounted for all fatalities secondary to head injury (8 of 9 fatalities). The single snowboarder fatality was not caused by head injury but rather pneumothorax. Injuries to the head that were more common in skiers were fractures to the facial bones (5.2% vs. 1.4%, p = 0.003) and facial lacerations (5.8% vs. 2.9%, p = 0.035). Skiers were more likely to sustain injuries to the lower extremities (51.3% vs. 26.2%, p < 0.001), whereas snowboarders commonly had injuries to the abdomen and its organs (22.4% vs. 11.2%, p < 0.001). A considerable amount of snowboarders had injuries to the spleen (11.2%), liver (3.7%), and kidney (2.2%). Injuries to the spine were common in both groups but more in snowboarders (20.7% vs. 13.4%, p = 0.002). On an average, skiers spent 3.4 days in the hospital (SD = 3), a day longer than snowboarders who averaged 2.4 (SD = 2). Skiers were more frequently admitted to the floor or the operating room, whereas snowboarders were more often admitted to the intensive care unit., Conclusion: Patients injured while skiing or snowboarding are predominantly men, and participants in both sports are at risk for sustaining major injuries. The types of injuries differ and are dependent on the sport. An awareness of these differences will help skiers and snowboarders minimize their risk of injury by altering their riding strategies and by choosing appropriate protective equipment.

Background: Airway management is an essential skill for air medical transport (AMT) providers. The endpoint of airway maneuvers is a cricothyrotomy which may be live-saving if other measures fail. We reviewed cricothyrotomy cases in our AMT program to evaluate the success rate and the circumstances surrounding the procedure., Methods: This was a retrospective review of cases in which a cricothyrotomy was performed at the University of Utah AirMed flight program during the years of 1995 to 2004. Data included incidence, indications, complications, neurologic outcome, and success rates of the procedure., Results: Of the 14,994 transports during the study period, 17 cricothyrotomies were performed. Airway obstruction by blood and/or vomit was the most frequent indication (47%) followed by airway edema/distorted anatomy (24%). The total number of cricothyrotomies decreased during the study period. Seven (41%) patients survived with a reasonable neurologic outcome. The remaining 10 patients died during initial treatment or subsequent hospitalization. Success rate of the procedure in our series was 100%. These results were compared with those of other cricothyrotomy studies., Conclusion: Cricothyrotomy has become less common as an emergency rescue technique. However, AMT personnel have a high success rate when performing the cricothyrotomy procedure. This rate is as high as or higher than other emergency personnel.

Background: Complications during central venous catheterization (CVC) are not rare and can be serious. The use of ultrasound (US) during CVC has been recommended to improve patient safety. We performed a survey to evaluate the frequency of, and factors influencing, US use., Methods: We conducted an electronic survey of all members of the Society of Cardiovascular Anesthesiologists. Univariate and multivariate logistic regressions were used to assess the association between the frequency of US use and hospital and physician factors. All tests were two-sided, and a P value <0.05 was considered statistically significant., Results: Of the 4235 members, 1494 responded (response rate = 35.3%). Two-thirds of the respondents never, or almost never, use US, whereas only 15% always, or almost always, use US. Thirty-three percent of the respondents never, or almost never, have US available, whereas 41% stated that US is always, or almost always, available. Availability of US equipment was strongly associated with US use for CVC (adj OR = 18.9; P value <0.001). The most common reason cited for not using US was "no apparent need for the use of US" (46%). When US was used, rescue or screening approaches were more common (72%) than real-time use (26%)., Conclusions: The use of US during CVC remains limited and is most strongly associated with the availability of equipment. Screening and rescue use of US are more common than real-time guidance. Our survey suggests that current use of US during CVC differs from existing evidence-based recommendations.