The use of e-learning in medical education for mountain rescuers concerning hypothermia

Objective: Victims of mountain accidents are often exposed to wet and cold environments which may increase the risk of hypothermia. Mountain rescuers should be able to recognize and manage hypothermia. We aimed to assess relevant knowledge in professional and volunteer mountain rescuers, as well as to evaluate the efficacy of an e-learning platform for continuing medical education. Methods: An e-learning platform was developed to provide access to updated information about hypothermia. Volunteer and professional mountain rescuers participated in an e-learning course. Pretest, post-test, and specific lesson test scores were compared. After 1 year, a follow-up course was performed. Results: In total, 187 rescuers, comprising 136 (72.7%) volunteers and 51 (27.3%) professionals, were enrolled. Ahead of the course, no difference in knowledge was found between professionals and volunteers. After the course, one's knowledge of hypothermia increased significantly (p < 0.001). The scores achieved in the field management of hypothermia were better among professional rescuers than among volunteer rescuers (p = 0.003), whereas in post-traumatic hypothermia half of the results were insufficient in both groups. Moreover, 57 rescuers repeated the course after 12 months. While professionals partially retained the achieved level of knowledge, the volunteers had dropped back to their initial level. Conclusions: The e-learning course increased the knowledge of hypothermia among mountain rescuers. The poor retention after 1 year indicates that the interval between lectures should be reduced. An e-learning platform is an effective tool for the medical education of mountain rescuers

Artifacts in fluoroscopy and changes in radiation dose caused by heating blankets and insulating covers during simulated endovascular treatment

Purpose We aimed to assess whether insulating covers and warming systems cause artifacts in fluoroscopy, and whether they alter the radiation dose. Methods Eight insulating and warming systems were wrapped around the phantom in order to obtain images in fluoroscopy, and to measure the absorbed and scattered radiation dose. A dosimeter, endovascular catheters, and stents were placed into a phantom. The other dosimeter was placed outside of a C-arm table, at the operator’s and anesthesiologist’s locations. Results Most of the insulating covers did not cause artifacts in the fluoroscopy and led to a significant decrease in both the absorbed and scattered radiation dose. The highest decrease in the absorbed dose was observed with metalized foil (− 2.09%; p = 0.001) and in the scattered dose with Helios cover (− 55%; p < 0.001). Only one heating system (Ready Heat combined with Hypothermia Prevention and Management Kit cover) caused significant artifacts and increased radiation up to 99% (p < 0.001). Conclusion Thermal insulation may be maintained during X-ray-guided emergency endovascular procedures in trauma victims. Self-heating blankets should be replaced with another warming system

Food intake changes across the menstrual cycle : a preliminary study

Wprowadzenie. Ostatnie doniesienia wskazują, że zmiana wydzielania hormonów w poszczególnych fazach cyklu u kobiet niestosujących terapii hormonalnej wpływa na ich zachowania żywieniowe. Cel pracy. Ocena zachowań żywieniowych kobiet w poszczególnych fazach cyklu menstruacyjnego w grupie kobiet niestosujących antykoncepcji hormonalnej. Materiał i metody. Do badania wykorzystano kwestionariusz składający się z 2 części. Oceny żywienia dokonano za pomocą wywiadu o spożyciu z 24 godzin. Obliczono dzienną podaż energetyczną diety (kcal) oraz zawartość białka, tłuszczu, węglowodanów i sacharozy (g, %). Grupę badaną stanowiły studentki jednej ze szkół wyższych. Do badania włączono 77 kobiet mających regularny cykl menstruacyjny. Kryterium wykluczenia z badania było przyjmowanie każdego rodzaju doustnej antykoncepcji hormonalnej, jakichkolwiek leków stosowanych w leczeniu chorób przewlekłych, zaburzenia odżywiania oraz brak zgody na udział w badaniu. Wyniki. Mediana podaży energii ze składników odżywczych była najwyższa w fazie lutealnej. W tej fazie zaobserwowano również najwyższe (mediana) spożycie białka, tłuszczu, węglowodanów i sacharozy. Procentowy udział energii pochodzącej z białka był najniższy w fazie lutealnej, a najwyższy w fazie folikularnej. Z kolei procentowy udział energii pochodzącej z sacharozy był najwyższy w fazie lutealnej i znacząco przewyższał udział energii z tego składnika w fazie owulacyjnej. Wnioski. Zachowania żywieniowe mogą być kształtowane przez hormony wydzielane podczas cyklu menstruacyjnego. Wzrost apetytu zaobserwowano w fazie lutealnej. Wartość energetyczna diety oraz spożycie tłuszczu, węglowodanów i białka ulega wahaniom w trakcie cyklu menstruacyjnego. Spożycie tłuszczu, białek, węglowodanów i sacharozy było najwyższe w fazie lutealnej.Background. Recent studies have reported that hormonal changes during the menstrual cycle in women who do not receive hormonal therapy have a significant influence on their eating habits. Objectives. The aim of this study was to evaluate the eating habits of women not receiving hormonal contraception in relation to menstrual cycle phases. Material and methods. A two-part survey questionnaire was used as a study tool. Eating habits were analyzed with a 24-hour dietary recall questionnaire. The following macronutrients were calculated: daily energy value (kcal), and amounts (g, %) of protein, fat, carbohydrates, and sucrose. The study group comprised 77 college students with regular menstrual cycles. Exclusion criteria included the use of any oral contraceptive, the use of medication for any chronic disease, any eating disorder, and a lack of written informed consent. Results. The median total energy intake from macronutrients was highest during the luteal phase. Median protein, fat, carbohydrate, and sucrose intake were also highest during the luteal phase. The percentage of energy intake from protein was lowest during the luteal phase and highest during the follicular phase. The percentage of energy intake from sucrose was highest during the luteal phase, which was significantly greater than that during the ovulation phase. Conclusions. Eating habits could be influenced by hormone secretion throughout the menstrual cycle. Increased appetite was observed in the luteal phase. Total energy, fat, carbohydrate, and protein intake fluctuated across the menstrual cycle. Fat, protein, carbohydrate, and sucrose intake were highest in the luteal phase

Efficacy of warming systems in mountain rescue : an experimental manikin study

Mountain accident casualties are often exposed to cold and windy weather. This may induce post-traumatic hypothermia which increases mortality. The aim of this study was to assess the ability of warming systems to compensate for the victim’s estimated heat loss in a simulated mountain rescue operation. We used thermal manikins and developed a thermodynamic model of a virtual patient. Manikins were placed on a mountain rescue stretcher and exposed to wind chill indices of 0 °C and - 20 °C in a climatic chamber. We calculated the heat balance for two simulated clinical scenarios with both a shivering and non-shivering victim and measured the heat gain from gel, electrical, and chemical warming systems for 3.5 h. The heat balance in the simulated shivering patient was positive. In the non-shivering patient, we found a negative heat balance for both simulated weather conditions (- 429.53 kJ at 0 °C and -1469.78 kJ at - 20 °C). Each warming system delivered about 300 kJ. The efficacy of the gel and electrical systems was higher within the first hour than later (p < 0.001). We conclude that none of the tested warming systems is able to compensate for heat loss in a simulated model of a non-shivering patient whose physiological heat production is impaired during a prolonged mountain evacuation. Additional thermal insulation seems to be required in these settings

Diagnosis and treatment of post-traumatic hypothermia in hospitals : a pilot study

Background: An unintentional drop in core body temperature of trauma victims is associated with increased mortality. Thermoregulation is impaired in these patients, especially when treated with opioids or anesthetics. Careful thermal insulation and active warming are necessary to maintain normothermia. The aim of the study was to assess the equipment and procedures for diagnosing and managing post-traumatic hypothermia in Polish hospitals. Methods: Survey forms regarding equipment and procedures on monitoring of core temperature (Tc) and active warming were distributed to every hospital that admits trauma victims in the Holy Cross Province. Questionnaires were addressed to surgery departments, intensive care units (ICUs), and operating rooms (ORs). Results: 92% of surgery departments did not have equipment to measure core body temperature and 85% did not have equipment to rewarm patients. Every ICU had equipment to measure Tc and 83% had active warming devices. In 50% of ICUs, there were no rewarming protocols based on Tc and the initiation of rewarming was left to the physician’s discretion. In 58% of ORs, Tc was not monitored and in 33% the patients were not actively warmed. Conclusions: The majority of surveyed ICUs and ORs are adequately equipped to identify and treat hypothermia, however the criteria for initiating Tc monitoring and rewarming remain unstandardized. Surgery departments are not prepared to manage post-traumatic hypothermia

Severe hypothermia management in mountain rescue : a survey study

Introduction: Severe hypothermia is a rare but demanding medical emergency. Although mortality is high, if well managed, the neurological outcome of survivors can be excellent. The aim of the study was to assess whether mountain rescue teams (MRTs) are able to meet the guidelines in the management of severe hypothermia, regarding their equipment and procedures. Methods: Between August and December 2016, an online questionnaire, with 24 questions to be completed using Google Forms, was sent to 123 MRTs in 27 countries. Results: Twenty-eight MRTs from 10 countries returned the completed questionnaire. Seventy-five percent of MRTs reportedly provide advanced life support (ALS) on-site and 89% are regularly trained in hypothermia management. Thirty-two percent of MRTs transport hypothermic patients in cardiac arrest to the nearest hospital instead of an Extracorporeal Life Support facility; 39% are equipped with mechanical chest compression devices; 36% measure core body temperature on-site and no MRT is equipped with a device to measure serum potassium concentration on-site in avalanche victims. Conclusions: Most MRTs are regularly trained in the treatment of severe hypothermia and provide ALS. The majority are not equipped to follow standard procedural guidelines for the treatment of severely hypothermic patients, especially with cardiac arrest. However, the low response rate—23% (28/123)—could have induced a bias