Humans evolved at sea level and with the exception of the high-altitude populations of Central As... more Humans evolved at sea level and with the exception of the high-altitude populations of Central Asia and South America (who have adapted over many generations to the rarefied air) are poorly suited to high altitude. The most significant problem is hypobaric hypoxia (low oxygen levels as a result of a reduced barometric pressure), but cold, wind, reduced humidity, increased ultraviolet radiation and a paucity of flora, fauna and readily available drinking water make this a challenging environment.
Advances in Experimental Medicine and Biology, 2016
The Caudwell Xtreme Everest (CXE) expedition in the spring of 2007 systematically studied 222 hea... more The Caudwell Xtreme Everest (CXE) expedition in the spring of 2007 systematically studied 222 healthy volunteers as they ascended from sea level to Everest Base Camp (5300 m). A subgroup of climbing investigators ascended higher on Everest and obtained physiological measurements up to an altitude of 8400 m. The aim of the study was to explore inter-individual variation in response to environmental hypobaric hypoxia in order to understand better the pathophysiology of critically ill patients and other patients in whom hypoxaemia and cellular hypoxia are prevalent. This paper describes the aims, study characteristics, organization and management of the CXE expedition.
ABSTRACT We read with interest the case report by Peter Paal and colleagues (Feb 9, p 506)1 of a ... more ABSTRACT We read with interest the case report by Peter Paal and colleagues (Feb 9, p 506)1 of a 70-year-old man surviving 6 days in a crevasse after a fall while crossing a glacier alone. Unlike the Case Report of successful resuscitation from 13·7°C,2 this climber's core temperature was 33·5°C. The authors speculate that the rescue foil used by the individual might have been a key factor in maintaining body temperature. We concur that heat loss occurs by different mechanisms,3 and that airtight foil will reduce convective and evaporative heat losses from the skin—the most important physical routes of heat loss in a cold environment.
The treatment of cold injuries to the periphery has advanced substantially in the last 10 years a... more The treatment of cold injuries to the periphery has advanced substantially in the last 10 years and optimal outcomes are only likely to be achieved if a multidisciplinary team uses the full range of diagnostic and treatment modalities that are now available. The internet and satellite phones with digital images allow immediate access by patients from remote geographical locations to hospital based specialists who can assess cold injuries and advise on early field care. The severity of frostbite injuries can now be assessed with triple phase bone scanning, allowing early prediction of likely subsequent tissue loss. Early hyperbaric oxygen therapy appears to improve outcome and the use of intravenous drugs such as synthetic prostaglandin analogues infusions and tissue plasminogen activator have been shown to reduce amputation rates. In non-freezing cold injuries the early administration of analgesia, the avoidance of secondary exposure, and the use of infrared thermography to assess the injuries are among newer approaches being introduced.
Everest: an observational cohort study of variation in human adaptation to progressive environmen... more Everest: an observational cohort study of variation in human adaptation to progressive environmental hypoxia
ABSTRACT We read with interest the case report by Peter Paal and colleagues (Feb 9, p 506)1 of a ... more ABSTRACT We read with interest the case report by Peter Paal and colleagues (Feb 9, p 506)1 of a 70-year-old man surviving 6 days in a crevasse after a fall while crossing a glacier alone. Unlike the Case Report of successful resuscitation from 13·7°C,2 this climber's core temperature was 33·5°C. The authors speculate that the rescue foil used by the individual might have been a key factor in maintaining body temperature. We concur that heat loss occurs by different mechanisms,3 and that airtight foil will reduce convective and evaporative heat losses from the skin—the most important physical routes of heat loss in a cold environment.
Humans evolved at sea level and with the exception of the high-altitude populations of Central As... more Humans evolved at sea level and with the exception of the high-altitude populations of Central Asia and South America (who have adapted over many generations to the rarefied air) are poorly suited to high altitude. The most significant problem is hypobaric hypoxia (low oxygen levels as a result of a reduced barometric pressure), but cold, wind, reduced humidity, increased ultraviolet radiation and a paucity of flora, fauna and readily available drinking water make this a challenging environment.
All in-text references underlined in blue are linked to publications on ResearchGate, letting you... more All in-text references underlined in blue are linked to publications on ResearchGate, letting you access and read them immediately.
Oxford Handbook of Expedition and Wilderness Medicine, 2015
The collapsed patient - Medical emergencies - Resuscitation in the wilderness - Basic life suppor... more The collapsed patient - Medical emergencies - Resuscitation in the wilderness - Basic life support (CPR) - Choking - Recovery position - Shock - Management of the shocked patient - Types of shock - Chest pain - Shortness of breath (dyspnoea) - Coma - Headache - Delirium/confusion - Convulsions - Diabetic emergencies - Gastrointestinal bleeding - Fever
Oxford Handbook of Expedition and Wilderness Medicine, 2015
Initial response to an incident - Triage - Assessment of a casualty - Airway - Breathing - Circul... more Initial response to an incident - Triage - Assessment of a casualty - Airway - Breathing - Circulation - Neck and other spinal injuries - Disability - Exposure and environmental control - Secondary survey - Continuing care - Blast injuries - Lightning
Oxford Handbook of Expedition and Wilderness Medicine, 2015
The environment - Heat-related illnesses (HRIs) - Pathophysiology of HRIs - Acclimatization to he... more The environment - Heat-related illnesses (HRIs) - Pathophysiology of HRIs - Acclimatization to heat - Prevention of HRIs - Fluids and electrolytes - Treatment of HRIs - Other heat-related problems
Humans evolved at sea level and with the exception of the high-altitude populations of Central As... more Humans evolved at sea level and with the exception of the high-altitude populations of Central Asia and South America (who have adapted over many generations to the rarefied air) are poorly suited to high altitude. The most significant problem is hypobaric hypoxia (low oxygen levels as a result of a reduced barometric pressure), but cold, wind, reduced humidity, increased ultraviolet radiation and a paucity of flora, fauna and readily available drinking water make this a challenging environment.
Advances in Experimental Medicine and Biology, 2016
The Caudwell Xtreme Everest (CXE) expedition in the spring of 2007 systematically studied 222 hea... more The Caudwell Xtreme Everest (CXE) expedition in the spring of 2007 systematically studied 222 healthy volunteers as they ascended from sea level to Everest Base Camp (5300 m). A subgroup of climbing investigators ascended higher on Everest and obtained physiological measurements up to an altitude of 8400 m. The aim of the study was to explore inter-individual variation in response to environmental hypobaric hypoxia in order to understand better the pathophysiology of critically ill patients and other patients in whom hypoxaemia and cellular hypoxia are prevalent. This paper describes the aims, study characteristics, organization and management of the CXE expedition.
ABSTRACT We read with interest the case report by Peter Paal and colleagues (Feb 9, p 506)1 of a ... more ABSTRACT We read with interest the case report by Peter Paal and colleagues (Feb 9, p 506)1 of a 70-year-old man surviving 6 days in a crevasse after a fall while crossing a glacier alone. Unlike the Case Report of successful resuscitation from 13·7°C,2 this climber's core temperature was 33·5°C. The authors speculate that the rescue foil used by the individual might have been a key factor in maintaining body temperature. We concur that heat loss occurs by different mechanisms,3 and that airtight foil will reduce convective and evaporative heat losses from the skin—the most important physical routes of heat loss in a cold environment.
The treatment of cold injuries to the periphery has advanced substantially in the last 10 years a... more The treatment of cold injuries to the periphery has advanced substantially in the last 10 years and optimal outcomes are only likely to be achieved if a multidisciplinary team uses the full range of diagnostic and treatment modalities that are now available. The internet and satellite phones with digital images allow immediate access by patients from remote geographical locations to hospital based specialists who can assess cold injuries and advise on early field care. The severity of frostbite injuries can now be assessed with triple phase bone scanning, allowing early prediction of likely subsequent tissue loss. Early hyperbaric oxygen therapy appears to improve outcome and the use of intravenous drugs such as synthetic prostaglandin analogues infusions and tissue plasminogen activator have been shown to reduce amputation rates. In non-freezing cold injuries the early administration of analgesia, the avoidance of secondary exposure, and the use of infrared thermography to assess the injuries are among newer approaches being introduced.
Everest: an observational cohort study of variation in human adaptation to progressive environmen... more Everest: an observational cohort study of variation in human adaptation to progressive environmental hypoxia
ABSTRACT We read with interest the case report by Peter Paal and colleagues (Feb 9, p 506)1 of a ... more ABSTRACT We read with interest the case report by Peter Paal and colleagues (Feb 9, p 506)1 of a 70-year-old man surviving 6 days in a crevasse after a fall while crossing a glacier alone. Unlike the Case Report of successful resuscitation from 13·7°C,2 this climber's core temperature was 33·5°C. The authors speculate that the rescue foil used by the individual might have been a key factor in maintaining body temperature. We concur that heat loss occurs by different mechanisms,3 and that airtight foil will reduce convective and evaporative heat losses from the skin—the most important physical routes of heat loss in a cold environment.
Humans evolved at sea level and with the exception of the high-altitude populations of Central As... more Humans evolved at sea level and with the exception of the high-altitude populations of Central Asia and South America (who have adapted over many generations to the rarefied air) are poorly suited to high altitude. The most significant problem is hypobaric hypoxia (low oxygen levels as a result of a reduced barometric pressure), but cold, wind, reduced humidity, increased ultraviolet radiation and a paucity of flora, fauna and readily available drinking water make this a challenging environment.
All in-text references underlined in blue are linked to publications on ResearchGate, letting you... more All in-text references underlined in blue are linked to publications on ResearchGate, letting you access and read them immediately.
Oxford Handbook of Expedition and Wilderness Medicine, 2015
The collapsed patient - Medical emergencies - Resuscitation in the wilderness - Basic life suppor... more The collapsed patient - Medical emergencies - Resuscitation in the wilderness - Basic life support (CPR) - Choking - Recovery position - Shock - Management of the shocked patient - Types of shock - Chest pain - Shortness of breath (dyspnoea) - Coma - Headache - Delirium/confusion - Convulsions - Diabetic emergencies - Gastrointestinal bleeding - Fever
Oxford Handbook of Expedition and Wilderness Medicine, 2015
Initial response to an incident - Triage - Assessment of a casualty - Airway - Breathing - Circul... more Initial response to an incident - Triage - Assessment of a casualty - Airway - Breathing - Circulation - Neck and other spinal injuries - Disability - Exposure and environmental control - Secondary survey - Continuing care - Blast injuries - Lightning
Oxford Handbook of Expedition and Wilderness Medicine, 2015
The environment - Heat-related illnesses (HRIs) - Pathophysiology of HRIs - Acclimatization to he... more The environment - Heat-related illnesses (HRIs) - Pathophysiology of HRIs - Acclimatization to heat - Prevention of HRIs - Fluids and electrolytes - Treatment of HRIs - Other heat-related problems
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