Env: Mountain Inj

Mountaineering Injuries

General Principles

1. Falling, sliding, tripping, improper equipment use most common causes of blunt and penetrating trauma
   • Falls are the most common mechanism of injury
   • Young men are affected mostly
   • Extremities are most commonly injured body part
   • Multisystem climbing-related trauma affects predominately the head/neck, chest and abdomen
   • Sprains, strains most common, followed by soft-tissue injuries
   • Fractures and dislocations < 5% of all injuries
   • Lightning strikes, animal trauma rare
2. ACLS, trauma for general diagnosis and management

Treatment

1. Wounds
   • Contusions
     • Cold compresses, cold water immersion first 48 hr, 20-30 min at a time
     • After 72hr, apply heat (not topical) to increase blood flow, promote healing
     • Splint for comfort
     • Consider fracture if large hematoma near joint
   • Subungual hematomas
     • Drain with hot paper clip or needle
   • Abrasions
     • Clean with soap and water, or surgical scrub
     • Copious irrigation
     • Dress with topical antimicrobial, dry dressing
   • Lacerations and avulsions
     • Inspect and remove debris
     • Irrigate with potable water using syringe and needle or IV catheter, or improvised, water-filled bag with small hole at bottom
     • Pack heavily contaminated with wet-to-dry dressings
       • consider evacuation
     • Splint if large or over joint
     • Minor wounds closed with tape, steri-strips, tissue glue, staples, or suture
     • Consider antibiotics, tetanus
   • Burns
     • Assess depth, extent, pain
     • Superficial: clean, remove skin of ruptured blisters, antibiotics ointment, cover with biologic dressing, non-adherent gauze, or dry cloth
     • Redress DAILY
     • Consider evacuation for partial or full-thickness burns >15% TBSA, serious facial burn, electrical or chemical
2. Orthopedic injuries (see also orthopedic)
   • In wilderness, may need to improvise (fracture/dislocation improvisation), make patient as functional as possible by allowing some assisted weight-bearing with stick, ice pick, ski pole
   • Urgent evacuation for open fractures, vascular compromise, significant blood loss
3. Eye injury
   • Globe injury: shield, oral antibiotics, evacuate
   • Corneal abrasion: bacitracin QID; cycloplegic, topical, anti-inflammatory (ketorolac 0.5%, diclofenac 0.1%), oral narcotics for larger, more painful abrasions
   • Fluorescein and cobalt blue light can help differentiate between occult open globe and other eye trauma
   • Patching not been proven to speed healing, but may provide some pain relief; remove after 24 hr
   • DDx: solar radiation, traumatic iritis, subconjunctival hemorrhage, conjunctivitis
4. Spinal injury
   • Some degree of immobilization for any patient with signs/symptoms (see cervical spine injury)
   • Full immobilization dependent on degree of difficulty evacuating, dangers posed to patient and rescuers
   • Can be cleared if
     • No posterior tenderness
     • Minimal pain on active ROM (and no distracting injury)
     • Normal MS, normal motor, and sensory exam
5. Head injury (see blunt head trauma)
   • Low risk: may be able to continue travel if LOC brief, normal MS, no neuro deficit, mild HA only
   • Consider evacuation for all others, spinal immobilization to degree practical for wilderness setting
6. Torso: abdomen, chest, or back
   • See specific injury section
   • Treat and evacuate to the degree practical for wilderness setting

References

1. Clarke C. Endeavour, altitude and risk: reflections on a lifetime of mountaineering and exploration. J Med Biogr. 2012;20(3):130-135
2. Knott JW. Causes of injuries in the mountains: a review of worldwide reports into accidents in mountaineering. J R Army Med Corps. 2011;157(1):92-99
3. McIntosh SE, Campbell A, Weber D, Dow J, Joy E, Grissom CK. Mountaineering medical events and trauma on Denali, 1992-2011. High Alt Med Biol. 2012;13(4):275-280
4. Platts-Mills TF, Hunold KM. Increase in older adults reporting mountaineering-related injury or illness in the United States, 1973-2010. Wilderness Environ Med. 2013;24(1):86-88
5. Schoffl V, Morrison A, Hefti U, Ullrich S, Kupper T. The UIAA Medical Commission injury classification for mountaineering and climbing sports. Wilderness Environ Med. 2011;22(1):46-51
6. Schoffl V, Morrison A, Schoffl I, Kupper T. The epidemiology of injury in mountaineering, rock and ice climbing. Med Sport Sci. 2012;58:17-43
7. Steffen R, Suter C, Patricia F, Lars O, Michael T, Stephan B. Multi-slice computed tomography (MSCT) of mountaineering casualties in the Swiss Alps - Advantages and limitations. Leg Med (Tokyo). 2010;12(6):271-275
8. Treibel W. [Injuries and overuse syndromes in hiking and mountaineering]. MMW Fortschr Med. 2009;151(11):33-37

1. Singh, Ajaydeep, MD