The Scottish mountain rescue casualty study.
(25/155)
AIM: To describe injuries and illnesses in casualties rescued by Scottish mountain rescue teams during 1998 and 1999, with particular emphasis on major trauma. METHODS: Retrospective study. Information from mountain rescue reports, Scottish Trauma Audit Group database, and hospital case notes. RESULTS: Teams undertook 622 emergency callouts in the two years. A total of 333 casualties with injuries and illnesses rescued. There were 57 fatal incidents, 261 (78.4%) rescued with traumatic injuries, 12 (3.6%) suffering from major trauma, and 12 (3.6%) had spinal injuries. Half had lower limb injuries. Twenty six (7.7%) were suffering from non-traumatic medical problems. Forty six (13.8%) were suffering from cold or exhaustion. Fifty three casualties were dead when the rescue team arrived. Four died during or after rescue, one from hypothermia and three from trauma. All major trauma casualties were evacuated by helicopter. DISCUSSION: No previous similar studies identified. Significant numbers of seriously injured and ill casualties are being cared for by mountain rescue team casualty carers, many of whom are not healthcare professionals. The need for improved training, research, and equipment is discussed. CONCLUSION: Scottish MRTs are called upon to provide an advanced level of care for a significant number of casualties. There is a need for formalised opportunities for in hospital training, management protocols, and continuing research and audit-none of which currently exists. (+info)
Relation between the occurrence of bony union and outcome for fractures of the lateral process of the talus: a case report and analysis of published reports.
(26/155)
Fractures of the lateral process of the talus are uncommon, but the incidence has probably risen because of the increased popularity of snowboarding, an increased awareness of doctors, and the ready availability of computed tomography scanning. One case report and a review of the literature are provided. Aggressive management rarely resulted in non-union (7%) and was always associated with a good outcome (100%), even if the fracture fragments were excised initially. The relations between method of treatment, bony union, and outcome were significant (Fisher's exact test, p<0.01). (+info)
Intermittent altitude exposures improve muscular performance at 4,300 m.
(27/155)
Chronic altitude residence improves muscular performance at altitude, but the effect of intermittent altitude exposures (IAE) on muscular performance at altitude has not been defined. The purpose of this study was to determine the effects of 3 wk of IAE, in combination with rest and cycle training, on muscular performance at altitude. Six lowlanders (23 +/- 2 yr, 77 +/- 6 kg; means +/- SE) completed a cycle time trial and adductor pollicis endurance test at sea level and during a 30-h acute exposure to 4,300 m altitude equivalent (barometric pressure = 446 mmHg) once before (pre-IAE) and once after (post-IAE) a 3-wk period of IAE (4 h/day, 5 days/wk, 4,300 m). During each IAE, three subjects cycled for 45-60 min/day at 60%-70% of maximal O2 uptake and three subjects rested. Cycle training during each IAE did not appear to affect muscular performance at altitude. Thus data from all six subjects were combined. Three weeks of IAE resulted in 1) a 21 +/- 6% improvement (P < 0.05) in cycle time-trial performance (min) from pre-IAE (32.8 +/- 3.7) to post-IAE (24.8 +/- 1.2), 2) a 63 +/- 26% improvement (P < 0.05) in adductor pollicis endurance (min) from pre-IAE (9.2 +/- 2.8) to post-IAE (14.8 +/- 4.2), and 3) a 10 +/- 4% increase (P < 0.05) in resting arterial O2 saturation (%) from pre-IAE (82 +/- 2) to post-IAE (90 +/- 1). These improvements in muscular performance after IAE correlated strongly with increases in resting arterial O2 saturation and were comparable to those reported previously after chronic altitude residence. IAE may therefore be used as an alternative to chronic altitude residence to facilitate improvements in muscular performance in athletes, soldiers, mountaineers, shift workers, and others that are deployed to altitude. (+info)
Fell walking injuries in Cumbria: a review.
(28/155)
An analysis of injuries sustained during fell walking in Cumbria and seen at the West Cumberland Hospital over a 3-year period is presented. There were 90 patients, including 19 multiple injuries and four deaths. This report focuses attention on the seriousness and magnitude of injuries associated with a pastime often thought to be harmless and risk-free. (+info)
Altitude-dependent changes of directional hearing in mountaineers.
(29/155)
This study demonstrates apparent deterioration in the ability to localize sound associated with acute exposure to high altitude in ten subjects on three mountaineering expeditions. Furthermore, the auditory localization errors improved to sea level values after a period of acclimatization. Occurring at altitudes where overt neurological symptoms are not usually seen, impairment of sensory perception may explain the increase in accidental deaths associated with altitude exposure due to disorientation and misjudgment but before hypoxia is evident. (+info)
Anthropometry of young competitive sport rock climbers.
(30/155)
BACKGROUND: Adult elite competitive rock climbers are small in stature with low body mass and very low body fat percentage. These characteristics have generated concern that young climbers may attempt body mass reduction to extreme levels with adverse consequences for health and performance. No published anthropometry data for young competitive climbers exist. OBJECTIVE: To describe the general anthropometric characteristics of junior US competitive rock climbers. METHODS: Ninety subjects (mean (SD) age 13.5 (3.0) years) volunteered to participate. All competed at the Junior Competition Climbers Association US National Championship. Anthropometric variables, including height, mass, body mass index (BMI), arm span, biiliocristal and biacromial breadths, skinfold thickness at nine anatomical sites, forearm and hand volumes, and handgrip strength, were measured. Selected variables were expressed as ratio values and as normative age and sex matched centile scores where appropriate. A control group (n=45) of non-climbing children and youths who participated in a variety of sports activities, including basketball, cross country running, cross country skiing, soccer, and swimming, underwent the same testing procedures in the Exercise Science Laboratory of Northern Michigan University. RESULTS: Mean (SD) self reported climbing ability was 11.80 (1.20), or about 5.11 d on the Yosemite decimal system scale. The mean (SD) experience level was 3.2 (1.9) years, and subjects competed in 10 (5) organised competitions over a 12 month period. Despite similarity in age, there were significant differences (p<0.01) between climbers and control subjects for height, mass, centile scores for height and mass, ratio of arm span to height ("ape index"), biiliocristal/biacromial ratio, sum of seven and sum of nine skinfolds, estimated body fat percentage, and handgrip/mass ratio. Despite significantly lower skinfold sums and estimated body fat percentage, no differences were found between climbers and controls for absolute BMI or BMI expressed as a centile score. CONCLUSIONS: Young competitive climbers have similar general anthropometric characteristics to elite adult climbers. These include relatively small stature, low body mass, low sums of skinfolds, and high handgrip to mass ratio. Relative to age matched athletic non-climbers, climbers appear to be more linear in body type with narrow shoulders relative to hips. Differences in body composition exist between climbers and non-climbing athletes despite similar BMI values. (+info)
Altered ion transporter expression in bronchial epithelium in mountaineers with high-altitude pulmonary edema.
(31/155)
Hypoxia inhibits activity and expression of transport proteins of cultured lung alveolar epithelial cells. Here we tested whether hypoxia at high altitude affected the expression of ion transport proteins in tissues obtained from controls and mountaineers with high-altitude pulmonary edema (HAPE) at the Capanna Margherita (4,559 m). Expression was determined by RT-PCR and Western blots from brush biopsies of bronchial epithelium and from leukocytes obtained before and during the stay at high altitude. At low altitude, amounts of mRNAs were not different between control and HAPE-susceptible subjects. At high altitude, the amount of mRNA of Na-K-ATPase, CFTR, and beta-actin of brush biopsies did not change in controls but decreased significantly (-60%) in HAPE-susceptible subjects. There was no change in Na channel mRNAs at high altitude in controls and HAPE. No statistically significant correlation was found between the expression of Na transporters and PO2 and O2 saturation. In leukocytes, 28S-rRNA and Na-K-ATPase decreased at altitude in control and HAPE-susceptible subjects, but no significant change in Na-K-ATPase protein was found. Hypoxia-inducible factor-1alpha mRNA and GAPDH mRNA tended to increase in leukocytes obtained from HAPE-susceptible subjects at high altitude but did not change in controls. These results show that hypoxia induces differences in mRNA expression of ion transport-related proteins between HAPE-susceptible and control subjects but that these changes may not necessarily predict differences in protein concentration or activity. It is therefore unclear whether these differences are related to the pathophysiology of HAPE. (+info)
Impact of acute hypoxic pulmonary hypertension on LV diastolic function in healthy mountaineers at high altitude.
(32/155)
In pulmonary hypertension right ventricular pressure overload leads to abnormal left ventricular (LV) diastolic function. Acute high-altitude exposure is associated with hypoxia-induced elevation of pulmonary artery pressure particularly in the setting of high-altitude pulmonary edema. Tissue Doppler imaging (TDI) allows assessment of LV diastolic function by direct measurements of myocardial velocities independently of cardiac preload. We hypothesized that in healthy mountaineers, hypoxia-induced pulmonary artery hypertension at high altitude is quantitatively related to LV diastolic function as assessed by conventional and TDI Doppler methods. Forty-one healthy subjects (30 men and 11 women; mean age 41 +/- 12 yr) underwent transthoracic echocardiography at low altitude (550 m) and after a rapid ascent to high altitude (4,559 m). Measurements included the right ventricular to right atrial pressure gradient (DeltaP(RV-RA)), transmitral early (E) and late (A) diastolic flow velocities and mitral annular early (E(m)) and late (A(m)) diastolic velocities obtained by TDI at four locations: septal, inferior, lateral, and anterior. At a high altitude, DeltaP(RV-RA) increased from 16 +/- 7 to 44 +/- 15 mmHg (P < 0.0001), whereas the transmitral E-to-A ratio (E/A ratio) was significantly lower (1.11 +/- 0.27 vs. 1.41 +/- 0.35; P < 0.0001) due to a significant increase of A from 52 +/- 15 to 65 +/- 16 cm/s (P = 0.0001). DeltaP(RV-RA) and transmitral E/A ratio were inversely correlated (r(2) = 0.16; P = 0.0002) for the whole spectrum of measured values (low and high altitude). Diastolic mitral annular motion interrogation showed similar findings for spatially averaged (four locations) as well as for the inferior and septal locations: A(m) increased from low to high altitude (all P < 0.01); consequently, E(m)/A(m) ratio was lower at high versus low altitude (all P < 0.01). These intraindividual changes were reflected interindividually by an inverse correlation between DeltaP(RV-RA) and E(m)/A(m) (all P < 0.006) and a positive association between DeltaP(RV-RA) and A(m) (all P < 0.0009). In conclusion, high-altitude exposure led to a two- to threefold increase in pulmonary artery pressure in healthy mountaineers. This acute increase in pulmonary artery pressure led to a change in LV diastolic function that was directly correlated with the severity of pulmonary hypertension. However, in contrast to patients suffering from some form of cardiopulmonary disease and pulmonary hypertension, in these healthy subjects, overt LV diastolic dysfunction was not observed because it was prevented by augmented atrial contraction. We propose the new concept of compensated diastolic (dys)function. (+info)