Spring 07 front cover - United States Special Operations Command

Acute Mountain Sickness: Influence of Fluid IntakeMaria Antonia Nerín, MD; Jorge Palop, MD; Juan Antonio Montaño, MD; José Ramón Morandeira, MD; ManuelVázquez, RNWilderness and Environmental Medicine: Vol. 17, No. 4, pp. 215–220.Objective: High altitude and exposure to cold are associated with significant levels of dehydration becauseof cold-altitude urine output, high energy expenditures, and poor access to water. The aims of the present study wereto measure the fluid intake and urine output among military mountaineers during their stay at high altitude and to studythe level of fluid intake and decrease in urine output in relation with acute mountain sickness (AMS). Methods: Thisstudy used an analytic prospective follow-up design of hydration-dehydration conditions of a group of mountaineerswith similar characteristics (military group). Data collected each day included quantity and type of fluid intake, urineoutput in 24 hours, other fluid output (as diarrhea or vomiting), and symptoms or signs of AMS according to the LakeLouise consensus score. Values are given as mean ± SE. A 1-factor analysis of variance procedure and t test were usedto compare variables. Results: The mountaineers consumed a variety of fluids, including water, tea, coffee, soup,Isostar, and milk. Daily fluid intake was 2800 ± 979 mL, with a maximum intake of 4700 mL. Daily urine output was1557 ± 758 mL. When we stratify our sample at the median by fluid intake, a significant correlation is detected withmean balance and mean urine output. Mountaineers developing AMS demonstrated reduced urine output (mean 1336mL) when compared with those without AMS (mean 1655 mL). Conclusions: We found that fluid intake was associatedbut insignificantly correlated with incidence and degree of AMS. Past research suggests that vigorous hydrationdecreases incidence and severity of AMS and other altitude illnesses. Our results also imply that aggressivefluid intake is protective, but our limited sample size yielded insufficient power to demonstrate a statistically significantdifference.Key Words: altitude sickness, dehydration, preventionVenomous Adversaries: A Reference to Snake Identification, Field Safety, and Bite-Victim First Aid for Disaster-Response Personnel Deploying Into the Hurricane-Prone Regions of North AmericaEdward J. Wozniak, DVM, PhD; John Wisser, MS; Michael Schwartz, MDWilderness and Environmental Medicine: Vol. 17, No. 4, pp. 246–266.Each hurricane season, emergency-preparedness deployment teams including but not limited to the Office ofForce Readiness and Deployment of the U.S. Public Health Service, Federal Emergency Management Agency, DeploymentMedical Assistance Teams, Veterinary Medical Assistance Teams, and the U.S. Army and Air Force NationalGuard are at risk for deploying into hurricane-stricken areas that harbor indigenous hazards, including those posed byvenomous snakes. North America is home to 2 distinct families of venomous snakes: 1) Viperidae, which includes therattlesnakes, copperheads, and cottonmouths; and 2) Elapidae, in which the only native species are the coral snakes.Although some of these snakes are easily identified, some are not, and many rank among the most feared and misunderstoodanimals. This article specifically addresses all the native species of venomous snakes that inhabit the hurricane-proneregions of North America and is intended to serve as a reference to snake identification, basic field safetyprocedures, and the currently recommended first-aid measures for snakebite casualties.Key Words: snakes, snakebite, envenomation, hurricanes, snake identification86Journal of Special Operations Medicine Volume 8, Edition 2 / Spring 08