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Interindividual collisions while skiing or snowboarding occur regularly, they can be associated with severe injuries.To elucidate causes of accidents, injury patterns and potential risk factors for injury severity in interindividual collisions of skiers and snowboarders.Retrospective analysis of the Austrian Registry for Mountain Accidents within a 13-year timeframe (2005-2018) with regard to on- or off-piste collisions of skiers and snowboarders.A total of 30,503 collisions, involving 52,430 (85.9%) skiers and 8,576 (14.1%) snowboarders were analysed. Denominators are lacking, since total numbers of skiers and snowboarders were not available. Compared to skiers, snowboarders were younger (23 vs. 42 years; p0.001), predominantly male (77.4% vs. 61.0%; p0.001) and less often severely injured (46.8% vs. 26.2%; p0.001). Most accidents occurred on slopes (95%). Collisions involving two snowboarders occurred proportionally more often in terrain parks (4.1% of 1,664 injured snowboarders; p0.001) and while one victim was standing or sitting (9.7%; p0.001). Contusions/strains/sprains were most prevalent (23%), as were head injuries (12%). In skiers, chest, shoulder, hip, thigh and knee injuries occurred more often, leading to fractures, dislocations, concussions and internal injuries more frequently. In snowboarders, spine/back, elbow, forearm, wrist and lower leg injuries were more prevalent. Female gender and standing or sitting prior to the accident was a risk factor for being more severely injured in collisions involving i) two skiers (OR: 4.02 (3.79-4.26) and 3.91 (3.26-4.68)), ii) a skier and a snowboarder (OR: 4.50 (3.95-5.14) and 11.49 (8.04-16.41)) or iii) two snowboarders (OR: 2.85 (2.12-3.84) and 12.47 (6.17-25.20)). Wearing a helmet increased the risk when two skiers collided (OR: 1.10 (1.03-1.17)). In skier vs. snowboarder collisions, the skier had a higher risk of being injured more severely (OR: 7.93 (6.98-9.01)).In interindividual collisions of skiers and snowboarders, injury patterns and preceding causes differ substantially. Skiers are more likely to be severely injured. Awareness of an increased risk of injury should be raised particularly while standing or sitting on the slope.

Mittermair, Christof, Eva Foidl, Bernd Wallner, Hermann Brugger, and Peter Paal. Extreme cooling rates in avalanche victims: case report and narrative review. High Alt Med Biol. 22: 235–240, 2021. ...

Introduction We aimed to describe the epidemiology and injury patterns of aviation sports crashes in the Austrian mountains and identify risk factors. Methods In this retrospective cohort study, out-of-hospital data on patients who sustained crashes when participating in aviation sports from January 1, 2006 through December 31, 2015 were assessed. The out-of-hospital data were merged with in-hospital data obtained from Innsbruck Medical University Hospital. Results A total of 2037 persons were involved in 1856 aviation sports crashes. Data on 126 in-hospital patients were available. Wind and pilot error were the most common causes. Most injuries occurred in paragliders (n=111, 88%). Most commonly, paragliders sustained injuries to the lumbar spine and hang gliders to the thoracic spine. Rescue operations were undertaken mainly by helicopter emergency medical services (n=87, 69%) or combined rescue forces (ground and helicopter, n=100, 79%.). The Injury Severity Score was 15±15, with a peak in patients with isolated injuries of the lower extremities (n=38, 32%) and a second peak in patients with multiple trauma (n=44, 35%). Conclusions In the Austrian mountains, wind and pilot errors are the most common causes of aviation crashes. Aviation sports crashes frequently resulted in severe injuries and multiple trauma. The lumbar spine is particularly at risk in paragliders, whereas the thoracic spine is commonly affected in hang gliders. Injuries frequently caused long-term paralysis and limitations in quality of life. To minimize long-term consequences and save lives, skilled and well-equipped teams may be beneficial to provide effective on-site care and safe transportation to a trauma center.

Accidental hypothermia is an unintentional drop of core temperature below 35 °C. Annually, thousands die of primary hypothermia and an unknown number die of secondary hypothermia worldwide. Hypothermia can be expected in emergency patients in the prehospital phase. Injured and intoxicated patients cool quickly even in subtropical regions. Preventive measures are important to avoid hypothermia or cooling in ill or injured patients. Diagnosis and assessment of the risk of cardiac arrest are based on clinical signs and core temperature measurement when available. Hypothermic patients with risk factors for imminent cardiac arrest (temperature < 30 °C in young and healthy patients and

Aims: This study aimed to determine the time needed for one or two companion rescuers to access, extricate, and deliver cardiopulmonary resuscitation (CPR) to a fully buried manikin during...

In 1805, W.D., a 16-y-old boy, became hypothermic after he was left alone on a grounded boat in Leith Harbour, near Edinburgh, Scotland. He was brought to his own house and resuscitated with warm blankets, smelling salts, and massage by Dr. George Kellie. W.D. made an uneventful recovery. We discuss the pathophysiology and treatment of accidental hypothermia, contrasting treatment in 1805 with treatment today. W.D. was hypothermic when found by passersby. Although he appeared dead, he was rewarmed with help from Dr. Kellie and his assistants over 200 y ago using simple methods. One concept that has not changed is the critical importance of attempting resuscitation, even if it seems to be futile. Don't give up!

Rescue blankets are medical devices made of a polyethylene terephthalate sheet coated with a thin aluminum layer. Blankets are used for protection against hypothermia in prehospital emergency medicine and outdoor sports, but totally different qualities are typical for these multi-functional tools. On the one hand, rescue sheets prevent hypothermia by reducing thermo-convection and diminishing heat loss from evaporation and thermal radiation. On the other hand, the sheets promote cooling by acting as a radiant barrier, by providing shade and even by increasing heat conduction when the sheet is in direct contact with the skin. As foils are watertight and windproof, they can function as vapor barriers and even as stopgap bivouac sacks. We evaluated three experimental studies, one on heat loss by rescue blankets according to surface color, one on transparency with ultraviolet radiation, high-energy visible light and visible light, and one on infrared radiation from rescue blankets. When evaluating the effects of different bands of the electromagnetic spectrum on rescue sheets, we focused on ultraviolet radiation (200&ndash, 380 nm), high-energy visible light in the violet/blue band (380&ndash, 450 nm), visible light (380&ndash, 760 nm) and infrared radiation (7500&ndash, 13,500 nm). Rescue sheets transmit between 1% and 8% of visible light and about 1% of ultraviolet B radiation (280&ndash, 315 nm), providing sufficient transparency and adequate protection from snow blindness. Reflection of visible light increases detectability in search and rescue missions performed in good visibility conditions, while reflection of infrared radiation increases detectability in poor visibility conditions and provides protection against hypothermia.

Unintentional hypothermia (core temperature < 36 °C) is a common side effect in patients undergoing surgery. Several patient-centred and external factors, e.g., drugs, comorbidities, trauma, environmental temperature, type of anaesthesia, as well as extent and duration of surgery, influence core temperature. Perioperative hypothermia has negative effects on coagulation, blood loss and transfusion requirements, metabolization of drugs, surgical site infections, and discharge from the post-anaesthesia care unit. Therefore, active temperature management is required in the pre-, intra-, and postoperative period to diminish the risks of perioperative hypothermia. Temperature measurement should be done with accurate and continuous probes. Perioperative temperature management includes a bundle of warming tools adapted to individual needs and local circumstances. Warming blankets and mattresses as well as the administration of properly warmed infusions via dedicated devices are important for this purpose. Temperature management should follow checklists and be individualized to the patient’s requirements and the local possibilities.

Background and aims Acute trauma pain is one of the most important patient complaints in emergency department (ED). Previous studies lack data on fentanyl sublingual (FSL) in comparison to fentanyl intravenous (FIV) for acute moderate to severe trauma pain in ED and on differences between female and male patients using FSL or FIV. We hypothesized that FSL is not inferior to FIV and no differences in terms of efficacy and side effects in the management of acute moderate to severe pain exist between female and male patients. Methods A prospective, randomized, double-blind, single-center, non-inferiority clinical trial was performed including 108 adults (54 females and 54 males) with acute trauma pain ≥4 on numeric rating scale (NRS) at ED triage. They received either fentanyl intravenous (1 µg kg-1) or sublingual (100 µg) and the correspondent placebo. NRS, SpO2, respiratory frequency, blood pressure and heart rate were assessed before and 5, 10, 20, 30 and 60 minutes after fentanyl administration and side effects during observation. Results Analgesia was not different but side effects were more present in the FIV group. There are no differences between female and male patients either in analgesia or presence of side effects, adverse events, need for rescue dose and patient satisfaction. Conclusions This study compares FSL and FIV for acute moderate to severe trauma pain in women and men in emergency department. The results indicate no sex differences in analgesia and side effects. This investigation could help reduce the lack of knowledge regarding sex differences in opioid use.

Climbing has become an increasingly popular sport, and the number of accidents is increasing in parallel. We aim at describing the characteristics of climbing accidents leading to severe (multisystem) trauma using data from the International Alpine Trauma Registry (IATR) and at reporting the results of a systematic review of the literature on the epidemiology, injury pattern, severity and prevention of climbing accidents. We found that climbing accidents are a rare event, since approximately 10% of all mountain accidents are climbing related. Climbing accidents mainly affect young men and mostly lead to minor injuries. Fall is the most common mechanism of injury. Extremities are the most frequently injured body part. However, in multisystem climbing-related trauma, the predominant portion of injuries are to head/neck, chest and abdomen. The fatality rate of climbing accidents reported in the literature varies widely. Data on climbing accidents in general are very heterogeneous as they include different subspecialties of this sport and report accidents from different regions. A number of risk factors are accounted for in the literature. Appropriate training, preparation and adherence to safety standards are key in reducing the incidence and severity of climbing accidents.

Background Lightning strikes are rare but potentially lethal. The risk for suffering a lightning strike in a mountain environment is unknown. The aim of this nationwide study was to analyse all lightning accidents in the Austrian Alps from 2005 to 2015, to assess the circumstances of the accident, the injury pattern as well as the outcome. Methods From 2005 to 2015, data from the national Austrian Alpine Police database as well as the Clinical Information System of Innsbruck Medical University Hospital were searched for the keywords lightning injury, lightning strike, lightning as well as ICD-10 Code T75.0. Additionally, the archive data of Innsbruck Medical University Hospital was searched manually. Results The Austrian Alpine Police database, containing 109.168 patients for the years 2005–2015, was screened for lightning accidents. Sixty-four patients had been hit by lightning in the Austrian Alps, 54 were male. Four persons died on scene; survival rate was 93.8%. Two deceased persons were hunters, who were killed by the same lightning strike. Sixty-three patients suffered a lightning strike while doing a recreational activity, mostly hiking (n = 55), a few hunting and only one doing occupational timberwork. Sixty-three patients suffered a lightning strike between June and August with nearly half (46.9%) of the accidents happening on a Saturday or Sunday, and mainly (95.3%) between 12:00 and 22:00 h. Discussion Persons who perform recreational outdoor and occupational activities in an alpine environment during summer and after noon incur a higher risk of sustaining a lightning strike. The primary risk group includes young male mountaineers and hunters. The mortality rate was low. Trial registration The study was approved by the Ethics Committee of the Medical University of Innsbruck (AN4757 315/4.4) and retrospectively registered with Clinical Trials NCT03405467, January 19, 2018.

Background: Nodding syndrome (NS) is a seemingly progressive epilepsy disorder of unknown underlying cause. We investigated association of pyridoxal-phosphate serum levels and occurrence of anti-neuronal antibodies against N-methyl-D-aspartate (NMDA) receptor and voltage gated potassium channel (VGKC) complex in NS patients.Methods: Sera of a Tanzanian cohort of epilepsy and NS patients and community controls were tested for the presence of anti-NMDA-receptor and anti-VGKC complex antibodies by indirect immunofluorescence assay. Furthermore pyridoxal-phosphate levels were measured.Results: Auto-antibodies against NMDA receptor or VGKC (LG1 or Caspr2) complex were not detected in sera of patients suffering from NS (n=6), NS plus other seizure types (n=16), primary generalized epilepsy (n=1) and community controls without epilepsy (n=7). Median Pyridoxal-phosphate levels in patients with NS compared to patients with primary generalized seizures and community controls were not significantly different. However, these median pyridoxal-phosphate levels are significantly lower compared to the range considered normal in Europeans.Conclusions: In this pilot study NS was not associated with serum anti-NMDA receptor or anti-VGKC complex antibodies and no association to pyridoxal-phosphate serum levels was found.Key words: nodding syndrome, epilepsy, anti-neuronal antibodies, pyridoxal-phosphate

Summary Objectives Nodding syndrome (NS), a new epilepsy disorder of sub-Saharan Africa, has only recently been classified. In a study conducted in southern Tanzania in 2005, 62 patients with NS were analyzed in great detail. The present study, a follow-up investigation, was conducted to evaluate the progression of NS over time and to obtain serial electroencephalography (EEG) data. Methods Of the 62 NS patients, 53 (85.5%), the majority of whom were currently on some form of antiepileptic treatment, could be reevaluated in 2009 with a standardized questionnaire. A subset of these patients (25/53) underwent EEG investigation. Results In patients with “head nodding (HN) only” in 2005, 10 (43.5%) of 23 remained with the same diagnosis, whereas 5 (21.7%) of 23 had developed “HN plus” (i.e., HN and generalized tonic–clonic seizures). Six patients (26.1%) had seizures other than HN only, and two patients (8.7%) had fully recovered. In the “HN plus” group of 2005, 9 (30.0%) of 30 patients remained “HN plus,” and 15 patients (50.0%) had seizures other than HN only. Four patients (13.3%) reverted to “HN only,” and two patients (6.7%) stopped all seizures. In 11 (44.0%) of 25 patients, electroencephalography (EEG) showed generalized slowing. Six (54.6%) of these 11 abnormal EEG studies further showed generalized epileptiform discharges: (1) ictal electroencephalographic pattern with generalized 2.5 Hz spike and waves in two patients and (2) interictal bursts of 1.5–2 Hz spike and waves in four patients. Significance This follow-up study confirms that HN represents an epilepsy disorder, possibly of the atypical absence type with dynamic development over time.

Verschiedene Studien bei Schizophrenen deuten darauf hin, das morphologische und funktionelle Veranderungen insbesondere im Frontal- und Temporallappen sowie im limbischen System bestehen (Suddath et al. 1990; Cleghorn et al. 1991; Swayze et al. 1992). Ungeklart ist bislang, ob die strukturellen und funktionellen Veranderungen bereits pramorbid oder erst mit Manifestation der Krankheit entstehen. Wir untersuchten deshalb die Frage, ob sich klinisch gesunde Nachkommen schizophrener Eltern in der Kernspintomographisch beurteilbaren Morphologie des Gehirns sowie in bestimmten Hirnleistungen von Nachkommen psychisch gesunder Eltern unterscheiden.

Ultrasonography was used to inspect the ankle anatomy of 20 healthy volunteers. The images produced were correlated with anatomical structures by examining three dissected cadaver ankles. The anterolateral pouch of the articular capsule was identified by ultrasonography in 91% of the normal ankle joints as a hypoechoic area. The posterolateral pouch of the articular capsule also could be identified by ultrasonography as a hypoechoic area in 84% of the normal ankles examined. The lateral aspect of 105 traumatized ankles was examined subsequently. The ultrasound results agreed in 100% of the cases with the operative findings for the anterior talofibular ligament and in 92% for the calcaneofibular ligament.