Measurements of rates of cooling of a manikin insulated with different mountain rescue casualty bags

Background: Accidental hypothermia is common in those who sustain injuries in remote environments. This is unpleasant and associated with adverse effects on subsequent patient outcomes. To minimise further heat loss, a range of insulating systems are available to mountain rescue teams although the most effective and cost-efficient have yet to be determined. Methods: Under ambient, still, dry, air conditions, a thermal manikin was filled with water at a temperature of 42 °C and then placed into a given insulation system. Water temperature was then continuously observed via an in-dwelling temperature sensor linked to a PROPAQ 100 series monitor and recorded every 10 min for 130 min. This method was repeated for each insulating package. Results: The vacuum mattress/Pertex©/fibrepile blanket system, either on its own or coupled with the Wiggy bag, was the most efficient with water temperatures only decreasing by 3.2 °C over 130 min. This was followed by the heavy-weight casualty bags without the vacuum mattress/Pertex©/fibrepile blanket system, decreasing by 4.2–4.3 °C. With the Blizzard bag, a decline in water temperature of 5.4 °C was seen over the study duration while a decrease of 9.5 °C was noted when the plastic survival bag was employed. Conclusions: Under the still-air conditions of the study, the vacuum mattress/Pertex©/fibrepile blanket was seen to offer comparable insulation effectiveness compared to be both heavy-weight casualty bags. In turn, these three systems appeared more efficient at insulating the manikin than the Blizzard bag or plastic survival bag

Abnormal blood flow in the sublingual microcirculation at high altitude

We report the first direct observations of deranged microcirculatory blood flow at high altitude, using sidestream dark-field imaging. Images of the sublingual microcirculation were obtained from a group of 12 volunteers during a climbing expedition to Cho Oyu (8,201 m) in the Himalayas. Microcirculatory flow index (MFI) was calculated from the moving images of microcirculatory red blood cell flow, and comparison was made between the baseline and high altitude measurements. Peripheral oxygen saturation (SpO2) and Lake Louise scores (LLS) were recorded along with MFI. Our data demonstrate that there was a significant reduction in MFI from baseline to 4,900 m in small (less than 25 μm) and medium (26–50 μm) sized blood vessels (P = 0.025 and P = 0.046, respectively). There was no significant correlation between MFI and SpO2 or MFI and LLS. Disruption of blood flow within microcirculatory may explain persistent abnormal oxygen flux to tissues following the normalisation of systemic oxygen delivery that accompanies acclimatisation to high altitude

Scaling maximal oxygen uptake to predict cycling time-trial performance in the field: a non-linear approach.

The purpose of the present article is to identify the most appropriate method of scaling VO2max for differences in body mass when assessing the energy cost of time-trial cycling. The data from three time-trial cycling studies were analysed (N = 79) using a proportional power-function ANCOVA model. The maximum oxygen uptake-to-mass ratio found to predict cycling speed was VO2max(m)(-0.32) precisely the same as that derived by Swain for sub-maximal cycling speeds (10, 15 and 20 mph). The analysis was also able to confirm a proportional curvilinear association between cycling speed and energy cost, given by (VO2max(m)(-0.32))0.41. The model predicts, for example, that for a male cyclist (72 kg) to increase his average speed from 30 km h(-1) to 35 km h(-1), he would require an increase in VO2max from 2.36 l min(-1) to 3.44 l min(-1), an increase of 1.08 l min(-1). In contrast, for the cyclist to increase his mean speed from 40 km h(-1) to 45 km h(-1), he would require a greater increase in VO2max from 4.77 l min(-1) to 6.36 l min(-1), i.e. an increase of 1.59 l min(-1). The model is also able to accommodate other determinants of time-trial cycling, e.g. the benefit of cycling with a side wind (5% faster) compared with facing a predominately head/tail wind (P<0.05). Future research could explore whether the same scaling approach could be applied to, for example, alternative measures of recording power output to improve the prediction of time-trial cycling performance