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Horakova L, Kriemler S, Študent V, Pichler Hefti J, Hillebrandt D, Jean D, Mateikaitė-Pipirienė K, Paal P, Rosier A, Andjelkovic M, Beidlemann B, Derstine M, Keyes LE. Hormonal Contraception and Menstrual Cycle Control at High Altitude: A Scoping Review-UIAA Medical Commission Recommendations. High Alt Med Biol 2024. [PMID: 38607652 DOI: 10.1089/ham.2024.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
Horakova, Lenka , Susi Kriemler, Vladimír Študent, Jacqueline Pichler Hefti, David Hillebrandt, Dominique Jean, Kastė Mateikaitė-Pipirienė, Peter Paal, Alison Rosier, Marija Andjelkovic, Beth Beidlemann, Mia Derstine, and Linda E. Keyes. Hormonal contraception and menstrual cycle control at high altitude: a scoping review-UIAA Medical Commission recommendations. High Alt Med Biol. 00:00-00, 2024. Background: Women who use hormonal contraception (HC) may have questions about their use during travel to high altitude. This scoping review summarizes current evidence on the efficacy and safety of HC and cycle control during high-altitude travel. Methods: We performed a scoping review for the International Climbing and Mountaineering Federation (UIAA) Medical Commission series on Women's Health in the Mountains. Pertinent literature from PubMed and Cochrane was identified by keyword search combinations (including contraception) with additional publications found by hand search. Results: We identified 17 studies from 7,165 potentially eligible articles. No articles assessed the efficacy of contraception during a short-term high-altitude sojourn. Current data show no advantage or disadvantage in HC users for acclimatization or acute mountain sickness (AMS). Use of HC during high-altitude travel is common and safe for menses suppression. A potential concern of estrogen-containing HC is the increased thrombotic risk, which theoretically could be compounded in hypobaric hypoxia. Conclusions: Evidence is limited for the interaction of HC and high altitude on performance, thrombosis, and contraceptive efficacy. HC does not affect the risk of AMS. The most efficacious and safest method at high altitude is generally the one women are most familiar with and already using.
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Affiliation(s)
- Lenka Horakova
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University Prague, Kladno, Czech Republic
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Vladimír Študent
- Department of Gynecology and Obstetrics, Prachatice Hospital, Prachatice, Czech Republic
| | | | - David Hillebrandt
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- General Medical Practitioner, Holsorthy, United Kingdom
| | - Dominique Jean
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Pediatrics, Infectious Diseases and Altitude Medicine, Grenoble, France
| | - Kastė Mateikaitė-Pipirienė
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Diaverum Dialysis Clinic, Elektrėnai, Lithuania
| | - Peter Paal
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Alison Rosier
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
| | - Marija Andjelkovic
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Pharmacy, Singidunum University, Belgrade, Serbia
| | - Beth Beidlemann
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Mia Derstine
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
| | - Linda E Keyes
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
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Wallner B, Lienhart H, Cools E, Paal P. Surviving 20 Hours of Critical Avalanche Burial and a Core Temperature of 22.5 °C. Wilderness Environ Med 2024; 35:94-99. [PMID: 38379467 DOI: 10.1177/10806032231220403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
A 24-year-old male snowboarder was buried in an avalanche for 20 h and rescued on the next day at a depth of 2.3 m below the snow surface. A large air pocket was noted in front of his mouth and nose. He was responsive but moved restlessly and uncoordinatedly. The epitympanic temperature was 22.5 °C. He was bradycardic (35/min), and a right bundle branch block with Osborn waves was noted. Rewarming (1 °C/h) was initiated with continuous hemodialysis; core temperature raised to 29.8 °C within 4 h. At 30 °C he became conscious. With rewarming, the heart rate increased to 90 beats per minute and the ECG changes disappeared; nonfreezing cold injuries were noted. On the next day, his pulmonary function deteriorated-fluid overload of 9 L since admission was diagnosed. With spontaneous diuresis, the situation improved. On Day 4, the neurologist reported subtle polyneuropathy in both legs secondary to hypothermia, without tendency to regress. This case occurred more than 20 years ago but has not been reported yet. To this day, this is the third-longest critical avalanche burial ever reported. We discuss the circumstances of this accident, the clinical course, and how treatment has changed since 2000.
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Affiliation(s)
- Bernd Wallner
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Hannes Lienhart
- Department of Anaesthesiology and Critical Care Medicine, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Evelien Cools
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
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3
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Sullivan-Kwantes W, Tikuisis P. Extremity cooling during an arctic diving training exercise. Int J Circumpolar Health 2023; 82:2190488. [PMID: 36966493 PMCID: PMC10044145 DOI: 10.1080/22423982.2023.2190488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2023] Open
Abstract
A field study was conducted to examine the vulnerability of military divers to non-freezing cold injury (NFCI) during Arctic ice-diving operations. Participants were instrumented with temperature sensors on the back of their hands and on the bottom of their big toe for each dive to measure cooling of their extremities. While NFCI was not diagnosed in any of the participants during this field study, the data indicate that the feet were particularly vulnerable during the dives given that they were mostly in a temperature zone that could cause pain and performance decrements. The data also show that for short term dives, the dry and wet suits with wet gloves in both configurations were thermally more comfortable for the hands than the dry suit with dry glove configuration; however, the latter would be more protective against potential NFCI during longer dives. Features such as hydrostatic pressure and repetitive diving that are unique to diving but not previously considered as risk factors for NFCI are examined herein and warrant deeper investigation given that symptoms of NFCI might be mistaken as decompression sickness.
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Affiliation(s)
| | - Peter Tikuisis
- Defence Research and Development Canada, Toronto, Canada
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4
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Lowe J, Warner M. Can iloprost be used for treatment of cold weather injury at the point of wounding in a forward operating environment? A literature review. Int J Circumpolar Health 2023; 82:2210340. [PMID: 37154780 PMCID: PMC10167884 DOI: 10.1080/22423982.2023.2210340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION Cold Weather Injury (CWI) represents a spectrum of pathology, the two main divisions being Freezing Cold Injury (FCI) and Non-Freezing Cold Injury (NFCI). Both are disabling conditions associated with microvascular and nerve injury often treated hours after initial insult when presenting to a healthcarestablishment. Given that iloprost is used for the treatment of FCI, could it be used in a forward operating environment to mitigate treatment delay? Is there a role for its use in the forward treatment of NFCI? This review sought to evaluate the strength of evidence for the potential use of iloprost in a forward operating environment. METHODS Literature searches were undertaken using the following question for both FCI and NFCI: in [patients with FCI/NFCI] does [the use of iloprost] compared to [standard care] reduce the incidence of [long-term complications]. Medline, CINAHL and EMBASE databases were searched using the above question and relevant alternative terminology. Abstracts were reviewed before full articles were requested. RESULTS The FCI search yielded 17 articles that were found to refer to the use of iloprost and FCI. Of the 17, one referred to pre-hospital treatment of frostbite at K2 base camp; however, this was utilising tPA. No articles referred to pre-hospital use in either FCI or NFCI. DISCUSSION Although evidence exists to support the use of iloprost in the treatment of FCI, its use to date has been in hospital. A common theme is delayed treatment due to the challenges of evacuating casualties from a remote location. There may be a role for iloprost in the treatment of FCI; however, further study is required to better understand the risk of its use.
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Affiliation(s)
- Jonathon Lowe
- British Antarctic Survey Medical Unit, Emergency Department, Derriford Hospital, Plymouth, UK
| | - Matthew Warner
- British Antarctic Survey Medical Unit, Emergency Department, Derriford Hospital, Plymouth, UK
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Sidhar K, Elliott K, Ibrahem M. Heat, Cold, and Environmental Emergencies in Athletes. Clin Sports Med 2023; 42:441-461. [PMID: 37208058 DOI: 10.1016/j.csm.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
With the increase in outdoor events, there is an inevitable rise in climate-related environmental emergencies. Heat exposure can place athletes at risk for life-threatening heatstroke which requires emergent diagnosis and rapid in-field management. Cold exposure can lead to hypothermia, frostbite, and other nonfreezing injuries that require prompt evaluation and management to minimize morbidity and mortality. Altitude exposure can lead to acute mountain sickness or other serious neurologic or pulmonary emergencies. Finally, harsh climate exposure can be life-threatening and require appropriate prevention and event planning.
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Affiliation(s)
- Kartik Sidhar
- Department of Family Medicine, University of Michigan Medical School, 300 North Ingalls Street, NI4C06, Ann Arbor, MI 48109-5435, USA.
| | - Katlyn Elliott
- University of Pittsburgh Medical Center, McKeesport Family Medicine Residency, 2347 5th Avenue, McKeesport, PA 15132, USA
| | - Michael Ibrahem
- University of Pittsburgh Medical Center, Shadyside Family Medicine Residency, 5215 Center Avenue, Pittsburgh, PA 15232, USA
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Kelly KR, Palombo LJ, Jensen AE, Bernards JR. Efficacy of closed cell wet-suit at various depths and gas mixtures for thermoprotection during military training dives. Front Physiol 2023; 14:1165196. [PMID: 37293261 PMCID: PMC10245272 DOI: 10.3389/fphys.2023.1165196] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/17/2023] [Indexed: 06/10/2023] Open
Abstract
Purpose: To evaluate a closed-cell wet-suit for thermal protective capability during extreme cold water exposure at various depths. Methods: Thirteen (n = 13) elite military divers who were tasked with cold-water training, participated in this study. To mimic various depths, the Ocean Simulation Facility (OSF) at the Navy Experimental Diving Unit (NEDU) was pressurized to simulate dive depths of 30, 50, and 75fsw. Water temperature remained at 1.8-2.0°C for all dives. Four divers dove each day and used the MK16 underwater breathing apparatus with gas mixes of either N202 (79:21) or HeO2 (88:12). Mean skin temperature (TSK) (Ramanathan, 1964), core temperature (Tc), hand and foot readings were obtained every 30 min for 30 and 50fsw and every 15 min during the 75fsw dive. Results: TC was significantly reduced across all dives (p = 0.004); however, was preserved above the threshold for hypothermia (post dive Tc = 36.5 ± 0.4). There was no effect of gas mix on TC. TSK significantly decreased (p < 0.001) across all dives independent of depth and gas. Hand and foot temperatures resulted in the termination of three of the dives. There were no significant main effects for depth or gas, but there were significant main effects for time on hand temperature (p < 0.001) and foot temperature (p < 0.001). Conclusion: Core temperature is maintained above threshold for hypothermia. Variatioins in TC and TSK are a function of dive duration independent of depth or gas for a closed-cell wet-suit in cold water at various depths. However, both hand and foot temperatures reached values at which dexterity is compromised.
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Affiliation(s)
- Karen R. Kelly
- Applied Translational Exercise and Metabolic Physiology Team, Warfighter Performance, Naval Health Research Center, San Diego, CA, United States
| | - Laura J. Palombo
- Applied Translational Exercise and Metabolic Physiology Team, Warfighter Performance, Naval Health Research Center, San Diego, CA, United States
- Leidos, Inc., San Diego, CA, United States
| | - Andrew E. Jensen
- Applied Translational Exercise and Metabolic Physiology Team, Warfighter Performance, Naval Health Research Center, San Diego, CA, United States
- Leidos, Inc., San Diego, CA, United States
| | - Jake R. Bernards
- Applied Translational Exercise and Metabolic Physiology Team, Warfighter Performance, Naval Health Research Center, San Diego, CA, United States
- Leidos, Inc., San Diego, CA, United States
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Lechner R, Brugger H, Paal P, Hüfner K, Agazzi G, Butler F, Gordon L, Darocha T, Zafren K. Survival in a Collapsed Stable for 37 Days After Avalanche Burial in 1755. Wilderness Environ Med 2023; 34:113-119. [PMID: 36526516 DOI: 10.1016/j.wem.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 12/15/2022]
Abstract
In 1755 in Bergemoletto, Italy, an avalanche buried 4 people (2 women, a girl, and a boy) and several animals in a stable. After 37 d in a pitch-dark confined space, 3 of the 4 people were rescued alive. The 3 survivors had only goat milk, a few chestnuts, a few kg of raw kid meat, and meltwater for nutrition. We describe the longest-known survival in an avalanche burial and discuss the medical and psychological problems of the survivors. The boy died. When they were extricated, all 3 survivors were exhausted, cachectic, and unable to stand or walk. They were severely malnourished and were experiencing tingling, tremors, and weakness in the legs; constipation; changes in taste; and amenorrhea. One of the women had persistent eye problems and developed symptoms consistent with post-traumatic stress disorder. The survivors were given slow refeeding. It took from 1 to 6 wk before they could walk. We compare this case to other long-duration burials, especially mining accidents, and describe the rescue and patient care after long-duration burials. This case demonstrates that people can overcome extremely adverse conditions and survive.
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Affiliation(s)
- Raimund Lechner
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Military Hospital, Ulm, Germany.
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy; Department of Anesthesiology and Intensive Care Medicine, the Medical University of Innsbruck, Innsbruck, Austria; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Katharina Hüfner
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Clinic for Psychiatry II (Psychosomatic Medicine), Innsbruck Medical University, Innsbruck, Austria
| | - Giancelso Agazzi
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Italian Society of Mountain Medicine, Padua, Italy; Italian Alpine Club Medical Commission, Milan, Italy
| | - Frank Butler
- US Department of Defense Joint Trauma System, San Antonio, TX; Departments of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Les Gordon
- Department of Anaesthesia, University Hospitals of Morecambe Bay Trust, Lancaster, United Kingdom
| | - Tomasz Darocha
- Department of Anesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
| | - Ken Zafren
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, AK; Department of Emergency Medicine, Stanford University Medical Center, Stanford, CA
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8
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Paal P, Pasquier M, Darocha T, Lechner R, Kosinski S, Wallner B, Zafren K, Brugger H. Accidental Hypothermia: 2021 Update. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:501. [PMID: 35010760 PMCID: PMC8744717 DOI: 10.3390/ijerph19010501] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 12/13/2022]
Abstract
Accidental hypothermia is an unintentional drop of core temperature below 35 °C. Annually, thousands die of primary hypothermia and an unknown number die of secondary hypothermia worldwide. Hypothermia can be expected in emergency patients in the prehospital phase. Injured and intoxicated patients cool quickly even in subtropical regions. Preventive measures are important to avoid hypothermia or cooling in ill or injured patients. Diagnosis and assessment of the risk of cardiac arrest are based on clinical signs and core temperature measurement when available. Hypothermic patients with risk factors for imminent cardiac arrest (temperature < 30 °C in young and healthy patients and <32 °C in elderly persons, or patients with multiple comorbidities), ventricular dysrhythmias, or systolic blood pressure < 90 mmHg) and hypothermic patients who are already in cardiac arrest, should be transferred directly to an extracorporeal life support (ECLS) centre. If a hypothermic patient arrests, continuous cardiopulmonary resuscitation (CPR) should be performed. In hypothermic patients, the chances of survival and good neurological outcome are higher than for normothermic patients for witnessed, unwitnessed and asystolic cardiac arrest. Mechanical CPR devices should be used for prolonged rescue, if available. In severely hypothermic patients in cardiac arrest, if continuous or mechanical CPR is not possible, intermittent CPR should be used. Rewarming can be accomplished by passive and active techniques. Most often, passive and active external techniques are used. Only in patients with refractory hypothermia or cardiac arrest are internal rewarming techniques required. ECLS rewarming should be performed with extracorporeal membrane oxygenation (ECMO). A post-resuscitation care bundle should complement treatment.
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Affiliation(s)
- Peter Paal
- Department of Anesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, 5020 Salzburg, Austria
- International Commission for Mountain Emergency Medicine (ICAR MedCom), 8302 Kloten, Switzerland; (M.P.); (K.Z.); (H.B.)
| | - Mathieu Pasquier
- International Commission for Mountain Emergency Medicine (ICAR MedCom), 8302 Kloten, Switzerland; (M.P.); (K.Z.); (H.B.)
- Department of Emergency Medicine, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Tomasz Darocha
- Department of Anesthesiology and Intensive Care, Medical University of Silesia, 40-001 Katowice, Poland;
| | - Raimund Lechner
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Military Hospital, 89081 Ulm, Germany;
| | - Sylweriusz Kosinski
- Faculty of Health Sciences, Jagiellonian University Medical College, 34-500 Krakow, Poland;
| | - Bernd Wallner
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Ken Zafren
- International Commission for Mountain Emergency Medicine (ICAR MedCom), 8302 Kloten, Switzerland; (M.P.); (K.Z.); (H.B.)
- Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, AK 99508, USA
- Department of Emergency Medicine, Stanford University Medical Center, Stanford University, Palo Alto, CA 94304, USA
| | - Hermann Brugger
- International Commission for Mountain Emergency Medicine (ICAR MedCom), 8302 Kloten, Switzerland; (M.P.); (K.Z.); (H.B.)
- Institute of Mountain Emergency Medicine, Eurac Research, 39100 Bolzano, Italy
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
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Fennell J, Onel K. Chilblains-Like Lesions in Pediatric Patients: A Review of Their Epidemiology, Etiology, Outcomes, and Treatment. Front Pediatr 2022; 10:904616. [PMID: 35813389 PMCID: PMC9259963 DOI: 10.3389/fped.2022.904616] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Vascular pathologies associated with SARS-CoV-2 infection are poorly understood. Color and sensory changes to the extremities, often referred to as "COVID toes" or chilblains-like lesions, have been widely reported in children and adolescents since the onset of the pandemic, raising the concern that they could be a vasculitis secondary to the infection. However, it is unclear if the lesions are a result of the infection or an epiphenomenon. Most literature focuses on adults, and while there are reports on children and adolescents, many of them are small. This review will help medical care providers better understand the epidemiology, etiology, outcomes, and potential treatments for chilblains-like lesions seen in children and adolescents during the pandemic.
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Affiliation(s)
- Jessica Fennell
- Pediatric Rheumatology, Hospital for Special Surgery, New York, NY, United States.,Department of Pediatrics, New York Presbyterian-Weill Cornell, New York, NY, United States
| | - Karen Onel
- Pediatric Rheumatology, Hospital for Special Surgery, New York, NY, United States.,Department of Pediatrics, New York Presbyterian-Weill Cornell, New York, NY, United States
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