Unilateral Facial Palsy at High Altitude: A Case Report.

Poudel Sangeeta, Bibechan Thapa, Saroj Adhikari Yadav, and Brenton Systermans. Unilateral facial palsy at high altitude: a case report. High Alt Med Biol. 22:426-428, 2021.-The facial nerve has a long and tortuous route predisposing it to palsy or paresis. Bell's palsy is the most common cause of facial nerve palsy. Most often Bell's palsy is self-limited but it is very crucial to rule out other causes and provide prompt treatment accordingly. Some causes of facial palsy that are specific to high altitude include hypoxia, cold weather, vitamin D deficiency, and high-altitude cerebral edema. Health facilities and diagnostic tools are compromised in resource-limited settings such as at high altitudes. This leads to a diagnostic dilemma, possibly delaying targeted treatment, and resulting in poorer outcomes. Clinical diagnosis plays an important role in such settings. The immediate descent and initiation of steroids improve the condition in many cases. In this article, we discuss the case of a Sherpa who presented to the Everest emergency clinic during the 2021 climbing season with unilateral facial palsy.

Helmets for snow sports: prevalence, trends, predictors and attitudes to use.

BACKGROUND: Traumatic head injury is the leading cause of mortality and serious morbidity in snow sports and is increasing in incidence. Helmet use in snow sports can reduce the incidence of head injury by up to 60%. Mandatory helmet use is not legislated in most recreational settings for snow sports. This study aimed to quantify the prevalence and trends of helmet use by skiers and snowboarders as well as to investigate predictors of helmet use and reasons why they are worn. METHODS: A cross-sectional study including observation of skiers and snowboarders allocated to adult and child groups (5,267 persons), retrospective review of ski patrol accident report forms recorded between 2003 and 2008 (3,984), and completion of specially designed questionnaires by randomly approached snow sport participants (1,029). RESULTS: In 2008, 16% of adults and 67% of children wore helmets. Helmet use increased for adult and child participants between 2003 and 2008. Children, men, and snowboarders were significantly more likely to wear a helmet than their respective counterparts. Significant predictors of helmet use were level of experience, past major crash requiring medical assistance, snow sport lessons, and location of activity. Key reasons for helmet use and disuse were identified. DISCUSSION: Child helmet use far exceeded adult helmet use. Rates of voluntary helmet use are increasing but many remain unprotected from the benefits of a helmet. Identification of the snow sport participants least likely to wear a helmet and their reasons for not doing so should allow targeted helmet promotion and injury prevention strategies to reduce serious head injuries in snow sports.

What to Expect Working as a Doctor at a High-Altitude Aid Post.

Over the past 40 years, in an attempt to reduce the morbidity and mortality of altitude illness, a number of volunteer-run, seasonal aid posts have been established at mountain ranges across the world. As each aid post is designed for the local population and tourists at hand, the range of problems seen and services offered vary accordingly. Although each clinic differs on its funding model, the services it offers, how it is staffed, and the interventions available, there are key similarities between each of these clinics. For physicians preparing to travel from their home country to volunteer at such aid posts, there are important preparations that need to be made before embarking on such endeavors. This article describes how to prepare for such work, what to expect, and some of the challenges that one might face.

Computed tomography in acute abdominal pain: an overused investigation?

BACKGROUND: The use of computed tomography (CT) for the evaluation of patients presenting to the emergency department (ED) with acute abdominal pain has increased. We set out to investigate its effectiveness. METHODS: A prospective study conducted at a tertiary referral centre between August and September 2012, utilizing a questionnaire completed by the ordering doctors. Patients with acute abdominal pain who underwent an abdominal CT scan were included in the study, excluding those with a history of recent abdominal trauma or abdominal, pelvic, groin or scrotal surgery. RESULTS: Of the 260 patients undergoing an abdominal CT scan for the investigation of acute abdominal pain, 60 had questionnaires completed. Fifty-seven per cent of abdominal CT scans were ordered by an ED registrar or consultant. Sixty-five per cent of patients were not discussed with the surgical team prior to ED staff ordering the CT scan. 'To confirm clinical suspicion' and 'to rule out sinister aetiology' were the most important reasons for ordering an abdominal CT. In 54% of cases, there was a change in primary diagnosis post CT scan and in 50% of patients, a change in disposition. Diagnostic confidence in the primary diagnosis did not change significantly post-CT scan. There was no significant difference between which group ordered a CT scan and the probability that the scan showed nil acute pathology. DISCUSSION: Abdominal CT scans frequently changed the clinical diagnosis and patient disposition. Twenty-three per cent of patients had no identifiable cause on CT scan for their acute abdominal pain.