98 results on '"Grant S. Lipman"'
Search Results
2. Recurrent pediatric abdominal pain
- Author
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Joseph Romero and Grant S. Lipman
- Subjects
Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Published
- 2021
- Full Text
- View/download PDF
3. Intensive Cryotherapy in the Emergency Department (ICED): A Randomized Controlled Trial
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Eric J. Leroux, Elizabeth A. Kaufman, Christian N. Kontaxis, and Grant S. Lipman
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Medicine ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Introduction: Pain control is an essential component of musculoskeletal injury treatment in the emergency department (ED). We evaluated the most effective type of cryotherapy for analgesia of acute musculoskeletal injury and the impact on opioid utilization. Methods: This was a prospective, randomized, single-blind controlled trial of adult ED patients who presented with acute musculoskeletal pain. Patients were randomized to either intensive targeted cryotherapy (crushed wetted ice in a plastic bag) or agitated chemical cold pack applied to the injury site for 20 minutes. All other diagnostic and therapeutic orders were at the discretion of the treating physician. Visual analog pain scores were measured at the time of cryotherapy application, at 20 minutes (time of cryotherapy removal), and at 60 minutes (40 minutes after removal). Results: We enrolled 38 patients, 17 randomized to intensive targeted cryotherapy and 21 to chemical cold packs, with well-matched demographics. The intensive targeted cryotherapy group achieved significantly greater pain relief at 20 minutes (2.1 [95% confidence interval (CI), 1.3 – 2.9] vs 0.9 [95% CI, 0.3 – 1.5], P < 0.05) and at 60 minutes (2.7 [95% CI, 1.6 – 3.7] vs 1.2 [95% CI, 0.6 – 1.7], P < 0.05), number need to trial (NNT) = 3.2. Opioid administration in the ED was significantly lower in the intensive targeted cryotherapy group (1 [6%] vs 7 [33%], P < 0.05), NNT = 3.6. Those who received a discharge opiate prescription had significantly higher 60-minute pain scores (7.3 ± 2.2 vs 4.1 ± 2.7, P < 0.05). Conclusion: Intensive targeted cryotherapy provided more effective analgesia than chemical cold packs for acute musculoskeletal injuries in the ED and may contribute to lower opioid usage.
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- 2020
- Full Text
- View/download PDF
4. Two cases of paradoxical hypothermia in a Sahara desert multi-stage ultramarathon
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Elizabeth A. Kaufman, Grant S. Lipman, Louis J. Sharp, and Brian J. Krabak
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hypothermia, ultramarathon, hypoglycemia, multi-stage, desert ,Medicine (General) ,R5-920 - Abstract
Exertional hypothermia in a hot environment, a seemingly contradictory state, is a clinical presentation that has not been previously described in the medical literature. We present two cases of symptomatic hypothermia of 34-35°C (95°F) which resolved with ingestion of calories in otherwise healthy men competing in a multi-stage ultramarathon in the Sahara desert, Egypt 2012 with ambient temperatures of approximately 38-39°C (100- 102°F). Hypothermia is well documented in the medical literature as a presenting sign of hypoglycemia in both conscious and comatose patients. The mechanism by which hypoglycemia contributes to hypothermia is poorly understood, but may represent a compensatory response that reflects a decrease in energy demand during glucose deprivation. Wilderness medicine practitioners at endurance events should be cognizant of hypothermia as a potential presenting sign of hypoglycemia, as it can be empirically treated and rapidly reversed.
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- 2014
- Full Text
- View/download PDF
5. Running Performance during the COVID-19 Pandemic
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Sriram, Venkatesan, primary, Mary, Starrs, additional, Sonja, Eagle, additional, Caleb, Phillips, additional, and Grant S, Lipman, additional
- Published
- 2022
- Full Text
- View/download PDF
6. Intensive Cryotherapy in the Emergency Department (ICED): A Randomized Controlled Trial
- Author
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Eric J. Leroux, Christian N Kontaxis, Grant S. Lipman, and Elizabeth A. Kaufman
- Subjects
Adult ,Male ,medicine.medical_treatment ,lcsh:Medicine ,Cryotherapy ,Medical Overuse ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Musculoskeletal Pain ,Outcome Assessment, Health Care ,medicine ,Humans ,Pain Management ,Single-Blind Method ,030212 general & internal medicine ,Medical prescription ,Pain Measurement ,Duration of Therapy ,business.industry ,Cold packs ,lcsh:R ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,030208 emergency & critical care medicine ,General Medicine ,Emergency department ,lcsh:RC86-88.9 ,Brief Research Report ,medicine.disease ,Confidence interval ,Analgesics, Opioid ,Opioid ,Patient Satisfaction ,Anesthesia ,Emergency Medicine ,Musculoskeletal injury ,Wounds and Injuries ,Female ,business ,Emergency Service, Hospital ,medicine.drug - Abstract
Author(s): Leroux, Eric J.; Kaufman, Elizabeth A.; Kontaxis, Christian N.; Lipman, Grant S. | Abstract: Introduction: Pain control is an essential component of musculoskeletal injury treatment in the emergency department (ED). We evaluated the most effective type of cryotherapy for analgesia of acute musculoskeletal injury and the impact on opioid utilization.Methods: This was a prospective, randomized, single-blind controlled trial of adult ED patients who presented with acute musculoskeletal pain. Patients were randomized to either intensive targeted cryotherapy (crushed wetted ice in a plastic bag) or agitated chemical cold pack applied to the injury site for 20 minutes. All other diagnostic and therapeutic orders were at the discretion of the treating physician. Visual analog pain scores were measured at the time of cryotherapy application, at 20 minutes (time of cryotherapy removal), and at 60 minutes (40 minutes after removal).Results: We enrolled 38 patients, 17 randomized to intensive targeted cryotherapy and 21 to chemical cold packs, with well-matched demographics. The intensive targeted cryotherapy group achieved significantly greater pain relief at 20 minutes (2.1 [95% confidence interval (CI), 1.3 – 2.9] vs 0.9 [95% CI, 0.3 – 1.5], P l 0.05) and at 60 minutes (2.7 [95% CI, 1.6 – 3.7] vs 1.2 [95% CI, 0.6 – 1.7], P l 0.05), number need to trial (NNT) = 3.2. Opioid administration in the ED was significantly lower in the intensive targeted cryotherapy group (1 [6%] vs 7 [33%], P l 0.05), NNT = 3.6. Those who received a discharge opiate prescription had significantly higher 60-minute pain scores (7.3 ± 2.2 vs 4.1 ± 2.7, P l 0.05).Conclusion: Intensive targeted cryotherapy provided more effective analgesia than chemical cold packs for acute musculoskeletal injuries in the ED and may contribute to lower opioid usage.
- Published
- 2021
7. Pain Is Inevitable But Suffering Is Optional: Relationship of Pain Coping Strategies to Performance in Multistage Ultramarathon Runners
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Crystal Irwin, Joshua Bautz, Anna L. Kratz, Grant S. Lipman, Dave Pomeranz, Claire Nordeen, Brian J. Krabak, Patrick Burns, Kevin N. Alschuler, and Mark P. Jensen
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Adult ,Male ,Musculoskeletal pain ,medicine.medical_specialty ,Coping (psychology) ,Pain ,Pain Interference ,Running ,Pain coping ,03 medical and health sciences ,0302 clinical medicine ,Adaptation, Psychological ,medicine ,Humans ,Pain Management ,Prospective Studies ,business.industry ,Public Health, Environmental and Occupational Health ,030208 emergency & critical care medicine ,030229 sport sciences ,Finish line ,Middle Aged ,Physical Endurance ,Emergency Medicine ,Physical therapy ,Female ,Observational study ,business ,Stress, Psychological - Abstract
Ultramarathon runners commonly endure musculoskeletal pain during endurance events. However, the effect of pain coping skills on performance has not been examined.A prospective observational study during three 250 km (155 mi), 6 stage ultramarathons was conducted. Finish line surveys were completed after each of the four 40 km (25 mi) and one 80 km (50 mi) stages of racing. Variables gathered included pain intensity, pain coping strategy use, pain interference, finishing position (quintile), and successful race completion.A total of 204 participants (age 41.4±10.3 y; 73% male) reported average pain intensity of 3.9 (±2.0 SD) and worst pain intensity of 5.3 (±2.3) on a 0 to 10 scale. They used greater adaptive pain coping strategies (3.0±1.3) relative to maladaptive strategies (1.3±1.1). Worst pain and pain interference increased over each stage of the race for all runners (P0.001), with worst pain being significantly different by finishing status (P=0.02). Although all runners endured increased pain and interference, the nonfinishers (28 [14%]) had significantly greater differences in changes in pain intensity (P0.01) and pain interference (P0.001). Maladaptive pain coping strategies were more common in nonfinishers; with each 1-point increase (0-6 scale), there was a 3 times increase in odds of not finishing the race.Although increased pain intensity and pain interference was found in all multistage ultramarathon runners, successful event completion was significantly associated with less maladaptive pain coping. Training in coping with pain may be a beneficial part of ultramarathon preparation.
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- 2020
8. A body bag can save your life: a novel method of cold water immersion for heat stroke treatment
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Sam Shen, Alexei M. Wagner, David Kim, Grant S. Lipman, and Benjamin Lindquist
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Stroke treatment ,Stroke patient ,Water immersion ,business.industry ,Anesthesia ,Oral temperature ,Immersion (virtual reality) ,Medicine ,Case Report ,Passive Exposure ,General Medicine ,Heat wave ,business - Abstract
Non‐exertional heat stroke is a life‐threatening condition characterized by passive exposure to high ambient heat, a core body temperature of 40°C (104°F) or greater, and central nervous system dysfunction. Rapid cooling is imperative to minimize mortality and morbidity. Although evaporative and convective measures are often used for cooling heat stroke patients, cold water immersion produces the fastest cooling. However, logistical difficulties make cold water immersion challenging to implement in the emergency department. To our knowledge, there is no documented case utilizing a body bag (ie, human remains pouch) as a cold water immersion tank for rapid resuscitation of heat stroke. During a regional heat wave an elderly woman was found unconscious in a parking lot with an oral temperature of 40°C (104°F) and altered mental status. She was cooled to 38.4°C (101.1°F) in 10 minutes by immersion in an ice‐ and water‐filled body bag. The patient rapidly regained normal mentation and was discharged home from the ED. This case highlights a novel method for efficient and convenient cold water immersion for heat stroke treatment in the emergency department.
- Published
- 2020
9. Older Age as a Predictive Risk Factor for Acute Mountain Sickness
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Grant S. Lipman, James Marvel, Caleb Phillips, and Elan Small
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Adult ,White Mountain ,Altitude Sickness ,Logistic regression ,Odds ,law.invention ,Randomized controlled trial ,law ,Risk Factors ,Medicine ,Humans ,Prospective Studies ,Risk factor ,Altitude sickness ,Aged ,geography ,business.industry ,Incidence (epidemiology) ,Incidence ,General Medicine ,medicine.disease ,geography.mountain ,Acute Disease ,business ,Risk assessment ,human activities ,Demography - Abstract
Background : Older populations are increasing and comprise a substantial portion of high-altitude travelers. Aging physiology may influence susceptibility to acute mountain sickness, though prior research remains inconclusive. The goal of this study was to investigate the relationship between increasing age and acute mountain sickness. Materials & Methods : This study was a pooled analysis of five prospective randomized controlled trials conducted at White Mountain, California from 2010, 2016-2019 with identical 4-hour rapid ascent from 1242 m to overnight sojourn at 3810 m. Acute mountain sickness was defined by the 2018 Lake Louise Questionnaire criteria. Results : 491 participants were analyzed, 234 (48%) diagnosed with acute mountain sickness and 71 (14%) with moderate acute mountain sickness. Mean age was 37(±13). There was no significant correlation between Lake Louise Questionnaire severity and age (r = -0.02, 95% CI -0.11 to 0.07, p = 0.7), 40 year-old dichotomy (t = -0.6, 95% CI -0.53 to 0.28, p = 0.6), or decade of life (p = 0.4). Logistic regression found no increased odds of acute mountain sickness for increasing age by decade of life (OR =1.0, 95% CI 0.97 to 1.0) or 40 year-old dichotomy (OR = 1.4, 95% 0.97 to 2.1. A history of acute mountain sickness increased odds of acute mountain sickness (OR = 3.2, 95% CI 1.5 to 7.7). Conclusions : Older age was not associated with incidence nor severity of acute mountain sickness. A history of altitude illness increased odds of acute mountain sickness and should be used for pre-ascent risk stratification.
- Published
- 2021
10. Re: 'Altitude, Acute Mountain Sickness, and Acetazolamide: Recommendations for Rapid Ascent' by Toussaint et al
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Marc M. Berger and Grant S. Lipman
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Physiology ,business.industry ,Altitude ,Public Health, Environmental and Occupational Health ,General Medicine ,Altitude Sickness ,Mountaineering ,Acetazolamide ,Anesthesia ,Acute Disease ,Medicine ,Humans ,business ,medicine.drug - Published
- 2021
11. Altitude Sickness Prevention with Ibuprofen Relative to Acetazolamide
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Peter H. Hackett, Grant S. Lipman, Keiran Warner, Linda L. Sanders, Mario Soto, Caleb Phillips, Patrick Burns, and Carrie Jurkiewicz
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geography ,Sleep quality ,White Mountain ,business.industry ,Incidence (epidemiology) ,General Medicine ,030204 cardiovascular system & hematology ,Ibuprofen ,medicine.disease ,Confidence interval ,03 medical and health sciences ,Capillary oxygen saturation ,geography.mountain ,0302 clinical medicine ,Anesthesia ,medicine ,030212 general & internal medicine ,Acetazolamide ,business ,human activities ,Altitude sickness ,medicine.drug - Abstract
Background Acute mountain sickness is a common occurrence for travel to high altitudes. Although previous studies of ibuprofen have shown efficacy for the prevention of acute mountain sickness, recommendations have been limited, as ibuprofen has not been compared directly with acetazolamide until this study. Methods Before their ascent to 3810 m on White Mountain in California, adult volunteers were randomized to ibuprofen (600 mg, 3 times daily, started 4 hours before the ascent), or to acetazolamide (125 mg, twice daily, started the night before the ascent). The main outcome measure was acute mountain sickness incidence, using the Lake Louise Questionnaire (LLQ), with a score of >3 with headache. Sleep quality and headache severity were measured with the Groningen Sleep Quality Survey (GSQS). This trial was registered at ClinicalTrials.gov: NCT03154645 Results Ninety-two participants completed the study: 45 (49%) on ibuprofen and 47 (51%) on acetazolamide. The total incidence of acute mountain sickness was 56.5%, with the incidence for the ibuprofen group being 11% greater than that for acetazolamide, surpassing the predetermined 26% noninferiority margin (62.2% vs 51.1%; 95% confidence interval [CI], –11.1 to 33.5). No difference was found in the total LLQ scores or subgroup symptoms between drugs (P = .8). The GSQS correlated with LLQ sleep (r = 0.77; 95% CI, 0.67–0.84)=%. The acetazolamide group had higher peripheral capillary oxygen saturation than the ibuprofen group (88.5% vs 85.6%; P = .001). Conclusion Ibuprofen was slightly inferior to acetazolamide for acute mountain sickness prevention and should not be recommended over acetazolamide for rapid ascent. Average symptoms and severity were similar between drugs, suggesting prevention of disease.
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- 2019
12. Predictive Capacity of Pulmonary Function Tests for Acute Mountain Sickness
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Elan Small, Grant S. Lipman, Mary Cheffers, Patrick Burns, David Pomeranz, Nicholas H. Juul, and Caleb Phillips
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Spirometry ,medicine.medical_specialty ,medicine.diagnostic_test ,Physiology ,business.industry ,Altitude ,Vital Capacity ,Public Health, Environmental and Occupational Health ,030229 sport sciences ,General Medicine ,030204 cardiovascular system & hematology ,Altitude Sickness ,Pulmonary function testing ,Respiratory Function Tests ,Acetazolamide ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Acute Disease ,Cardiology ,Medicine ,Humans ,business - Abstract
Small, Elan, Nicholas Juul, David Pomeranz, Patrick Burns, Caleb Phillips, Mary Cheffers, and Grant S. Lipman. Predictive capacity of pulmonary function tests for acute mountain sickness. High Alt ...
- Published
- 2021
13. Recurrent pediatric abdominal pain
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Grant S. Lipman and Joseph Romero
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Abdominal pain ,medicine.medical_specialty ,Text mining ,business.industry ,General surgery ,MEDLINE ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,Medicine ,Images in Emergency Medicine ,lcsh:RC86-88.9 ,medicine.symptom ,business ,Recurrent pediatric - Published
- 2021
14. Prospective Observational Study of Weight-based Assessment of Sodium Supplements on Ultramarathon Performance (WASSUP)
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Patrick Burns, Grant S. Lipman, Brian J. Krabak, Tamara Hew-Butler, and Caleb Phillips
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Percentile ,Sodium ,Performance ,Sodium supplements ,chemistry.chemical_element ,Physical Therapy, Sports Therapy and Rehabilitation ,Running ,Endurance ,Electrolytes ,Animal science ,Exercise-associated hyponatremia ,medicine ,Ingestion ,Orthopedics and Sports Medicine ,Original Research Article ,Supplements ,Ultramarathon ,Dehydration ,business.industry ,Weight change ,Overhydration ,medicine.disease ,chemistry ,Observational study ,business ,Weight based dosing - Abstract
BackgroundSodium supplements are ubiquitous in endurance running, but their impact on performance has been subjected to much debate. The objective of the study was to assess the effect of sodium supplementation as a weight-based predictor of race performance in ultramarathon runners.MethodsProspective observational study during an 80 km (50 mi) stage of a 6-stage 250 km (155 mi) ultramarathon in Chile, Patagonia, Namibia, and Mongolia. Finish line hydration status as measured by weight change, point-of-care serum sodium, and questionnaire provided sodium ingestion categories at 33rd percentile and 66th percentile both for weight-adjusted rate and total sodium consumption, then analyzed for significant relationships to race performance, dysnatremia, and hydration.ResultsTwo hundred sixty-six participants were enrolled, with 217 (82%) with complete sodium supplement rate data, 174 (80%) with finish line sodium, and 161 (74%) with both pre-race weights and total sodium ingestion allowing weight-based analysis. Sodium intake ranged from 131–533 mg/h/kg (2–7.2 gm), with no statistically significant impact on pace, race time, or quintile rank. These outcomes did not change when sodium intake was analyzed as a continuous variable or by sub-group analysis of the 109 (68%) normonatremic runners. When controlled for weight-adjusted sodium intake, performance was poorly correlated with hydration (r= − 0.152, 95% CI − 0.348–0.057). Dehydrated runners outperformed those overhydrated, with 11% of top 25th percentile finishers dehydrated (versus 2.8% overhydrated), with 3.6 min/km faster pace and time 4.6 h faster finishing time.ConclusionsNo association was found between sodium supplement intake and ultramarathon performance. Dehydrated runners were found to have the best performance. This reinforces the message to avoid overhydration.
- Published
- 2020
15. The Scout's Guide to Wilderness Survival and First Aid : 400 Essential Skills—Signal for Help, Build a Shelter, Emergency Response, Treat Wounds, Stay Warm, Gather Resources (A Licensed Product of the Boy Scouts of America®)
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J. Wayne Fears, Grant S. Lipman, J. Wayne Fears, and Grant S. Lipman
- Abstract
2 books in 1 at a value price! Be Prepared! Time-tested advice on emergency preparedness. An official publication of the Boy Scouts of America! Each year hundreds of outdoor enthusiasts find themselves in an unexpected outdoor emergency. They get lost, injured, or stranded. Cut off from the rest of the world, they have to depend upon their survival skills to survive. For most people, thanks to modern communications such as cell phones, satellite messengers, and personal locator beacons (PLB), it is merely a sobering two- or three-hour adventure. However, for some who did not take the proper precautions before they left home or do not have survival skills, it can end in tragedy.The Scout's Handbook for Wilderness Survival and First Aid offers practical advice to help with: Building a firePurifying waterIdentifying common edible plants and mushroomsSignaling for helpBuilding simple sheltersPractical navigation skillsTreating woundsResponding in a medical emergencyAnd so much more! Since 1910, the Boy Scouts of America has helped build the future leaders of this country by combining educational activities and lifelong values with fun. The BSA is committed to training youth in responsible citizenship, character development, and self-reliance through participation in a wide range of outdoor activities.
- Published
- 2023
16. The Reply
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Patrick Burns, Grant S. Lipman, Keiran Warner, Carrie Jurkiewicz, Caleb Phillips, Linda Sanders, Mario Soto, and Peter Hackett
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Acetazolamide ,Humans ,Ibuprofen ,General Medicine ,Altitude Sickness - Published
- 2020
17. A Randomized Controlled Trial of the Lowest Effective Dose of Acetazolamide for Acute Mountain Sickness Prevention
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James Marvel, Cassie Lowry, Andre Burnier, Carrie Jurkiewicz, Grant S. Lipman, Andrew Navlyt, Jessica Hawkins, Caleb Phillips, and Erik R. Swenson
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medicine.medical_specialty ,Evening ,030204 cardiovascular system & hematology ,Altitude Sickness ,Severity of Illness Index ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Double-Blind Method ,law ,Risk Factors ,Internal medicine ,Surveys and Questionnaires ,medicine ,Odds Ratio ,Humans ,030212 general & internal medicine ,Dosing ,Carbonic Anhydrase Inhibitors ,Dose-Response Relationship, Drug ,business.industry ,General Medicine ,Number needed to harm ,Effects of high altitude on humans ,Confidence interval ,Acetazolamide ,Number needed to treat ,business ,medicine.drug - Abstract
Background Acetazolamide is the most common medication used for acute mountain sickness prevention, with speculation that a reduced dose may be as efficacious as standard dosing with fewer side effects. Methods This double-blind, randomized, controlled noninferiority trial compared acetazolamide 62.5 mg twice daily to the standard dose acetazolamide 125 mg twice daily starting the evening prior to ascent from 1240 m (4100 ft) to 3810 m (12,570 ft) over 4 hours. The primary outcome was acute mountain sickness incidence (ie, headache, Lake Louise Questionnaire ≥3, and another symptom). Results A total of 106 participants were analyzed, with 51 (48%) randomized to 125 mg and 55 (52%) to 62.5 mg, with a combined acute mountain sickness incidence of 53 (50%) and mean severity of 3 (± 2.1). The 62.5-mg group failed to fall within the prespecified 26% noninferiority margin for acute mountain sickness incidence (62.5 mg = 30 [55%] vs 125 mg = 23 [45%], 95% confidence interval [CI] -11% to 30%). Participants in the 62.5-mg group had a higher risk of acute mountain sickness (odds ratio = 1.5, 95% CI 0.7-3.2) and moderate acute mountain sickness (odds ratio = 1.8, 95% CI 0.6-5.9), with a number needed to harm (NNH) of 9, with a number needed to treat (NNT) in the 125-mg group of 4.8. Increased acute mountain sickness incidence and symptom severity corresponded to lower weight-based and body mass index dosing, with similar side effects between groups. Conclusion Acetazolamide 62.5 mg twice daily failed to demonstrate equal effectiveness to 125 mg twice daily for prevention of acute mountain sickness. With increased risk and no demonstrable symptomatic or physiologic benefits, acetazolamide 62.5 mg twice daily should not be recommended for acute mountain sickness prevention.
- Published
- 2020
18. Precipitous Delivery Masquerading as Biliary Colic in the Setting of Depo-Provera® Failure
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Grant S. Lipman and Allen D. Chang
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footling breech ,medicine.medical_specialty ,Long-acting reversible contraception ,Maternal morbidity ,Prenatal care ,030204 cardiovascular system & hematology ,Biliary colic ,unknown pregnancy ,Intrauterine pregnancy ,long-acting reversible contraception ,03 medical and health sciences ,0302 clinical medicine ,biliary colic ,medicine ,academic emergency medicine ,business.industry ,General surgery ,General Engineering ,Depo provera ,Emergency department ,depo provera failure ,contraception failure ,emergency obstetrics ,General Surgery ,Emergency Medicine ,Obstetrics/Gynecology ,prenatal care ,medicine.symptom ,precipitous delivery ,business ,030217 neurology & neurosurgery ,Precipitous delivery - Abstract
Precipitous delivery in the emergency department is a high-acuity, low-occurrence event that requires rapid recognition and interdepartment cooperation to prevent fetal and maternal morbidity and mortality. Prompt recognition of the peripartum state can be delayed by reported usage of long-acting contraception and concurrent distracting complaints. In this case report, a young female presented to the emergency department with epigastric abdominal pain in the setting of recent workup for biliary colic and multiple doses of long-acting, depot contraceptive agents. Early utilization of bedside ultrasound confirmed a full-term, intrauterine pregnancy as well as an impacted gallbladder stone, followed by a precipitous footling breech presentation that required an emergent cesarean section.
- Published
- 2020
19. How variability in pain and pain coping relate to pain interference during multistage ultramarathons
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Anna L. Kratz, Kevin N. Alschuler, Joshua Bautz, Mark P. Jensen, Claire Nordeen, Crystal Irwin, Dave Pomeranz, Patrick Burns, Brian J. Krabak, and Grant S. Lipman
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Adult ,Male ,Coping (psychology) ,Population ,Pain ,Pain Interference ,Severity of Illness Index ,High functioning ,Running ,Thinking ,Pain coping ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,Adaptation, Psychological ,Severity of illness ,Humans ,Pain Management ,Young adult ,education ,Aged ,Pain Measurement ,education.field_of_study ,Middle Aged ,Treatment Outcome ,Anesthesiology and Pain Medicine ,Neurology ,Maladaptive coping ,Female ,Neurology (clinical) ,Psychology ,030217 neurology & neurosurgery ,Clinical psychology - Abstract
An important and substantial body of literature has established that maladaptive and adaptive coping strategies significantly impact pain-related outcomes. This literature, however, is based primarily on populations with painful injuries and illnesses. Little is known about coping in individuals who experience pain in other contexts and whether coping impacts outcomes in the same way. In an effort to better understand pain coping in such contexts, this study evaluated pain coping in ultramarathon runners, a population known to experience moderate levels of pain with minimal perceived negative effects. This study reports on pain coping in 204 entrants in 2016 RacingThePlanet multistage ultramarathon events. Participants provided data over 5 consecutive days on pain severity, pain interference, exertion, and coping. Results demonstrated that the study participants were more likely to use adaptive than maladaptive coping responses. However, maladaptive coping, but not adaptive coping, was positively associated with percent time spent thinking about pain and pain-related interference. Taken together, the study supports the idea that this high functioning group of individuals experiencing pain emphasizes the use of adaptive coping strategies over maladaptive strategies, reinforcing the perspective that such a pattern may be the most effective way to cope with pain. Within the group, however, results supported traditional patterns, such that greater use of maladaptive strategies was associated with greater pain-related interference, suggesting that optimizing pain coping may be critical to reducing factors that may interfere with ultramarathon performance.
- Published
- 2018
20. Wilderness Medical Society Clinical Practice Guidelines for Diabetes Management
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Grant S. Lipman, Carrie Jurkiewicz, Barry P. Conrad, Ryan T. Finigan, Morteza Khodaee, Andre Burnier, Laura M. Nally, and Karin VanBaak
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medicine.medical_specialty ,Diabetic ketoacidosis ,Best practice ,media_common.quotation_subject ,Wilderness Medicine ,Sports Medicine ,Article ,03 medical and health sciences ,0302 clinical medicine ,Diabetes management ,Diabetes mellitus ,Medicine ,Humans ,Wilderness ,Practice Patterns, Physicians' ,Intensive care medicine ,Societies, Medical ,Glycemic ,media_common ,biology ,business.industry ,Athletes ,Public Health, Environmental and Occupational Health ,030208 emergency & critical care medicine ,030229 sport sciences ,biology.organism_classification ,medicine.disease ,Hypoglycemia ,Clinical Practice ,Diabetes Mellitus, Type 1 ,Diabetes Mellitus, Type 2 ,Hyperglycemia ,Emergency Medicine ,business - Abstract
The Wilderness Medical Society convened an expert panel in 2018 to develop a set of evidence-based guidelines for the treatment of type 1 and 2 diabetes, as well as the recognition, prevention, and treatment of complications of diabetes in wilderness athletes. We present a review of the classifications, pathophysiology, and evidence-based guidelines for planning and preventive measures, as well as best practice recommendations for both routine and urgent therapeutic management of diabetes and glycemic complications. These recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks or burdens for each recommendation.
- Published
- 2019
21. Large-Volume Hypertonic Saline for Empiric Treatment of Severe Exercise-Associated Hyponatremia in an Ultramarathon Runner
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Grant S. Lipman, David Pomeranz, and Crystal Irwin
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Adult ,Saline Solution, Hypertonic ,business.industry ,Sodium ,Public Health, Environmental and Occupational Health ,General Medicine ,Sodium blood ,medicine.disease ,Running ,Hypertonic saline ,Volume (thermodynamics) ,Anesthesia ,Severe exercise ,Humans ,Medicine ,Female ,Orthopedics and Sports Medicine ,business ,Hyponatremia ,Empiric treatment - Published
- 2019
22. Elderly woman with proptosis after head injury
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Grant S. Lipman
- Subjects
orbital emphysema ,medicine.medical_specialty ,business.industry ,Orbital emphysema ,Head injury ,needle decompression ,Needle decompression ,Images in Emergency Medicine ,medicine.disease ,Surgery ,compartment syndrome ,trauma ,Medicine ,business - Published
- 2020
23. 248 Weight-Based Assessment of Sodium Supplements on Ultramarathon Performance
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Grant S. Lipman, Tamara Hew-Butler, Brian J. Krabak, Caleb Phillips, and Patrick Burns
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business.industry ,Emergency Medicine ,Medicine ,Sodium supplements ,Food science ,business ,Weight based dosing - Published
- 2020
24. A Novel Cooling Method and Comparison of Active Rewarming of Mildly Hypothermic Subjects
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Mark Christensen, H. Craig Heller, Grant S. Lipman, Kate Shea, Dennis A. Grahn, and Joseph Einhorn
- Subjects
Adult ,Male ,Afterdrop ,medicine.medical_treatment ,Hypothermia ,030204 cardiovascular system & hematology ,Core temperature ,Convection ,03 medical and health sciences ,0302 clinical medicine ,Immersion ,medicine ,Humans ,Rewarming ,Treadmill ,Saline ,Core (anatomy) ,business.industry ,Arteriovenous Anastomosis ,Shivering ,Public Health, Environmental and Occupational Health ,030208 emergency & critical care medicine ,Middle Aged ,Water immersion ,Anesthesia ,Emergency Medicine ,Administration, Intravenous ,Female ,medicine.symptom ,business - Abstract
Objective To compare the effectiveness of arteriovenous anastomosis (AVA) vs heated intravenous fluid (IVF) rewarming in hypothermic subjects. Additionally, we sought to develop a novel method of hypothermia induction. Methods Eight subjects underwent 3 cooling trials each to a core temperature of 34.8±0.6 (32.7 to 36.3°C [mean±SD with range]) by 14°C water immersion for 30 minutes, followed by walking on a treadmill for 5 minutes. Core temperatures (Δtes) and rates of cooling (°C/h) were measured. Participants were then rewarmed by 1) control: shivering only in a sleeping bag; 2) IVF: shivering in sleeping bag and infusion of 2 L normal saline warmed to 42°C at 77 mL/min; and 3) AVA: shivering in sleeping bag and circulation of 45°C warmed fluid through neoprene pads affixed to the palms and soles of the feet. Results Cold water immersion resulted in a decrease of 0.5±0.5°C Δtes and 1±0.3°C with exercise ( P P R 2 = 0.683; IVF 1.3±0.7 ° C/h, R 2 = 0.863; and AVA 1.4 ± 0.6°C/h, R 2 = 0.853; P = .58). Shivering inhibition was greater with AVA but was not significantly different ( P = .07). Conclusions This study developed a novel and efficient model of hypothermia induction through exercise-induced convective afterdrop. Although there was not a clear benefit in either of the 2 active rewarming methods, AVA rewarming showed a nonsignificant trend toward greater shivering inhibition, which may be optimized by an improved interface.
- Published
- 2017
25. Evidence-Based Review of Wilderness First Aid Practices
- Author
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Grant S. Lipman, Tod Schimelpfenig, David H. McEvoy, Brad L. Bennett, and David E. Johnson
- Subjects
Medical education ,Outdoor education ,business.industry ,media_common.quotation_subject ,Best practice ,Environmental resource management ,030208 emergency & critical care medicine ,Evidence-based medicine ,Certification ,03 medical and health sciences ,0302 clinical medicine ,030212 general & internal medicine ,Wilderness ,business ,Psychology ,Recreation ,Core Knowledge ,media_common ,First aid - Abstract
Wilderness First Aid is a common certification for outdoor recreationists, educators, and trip leaders. A panel of educators, researchers, and clinicians evaluated 15 core and eight elective WFA practices for strength of recommendations based on the quality of supporting evidence and balance between the benefits and risks/burdens according to the methodology stipulated by the American College of Chest Physicians. The strength of the evidence for these 23 WFA practices varies widely because of scant published research to date. When no evidence existed, the panel based recommendations on a consensus of the panelists for risk/benefit and best practices. This review clearly points out the need for conducting greater research to strengthen the level of evidence in numerous WFA topics and for educational strategies that improve retention of core knowledge, as well as skill application for the lay first aid provider. Subscribe to JOREL
- Published
- 2017
26. Effect of Sodium Supplements and Climate on Dysnatremia During Ultramarathon Running
- Author
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Colin E. Little, Bryan Jarrett, Jacob Jensen, Carrie Jurkiewicz, Nicky Mansfield, Patrick Burns, Brian J. Krabak, Caleb Phillips, Anne Walker, and Grant S. Lipman
- Subjects
Adult ,Sodium ,chemistry.chemical_element ,Physical Therapy, Sports Therapy and Rehabilitation ,Marathon Running ,Running ,03 medical and health sciences ,0302 clinical medicine ,Animal science ,Medicine ,Humans ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Dehydration ,Risk factor ,Exercise ,business.industry ,Incidence (epidemiology) ,Weight change ,030229 sport sciences ,medicine.disease ,Confidence interval ,chemistry ,Female ,Hypernatremia ,business ,Hyponatremia - Abstract
OBJECTIVE Analyze the effect of sodium supplementation, hydration, and climate on dysnatremia in ultramarathon runners. DESIGN Prospective observational study. SETTING The 2017 80 km (50 mile) stage of the 250 km (150 mile) 6-stage RacingThePlanet ultramarathon in 2017 Chilean, Patagonian, and 2018 Namibian, Mongolian, and Chilean deserts. PARTICIPANTS All race entrants who could understand English were invited to participate, with 266 runners enrolled, mean age of 43 years (± 9), 61 (36%) females, average weight 74 kg (± 12.5), and average race time 14.5 (± 4.1) hours. Post-race sodium collected on 174 (74%) and 164 (62%) participants with both the blood sample and post-race questionnaire. INTERVENTION Weight change and finish line serum sodium levels were gathered. MAIN OUTCOME MEASURES Incidence of exercise-associated hyponatremia (EAH; 145 mmol·L-1) by sodium ingestion and climate. RESULTS Eleven (6.3%) runners developed EAH, and 30 (17.2%) developed hypernatremia. Those with EAH were 14 kg heavier at baseline, had significantly less training distances, and averaged 5 to 6 hours longer to cover 50 miles (80 km) than the other participants. Neither rate nor total ingested supplemental sodium was correlated with dysnatremia, without significant differences in drinking behaviors or type of supplement compared with normonatremic runners. Hypernatremic runners were more often dehydrated [8 (28%), -4.7 kg (± 9.8)] than EAH [4 (14%), -1.1 kg (± 3.8)] (P < 0.01), and EAH runners were more frequently overhydrated (6, 67%) than hypernatremia (1, 11%) (P < 0.01). In the 98 (56%) runners from hot races, there was EAH OR = 3.5 [95% confidence interval (CI), 0.9-25.9] and hypernatremia OR = 8.8 (95% CI, 2.9-39.5) compared with cold races. CONCLUSIONS This was the first study to show that hot race climates are an independent risk factor for EAH and hypernatremia. Sodium supplementation did not prevent EAH nor cause hypernatremia. Longer training distances, lower body mass, and avoidance of overhydration were shown to be the most important factors to prevent EAH and avoidance of dehydration to prevent hypernatremia.
- Published
- 2019
27. Day of Ascent Dosing of Acetazolamide for Prevention of Acute Mountain Sickness
- Author
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Joseph Romero, Patrick Burns, Keiran Warner, Caleb Phillips, Peter H. Hackett, Anne Walker, Andre Burnier, Andrew Navlyt, Aaron J. Reilly, Carrie Jurkiewicz, Christopher Winstead-Derlega, and Grant S. Lipman
- Subjects
Adult ,Male ,Physiology ,030204 cardiovascular system & hematology ,Altitude Sickness ,Severity of Illness Index ,03 medical and health sciences ,0302 clinical medicine ,Double-Blind Method ,medicine ,Humans ,Dosing ,Carbonic Anhydrase Inhibitors ,business.industry ,Drug Chronotherapy ,Incidence ,Public Health, Environmental and Occupational Health ,030229 sport sciences ,General Medicine ,Mountaineering ,Acetazolamide ,Anesthesia ,Female ,business ,human activities ,medicine.drug - Abstract
Background: Acetazolamide is the most common medication used for prevention of acute mountain sickness (AMS), usually administered the day or night before ascent. The objective of this stu...
- Published
- 2019
28. Wilderness Medical Society Clinical Practice Guidelines for the Management of Exercise-Associated Hyponatremia: 2019 Update
- Author
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Grant S. Lipman, Tamara Hew-Butler, Thomas M. Myers, Brad L. Bennett, and Mitchell H. Rosner
- Subjects
medicine.medical_specialty ,media_common.quotation_subject ,Heat exhaustion ,Best practice ,Wilderness Medicine ,03 medical and health sciences ,0302 clinical medicine ,Exercise-associated hyponatremia ,medicine ,Humans ,Wilderness ,Practice Patterns, Physicians' ,Intensive care medicine ,Stroke ,Exercise ,Societies, Medical ,media_common ,business.industry ,Public Health, Environmental and Occupational Health ,030208 emergency & critical care medicine ,030229 sport sciences ,medicine.disease ,Hypertonic saline ,Clinical Practice ,Emergency Medicine ,business ,Hyponatremia - Abstract
Exercise-associated hyponatremia (EAH) is defined by a serum or plasma sodium concentration below the normal reference range of 135 mmol·L-1 that occurs during or up to 24 h after prolonged physical activity. It is reported to occur in individual physical activities or during organized endurance events conducted in environments in which medical care is limited and often not available, and patient evacuation to definitive care is often greatly delayed. Rapid recognition and appropriate treatment are essential in the severe form to increase the likelihood of a positive outcome. To mitigate the risk of EAH mismanagement, care providers in the prehospital and in hospital settings must differentiate from other causes that present with similar signs and symptoms. EAH most commonly has overlapping signs and symptoms with heat exhaustion and exertional heat stroke. Failure in this regard is a recognized cause of worsened morbidity and mortality. In an effort to produce best practice guidelines for EAH management, the Wilderness Medical Society convened an expert panel in May 2018. The panel was charged with updating the WMS Practice Guidelines for Treatment of Exercise-Associated Hyponatremia published in 2014 using evidence-based guidelines for the prevention, recognition, and treatment of EAH. Recommendations are made based on presenting with symptomatic EAH, particularly when point-of-care blood sodium testing is unavailable in the field. These recommendations are graded on the basis of the quality of supporting evidence and balanced between the benefits and risks/burdens for each parameter according to the methodology stipulated by the American College of Chest Physicians.
- Published
- 2019
29. In Response to Ibuprofen vs Acetaminophen in AMS Prevention by Kanaan et al
- Author
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Grant S. Lipman and Peter H. Hackett
- Subjects
Analgesics.non-narcotic ,business.industry ,Public Health, Environmental and Occupational Health ,030208 emergency & critical care medicine ,Ibuprofen ,Acetaminophen ,03 medical and health sciences ,0302 clinical medicine ,Anesthesia ,Emergency Medicine ,Medicine ,030212 general & internal medicine ,business ,medicine.drug - Published
- 2017
30. The Scouting Guide to Wilderness First Aid: An Officially-Licensed Book of the Boy Scouts of America : More Than 200 Essential Skills for Medical Emergencies in Remote Environments
- Author
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The Boy Scouts of America, Grant S. Lipman, The Boy Scouts of America, and Grant S. Lipman
- Subjects
- Boy Scouts of America--Handbooks, manuals, etc, Outdoor medical emergencies--Handbooks, manuals,, First aid in illness and injury--Handbooks, manu
- Abstract
In the Scouting Guide to Wilderness First Aid, current Scouts, Scout alumni, and readers interested in the outdoors are provided with time-tested advice on how to safely identify, harvest, and use edible wild plants. Some practical tips include: How to triage, assess, and identify medical emergenciesWhat to include in a first aid kit for your homeWhen to seek help for health emergenciesHow to safely move a sick or injured personHow to perform CPR and use an automatic external defibrillatorWhat the proper procedures are for broken bones, hypothermia, burns, and sprainsAnd so much more!Since 1910, the Boy Scouts of America has helped build the future leaders of this country by combining educational activities and lifelong values with fun. The BSA is committed to training youth in responsible citizenship, character development, and self-reliance through participation in a wide range of outdoor activities.
- Published
- 2019
31. Snakebites and climate change in California, 1997-2017
- Author
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Katie Doering, Grant S. Lipman, Caleb Phillips, Hallam Gugelmann, and Derrick Lung
- Subjects
Adult ,Male ,Poison Control Centers ,Fauna ,Climate Change ,Climate change ,Poison control ,Snake Bites ,Toxicology ,Suicide prevention ,Occupational safety and health ,California ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Environmental health ,Injury prevention ,Medicine ,Humans ,030212 general & internal medicine ,Weather ,Retrospective Studies ,business.industry ,Incidence (epidemiology) ,Incidence ,Temperature ,030208 emergency & critical care medicine ,General Medicine ,Middle Aged ,Poison control center ,Droughts ,Treatment Outcome ,Female ,Seasons ,business - Abstract
Climate change effect on flora and fauna has been scientifically documented, but the effect on North American venomous snakebites is unknown. The objectives were to examine Californian snakebite incidence and correlate with weather patterns and climate changes.A retrospective analysis of snakebites reported to the Californian Poison Control System from 1 September 1997 to 30 September 2017. Venomous snakebite reports were aggregated by caller zip code, and correlated per county with weather data, air temperature, precipitation, population data, eco-regions, and land characteristics. Time series decomposition by seasonality and trend, regression, and autocorrelation were used to assess association between climate variables and incidence.There were 5365 reported venomous snakebites during the study period, with a median age of 37 years (22-51) with 76% male (p .001, 95% CI 75.6-77.9%). Most snakebite outcomes were coded as minor (1363, 25%) or moderate (2607, 49%), with three deaths. Adjusted for population, the annualized incidence of snakebites statewide slightly decreased (rho = -0.11, p = .65). The snakebite incidence per million people rose after a period of no drought and declined during drought (r = -0.41, p ≪ .01). Snakebite incidence decreased by 6-month prior drought (-3.8% for each 10% increase in drought), and increased by 18-month prior precipitation (+3.9% for each 10% increase in precipitation).Patterns of precipitation and drought had a significant and predictive effect on snakebites in California over a 20-year period. Snakebite incidence decreased following drought, and increased after precipitation.
- Published
- 2018
32. Re: 'Ultrasound in Austere Environments' by Canepa and Harris (High Alt Med Biol 2019;20:103–111)
- Author
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Grant S. Lipman, Patrick Burns, and James Marvel
- Subjects
medicine.medical_specialty ,Physiology ,business.industry ,Point-of-Care Systems ,General surgery ,Ultrasound ,Public Health, Environmental and Occupational Health ,medicine ,General Medicine ,business ,Ultrasonography - Published
- 2019
33. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2019 Update
- Author
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Kurt P. Eifling, Grant S. Lipman, Edward M. Otten, Flavio G. Gaudio, Mark A. Ellis, and Colin K. Grissom
- Subjects
medicine.medical_specialty ,Practice patterns ,business.industry ,Best practice ,media_common.quotation_subject ,Public Health, Environmental and Occupational Health ,MEDLINE ,Wilderness Medicine ,030208 emergency & critical care medicine ,030229 sport sciences ,medicine.disease ,Heat Stress Disorders ,Clinical Practice ,03 medical and health sciences ,0302 clinical medicine ,Heat illness ,Family medicine ,Emergency Medicine ,medicine ,Humans ,Wilderness ,Practice Patterns, Physicians' ,business ,Societies, Medical ,media_common - Abstract
The Wilderness Medical Society convened an expert panel in 2011 to develop a set of evidence-based guidelines for the recognition, prevention, and treatment of heat illness. We present a review of the classifications, pathophysiology, and evidence-based guidelines for planning and preventive measures, as well as best practice recommendations for both field- and hospital-based therapeutic management of heat illness. These recommendations are graded based on the quality of supporting evidence and balance the benefits and risks or burdens for each modality. This is an updated version of the original Wilderness Medical Society Practice Guidelines for the Treatment and Prevention of Heat-Related Illness published in 2013.
- Published
- 2018
34. Woman With Pain and Deformity in Left Wrist
- Author
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Grant S. Lipman and Jeffrey Tadashi Sakamoto
- Subjects
medicine.medical_specialty ,Lidocaine ,Radiography ,MEDLINE ,Joint Dislocations ,Ulna ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Musculoskeletal Pain ,medicine ,Deformity ,Humans ,030212 general & internal medicine ,Young adult ,Anesthetics, Local ,Physical Therapy Modalities ,business.industry ,030208 emergency & critical care medicine ,Wrist Injuries ,Left wrist ,Surgery ,Emergency Medicine ,Female ,medicine.symptom ,business ,medicine.drug - Published
- 2018
35. Novel Application of Chemical Cold Packs for Treatment of Exercise-Induced Hyperthermia: A Randomized Controlled Trial
- Author
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Vinh H. Cao, Samson Phan, Grant S. Lipman, Michael Shaheen, Eric A. Weiss, John Lissoway, Dennis A. Grahn, and H. Craig Heller
- Subjects
Male ,Hyperthermia ,medicine.medical_specialty ,Hot Temperature ,Fever ,Adult male ,Common disease ,law.invention ,Randomized controlled trial ,law ,Humans ,Medicine ,Treadmill ,Exercise ,Groin ,business.industry ,Cold packs ,Public Health, Environmental and Occupational Health ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Cryotherapy ,Adjunctive treatment ,Emergency Medicine ,business ,Body Temperature Regulation - Abstract
Heat-related illness is a common disease with significant morbidity and mortality. Despite no proven efficacy, application of chemical cold packs (CCP) to the skin overlying the large vessels of the neck, groin, and axillae is a traditional recommended cooling modality. The study objective was to compare the cooling rates of CCP applied to these traditional areas vs the glabrous skin surfaces of the cheeks, palms, and soles in exercise-induced hyperthermia.Ten healthy adult male volunteers walked on a treadmill in a heated room (40°±0.5°C) while wearing insulated military overgarments until their esophageal temperatures (Tes) reached 39.2°C. Each participant had three heat stress trials on separate days: no treatment followed by randomly ordered traditional (neck, groin, and axillae) cooling and glabrous skin cooling.With no treatment, Tes remained stable after the first 5 minutes of the heat trial (ΔTes=0.12°±0.07°C/10 min). Traditional cooling followed a linear decline (ΔTes=0.17°±0.04°C/10 min; P.001). Glabrous cooling enhanced the treatment effect by a steeper decline (ΔTes=0.30°±0.06°C/10 min; P.001), significantly different from traditional cooling by 2-way analysis of variance (P.001).Application of CCP to glabrous skin surfaces was more effective for treating exercise-induced heat stress than the traditional CCP cooling intervention. This novel cooling technique may be beneficial as an adjunctive treatment for heat-related illness in the prehospital environment.
- Published
- 2015
36. A Prospective Randomized Blister Prevention Trial Assessing Paper Tape in Endurance Distances (Pre-TAPED)
- Author
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Erica Lewis, Grant S. Lipman, Brian J. Krabak, Mark A. Ellis, Brandee L. Waite, Garrett K. Chan, and John Lissoway
- Subjects
Adult ,Male ,China ,medicine.medical_specialty ,Running ,law.invention ,Blister ,Nepal ,Randomized controlled trial ,law ,Surveys and Questionnaires ,medicine ,Humans ,Prospective Studies ,Chile ,End point ,Paper tape ,business.industry ,User satisfaction ,Australia ,Public Health, Environmental and Occupational Health ,Blisters ,Mean age ,Bandages ,Surgery ,Treatment Outcome ,Emergency Medicine ,Physical therapy ,Egypt ,Female ,medicine.symptom ,business ,Foot (unit) - Abstract
Objective Friction foot blisters are a common injury occurring in up to 39% of marathoners, the most common injury in adventure racing, and represent more than 70% of medical visits in multi-stage ultramarathons. The goal of the study was to determine whether paper tape could prevent foot blisters in ultramarathon runners. Methods This prospective randomized trial was undertaken during RacingThePlanet 155-mile (250-km), 7-day self-supported ultramarathons in China, Australia, Egypt, Chile, and Nepal in 2010 and 2011. Paper tape was applied prerace to one randomly selected foot, with the untreated foot acting as the own control. The study end point was development of a hot spot or blister on any location of either foot. Results One hundred thirty-six participants were enrolled with 90 (66%) having completed data for analysis. There were 36% women, with a mean age of 40 ± 9.4 years (range, 25–40 years) and pack weight of 11 ± 1.8 kg (range, 8–16 kg). All participants developed blisters, with 89% occurring by day 2 and 59% located on the toes. No protective effect was observed by the intervention (47 versus 35; 52% versus 39%; P = .22), with fewer blisters occurring around the tape on the experimental foot than under the tape (23 vs 31; 25.6% versus 34.4%), yet 84% of study participants when queried would choose paper tape for blister prevention in the future. Conclusions Although paper tape was not found to be significantly protective against blisters, the intervention was well tolerated with high user satisfaction.
- Published
- 2014
37. Effect of an Emergency Department Fast Track on Press-Ganey Patient Satisfaction Scores
- Author
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Grant S. Lipman, Calvin E. Hwang, and Marlena Kane
- Subjects
medicine.medical_specialty ,Press-Ganey ,Cross-sectional study ,management, quality assurance ,lcsh:Medicine ,Patient satisfaction ,Surveys and Questionnaires ,Patient experience ,medicine ,Odds Ratio ,Humans ,business.industry ,lcsh:R ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,General Medicine ,Odds ratio ,Emergency department ,lcsh:RC86-88.9 ,Brief Research Report ,emergency department management ,Patient Satisfaction Scores ,Triage ,United States ,emergency care systems, efficiency ,Cross-Sectional Studies ,Patient Satisfaction ,Health Care Surveys ,Emergency medicine ,Emergency Medicine ,Fast Track ,Emergency Department Operations ,Fast track ,business ,Emergency Service, Hospital ,Medicaid - Abstract
Introduction: Mandated patient surveys have become an integral part of Medicare remuneration, putting hundreds of millions of dollars in funding at risk. The Centers for Medicare & Medicaid Services (CMS) recently announced a patient experience survey for the emergency department (ED). Development of an ED Fast Track, where lower acuity patients are rapidly seen, has been shown to improve many of the metrics that CMS examines. This is the first study examining if ED Fast Track implementation affects Press-Ganey scores of patient satisfaction. Methods: We analyzed returned Press-Ganey questionnaires from all ESI 4 and 5 patients seen 11AM - 11PM, August-December 2011 (pre-fast track), and during the identical hours of fast track, August-December 2012. Raw ordinal scores were converted to continuous scores for paired student t-test analysis. We calculated an odds ratio with 100% satisfaction considered a positive response. Results: An academic ED with 52,000 annual visits had 140 pre-fast track and 85 fast track respondents. Implementation of a fast track significantly increased patient satisfaction with the following: wait times (68% satisfaction to 88%, OR 4.13, 95% CI [2.32-7.33]), doctor courtesy (90% to 95%, OR 1.97, 95% CI [1.04-3.73]), nurse courtesy (87% to 95%, OR 2.75, 95% CI [1.46-5.15]), pain control (79% to 87%, OR 2.13, 95% CI [1.16-3.92]), likelihood to recommend (81% to 90%, OR 2.62, 95% CI [1.42-4.83]), staff caring (82% to 91%, OR 2.82, 95% CI [1.54-5.19]), and staying informed about delays (66% to 83%, OR 3.00, 95% CI [1.65-5.44]). Conclusion: Implementation of an ED Fast Track more than doubled the odds of significant improvements in Press-Ganey patient satisfaction metrics and may play an important role in improving ED performance on CMS benchmarks.[West J Emerg Med. 2015;16(1):–0.]
- Published
- 2014
38. Evaluation and Treatment of Injury and Illness in the Ultramarathon Athlete
- Author
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Grant S. Lipman, Brandee L. Waite, and Brian J. Krabak
- Subjects
medicine.medical_specialty ,Fever ,biology ,business.industry ,Athletes ,Rehabilitation ,Physical Therapy, Sports Therapy and Rehabilitation ,Sports Medicine ,biology.organism_classification ,Running ,Athletic Injuries ,Physical therapy ,Humans ,Medicine ,Proper treatment ,business ,Hyponatremia - Abstract
Participation in ultramarathon races and knowledge of these athletes continues to increase as the sport becomes more popular. Physicians and athletes need to better understand the impact of the unique aspects of ultramarathon races, such as race environment (temperature, humidity, and altitude), race distance, race stages, nutritional requirements and equipment, on athlete injuries and illness. Proper treatment of injuries and illnesses during an ultramarathon race is important for avoiding long-term medical issues. In this article, the evaluation and treatment of common musculoskeletal injuries and medical illnesses in ultramarathon runners are reviewed.
- Published
- 2014
39. The Long Distance Runner's Guide to Injury Prevention and Treatment : How to Avoid Common Problems and Deal with Them When They Happen
- Author
-
Brian J. Krabak, Grant S. Lipman, Brandee L. Waite, Brian J. Krabak, Grant S. Lipman, and Brandee L. Waite
- Subjects
- Running--Physiological aspects, Running injuries--Prevention, Running injuries--Treatment
- Abstract
For any runner who loves hitting the pavement and conquering half-, full-, and ultra-marathons, getting injured is a terrifying, and often heartbreaking, setback. Yet, almost three-quarters of long distance runners will suffer from a serious injury several times in their athletic career.Although it may be impossible to completely avoid injury, The Long Distance Runner's Guide to Injury Prevention and Treatment is a vital source to help those who love to run understand some of the most common causes of injuries, and learn how to best avoid and treat athletic ailments. In this book, expert editors and long-time runners Brian Krabak and Grant Lipman combine valuable insights, tips, and tactics from over a dozen medical professionals who specialize in treating endurance athletes.With chapters on important and diverse topics such as proper nutrition, muscular ailments, skeletal injuries, medical illnesses caused by racing and proper recovery, The Long Distance Runner's Guide to Injury Prevention and Treatment is a must-have on the shelf of every harrier.
- Published
- 2017
40. Budesonide Versus Acetazolamide for Prevention of Acute Mountain Sickness
- Author
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Grant S. Lipman, David Pomeranz, Caleb Phillips, Nick Juul, Peter H. Hackett, Kristina Evans, Carrie Jurkiewicz, Mary Cheffers, and Patrick Burns
- Subjects
Budesonide ,Adult ,Male ,Administration, Oral ,030204 cardiovascular system & hematology ,Altitude Sickness ,Placebo ,Severity of Illness Index ,03 medical and health sciences ,0302 clinical medicine ,Double-Blind Method ,Administration, Inhalation ,Medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Carbonic Anhydrase Inhibitors ,Glucocorticoids ,business.industry ,Incidence (epidemiology) ,General Medicine ,Odds ratio ,Effects of high altitude on humans ,Confidence interval ,Acetazolamide ,Anesthesia ,Number needed to treat ,Female ,business ,human activities ,medicine.drug - Abstract
Background Inhaled budesonide has been suggested as a novel prevention for acute mountain sickness. However, efficacy has not been compared with the standard acute mountain sickness prevention medication acetazolamide. Methods This double-blind, randomized, placebo-controlled trial compared inhaled budesonide versus oral acetazolamide versus placebo, starting the morning of ascent from 1240 m (4100 ft) to 3810 m (12,570 ft) over 4 hours. The primary outcome was acute mountain sickness incidence (headache and Lake Louise Questionnaire ≥3 and another symptom). Results A total of 103 participants were enrolled and completed the study; 33 (32%) received budesonide, 35 (34%) acetazolamide, and 35 (34%) placebo. Demographics were not different between the groups ( P > .09). Acute mountain sickness prevalence was 73%, with severe acute mountain sickness of 47%. Fewer participants in the acetazolamide group (n = 15, 43%) developed acute mountain sickness compared with both budesonide (n = 24, 73%) (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.3-10.1) and placebo (n = 22, 63%) (OR 0.5, 95% CI 0.2-1.2). Severe acute mountain sickness was reduced with acetazolamide (n = 11, 31%) compared with both budesonide (n = 18, 55%) (OR 2.6, 95% CI 1-7.2) and placebo (n = 19, 54%) (OR 0.4, 95% CI 0.1-1), with a number needed to treat of 4. Conclusion Budesonide was ineffective for the prevention of acute mountain sickness, and acetazolamide was preventive of severe acute mountain sickness taken just before rapid ascent.
- Published
- 2017
41. Correction: Biochemistry in Endeavor Adventure Racers Study (BEARS)
- Author
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Grant S. Lipman, Matthew Wetschler, Sean D. Rundell, David Radler, and Mark Christensen
- Subjects
medicine.medical_specialty ,Poison control ,Orienteering ,adventure athletes ,chemistry.chemical_compound ,Weight loss ,Internal medicine ,Injury prevention ,medicine ,Creatinine ,biology ,Athletes ,business.industry ,General Engineering ,Acute kidney injury ,Correction ,Adventure ,medicine.disease ,biology.organism_classification ,chemistry ,acute kidney injury ,Physical therapy ,Emergency Medicine ,Engineering ethics ,medicine.symptom ,business ,Body mass index ,wilderness medicine - Abstract
BACKGROUND: Adventure sports events consist of a combination of two or more endurance disciplines, such as orienteering, running, and rock climbing, that range from a day's to a week's duration. No studies have examined acute kidney injury (AKI) in adventure sports athletes. OBJECTIVES: To describe the prevalence of AKI in participants in the Endeavor Team Challenge, a 30-hour, 40-mile adventure race. METHODS: In this prospective observational study, body weights were recorded at race registration. At the finish line, blood sample results by point-of-care testing and weights were recorded. Changes in serum creatinine (Cr) from an estimated baseline value and severity of AKI were calculated, with "risk of injury" defined as 1.5 x baseline Cr, and "injury" defined as 2 x baseline Cr. These two categories of AKI were combined to calculate the total prevalence. Results: There were 88 enrolled study participants with complete data available on 46 (52%). The mean age of those enrolled in the study was 36.8 years (+/- 7.7), 90% were males, and body mass index (BMI) was 25.7 kg/m(2) (+/- 2.4). Of the competitors who completed the study, 34 (73%) had some degree of AKI, with 27 (58%) found to be at "risk" and seven (15%) with "injury". There was a significant correlation between weight loss and elevated Cr (r = -0.29, p = 0.047), with a trend towards nonsteroidal anti-inflammatory drug (NSAID) use being correlated with AKI (p = 0.058). CONCLUSION: Acute kidney injury was observed in the majority of the Endeavor Team Challenge adventure racers, similar to what has been observed in multistage ultramarathons, and greater than after standard marathons and single-stage ultramarathons. Language: en
- Published
- 2017
42. Medical Services at Ultra-Endurance Foot Races in Remote Environments: Medical Issues and Consensus Guidelines
- Author
-
Ian R. Rogers, David A. Townes, Andy Pasternak, Grant S. Lipman, Martin D. Hoffman, Morteza Khodaee, Brian J. Krabak, John C. Hill, Bernd Volker Scheer, and Patrick Basset
- Subjects
Emergency Medical Services ,Gastrointestinal Diseases ,media_common.quotation_subject ,Respiratory Tract Diseases ,Vision Disorders ,MEDLINE ,Physical Therapy, Sports Therapy and Rehabilitation ,Altitude Sickness ,Environment ,Heat Stress Disorders ,Running ,Race (biology) ,Presentation ,Clinical Protocols ,medicine ,Humans ,Orthopedics and Sports Medicine ,Musculoskeletal Diseases ,media_common ,business.industry ,Event (computing) ,Major trauma ,Acute Kidney Injury ,medicine.disease ,Variety (cybernetics) ,Medical services ,Athletic Injuries ,Practice Guidelines as Topic ,Physical Endurance ,Medical emergency ,business ,Foot (unit) - Abstract
An increasing participation in ultra-endurance foot races is cause for greater need to ensure the presence of appropriate medical care at these events. Unique medical challenges result from the extreme physical demands these events place on participants, the often remote settings spanning broad geographical areas, and the potential for extremes in weather conditions and various environmental hazards. Medical issues in these events can adversely affect race performance, and there is the potential for the presentation of life-threatening issues such as exercise-associated hyponatremia, severe altitude illnesses, and major trauma from falls or animal attacks. Organization of a medical support system for ultra-endurance foot races starts with a determination of the level of medical support that is appropriate and feasible for the event. Once that is defined, various legal considerations and organizational issues must be addressed, and medical guidelines and protocols should be developed. While there is no specific or universal standard of medical care for ultra-endurance foot races since a variety of factors determine the level and type of medical services that are appropriate and feasible, the minimum level of services that each event should have in place is a plan for emergency transport of injured or ill participants, pacers, spectators and event personnel to local medical facilities.
- Published
- 2014
43. Core Content for Wilderness Medicine Fellowship Training of Emergency Medicine Graduates
- Author
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Christopher Tedeschi, Angela F. Gardner, Grant S. Lipman, Paul S. Auerbach, Henderson D. McGinnis, Jay Lemery, Susanne J. Spano, Scott E. McIntosh, Mark A. Ellis, Jennifer Dow, Marion McDevitt, Eric A. Weiss, Tracy Cushing, Lori Weichenthal, Darryl Macias, N. Stuart Harris, Michael J. Caudell, and Vicki Mazzorana
- Subjects
medicine.medical_specialty ,business.industry ,MEDLINE ,Wilderness Medicine ,General Medicine ,United States ,Emergency medicine ,Emergency Medicine ,medicine ,Humans ,Clinical Competence ,Curriculum ,Wilderness medicine ,Fellowships and Scholarships ,Clinical competence ,business ,Fellowship training - Abstract
Wilderness medicine is the practice of resource-limited medicine under austere conditions. In 2003, the first wilderness medicine fellowship was established, and as of March 2013, a total of 12 wilderness medicine fellowships exist. In 2009 the American College of Emergency Physicians Wilderness Medicine Section created a Fellowship Subcommittee and Taskforce to bring together fellowship directors, associate directors, and other interested stakeholders to research and develop a standardized curriculum and core content for emergency medicine (EM)-based wilderness medicine fellowships. This paper describes the process and results of what became a 4-year project to articulate a standardized curriculum for wilderness medicine fellowships. The final product specifies the minimum core content that should be covered during a 1-year wilderness medicine fellowship. It also describes the structure, length, site, and program requirements for a wilderness medicine fellowship.
- Published
- 2014
44. Hydration Status as a Predictor of High-altitude Mountaineering Performance
- Author
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Grant S. Lipman, Eric R. Ladd, Katherine M. Shea, Elizabeth A. Pirrotta, Patrick Bagley, Paul S. Auerbach, Ewen Wang, and Sean D. Rundell
- Subjects
0301 basic medicine ,Gerontology ,mountaineering ,030232 urology & nephrology ,MEDLINE ,Urine ,030204 cardiovascular system & hematology ,Inferior vena cava ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Hydration status ,Univariate analysis ,Mountaineering ,Urine specific gravity ,business.industry ,ultrasound ,General Engineering ,Correction ,dehydration ,030229 sport sciences ,Effects of high altitude on humans ,Confidence interval ,030104 developmental biology ,medicine.vein ,Anesthesia ,business ,Environmental Health ,performance ,hydration - Abstract
Background: Hydration status is a controversial determinant of athletic performance. This relationship has not been examined with mountaineering performance. Methods: This was a prospective observational study of mountaineers who attempted to climb Denali in Alaska. Participants’ urine specific gravity (SG), and ultrasound measurements of the inferior vena cava size and collapsibility index (IVC-CI) were measured at rest prior to ascent. Upon descent, climbers reported maximum elevation gained for determination of summit success. Results: One hundred twenty-one participants enrolled in the study. Data were collected on 111 participants (92% response rate); of those, 105 (87%) had complete hydration data. Fifty-seven percent of study participants were found to be dehydrated by IVC-CI on ultrasound, and 55% by urine SG. No significant association was found with summit success and quantitative measurements of hydration: IVC-CI (50.4% +/- 15.6 vs. 52.9% +/- 15.4, p = 0.91), IVC size (0.96 cm +/- 0.3 vs. 0.99 cm +/- 0.3, p = 0.81), and average SG (1.02 +/- 0.008 vs. 1.02 +/- 0.008, p = 0.87). Categorical measurements of urine SG found 24% more successful summiters were hydrated at 14 Camp, but this was not found to be statistically significant (p = 0.56). Summit success was associated with greater water-carrying capacity on univariate analysis only: 2.3 L, 95% confidence interval (2.1 – 2.5) vs. 2.1 L, 95% confidence interval (2 – 2.2); p < 0.01. Conclusions: Intravascular dehydration was found in approximately half of technical high-altitude mountaineers. Hydration status was not significantly associated with summit success, but increased water-carrying capacity may be an easy and inexpensive educational intervention to improve performance.
- Published
- 2016
45. 357 Climate Change and Snakebites in California, 1997 to 2017
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Grant S. Lipman, Hallam Gugelmann, Caleb Phillips, Derrick Lung, and K. Doering
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business.industry ,Agroforestry ,Emergency Medicine ,Medicine ,Climate change ,business - Published
- 2018
46. Improvised Method for Increasing the Temperature of an i-STAT Analyzer and Cartridge in Cold Environments
- Author
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Grant S. Lipman, Mark Christensen, David Radler, and Matthew Wetschler
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Blood Specimen Collection ,Spectrum analyzer ,Time Factors ,business.industry ,Point-of-Care Systems ,Public Health, Environmental and Occupational Health ,Cold Temperature ,Cartridge ,Wilderness ,Emergency Medicine ,Humans ,Environmental science ,business ,Blood Chemical Analysis ,Computer hardware ,Simulation - Published
- 2015
47. Chemical Cold Packs May Provide Insufficient Enthalpy Change for Treatment of Hyperthermia
- Author
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Grant S. Lipman, Samson Phan, and John Lissoway
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Male ,Hyperthermia ,medicine.medical_specialty ,Fever ,Ice ,Enthalpy ,Cold packs ,Public Health, Environmental and Occupational Health ,Environment controlled ,Humidity ,medicine.disease ,Surgery ,Cold Temperature ,High morbidity ,Treatment Outcome ,Animal science ,Heat illness ,Cryotherapy ,Heat transfer ,Emergency Medicine ,medicine ,Humans ,Environmental science ,Female ,Body Temperature Regulation - Abstract
Objective Heat illness is a common ailment that, if left untreated, is associated with high morbidity and mortality. Chemical cold packs (CCPs) and ice packs are widely used in the pre-hospital setting and by those with limited resources, yet no controlled studies have compared the cooling of ice to that of CCPs. This study determined the theoretical cooling of CCPs on a benchtop model, comparing the results to similarly sized ice packs, and is the first known comparison of these hyperthermia treatments. Methods The CCPs used in Stanford University's Emergency Department were activated in an insulated volume of water (2 L), and temperature was recorded at 1-second intervals in a controlled environment (41°C at 20% humidity). The procedure was repeated with 1-quart ice packs. Results The CCPs resulted in a 5.25°C degree temperature drop, with a time constant (time to 63% of initial temperature—a common engineering characterization metric) of 1.72 minutes for the test volume. Ice packs resulted on average in a 19.8°C temperature change, with a time constant of 26.8 minutes. The CCPs provide less overall temperature change and were shorter lived. Application of 6 CCPs on a 50th percentile male (weight 86.6 kg, height 1.7 m), assuming ideal heat transfer, would result in less than 0.5°C temperature change. Similarly configured ice packs would result in a 2.5°C change. Conclusions Experiments demonstrate that CCPs are inferior to similarly sized ice packs for thermal regulation, and lose their effectiveness more quickly. These findings support the consideration of ice packs as an alternative to chemical cold packs when cooling hyperthermic patients.
- Published
- 2013
48. Ibuprofen versus placebo effect on acute kidney injury in ultramarathons: a randomised controlled trial
- Author
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Rebecca Higbee, Brian J. Krabak, Mark Christensen, Kurt P. Eifling, Grant S. Lipman, Patrick Burns, Viktoria Koskenoja, Kate Shea, and Caleb Phillips
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Adult ,Male ,medicine.medical_specialty ,Ibuprofen ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,Critical Care and Intensive Care Medicine ,Placebo ,law.invention ,Running ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Randomized controlled trial ,Double-Blind Method ,law ,Weight loss ,Internal medicine ,Medicine ,Humans ,Creatinine ,business.industry ,Incidence (epidemiology) ,Incidence ,Acute kidney injury ,030229 sport sciences ,General Medicine ,Number needed to harm ,Acute Kidney Injury ,Middle Aged ,medicine.disease ,Placebo Effect ,Surgery ,Logistic Models ,chemistry ,Emergency Medicine ,Female ,medicine.symptom ,business ,medicine.drug - Abstract
Background Despite concerns that non-steroidal anti-inflammatory drugs (NSAIDs) contribute to acute kidney injury (AKI), up to 75% of ultramarathon runners ingest these during competition. The effect of NSAID on AKI incidence in ultramarathon runners is unclear. Methods Multisite randomised double-blind placebo-controlled trial in the Gobi, Atacama, Ecuador and Sri Lankan deserts to determine whether ibuprofen (400 mg every 4 hours) would be non-inferior to placebo during a 50-mile (80 km) foot race. The primary outcome was incidence of AKI defined as severity categories of ‘risk’ of injury of 1.5× baseline creatinine (Cr) or ‘injury’ as 2× Cr, combined to calculate total incidence at the finish line. Non-inferiority margin for difference in AKI rates was defined as 15%. Results Eighty-nine participants (47% ibuprofen and 53% placebo) were enrolled with similar demographics between groups. The overall incidence of AKI was 44%. Intent-to-treat analysis found 22 (52%) ibuprofen versus 16 (34%) placebo users developed AKI (18% difference, 95% CI –4% to 41%; OR 2.1, 95% CI 0.9 to 5.1) with a number needed to harm of 5.5. Greater severity of AKI was seen with ibuprofen compared with placebo (risk=38% vs 26%; 95% CI –9% to 34%; injury=14% vs 9%; 95% CI –10% to 21%). Slower finishers were less likely to encounter AKI (OR 0.67, 95% CI 0.47 to 0.98) and greater weight loss (−1.3%) increased AKI (OR 1.24, 95% CI 1.00 to 1.63). Conclusion There were increased rates of AKI in those who took ibuprofen, and although not statistically inferior to placebo by a small margin, there was a number needed to harm of 5.5 people to cause 1 case of AKI. Consideration should therefore be taken before ingesting NSAID during endurance running as it could exacerbate renal injury. Trial registration number NCT02272725.
- Published
- 2016
49. Exercise-Associated Hyponatremia, Hypernatremia, and Hydration Status in Multistage Ultramarathons
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Sean D. Rundell, Grant S. Lipman, Brian J. Krabak, and Brandee L. Waite
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Adult ,Male ,medicine.medical_specialty ,Organism Hydration Status ,Running ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Exercise-associated hyponatremia ,medicine ,Prevalence ,Humans ,Cumulative incidence ,030212 general & internal medicine ,Prospective Studies ,Prospective cohort study ,Hypernatremia ,business.industry ,Incidence (epidemiology) ,Incidence ,Weight change ,Sodium ,Public Health, Environmental and Occupational Health ,030229 sport sciences ,Middle Aged ,medicine.disease ,Surgery ,Emergency Medicine ,Female ,medicine.symptom ,Hyponatremia ,business ,Weight gain - Abstract
Dysnatremia and altered hydration status are potentially serious conditions that have not been well studied in multistage ultramarathons. The purpose of this study was to assess the incidence and prevalence of exercise-associated hyponatremia (EAH) (NaThis study involved a prospective observational cohort study of runners competing in a 250-km (155-mile) multistage ultramarathon (in the Jordan, Atacama, or Gobi Desert). Prerace body weight and poststage (stage [S] 1 [42 km], S3 [126 km], and S5 [250 km]) body weight and serum sodium concentration levels were obtained from 128 runners.The prevalence of EAH per stage was 1.6% (S1), 4.8% (S3), and 10.1% (S5) with a cumulative incidence of 14.8%. Per-stage prevalence of hypernatremia was 35.2% (S1), 20.2% (S3), and 19.3% (S5) with a cumulative incidence of 52.3%. Runners became more dehydrated (weight change-3%) throughout the race (S1=22.1%; S3=51.2%; S5=53.5%). Body weight gain correlated with EAH (r=-0.21, P = .02). Nonfinishers of S3 were significantly more likely to have EAH compared with finishers (75% vs 5%, P = .001), but there was no difference in either EAH or hypernatremia between nonfinishers and finishers of S5.The incidence of EAH in multistage ultramarathons was similar to marathons and single-stage ultramarathons, but the cumulative incidence of hypernatremia was 3 times greater than that of EAH. EAH was associated with increased weight gain (overhydration) in early stage nonfinishers and postrace finishers.
- Published
- 2016
50. Paper Tape Prevents Foot Blisters: A Randomized Prevention Trial Assessing Paper Tape in Endurance Distances II (Pre-TAPED II)
- Author
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Alexandra DiTullio, Brian J. Krabak, Katherine M. Shea, Grant S. Lipman, Louis J. Sharp, Mark Christensen, Pearlly Ng, Andrew Dalton, Caleb Phillips, and Jennifer Shangkuan
- Subjects
Adult ,Male ,medicine.medical_specialty ,Treatment outcome ,Physical Therapy, Sports Therapy and Rehabilitation ,law.invention ,Running ,03 medical and health sciences ,0302 clinical medicine ,Blister ,Randomized controlled trial ,law ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Prospective Studies ,business.industry ,Running injuries ,Paper tape ,Incidence ,030208 emergency & critical care medicine ,Blisters ,030229 sport sciences ,Middle Aged ,Bandages ,Surgery ,Logistic Models ,Treatment Outcome ,Physical therapy ,Female ,medicine.symptom ,business ,Foot (unit) - Abstract
To determine whether paper tape prevents foot blisters in multistage ultramarathon runners.Multisite prospective randomized trial.The 2014 250-km (155-mile) 6-stage RacingThePlanet ultramarathons in Jordan, Gobi, Madagascar, and Atacama Deserts.One hundred twenty-eight participants were enrolled: 19 (15%) from the Jordan, 35 (27%) from Gobi, 21 (16%) from Madagascar, and 53 (41%) from the Atacama Desert. The mean age was 39.3 years (22-63) and body mass index was 24.2 kg/m (17.4-35.1), with 31 (22.5%) females.Paper tape was applied to a randomly selected foot before the race, either to participants' blister-prone areas or randomly selected location if there was no blister history, with untaped areas of the same foot used as the control.Development of a blister anywhere on the study foot.One hundred six (83%) participants developed 117 blisters, with treatment success in 98 (77%) runners. Paper tape reduced blisters by 40% (P0.01, 95% confidence interval, 28-52) with a number needed to treat of 1.31. Most of the study participants had 1 blister (78%), with most common locations on the toes (n = 58, 50%) and heel (n = 27, 23%), with 94 (80%) blisters occurring by the end of stage 2. Treatment success was associated with earlier stages [odds ratio (OR), 74.9, P0.01] and time spent running (OR, 0.66, P = 0.01).Paper tape was found to prevent both the incidence and frequency of foot blisters in runners.
- Published
- 2016
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