Many health care providers fail to recognize, assess, and treat pain adequately. Assessment scales and treatment protocols should be implemented in mountain rescue services to encourage better management of pain. Specific training in assessing and managing pain is essential for all mountain rescuers. Persons administrating analgesics should receive appropriate detailed training. There is no ideal analgesic that will accomplish all that is expected in every situation. A range of drugs and delivery methods will be needed. Thus, an 'analgesic module' reflecting its users and the environment should be developed. The number of drugs carried should be reduced to a minimum by careful selection and, where possible, utilizing drugs with multiple delivery options. A strong opioid is recommended as the core drug for managing moderate or severe pain; a multimodal approach may provide additional benefits.

BackgroundFew pre-hospital services have the possibility to accurately measure core temperature (Tcore). Non-invasive estimation of Tcore will improve pre-hospital decision-making regarding the triage and management of hypothermic patients. Thermistor-based tympanic temperature (Ttymp) correlates well with Tcore in controlled studies; however, little is known about the feasibility of using Ttymp under field conditions. This study assessed the impact of pre-hospital environmental factors on the accuracy of Ttymp. Deep rectal temperature (Trect) was used as a substitute for Tcore.MethodsNormothermic volunteers (n = 13) were exposed to four simulated field conditions producing local cooling of the head and ear canal. After exposure, Ttymp was recorded every 15 s for 10 min and compared with Trect. Descriptive analysis and Bland-Altman plots were used to assess agreement.ResultsImmediately after exposure mean Ttymp was low, but increased rapidly and reached an apparent steady state after 3–5 min. After 5 and 10 min, the mean temperature difference (∆Trect-tymp) ranged from 1.5–3.2 °C (SD = 0.5) and 1.2–2.0 °C, respectively. Trect remained unchanged throughout the study period.ConclusionsAfter surface cooling of head and neck, Ttymp did not accurately reflect core temperature within the first 10 min of measurement. The variation of ∆Trect-tymp was low after 10 min, regardless of the initial degree of cooling. With the risk of over-triage, Ttymp may at this point provide an indication of Tcore and also exhibit a trend.Trial registrationClinicalTrials.gov: NCT02274597Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-015-0148-5) contains supplementary material, which is available to authorized users.

We report the case of a previously healthy 32-year-old man presenting with severe headache on 2 separate expeditions to Cho Oyu (8201 m). No brain imaging was performed after the first expedition. On the second expedition, thrombosis of the superior sagittal sinus was detected. Investigations for hypercoagulable states, including polycythemia, were negative. He had no neurological symptoms except headache, vomiting, and slight drowsiness. In retrospect, there are strong indications that cerebral thrombosis caused his headache on the first expedition as well. Severe headache occurring at high altitude that persists despite adequate treatment for high-altitude cerebral edema should raise suspicion of a cerebrovascular disorder.

Manual chest compression is possible on a snowmobile during transport even in challenging terrain. This experimental study shows that high-quality chest compressions and manual ventilation can be performed in an intubated patient during a short-term transportation on a sledge.

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