Emergency Care for High-Altitude Trekking and Climbing.

High altitude regions are characterized by harsh conditions (environmental, rough terrain, natural hazards, and limited hygiene and health care), which all may contribute to the risk of accidents/emergencies when trekking or climbing. Exposure to hypoxia, cold, wind, and solar radiation are typical features of the high altitude environment. Emergencies in these remote areas place high demands on the diagnostic and treatment skills of doctors and first-aiders.

Comparison of Laryngeal Mask Airway Seal Between Anesthesiologists and Individuals Without Previous Airway Experience.

Background: Tracheal intubation is the gold standard for airway management in emergency medicine, but more difficult to apply for inexperienced individuals than laryngeal mask airway (LMA).

Objective: The aim of our study was to investigate if inexperienced individuals are able to secure the airway with the help of LMA after a short introduction. A second aim was to evaluate Thiel-fixed specimens against unfixed ones.

Analysis of tourniquet pressure over military winter clothing and a short review of combat casualty care in cold weather warfare.

Cold weather warfare is of increasing importance. Haemorrhage is the most common preventable cause of death in military conflicts. We analysed the pressure of the Combat Application Tourniquet® Generation 7 (CAT), the SAM® Extremity Tourniquet (SAMXT) and the SOF® Tactical Tourniquet Wide Generation 4 (SOFTT) over different military cold weather clothing setups with a leg tourniquet trainer.

Editorial on the Research Topic of Sports Training and the Promotion of Physical Health.

Sport activities are a deciding factor in maintaining or achieving physical health [...

Initial Treatment of High-Altitude Pulmonary Edema: Comparison of Oxygen and Auto-PEEP.

Background: Improvement of oxygenation is the aim in the therapy of high-altitude pulmonary edema (HAPE). However, descent is often difficult and hyperbaric chambers, as well as bottled oxygen, are often not available. We compare Auto-PEEP (AP-Pat), a special kind of pursed lips breathing, against the application of bottled oxygen (O-Pat) in two patients suffering from HAPE.

Effects of Acute Exposure and Acclimatization to High-Altitude on Oxygen Saturation and Related Cardiorespiratory Fitness in Health and Disease.

Maximal values of aerobic power (VOmax) and peripheral oxygen saturation (SpOmax) decline in parallel with gain in altitude. Whereas this relationship has been well investigated when acutely exposed to high altitude, potential benefits of acclimatization on SpO and related VOmax in healthy and diseased individuals have been much less considered. Therefore, this narrative review was primarily aimed to identify relevant literature reporting altitude-dependent changes in determinants, in particular SpO, of VOmax and effects of acclimatization in athletes, healthy non-athletes, and patients suffering from cardiovascular, respiratory and/or metabolic diseases.

Rapid ascents of Mt Everest: normobaric hypoxic preacclimatization.

Background: Acclimatization to high altitude is time consuming. An expedition to Mt Everest (8848 m) requires roughly 8 weeks. Therefore it seems very attractive to reach the summit within 3 weeks from home, which is currently promised by some expedition tour operators.

The correct measurement of oxygen saturation at high altitude.

Background: Compared to measurements at sea level, measurement of oxygen saturation by pulse oximetry (SpO) at altitude differs fundamentally because of the cyclical course of SpO, caused by periodic breathing. Therefore, the determination of a representative SpO value is difficult. In the literature, recommendations for a standardized measurement procedure are missing; different studies measure SpO in different ways.

Challenges of Military Health Service Support in Mountain Warfare.

Introduction: History is full of examples of the influence of the mountain environment on warfare. The aim of this article is to identify the main environmental hazards and summarize countermeasures to mitigate the impact of this unique environment.

Methods: A selective PubMed and Internet search was conducted.

Oxygen saturation increases over the course of the night in mountaineers at high altitude (3050-6354 m).

Background: Blood oxygen saturation (SpO 2 ) is frequently measured to determine acclimatization status in high-altitude travellers. However, little is known about nocturnal time course of SpO 2 (SpO 2N ), but alterations in SpO 2N might be practically relevant as well. To this end, we describe the time-course of SpO 2N in mountaineers at high altitude.

[What Surgeons Should Know about Risk Management].

The fact that medical treatment is associated with errors has long been recognized. Based on the principle of "first do no harm", numerous efforts have since been made to prevent such errors or limit their impact. However, recent statistics show that these measures do not sufficiently prevent grave mistakes with serious consequences.

Injuries, Medical Conditions, and Changes in Blood Levels in German Special Operations Forces Selection.

Background: Medical conditions often develop during military training. The aim of this study was to compile medical conditions and injuries sustained during a 5-day military exercise, compare them with incidences at similar civilian events, and subsequently identify differences between those who finished the exercise (Finishers) and those who did not (Nonfinishers) to identify preventable causes for not finishing and to reduce unnecessary health risks.

Methods: Fifty-one soldiers had their blood parameters (creatine kinase [CK], aspartate transaminase [AST], alanine transaminase [ALT], gamma-glutamyl transferase [GGT], C-reactive protein [CRP], leukocytes, sodium), weight loss, and body temperature determined after the exercise.

Improvement in altitude performance test after further acclimatization in pre-acclimatized soldiers.

The Altitude Performance Test is a measure designed to assess an individual's degree of acclimatization to reduce the risk of acute mountain sickness during high-altitude activities. The aim of this study was to investigate the hypothesis that test results will improve in pre-acclimatized soldiers after several days of further acclimatization. The Altitude Performance Test consists of an uphill run at high altitude.

[Neuromuscular deficits in chronic ankle instability. Frequency and significance - multicenter study].

The peroneal reaction time (PRT) is used in the assessment of neuromuscular deficits in chronic functional ankle instability. Powered by the Editorial Manager and Preprint Manager from Aries Systems Corporation the present study was conducted to determine the PRT in a large collective of patients with chronic ankle instability because it is unclear if this parameter of neuromuscular deficit is prolonged. In this study 186 patients underwent a diagnostic algorithm consisting of anamnesis, clinical examination, X-ray and determination of the PRT on a tilting platform.

Decrease of asymmetric dimethylarginine predicts acute mountain sickness.

Introduction: Each year, 40 million tourists worldwide are at risk of getting acute mountain sickness (AMS), because they travel to altitudes of over 2500 m. As asymmetric dimethylarginine (ADMA) is a nitric oxide synthase (NOS) inhibitor, it should increase pulmonary artery pressure (PAP) and raise the risk of acute mountain sickness and high-altitude pulmonary edema (HAPE). With this in mind, we investigated whether changes in ADMA levels (Δ-ADMA) at an altitude of 4000 m can predict an individual's susceptibility to AMS or HAPE.

[Clinical relevance of a routinely performed magnetic resonance cholangiopancreatography (MRCP) prior to cholecystectomy].

Background: A preoperative diagnostic imaging procedure is essential for therapy in cholecystolithiasis. According to the S3-Guidelines of the German Society for General and Visceral Surgery only an ultrasound scan is needed before a cholecystectomy. But an anatomic variant of the bile ducts or choledocholithiasis is poorly shown by an ultrasound.

Critical limb ischaemia: initial treatment and predictors of amputation-free survival.

Objectives: To evaluate initial treatment and risk factors for amputation-free survival in patients with critical limb ischaemia (CLI).

Design: Prospective clinical cohort study at a single vascular surgical centre in Germany.

Methods: Data on 104 consecutive patients (115 ischaemic limbs) presenting with their first episode of CLI were collected prospectively over a 3-year period.

Changes of hematocrit and hemoglobin concentration in the cold Himalayan environment in dependence on total body fluid.

Introduction: The organism is exposed to a considerable hypoxic stress at high altitude, and the well-known polyglobulia is an effective strategy to sustain oxygen delivery to the tissue at reduced saturation of hemoglobin. In general, an increasing erythropoiesis is thought to be the reason, although this increase of red blood count can be observed after a short time of altitude exposure and the parameters are expressed as water-depending concentrations. Therefore, the influence of water distribution on hemoglobin (Hb) and hematocrit (Hct) values during a long-term exposure at high altitude was investigated.

Testing individual risk of acute mountain sickness at greater altitudes.

The assessment of an individual's degree of acclimatization to altitude is difficult. This is particularly applicable to military operations that have to be performed at altitude. This study describes a new and simple test that allows for the determination of an individual's risk for high-altitude illness at higher altitudes.

Auto-PEEP in the therapy of AMS in one person at 4,330 m.

Background: The human organism is exposed to considerable hypoxic stress at high altitudes. Our intention was to investigate if a special breathing pattern with expiration against the resistance of pursed lips leads to an elevation in oxygen saturation (SaO(2)). For the first time ever, oxygen saturation was measured continuously during the initial situation, during self-performed positive end-expiratory pressure breathing (auto-PEEP) itself, and during observation afterwards.

[Patient assessments of quality of life following bypass for chronic critical limb ischaemia].

The value of infrainguinal bypass surgery for critical limb ischaemia (CLI) in elderly patients is being scrutinised more as medical resources decline. Despite technically successful revascularisation, patient quality of life seems impaired by delayed wound healing and repeated hospitalisation for interventions and operations. Therefore it is questionable whether these frail patients benefit from bypass surgery with respect to their health-related quality of life.

EEG, ECG and oxygen concentration changes from sea level to a simulated altitude of 4000m and back to sea level.

In order to describe how high altitude affects the body during a one night stay at 4000m experiments were performed in a hypobaric chamber and compared to a study on Dachstein (mountain in Austria, 2700m). Ten subjects had to perform a reaction time task at different altitudes. The EEG and ECG were recorded simultaneously.

[Removal of a thoracic impaling agent without direct observation. The significance of pre-operative diagnosis].

Impalement injuries are uncommon and only occasional reports exist in the literature, resulting in non standardized approaches. Depending on the location, completely different combinations of injuries occur, making every impalement unique. Nevertheless some basic principles for dealing with impalements exist.