RESUMEN
To provide guidance to clinicians about best practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for prevention, diagnosis, and treatment of acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema. Recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks/burdens according to criteria put forth by the American College of Chest Physicians. The guidelines also provide suggested approaches for managing each form of acute altitude illness that incorporate these recommendations as well as recommendations on how to approach high altitude travel following COVID-19 infection. This is an updated version of the original WMS Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness published in Wilderness & Environmental Medicine in 2010 and the subsequently updated WMS Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness published in 2014 and 2019.
Asunto(s)
Mal de Altura , COVID-19 , Humanos , Mal de Altura/diagnóstico , Mal de Altura/prevención & control , Altitud , COVID-19/diagnóstico , COVID-19/prevención & control , Consenso , Sociedades Médicas , Prueba de COVID-19RESUMEN
The Wilderness Medical Society convened an expert panel to develop a set of evidence-based guidelines for the prevention and treatment of frostbite. We present a review of pertinent pathophysiology. We then discuss primary and secondary prevention measures and therapeutic management. Recommendations are made regarding each treatment and its role in management. These recommendations are graded on the basis of the quality of supporting evidence and balance between the beneï¬ts and risks or burdens for each modality according to methodology stipulated by the American College of Chest Physicians. This is an updated version of the guidelines published in 2019.
Asunto(s)
Congelación de Extremidades , Sociedades Médicas , Medicina Silvestre , Congelación de Extremidades/terapia , Congelación de Extremidades/prevención & control , Medicina Silvestre/normas , Medicina Silvestre/métodos , HumanosAsunto(s)
Mal de Altura , Hipoxia/etiología , Viaje , Acetazolamida/uso terapéutico , Altitud , Mal de Altura/tratamiento farmacológico , Mal de Altura/etiología , Mal de Altura/prevención & control , Mal de Altura/terapia , Edema Encefálico/etiología , Edema Encefálico/terapia , Enfermedad Crónica/epidemiología , Dexametasona/uso terapéutico , Femenino , Humanos , Hipertensión Pulmonar/terapia , Hipoxia/fisiopatología , Masculino , Saturación de Oxígeno , Embarazo , Factores de RiesgoRESUMEN
To provide guidance to clinicians about best preventive and therapeutic practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for prevention and treatment of acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema. Recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks/burdens according to criteria put forth by the American College of Chest Physicians. The guidelines also provide suggested approaches to prevention and management of each form of acute altitude illness that incorporate these recommendations. This is an updated version of the original WMS Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness published in 2010 and subsequently updated as the WMS Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness in 2014.
Asunto(s)
Mal de Altura/prevención & control , Edema Encefálico/prevención & control , Pautas de la Práctica en Medicina , Edema Pulmonar/prevención & control , Medicina Silvestre/normas , Mal de Altura/terapia , Edema Encefálico/terapia , Humanos , Montañismo , Edema Pulmonar/terapia , Sociedades MédicasRESUMEN
The Wilderness Medical Society convened an expert panel to develop a set of evidence-based guidelines for prevention and treatment of frostbite. We present a review of pertinent pathophysiology. We then discuss primary and secondary prevention measures and therapeutic management. Recommendations are made regarding each treatment and its role in management. These recommendations are graded on the basis of the quality of supporting evidence and balance between the benefits and risks or burdens for each modality according to methodology stipulated by the American College of Chest Physicians. This is an updated version of the guidelines published in 2014.
Asunto(s)
Congelación de Extremidades/prevención & control , Pautas de la Práctica en Medicina , Medicina Silvestre/normas , Congelación de Extremidades/terapia , Humanos , Sociedades MédicasRESUMEN
To provide guidance to clinicians, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of accidental hypothermia. The guidelines present the main diagnostic and therapeutic modalities and provide recommendations for the management of hypothermic patients. The panel graded the recommendations based on the quality of supporting evidence and a balance between benefits and risks/burdens according to the criteria published by the American College of Chest Physicians. The guidelines also provide suggested general approaches to the evaluation and treatment of accidental hypothermia that incorporate specific recommendations. This is the 2019 update of the Wilderness Medical Society Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2014 Update.
Asunto(s)
Hipotermia/diagnóstico , Hipotermia/terapia , Pautas de la Práctica en Medicina , Medicina Silvestre/normas , Humanos , Hipotermia/fisiopatología , Sociedades Médicas , Medicina Silvestre/métodosRESUMEN
OBJECTIVE: To evaluate whether women engage in outdoor activities and high altitude travel during pregnancy; the health care advice received regarding high altitude during pregnancy; and the association between high altitude exposure and self-reported pregnancy complications. METHODS: An online survey of women with at least 1 pregnancy distributed on websites and e-mail lists targeting mothers and/or mountain activities. Outcome measures were outdoor activities during pregnancy, high altitude (>2440 m) exposure during pregnancy, and pregnancy and perinatal complications. RESULTS: Hiking, running, and swimming were the most common activities performed during pregnancy. Women traveled to high altitude in over half of the pregnancies (244/459), and most did not receive counseling regarding altitude (355, 77%), although a small proportion (14, 3%) were told not to go above 2440 m. Rates of miscarriage and most other complications were similar between pregnancies with and without travel above 2440 m. Pregnancies with high altitude exposure were more likely to have preterm labor (odds ratio [OR] 2.3; 95% CI 0.97-5.4; P = .05). Babies born to women who went to high altitude during pregnancy were more likely to need oxygen at birth (OR 2.34; 95% CI 1.04-5.26; P < .05) but had similar rates of neonatal intensive care unit admission (P = not significant). CONCLUSIONS: Our results suggest pregnant women who are active in outdoor sports and travel to high altitude have a low rate of complications. Given the limitations of our data, further research is necessary on the risks associated with high altitude travel and physical activity and how these apply to the general population.
Asunto(s)
Altitud , Ejercicio Físico , Complicaciones del Embarazo/etiología , Adulto , Anciano , Estudios Transversales , Femenino , Personal de Salud , Encuestas Epidemiológicas , Humanos , Internet , Persona de Mediana Edad , Embarazo , Carrera , Autoinforme , Natación , ViajeRESUMEN
Despite advances in outdoor clothing and medical management of frostbite, individuals still experience catastrophic amputations. This is a particular risk for those in austere environments, due to resource limitations and delayed definitive treatment. The emerging best therapies for severe frostbite are thrombolytics and iloprost. However, they must be started within 24 hours after rewarming for recombinant tissue plasminogen activator (rt-PA) and within 48 hours for iloprost. Evacuation of individuals experiencing frostbite from remote environments within 24 to 48 hours is often impossible. To date, use of these agents has been confined to hospitals, thus depriving most individuals in the austere environment of the best treatment. We propose that thrombolytics and iloprost be considered for field treatment to maximize chances for recovery and reduce amputations. Given the small but potentially serious risk of complications, rt-PA should only be used for grade 4 frostbite where amputation is inevitable, and within 24 hours of rewarming. Prostacyclin has less risk and can be used for grades 2 to 4 frostbite within 48 hours of rewarming. Until more field experience is reported with these agents, their use should probably be restricted to experienced physicians. Other modalities, such as local nerve blocks and improving oxygenation at high altitude may also be considered. We submit that it remains possible to improve frostbite outcomes despite delayed evacuation using resource-limited treatment strategies. We present 2 cases of frostbite treated with rt-PA at K2 basecamp to illustrate feasibility and important considerations.
Asunto(s)
Ambientes Extremos , Fibrinolíticos/uso terapéutico , Congelación de Extremidades/terapia , Oxigenoterapia Hiperbárica , Bloqueo Nervioso , Prostaglandinas I/uso terapéutico , Terapia Trombolítica/métodos , Congelación de Extremidades/tratamiento farmacológico , Humanos , Oxigenoterapia Hiperbárica/estadística & datos numéricos , Bloqueo Nervioso/estadística & datos numéricos , Nervios Periféricos/efectos de los fármacosRESUMEN
To provide guidance to clinicians about best practices, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for prevention and treatment of acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema. These guidelines present the main prophylactic and therapeutic modalities for each disorder and provide recommendations about their role in disease management. Recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks/burdens according to criteria put forth by the American College of Chest Physicians. The guidelines also provide suggested approaches to prevention and management of each disorder that incorporate these recommendations. This is an updated version of the original WMS Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness published in Wilderness & Environmental Medicine 2010;21(2):146-155.
Asunto(s)
Mal de Altura/prevención & control , Edema Encefálico/prevención & control , Pautas de la Práctica en Medicina , Edema Pulmonar/prevención & control , Medicina Silvestre , Mal de Altura/terapia , Edema Encefálico/terapia , Humanos , Montañismo , Edema Pulmonar/terapia , Sociedades Médicas , Medicina Silvestre/normasRESUMEN
The Wilderness Medical Society convened an expert panel to develop a set of evidence-based guidelines for the prevention and treatment of frostbite. We present a review of pertinent pathophysiology. We then discuss primary and secondary prevention measures and therapeutic management. Recommendations are made regarding each treatment and its role in management. These recommendations are graded on the basis of the quality of supporting evidence and balance between the benefits and risks or burdens for each modality according to methodology stipulated by the American College of Chest Physicians. This is an updated version of the original guidelines published in Wilderness & Environmental Medicine 2011;22(2):156-166.
Asunto(s)
Congelación de Extremidades/clasificación , Congelación de Extremidades/terapia , Pautas de la Práctica en Medicina , Medicina Silvestre , Congelación de Extremidades/fisiopatología , Congelación de Extremidades/prevención & control , Humanos , Sociedades Médicas , Medicina Silvestre/normasRESUMEN
To provide guidance to clinicians, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of accidental hypothermia. The guidelines present the main diagnostic and therapeutic modalities and provide recommendations for the management of hypothermic patients. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according the criteria published by the American College of Chest Physicians. The guidelines also provide suggested general approaches to the evaluation and treatment of accidental hypothermia that incorporate specific recommendations.
Asunto(s)
Hipotermia/diagnóstico , Hipotermia/terapia , Medicina Silvestre/métodos , Accidentes , Atención Ambulatoria/métodos , Avalanchas , Temperatura Corporal , Medicina de Emergencia/métodos , Práctica Clínica Basada en la Evidencia , Hipotermia/fisiopatología , Pautas de la Práctica en Medicina , Trabajo de Rescate/métodos , Índice de Severidad de la Enfermedad , Tiritona , Sociedades MédicasRESUMEN
To provide guidance to clinicians, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of accidental hypothermia. The guidelines present the main diagnostic and therapeutic modalities and provide recommendations for the management of hypothermic patients. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according the criteria published by the American College of Chest Physicians. The guidelines also provide suggested general approaches to the evaluation and treatment of accidental hypothermia that incorporate specific recommendations. This is an updated version of the original Wilderness Medical Society Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia published in Wilderness & Environmental Medicine 2014;25(4):425-445.
Asunto(s)
Hipotermia/diagnóstico , Hipotermia/terapia , Pautas de la Práctica en Medicina , Medicina Silvestre/métodos , Humanos , Hipotermia/fisiopatología , Montañismo , Sociedades Médicas , Medicina Silvestre/normasRESUMEN
BACKGROUND: Altitude sojourns increasingly attract individuals of all ages and different health statuses due to the appeal of high-altitude destinations worldwide and easy access to air travel. The risk of acute mountain sickness (AMS) when flying to high-altitude destinations remains underemphasized. Thus, this review aims to evaluate the altitude-dependent AMS incidence depending on the mode of ascending, e.g. by air vs terrestrial travel. METHODS: A literature search was performed to identify the observational studies assessing AMS incidence after acute ascent of primarily healthy adults to real high altitude. In addition, placebo arms of interventional trials evaluating the prophylactic efficacy of various drugs have been separately analysed to confirm or refute the findings from the observational studies. Linear regression analyses were used to evaluate the altitude-dependent AMS incidence. RESULTS: Findings of 12 observational studies, in which the AMS incidence in 11 021 individuals ascending to 19 different altitudes (2200-4559 m) was evaluated, revealed an impressive 4.5-fold steeper increase in the AMS incidence for air travel as compared with slower ascent modes, i.e. hiking or combined car and/or air travel and hiking. The higher AMS incidence following transportation by flight vs slower means was also confirmed in placebo-treated participants in 10 studies of drug prophylaxis against AMS. CONCLUSIONS: Due to the short time span in going from low to high altitude, reduced acclimatization likely is the main reason for a higher AMS risk when travelling to high-altitude destinations by flight. To avoid frustrating travel experiences and health risks, appropriate and timely medical advice on how to prepare for air travel to high altitude is of vital importance. Effective preparation options include the use of modern pre-acclimatization strategies and pharmacological prophylaxis by acetazolamide or dexamethasone, or even considering alternate itineraries with more gradual ascent.
Asunto(s)
Viaje en Avión , Mal de Altura , Adulto , Humanos , Mal de Altura/epidemiología , Mal de Altura/prevención & control , Altitud , Enfermedad Aguda , Acetazolamida/uso terapéuticoRESUMEN
The Wilderness Medical Society convened an expert panel to develop a set of evidence-based guidelines for the prevention and treatment of frostbite. We present a review of pertinent pathophysiology. We then discuss primary and secondary prevention measures and therapeutic management. Recommendations are made regarding each treatment and its role in management. These recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks/burdens for each modality according to methodology stipulated by the American College of Chest Physicians.
Asunto(s)
Medicina Basada en la Evidencia/normas , Congelación de Extremidades/prevención & control , Congelación de Extremidades/terapia , Medicina Ambiental , Congelación de Extremidades/clasificación , Congelación de Extremidades/fisiopatología , Humanos , Sociedades MédicasRESUMEN
To provide guidance to clinicians about best practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the prevention and treatment of acute mountain sickness (AMS), high altitude cerebral edema (HACE), and high altitude pulmonary edema (HAPE). These guidelines present the main prophylactic and therapeutic modalities for each disorder and provide recommendations for their roles in disease management. Recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks/burdens according to criteria put forth by the American College of Chest Physicians. The guidelines also provide suggested approaches to the prevention and management of each disorder that incorporate these recommendations.
Asunto(s)
Mal de Altura/prevención & control , Mal de Altura/terapia , Montañismo , Medicina Silvestre/normas , Acetazolamida/uso terapéutico , Enfermedad Aguda , Albuterol/análogos & derivados , Albuterol/uso terapéutico , Edema Encefálico/prevención & control , Edema Encefálico/terapia , Carbolinas/uso terapéutico , Dexametasona/uso terapéutico , Humanos , Nifedipino/uso terapéutico , Piperazinas/uso terapéutico , Edema Pulmonar/prevención & control , Edema Pulmonar/terapia , Purinas/uso terapéutico , Xinafoato de Salmeterol , Citrato de Sildenafil , Sociedades , Sulfonas/uso terapéutico , TadalafiloRESUMEN
Berger, Marc Moritz, Peter H. Hackett, and Peter Bärtsch. No relevant analogy between COVID-19 and acute mountain sickness. High Alt Med Biol. 21:315-318, 2020.-Clinicians and scientists have suggested therapies for coronavirus disease-19 (COVID-19) that are known to be effective for other medical conditions. A recent publication suggests that pathophysiological mechanisms underlying acute mountain sickness (a syndrome of nonspecific neurological symptoms typically experienced by nonacclimatized individuals at altitudes >2500 m) may overlap with the mechanisms causing COVID-19. In this short review, we briefly evaluate this mistaken analogy and demonstrate that this concept is not supported by scientific evidence.
Asunto(s)
Mal de Altura , Tratamiento Farmacológico de COVID-19 , COVID-19 , Eritropoyetina , Enfermedad Aguda , Mal de Altura/complicaciones , Mal de Altura/tratamiento farmacológico , Enzima Convertidora de Angiotensina 2/metabolismo , COVID-19/complicaciones , Eritropoyetina/uso terapéutico , Humanos , Hipoxia/complicaciones , Inflamación/complicaciones , SARS-CoV-2 , Evaluación de SíntomasRESUMEN
Background: Genetic testing for pedigree accuracy is critical for managing genetic diversity in North American (NA) yak ( Bos grunniens), a population expanded mostly from imported zoological park specimens. DNA testing also enhances species conservation by identifying recent B. taurus F1 hybrid ancestors (within three generations). Biallelic single nucleotide polymorphisms (SNPs) can accomplish either task, but increases the marker count and costs necessary to achieve both. Our aim was to identify novel, multifunctional, triallelic yak SNPs (tySNPs), with each having two alleles for yak parentage testing, and a third allele for identifying recent cattle introgression. Methods: Genome sequences were aligned to the cattle UMD3.1 assembly and SNPs were screened for 1) heterozygosity in a NA and a Chinese yak, 2) a third allele at high frequency in cattle, and 3) flanking sequences conserved in both species. Subsequently, tySNPs were filtered for unique alignment to the haplotype-resolved F1 yak assembly. Allele frequencies were estimated in a subset of 87 tySNPs by genotyping 170 NA yak. Results: We identified 610 autosomal tySNPs, distributed in 441 clusters with 5 Mb average genome spacing. The average NA yak minor allele frequency was high (0.296), while average introgressed cattle alleles were low (0.004). In simulations with tySNPs, 28 were sufficient for globally-unique animal identification (P I=5.81x10 -12), 87 were able to exclude 19 random bulls from parentage at the 99% level without using the dam's genotype (P E=5.3x10 -4), and 87 were able to detect F1 hybridization events after three generations of yak backcrosses (1/16th B. taurus germplasm). Conclusions: Identifying animals, determining parentage and detecting recent hybridization events was efficient with as few as 87 tySNPs. A similar triallelic approach could be used with other bottlenecked Bos species that hybridize with cattle, such as NA plains bison ( B. bison).
Asunto(s)
ADN , Polimorfismo de Nucleótido Simple , Animales , Bovinos/genética , Frecuencia de los Genes , Genotipo , Haplotipos , Masculino , Estados UnidosRESUMEN
BACKGROUND: The development of trio binning as an approach for assembling diploid genomes has enabled the creation of fully haplotype-resolved reference genomes. Unlike other methods of assembly for diploid genomes, this approach is enhanced, rather than hindered, by the heterozygosity of the individual sequenced. To maximize heterozygosity and simultaneously assemble reference genomes for 2 species, we applied trio binning to an interspecies F1 hybrid of yak (Bos grunniens) and cattle (Bos taurus), 2 species that diverged nearly 5 million years ago. The genomes of both of these species are composed of acrocentric autosomes. RESULTS: We produced the most continuous haplotype-resolved assemblies for a diploid animal yet reported. Both the maternal (yak) and paternal (cattle) assemblies have the largest 2 chromosomes in single haplotigs, and more than one-third of the autosomes similarly lack gaps. The maximum length haplotig produced was 153 Mb without any scaffolding or gap-filling steps and represents the longest haplotig reported for any species. The assemblies are also more complete and accurate than those reported for most other vertebrates, with 97% of mammalian universal single-copy orthologs present. CONCLUSIONS: The high heterozygosity inherent to interspecies crosses maximizes the effectiveness of the trio binning method. The interspecies trio binning approach we describe is likely to provide the highest-quality assemblies for any pair of species that can interbreed to produce hybrid offspring that develop to sufficient cell numbers for DNA extraction.