Bio

Clinical Focus

  • Emergency Medicine

Academic Appointments

Administrative Appointments

  • Executive Board Member, American College of Emergency Physicians Section of Wilderness Medicine (2006 - 2014)
  • Medical Advisor, Stanford Outdoor Education, Stanford University (2009 - Present)
  • Director, ED Fast Track, Division of Emegency Medicine, Stanford University School of Medicine (2012 - 2015)
  • Medical Advisor, California Outward Bound (2012 - Present)
  • Editorial Board, Wilderness & Environmental Medicine (2014 - 2017)
  • Director, Wilderness Medicine Fellowship, Stanford Department of Emergency Medicine (2015 - Present)
  • Director, Wilderness Medicine Section, Stanford Department of Emergency Medicine (2017 - Present)
  • Board of Directors, Wilderness Medical Society (2018 - Present)
  • Chair of Research Council, Wilderness Medical Society (2018 - Present)
  • Editorial Board, High Altitude Medicine & Biology (2018 - Present)

Honors & Awards

  • Research Award, Wilderness Medical Society (2013)
  • 2014 ACEP Service to Section Award, American College of Emergency Physicians (2014)
  • Top 25 Papers of 2012 in Annals of Emergency Medicine, ScienceDirect (2013)

Boards, Advisory Committees, Professional Organizations

  • Research Director, RacingThePlanet (2011 - Present)
  • Medical Advisory Board, RacingThePlanet (2011 - Present)

Professional Education

  • Residency: St Lukes Roosevelt Hospital Emergency Medicine Residency (2004) NY
  • Medical Education: St Georges University School of Medicine Grenada West Indies (2001) NY West Indies
  • Board Certification: American Board of Emergency Medicine, Emergency Medicine (2005)
  • BA, Connecticut College, Environmental Studies (1995)
  • MD, St. George's School of Medicine, Medicine (2001)
  • Residency, St. Luke's -Roosevelt Hospital, Emergency Medicine (2004)
  • Fellow, Stanford University Hospital, Wilderness Medicine (2005)

Contact

  • Stanford Emergency Medicine Dept 300 Pasteur Dr Rm M121 Alway Bldg MC 5119 Stanford, CA 94305
    • Tel: (650) 725-9445
    Fax: (650) 723-0121

Research & Scholarship

Current Research and Scholarly Interests

Examination of novel devices and medications for the prevention of acute mountain sickness. Examination of epidemiology of injuries in ultra-marathon runners including, exercise-associated hyponatremia, hypernatremia, acute kidney injury (AKI), and blisters. Climate change and effect on injury and illness. Randomized interventional trials, prospective observational studies, translational studies, and correlation of big data sets examining the interface of the human condition with the outdoors.

GRANTS

2018 Igor Gamow Grant
Institute for Altitude Medicine, Telluride, CO

2018 Herbert N. Hultgren Grant
Wilderness Medical Society

2017 Igor Gamow Grant
Institute for Altitude Medicine, Telluride, CO

2016 Herbert N. Hultgren Grant
Wilderness Medical Society

2016 RacingThePlanet© Research Grant
RacingThePlanet© ? Hong Kong

2016 Research Grant
American Alpine Club

2016 Igor Gamow Grant
Institute for Altitude Medicine, Telluride, CO

2015 RacingThePlanet© Research Grant
RacingThePlanet© ? Hong Kong

2014 RacingThePlanet© Research Grant
RacingThePlanet© ? Hong Kong

2013 RacingThePlanet© Research Grant
RacingThePlanet© ? Hong Kong

2010 Emergency Medicine Research Grant
Division of Emergency Medicine, Stanford University School of Medicine

Clinical Trials

  • Altitude Sickness Prevention and Efficacy of Comparative Treatments Not Recruiting

    This study is designed to be the first to examine the novel drug budesonide for prevention of acute mountain sickness in comparison to acetazolamide and in the context of rapid ascent to high altitude. The investigators will accomplish these objectives with a prospective, double blinded view of a large population of hikers who are ascending at their own rate in a true hiking environment.

    Stanford is currently not accepting patients for this trial. For more information, please contact Grant S Lipman, MD, 415-290-9286.

    View full details

  • Chemical Ice Packs for Cooling Hyperthermic Patients Not Recruiting

    A common tool to cool people in the pre-hospital setting is the chemical ice pack. These are used by athletic trainers, EMS personnel, ER staff, and people in the prehosoital setting. The ability of these to cool a person has never been quantified, the efficiency and extent of cooling, as well as location of placement of ice packs is purely anecdotal. The purpose of this study is to determine whether strategically placed chemical ice packs will provide benefit to individuals subjected to heat stress.

    Stanford is currently not accepting patients for this trial.

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  • Non-steroidal Anti-inflammatory Affect on Kidneys in Endurance Distances Not Recruiting

    The specific aim of this study is to evaluate the safety of non-steroidal anti-inflammatory drugs (NSAIDs) and their impact on renal function and/or contribution to exercise-associated hyponatremia (EAH) during an ultramarathon foot race. There is currently much debate over whether NSAID ingestion during endurance events contributes to acute kidney injury. Endurance events often ignite a "perfect storm" of physiologic insults- heat stress, dehydration, and myopathy- which can all negatively impact kidney function. There is a concern that NSAIDs may further potentiate these negative effects as well as contribute to EAH through its anti-diuretic affect. To date, no powered, prospective study has ever examined the effects of NSAIDs on either of these two biochemical outcomes Ultramarathon endurance events, defined as any race longer than a marathon (26.2 miles), are increasing in popularity, with a 10% increase in annual participants, and more than 69,000 finishers worldwide in 2013. Considerable literature has documented alterations in serum biochemical profiles of these endurance athletes, with consistent evidence of elevated serum creatinine (Cr) levels in healthy race finishers as well as those seeking medical care. While acute renal failure in ultramarathon runners is a rare occurrence, acute kidney injury is common, ranging from 34% in a single-stage ultramarathon to 55-80% in multi-stage ultramarathons. The evidence is equivocal regarding NSAID ingestion and AKI. One study showed that runners who ingested NSAIDs prior to marathons had greater post-race creatinine levels than matched controls as well as higher rates of hospitalization and acute renal failure. However, this contrasts with several other studies that showed a marked lack of difference in creatinine levels or development of acute kidney injury between NSAID users and non-users during ultramarathons. The only randomized trial to date on this subject found no difference in serum creatinine levels between the NSAID and placebo groups at ultramarathon race end, however conclusions were limited by a small unpowered sample size. Exercise associated hyponatremia (EAH), defined as a serum sodium concentration below 135mEq/L, is recognized as a relatively common issue in endurance running events. The incidence of EAH varies depending upon the distance of the race, with reported values of 3-28% for marathons, 23 - 38% for triathlons and 4-51% in single-stage ultramarathons. EAH is likely under-diagnosed as athletes are often asymptomatic. While EAH most often manifests as non-specific symptoms such as nausea, vomiting, dizziness, and fatigue, it can be a potentially fatal disease that can progress to encephalopathy, seizures, pulmonary edema, and death. There have been no large prospective studies examining the relationship between EAH and NSAID ingestion.

    Stanford is currently not accepting patients for this trial.

    View full details

  • Prevention of Altitude Illness With Non-steroidal Anti-inflammatory Study (PAINS) Not Recruiting

    This is a research study on Altitude Illness. From the information collected and studied in this project we hope to learn more about Altitude Illness, including factors that may affect and prevent the development and progression of this condition. We hope to learn if the commonly used non-steroidal anti-inflammatory medication, ibuprofen can prevent altitude illness. Possible participants in this study are healthy adults who indicated they would like to participate, learn about altitude illness, and desire to hike Barcroft Peak. Stanford University researchers hope to enroll about 100 participants.

    Stanford is currently not accepting patients for this trial. For more information, please contact Grant Lipman, (650) 723 - 6576.

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  • Prevention Trial Assessing Paper-Tape in Endurance Distances (PreTAPED) Not Recruiting

    Blisters are a very common complaint in both the general population and also the athlete. This study's aim is to determine whether applying paper tape (an inexpensive and common component of most foot care kits) to the foot of endurance runners prevents the frequency and severity of friction blisters.

    Stanford is currently not accepting patients for this trial. For more information, please contact Grant Lipman, (650) 725 - 9445.

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  • Prevention Trial Assessing Paper-Tape in Endurance Distances II (Pre-TAPED II) Not Recruiting

    Friction foot blisters are one of the most common and often debilitating complaints of all athletes, and hikers and runners in particular. Blistering rates in the literature of outdoor hikers range from 7%-54%. This study's aim is to build on Pre-TAPED I, and determine whether applying paper tape to the areas of the foot where blisters historically occur in endurance runners can prevent the incidence of friction blisters.

    Stanford is currently not accepting patients for this trial. For more information, please contact Grant S Lipman, MD, 415-290-9286.

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  • Study Looking at End Expiratory Pressure for Altitude Illness Decrease (SLEEP-AID) Not Recruiting

    The study is examining if an over-the-counter device (Theravent) worn while sleeping can reduce acute mountain sickness upon awakening in a high altitude trekking population.

    Stanford is currently not accepting patients for this trial. For more information, please contact Grant S Lipman, MD, 415-290-9286.

    View full details

Teaching

2020-21 Courses

Publications

All Publications

  • Wilderness Medical Society Clinical Practice Guidelines for the Management of Exercise-Associated Hyponatremia: 2019 Update. Wilderness & environmental medicine Bennett, B. L., Hew-Butler, T., Rosner, M. H., Myers, T., Lipman, G. S. 2020

    View details for DOI 10.1016/j.wem.2019.11.003

    View details for PubMedID 32044213

  • Paper Tape Prevents Foot Blisters: A Randomized Prevention Trial Assessing Paper Tape in Endurance Distances II (Pre-TAPED II). Clinical journal of sport medicine Lipman, G. S., Sharp, L. J., Christensen, M., Phillips, C., DiTullio, A., Dalton, A., Ng, P., Shangkuan, J., Shea, K., Krabak, B. J. 2016; 26 (5): 362-368

    Abstract

    To determine whether paper tape prevents foot blisters in multistage ultramarathon runners.Multisite prospective randomized trial.The 2014 250-km (155-mile) 6-stage RacingThePlanet ultramarathons in Jordan, Gobi, Madagascar, and Atacama Deserts.One hundred twenty-eight participants were enrolled: 19 (15%) from the Jordan, 35 (27%) from Gobi, 21 (16%) from Madagascar, and 53 (41%) from the Atacama Desert. The mean age was 39.3 years (22-63) and body mass index was 24.2 kg/m (17.4-35.1), with 31 (22.5%) females.Paper tape was applied to a randomly selected foot before the race, either to participants' blister-prone areas or randomly selected location if there was no blister history, with untaped areas of the same foot used as the control.Development of a blister anywhere on the study foot.One hundred six (83%) participants developed 117 blisters, with treatment success in 98 (77%) runners. Paper tape reduced blisters by 40% (P < 0.01, 95% confidence interval, 28-52) with a number needed to treat of 1.31. Most of the study participants had 1 blister (78%), with most common locations on the toes (n = 58, 50%) and heel (n = 27, 23%), with 94 (80%) blisters occurring by the end of stage 2. Treatment success was associated with earlier stages [odds ratio (OR), 74.9, P < 0.01] and time spent running (OR, 0.66, P = 0.01).Paper tape was found to prevent both the incidence and frequency of foot blisters in runners.

    View details for DOI 10.1097/JSM.0000000000000319

    View details for PubMedID 27070112

  • Wilderness medical society practice guidelines for the prevention and treatment of heat-related illness. Wilderness & environmental medicine Lipman, G. S., Eifling, K. P., Ellis, M. A., Gaudio, F. G., Otten, E. M., Grissom, C. K. 2013; 24 (4): 351-361

    Abstract

    The Wilderness Medical Society (WMS) convened an expert panel to develop a set of evidence-based guidelines for the recognition, prevention, and treatment of heat-related illness. We present a review of the classifications, pathophysiology, and evidence-based guidelines for planning and preventive measures as well as best-practice recommendations for both field- and hospital-based therapeutic management of heat-related illness. These recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks or burdens for each modality.

    View details for DOI 10.1016/j.wem.2013.07.004

    View details for PubMedID 24140191

  • Ibuprofen Prevents Altitude Illness: A Randomized Controlled Trial for Prevention of Altitude Illness With Nonsteroidal Anti-inflammatories ANNALS OF EMERGENCY MEDICINE Lipman, G. S., Kanaan, N. C., Holck, P. S., Constance, B. B., Gertsch, J. H. 2012; 59 (6): 484-490

    Abstract

    Acute mountain sickness occurs in more than 25% of the tens of millions of people who travel to high altitude each year. Previous studies on chemoprophylaxis with nonsteroidal anti-inflammatory drugs are limited in their ability to determine efficacy. We compare ibuprofen versus placebo in the prevention of acute mountain sickness incidence and severity on ascent from low to high altitude.Healthy adult volunteers living at low altitude were randomized to ibuprofen 600 mg or placebo 3 times daily, starting 6 hours before ascent from 1,240 m (4,100 ft) to 3,810 m (12,570 ft) during July and August 2010 in the White Mountains of California. The main outcome measures were acute mountain sickness incidence and severity, measured by the Lake Louise Questionnaire acute mountain sickness score with a diagnosis of ? 3 with headache and 1 other symptom.Eighty-six participants completed the study; 44 (51%) received ibuprofen and 42 (49%) placebo. There were no differences in demographic characteristics between the 2 groups. Fewer participants in the ibuprofen group (43%) developed acute mountain sickness compared with those receiving placebo (69%) (odds ratio 0.3, 95% confidence interval 0.1 to 0.8; number needed to treat 3.9, 95% confidence interval 2 to 33). The acute mountain sickness severity was higher in the placebo group (4.4 [SD 2.6]) than individuals receiving ibuprofen (3.2 [SD 2.4]) (mean difference 0.9%; 95% confidence interval 0.3% to 3.0%).Compared with placebo, ibuprofen was effective in reducing the incidence of acute mountain sickness.

    View details for DOI 10.1016/j.annemergmed.2012.01.019

    View details for PubMedID 22440488

  • A Randomized Controlled Trial of the Lowest Effective Dose of Acetazolamide for Acute Mountain Sickness Prevention. The American journal of medicine Lipman, G. S., Jurkiewicz, C., Burnier, A., Marvel, J., Phillips, C., Lowry, C., Hawkins, J., Navlyt, A., Swenson, E. R. 2020

    Abstract

    BACKGROUND: Acetazolamide is the most common medication used for acute mountain sickness prevention, with speculation that a reduced dose may be as efficacious as standard dosing with fewer side effects.METHODS: This double-blind, randomized, controlled non-inferiority trial compared acetazolamide 62.5 mg twice daily to the standard dose acetazolamide 125 mg twice daily starting the evening prior to ascent from 1,240 m (4,100 ft) to 3,810 m (12,570 ft) over 4 hours. The primary outcome was acute mountain sickness incidence (headache and Lake Louise Questionnaire ? 3 and another symptom).RESULTS: 106 participants were analyzed, with 51 (48%) randomized to 125 mg and 55 (52%) to 62.5 mg, with a combined acute mountain sickness incidence of 53 (50%) and mean severity of 3 (± 2.1). The 62.5 mg group failed to fall within the pre-specified 26% non-inferiority margin for acute mountain sickness incidence [62.5 mg?=?30 (55%) versus 125 mg?=?23 (45%), 95% CI -11% to 30%]. Participants in the 62.5 mg group had a higher risk of acute mountain sickness (OR?=?1.5, 95% CI 0.7 to 3.2) and moderate acute mountain sickness (OR?=?1.8, 95% CI 0.6 to 5.9), with a NNH of 9, with a NNT in the 125 mg group of 4.8. Increased acute mountain sickness incidence and symptom severity corresponded to lower weight-based and body mass index dosing, with similar side effects between groups.CONCLUSION: Acetazolamide 62.5 mg twice daily failed to demonstrate equal effectiveness to 125 mg twice daily for prevention of acute mountain sickness. With increased risk and no demonstrable symptomatic or physiologic benefits, acetazolamide 62.5 mg twice daily should not be recommended for acute mountain sickness prevention.

    View details for DOI 10.1016/j.amjmed.2020.05.003

    View details for PubMedID 32479750

  • Pain Is Inevitable But Suffering Is Optional: Relationship of Pain Coping Strategies to Performance in Multistage Ultramarathon Runners. Wilderness & environmental medicine Alschuler, K. N., Krabak, B. J., Kratz, A. L., Jensen, M. P., Pomeranz, D., Burns, P., Bautz, J., Nordeen, C., Irwin, C., Lipman, G. S. 2020

    Abstract

    INTRODUCTION: Ultramarathon runners commonly endure musculoskeletal pain during endurance events. However, the effect of pain coping skills on performance has not been examined.METHODS: A prospective observational study during three 250 km (155 mi), 6 stage ultramarathons was conducted. Finish line surveys were completed after each of the four 40 km (25 mi) and one 80 km (50 mi) stages of racing. Variables gathered included pain intensity, pain coping strategy use, pain interference, finishing position (quintile), and successful race completion.RESULTS: A total of 204 participants (age 41.4±10.3 y; 73% male) reported average pain intensity of 3.9 (±2.0) and worst pain intensity of 5.3 (±2.3) on a 0 to 10 scale. They used greater adaptive pain coping strategies (3.0±1.3) relative to maladaptive strategies (1.3±1.1). Worst pain and pain interference increased over each stage of the race for all runners (P<0.001), with worst pain being significantly different by finishing status (P=0.02). Although all runners endured increased pain and interference, the nonfinishers (28 [14%]) had significantly greater differences in changes in pain intensity (P<0.01) and pain interference (P<0.001). Maladaptive pain coping strategies were more common in nonfinishers; with each 1-point increase (0-6 scale), there was a 3 times increase in odds of not finishing the race.CONCLUSIONS: Although increased pain intensity and pain interference was found in all multistage ultramarathon runners, successful event completion was significantly associated with less maladaptive pain coping. Training in coping with pain may be a beneficial part of ultramarathon preparation.

    View details for DOI 10.1016/j.wem.2019.10.007

    View details for PubMedID 32044211

  • Precipitous Delivery Masquerading as Biliary Colic in the Setting of Depo-Provera (R) Failure CUREUS Chang, A. D., Lipman, G. S. 2020; 12 (1)

    View details for DOI 10.7759/cureus.6776

    View details for Web of Science ID 000509551000002

  • Effect of Sodium Supplements and Climate on Dysnatremia During Ultramarathon Running. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine Lipman, G. S., Burns, P., Phillips, C., Jensen, J., Little, C., Jurkiewicz, C., Jarrett, B., Walker, A., Mansfield, N., Krabak, B. J. 2020

    Abstract

    Analyze the effect of sodium supplementation, hydration, and climate on dysnatremia in ultramarathon runners.Prospective observational study.The 2017 80 km (50 mile) stage of the 250 km (150 mile) 6-stage RacingThePlanet ultramarathon in 2017 Chilean, Patagonian, and 2018 Namibian, Mongolian, and Chilean deserts.All race entrants who could understand English were invited to participate, with 266 runners enrolled, mean age of 43 years (± 9), 61 (36%) females, average weight 74 kg (± 12.5), and average race time 14.5 (± 4.1) hours. Post-race sodium collected on 174 (74%) and 164 (62%) participants with both the blood sample and post-race questionnaire.Weight change and finish line serum sodium levels were gathered.Incidence of exercise-associated hyponatremia (EAH; <135 mmol·L) and hypernatremia (>145 mmol·L) by sodium ingestion and climate.Eleven (6.3%) runners developed EAH, and 30 (17.2%) developed hypernatremia. Those with EAH were 14 kg heavier at baseline, had significantly less training distances, and averaged 5 to 6 hours longer to cover 50 miles (80 km) than the other participants. Neither rate nor total ingested supplemental sodium was correlated with dysnatremia, without significant differences in drinking behaviors or type of supplement compared with normonatremic runners. Hypernatremic runners were more often dehydrated [8 (28%), -4.7 kg (± 9.8)] than EAH [4 (14%), -1.1 kg (± 3.8)] (P < 0.01), and EAH runners were more frequently overhydrated (6, 67%) than hypernatremia (1, 11%) (P < 0.01). In the 98 (56%) runners from hot races, there was EAH OR = 3.5 [95% confidence interval (CI), 0.9-25.9] and hypernatremia OR = 8.8 (95% CI, 2.9-39.5) compared with cold races.This was the first study to show that hot race climates are an independent risk factor for EAH and hypernatremia. Sodium supplementation did not prevent EAH nor cause hypernatremia. Longer training distances, lower body mass, and avoidance of overhydration were shown to be the most important factors to prevent EAH and avoidance of dehydration to prevent hypernatremia.

    View details for DOI 10.1097/JSM.0000000000000832

    View details for PubMedID 32097177

  • Precipitous Delivery Masquerading as Biliary Colic in the Setting of Depo-Provera® Failure. Cureus Chang, A. D., Lipman, G. S. 2020; 12 (1): e6776

    Abstract

    Precipitous delivery in the emergency department is a high-acuity, low-occurrence event that requires rapid recognition and interdepartment cooperation to prevent fetal and maternal morbidity and mortality. Prompt recognition of the peripartum state can be delayed by reported usage of long-acting contraception and concurrent distracting complaints. In this case report, a young female presented to the emergency department with epigastric abdominal pain in the setting of recent workup for biliary colic and multiple doses of long-acting, depot contraceptive agents. Early utilization of bedside ultrasound confirmed a full-term, intrauterine pregnancy as well as an impacted gallbladder stone, followed by a precipitous footling breech presentation that required an emergent cesarean section.

    View details for DOI 10.7759/cureus.6776

    View details for PubMedID 32117662

    View details for PubMedCentralID PMC7041648

  • Elderly woman with proptosis after head injury. Journal of the American College of Emergency Physicians open Lipman, G. S. 2020; 1 (6): 1757?58

    View details for DOI 10.1002/emp2.12303

    View details for PubMedID 33392595

    View details for PubMedCentralID PMC7771796

  • A body bag can save your life: a novel method of cold water immersion for heat stroke treatment. Journal of the American College of Emergency Physicians open Kim, D. A., Lindquist, B. D., Shen, S. H., Wagner, A. M., Lipman, G. S. 2020; 1 (1): 49?52

    Abstract

    Non-exertional heat stroke is a life-threatening condition characterized by passive exposure to high ambient heat, a core body temperature of 40°C (104°F) or greater, and central nervous system dysfunction. Rapid cooling is imperative to minimize mortality and morbidity. Although evaporative and convective measures are often used for cooling heat stroke patients, cold water immersion produces the fastest cooling. However, logistical difficulties make cold water immersion challenging to implement in the emergency department. To our knowledge, there is no documented case utilizing a body bag (ie, human remains pouch) as a cold water immersion tank for rapid resuscitation of heat stroke. During a regional heat wave an elderly woman was found unconscious in a parking lot with an oral temperature of 40°C (104°F) and altered mental status. She was cooled to 38.4°C (101.1°F) in 10 minutes by immersion in an ice- and water-filled body bag. The patient rapidly regained normal mentation and was discharged home from the ED. This case highlights a novel method for efficient and convenient cold water immersion for heat stroke treatment in the emergency department.

    View details for DOI 10.1002/emp2.12007

    View details for PubMedID 33000014

    View details for PubMedCentralID PMC7493529

  • Interstitial Pulmonary Edema Assessed by Lung Ultrasound on Ascent to High Altitude and Slight Association with Acute Mountain Sickness: A Prospective Observational Study HIGH ALTITUDE MEDICINE & BIOLOGY Alsup, C., Lipman, G. S., Pomeranz, D., Huang, R., Burns, P., Juul, N., Phillips, C., Jurkiewicz, C., Cheffers, M., Evans, C., Saraswathula, A., Baumeister, P., Lai, L., Rainey, J., Lobo, V. 2019

    View details for DOI 10.1089/ham.2018.0123

    View details for Web of Science ID 000466520900001

  • Large-Volume Hypertonic Saline for Empiric Treatment of Severe Exercise-Associated Hyponatremia in an Ultramarathon Runner CURRENT SPORTS MEDICINE REPORTS Pomeranz, D., Irwin, C., Lipman, G. S. 2019; 18 (5): 163?65

    View details for DOI 10.1249/JSR.0000000000000593

    View details for Web of Science ID 000468282700004

  • Accuracy of Estimated Creatinine in Multistage Ultramarathon Runners. Wilderness & environmental medicine Little, C. E., Lipman, G. S., Migliaccio, D., Young, D. S., Krabak, B. J. 2019

    Abstract

    INTRODUCTION: Ultramarathon running is increasing in popularity worldwide, as is the growing body of research on these athletes. Multiple studies have examined acute kidney injury through estimated baseline creatinine (Cr) and glomerular filtration rate (GFR). Values are estimated through an age-based formula of GFR and the modification of diet in renal disease (MDRD) equation. However, the accuracy of this practice in a cohort of healthy athletes is unknown.METHODS: A prospective analysis of the first 40-km (25-mi) stage of 6-stage 250-km (155-mi) multistage ultramarathons in the Sahara, Namibia, Atacama, and Gobi Deserts. Runners had prerace measured baseline Cr compared to estimated values through age-based estimated GFR and back calculation of Cr through the MDRD equation.RESULTS: Forty-eight participants (27% female, age 39±10 y) had Cr values analyzed. The mean measured Cr was 0.99±0.17, which was 11% higher than an estimated Cr of 0.88±0.14 (P<0.01). Estimated age-based GFR was 95.9±5.8 mLmin-1 compared to GFR based on measured Cr and MDRD of 86.1±14.6 (P<0.001).CONCLUSIONS: Estimated values of GFR and Cr by standard age-based values and MDRD equation were significantly inaccurate, which would overinflate the incidence of acute kidney injury. Future studies should devise a new model for estimation of baseline Cr that is validated in this population.

    View details for DOI 10.1016/j.wem.2018.12.006

    View details for PubMedID 30872022

  • Snakebites and climate change in California, 1997-2017 CLINICAL TOXICOLOGY Phillips, C., Lipman, G. S., Gugelmann, H., Doering, K., Lung, D. 2019; 57 (3): 168?74

    View details for DOI 10.1080/15563650.2018.1508690

    View details for Web of Science ID 000462319600003

  • Altitude Sickness Prevention with Ibuprofen Relative to Acetazolamide AMERICAN JOURNAL OF MEDICINE Burns, P., Lipman, G. S., Warner, K., Jurkiewicz, C., Phillips, C., Sanders, L., Soto, M., Hackett, P. 2019; 132 (2): 247?51

    View details for DOI 10.1016/j.amjmed.2018.10.021

    View details for Web of Science ID 000456546400037

  • Interstitial Pulmonary Edema Assessed by Lung Ultrasound on Ascent to High Altitude and Slight Association with Acute Mountain Sickness: A Prospective Observational Study. High altitude medicine & biology Alsup, C., Lipman, G. S., Pomeranz, D., Huang, R. W., Burns, P., Juul, N., Phillips, C., Jurkiewicz, C., Cheffers, M., Evans, C., Saraswathula, A., Baumeister, P., Lai, L., Rainey, J., Lobo, V. 2019

    Abstract

    Alsup, Carl, Grant S. Lipman, David Pomeranz, Rwo-Wen Huang, Patrick Burns, Nicholas Juul, Caleb Phillips, Carrie Jurkiewicz, Mary Cheffers, Christina Evans, Anirudh Saraswathula, Peter Baumeister, Lucinda Lai, Jessica Rainey, and Viveta Lobo. Interstitial pulmonary edema assessed by lung ultrasound on ascent to high altitude and slight association with acute mountain sickness: A prospective observational study. High Alt Med Biol. 00:000-000, 2019. Background: Acute mountain sickness (AMS) is a common disease that may have a pulmonary component, as suggested by interstitial pulmonary edema quantified by the B-line score (BLS) on ultrasound (US). This subclinical pulmonary edema has been shown to increase with ascent to high altitude and AMS severity, but has not been prospectively associated with AMS incidence in a large prospective study. Materials and Methods: This prospective observational study was part of a randomized controlled trial enrolling healthy adults over four weekends ascending White Mountain, California. Subjects were assessed by lung US and the Lake Louise Questionnaire at 4110?ft (1240?m), upon ascent to 12,500?ft (3810?m), and the next morning at 12,500?ft (3810?m). Results: Three hundred five USs in total were completed on 103 participants, with 73% total incidence of AMS. The mean (±standard deviation) BLS increased from baseline (1.15?±?1.80) to high altitude (2.56?±?2.86), a difference of 1.37 (±2.48) (p?=?0.04). Overall BLS was found, on average, to be higher among those diagnosed with AMS than without (2.97 vs. 2.0, p?=?0.04, 95% confidence interval [CI] -? to -0.04). The change in BLS (?BLS) from low altitude baseline was significantly associated with AMS (0.88 vs. 1.72, r2?=?0.023, 95% CI -? to -0.01, p?=?0.048). Conclusions: Interstitial subclinical pulmonary edema by lung US was found to have a small but significant association with AMS.

    View details for PubMedID 31045443

  • Re: "Ultrasound in Austere Environments" by Canepa and Harris (High Alt Med Biol 2019;20:103-111). High altitude medicine & biology Lipman, G. S., Marvel, J. T., Burns, P. 2019; 20 (4): 440

    View details for DOI 10.1089/ham.2019.0102

    View details for PubMedID 31880496

  • How variability in pain and pain coping relate to pain interference during multistage ultramarathons. Pain Alschuler, K. N., Kratz, A. L., Lipman, G. S., Krabak, B. J., Pomeranz, D., Burns, P., Bautz, J., Nordeen, C., Irwin, C., Jensen, M. P. 2019; 160 (1): 257?62

    Abstract

    An important and substantial body of literature has established that maladaptive and adaptive coping strategies significantly impact pain-related outcomes. This literature, however, is based primarily on populations with painful injuries and illnesses. Little is known about coping in individuals who experience pain in other contexts and whether coping impacts outcomes in the same way. In an effort to better understand pain coping in such contexts, this study evaluated pain coping in ultramarathon runners, a population known to experience moderate levels of pain with minimal perceived negative effects. This study reports on pain coping in 204 entrants in 2016 RacingThePlanet multistage ultramarathon events. Participants provided data over 5 consecutive days on pain severity, pain interference, exertion, and coping. Results demonstrated that the study participants were more likely to use adaptive than maladaptive coping responses. However, maladaptive coping, but not adaptive coping, was positively associated with percent time spent thinking about pain and pain-related interference. Taken together, the study supports the idea that this high functioning group of individuals experiencing pain emphasizes the use of adaptive coping strategies over maladaptive strategies, reinforcing the perspective that such a pattern may be the most effective way to cope with pain. Within the group, however, results supported traditional patterns, such that greater use of maladaptive strategies was associated with greater pain-related interference, suggesting that optimizing pain coping may be critical to reducing factors that may interfere with ultramarathon performance.

    View details for PubMedID 30204649

  • Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Heat Illness: 2019 Update. Wilderness & environmental medicine Lipman, G. S., Gaudio, F. G., Eifling, K. P., Ellis, M. A., Otten, E. M., Grissom, C. K. 2019

    Abstract

    The Wilderness Medical Society convened an expert panel in 2011 to develop a set of evidence-based guidelines for the recognition, prevention, and treatment of heat illness. We present a review of the classifications, pathophysiology, and evidence-based guidelines for planning and preventive measures, as well as best practice recommendations for both field- and hospital-based therapeutic management of heat illness. These recommendations are graded based on the quality of supporting evidence and balance the benefits and risks or burdens for each modality. This is an updated version of the original Wilderness Medical Society Practice Guidelines for the Treatment and Prevention of Heat-Related Illness published in 2013.

    View details for DOI 10.1016/j.wem.2018.10.004

    View details for PubMedID 31221601

  • Wilderness Medical Society Clinical Practice Guidelines for Diabetes Management. Wilderness & environmental medicine VanBaak, K. D., Nally, L. M., Finigan, R. T., Jurkiewicz, C. L., Burnier, A. M., Conrad, B. P., Khodaee, M., Lipman, G. S. 2019

    Abstract

    The Wilderness Medical Society convened an expert panel in 2018 to develop a set of evidence-based guidelines for the treatment of type 1 and 2 diabetes, as well as the recognition, prevention, and treatment of complications of diabetes in wilderness athletes. We present a review of the classifications, pathophysiology, and evidence-based guidelines for planning and preventive measures, as well as best practice recommendations for both routine and urgent therapeutic management of diabetes and glycemic complications. These recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks or burdens for each recommendation.

    View details for DOI 10.1016/j.wem.2019.10.003

    View details for PubMedID 31753543

  • Large-Volume Hypertonic Saline for Empiric Treatment of Severe Exercise-Associated Hyponatremia in an Ultramarathon Runner. Current sports medicine reports Pomeranz, D., Irwin, C., Lipman, G. S. 2019; 18 (5): 163?65

    View details for PubMedID 31082888

  • How variability in pain and pain coping relate to pain interference during multistage ultramarathons PAIN Alschuler, K. N., Kratz, A. L., Lipman, G. S., Krabak, B. J., Pomeranz, D., Burns, P., Bautz, J., Nordeen, C., Irwin, C., Jensen, M. P. 2019; 160 (1): 257?62

    View details for DOI 10.1097/j.pain.0000000000001397

    View details for Web of Science ID 000462391500026

  • Day of Ascent Dosing of Acetazolamide for Prevention of Acute Mountain Sickness. High altitude medicine & biology Lipman, G. S., Jurkiewicz, C., Winstead-Derlega, C., Navlyt, A., Burns, P., Walker, A., Phillips, C., Reilly, A., Burnier, A., Romero, J., Warner, K., Hackett, P. 2019

    Abstract

    Lipman, Grant S., Carrie Jurkiewicz, Christopher Winstead-Derlega, Andrew Navlyt, Patrick Burns, Anne Walker, Caleb Phillips, Aaron Reilly, Andre Burnier, Joseph Romero, Keiran Warner, and Peter Hackett. Day of ascent dosing of acetazolamide for prevention of acute mountain sickness. High Alt Med Biol 00:000-000, 2019. Background: Acetazolamide is the most common medication used for prevention of acute mountain sickness (AMS), usually administered the day or night before ascent. The objective of this study was to evaluate the efficacy of day of ascent dosing of acetazolamide for AMS prevention. Methods: Double-blind, randomized, controlled noninferiority trial of acetazolamide 125?mg twice daily beginning either the night before or the morning of ascent. Healthy low altitude adults ascended from 1240?m (4100 ft) to 3810?m (12,570 ft) during summer 2018 on White Mountain, California. Primary outcome was incidence of AMS with the two different dosing patterns, assessed by the 1993 Lake Louise Questionnaire (LLQ) of ?3 with headache and a minimum of 1 for other symptom. Results: One hundred four participants completed the study, with 54 (52%) randomized to night before acetazolamide and 50 (48%) to day of ascent dosing, without differences in baseline characteristics. There was 9% greater incidence of AMS in the day of ascent acetazolamide group (48.0% vs. 39%, 95% confidence interval [CI] -11.8 to 30, p?=?0.46, number needed to treat [NNT]?=?5.6 vs. 3.7), with the CI just surpassing the predetermined 26% noninferiority margin. There was a lower incidence of severe AMS (1993 LLQ >5) in the day of ascent group (n?=?5, 10%, NNT?=?2.3) compared with night before dosing (n?=?12, 22%, NNT?=?3.1) (95% CI -28 to 3.6), and lower average symptom severity in the day of ascent group (3 vs. 3.5, 95% CI -0.5 to 1.4). Conclusions: Day of ascent acetazolamide demonstrated higher rates of AMS compared with traditional dosing by a small margin. With similar rates of severe AMS and overall symptom severity, the potential for improved convenience and compliance may support day of ascent use.

    View details for DOI 10.1089/ham.2019.0007

    View details for PubMedID 31259608

  • Altitude Sickness Prevention with Ibuprofen Relative to Acetazolamide. The American journal of medicine Burns, P., Lipman, G. S., Warner, K., Jurkiewicz, C., Phillips, C., Sanders, L., Soto, M., Hackett, P. 2018

    Abstract

    BACKGROUND: Acute mountain sickness is a common occurrence with travel to high altitude. Although previous studies of ibuprofen have shown efficacy for acute mountain sickness prevention, recommendations have been limited, as it has not been compared directly with acetazolamide, until this study.METHODS: Adult volunteers were randomized to ibuprofen 600 mg, three times daily, 4 hours before ascent or acetazolamide 125 mg, twice daily, started the night before ascent to 3810m in the White Mountains of California. The main outcome measure was acute mountain sickness incidence, using the Lake Louise Questionnaire (LLQ), with a score of >3 with headache. Sleep quality and headache severity were measured with the Groningen Sleep Quality Survey (GSQS) and a modified visual analogue scale (mVAS).RESULTS: Ninety-two participants completed the study: 45 (49%) ibuprofen and 47 (51%) acetazolamide. The incidence of acute mountain sickness was 56.5%, with ibuprofen 11% greater than acetazolamide, surpassing the predetermined 26% noninferiority margin (62.2% vs. 51.1%, 95% CI: - 11.1% to 33.5%). No difference was found in the total LLQ scores or subgroup symptoms between drugs (p=0.8). The GSQS correlated with LLQ sleep (r=0.77, 95% CI: 0.67 to 0.84) as was the mVAS with total LLQ severity (r?=?0.57, 95% CI: 0.42 to 0.7). The acetazolamide group had higher SpO2 than ibuprofen (88.5% vs. 85.6%, p=0.001).CONCLUSION: Ibuprofen was slightly inferior to acetazolamide for acute mountain sickness prevention and should not be recommended over acetazolamide for rapid ascent. Average symptoms and severity were similar between drugs, suggesting prevention of disease.

    View details for PubMedID 30419226

  • Snakebites and climate change in California, 1997-2017. Clinical toxicology (Philadelphia, Pa.) Phillips, C., Lipman, G. S., Gugelmann, H., Doering, K., Lung, D. 2018: 1?7

    Abstract

    BACKGROUND: Climate change effect on flora and fauna has been scientifically documented, but the effect on North American venomous snakebites is unknown. The objectives were to examine Californian snakebite incidence and correlate with weather patterns and climate changes.METHODS: A retrospective analysis of snakebites reported to the Californian Poison Control System from 1 September 1997 to 30 September 2017. Venomous snakebite reports were aggregated by caller zip code, and correlated per county with weather data, air temperature, precipitation, population data, eco-regions, and land characteristics. Time series decomposition by seasonality and trend, regression, and autocorrelation were used to assess association between climate variables and incidence.RESULTS: There were 5365 reported venomous snakebites during the study period, with a median age of 37 years (22-51) with 76% male (p<.001, 95% CI 75.6-77.9%). Most snakebite outcomes were coded as minor (1363, 25%) or moderate (2607, 49%), with three deaths. Adjusted for population, the annualized incidence of snakebites statewide slightly decreased (rho=-0.11, p=.65). The snakebite incidence per million people rose after a period of no drought and declined during drought (r=-0.41, p?.01). Snakebite incidence decreased by 6-month prior drought (-3.8% for each 10% increase in drought), and increased by 18-month prior precipitation (+3.9% for each 10% increase in precipitation).CONCLUSIONS: Patterns of precipitation and drought had a significant and predictive effect on snakebites in California over a 20-year period. Snakebite incidence decreased following drought, and increased after precipitation.

    View details for PubMedID 30180761

  • Woman With Pain and Deformity in Left Wrist. Annals of emergency medicine Sakamoto, J. T., Lipman, G. S. 2018; 72 (3): 254?69

    View details for PubMedID 30144862

  • IMAGES IN EMERGENCY MEDICINE DIAGNOSIS: Volar dislocation of the ulna at the distal radioulnar joint ANNALS OF EMERGENCY MEDICINE Sakamoto, J. T., Lipman, G. S. 2018; 72 (3): 254-+

    View details for DOI 10.1016/j.annemergmed.2018.02.009

    View details for Web of Science ID 000444220700003

  • Budesonide Versus Acetazolamide for Prevention of Acute Mountain Sickness AMERICAN JOURNAL OF MEDICINE Lipman, G. S., Pomeranz, D., Burns, P., Phillips, C., Cheffers, M., Evans, K., Jurkiewicz, C., Juul, N., Hackett, P. 2018; 131 (2)

    View details for DOI 10.1016/j.amjmed.2017.05.034

    View details for Web of Science ID 000424408300037

  • Budesonide Versus Acetazolamide for Prevention of Acute Mountain Sickness. The American journal of medicine Lipman, G. S., Pomeranz, D., Burns, P., Phillips, C., Cheffers, M., Evans, K., Jurkiewicz, C., Juul, N., Hackett, P. 2018; 131 (2)

    Abstract

    BACKGROUND: Inhaled budesonide has been suggested as a novel prevention for acute mountain sickness. However, efficacy has not been compared with the standard acute mountain sickness prevention medication acetazolamide.METHODS: This double-blind, randomized, placebo-controlled trial compared inhaled budesonide versus oral acetazolamide versus placebo, starting the morning of ascent from 1240m (4100 ft) to 3810m (12,570 ft) over 4 hours. The primary outcome was acute mountain sickness incidence (headache and Lake Louise Questionnaire?3 and another symptom).RESULTS: A total of 103 participants were enrolled and completed the study; 33 (32%) received budesonide, 35 (34%) acetazolamide, and 35 (34%) placebo. Demographics were not different between the groups (P>.09). Acute mountain sickness prevalence was 73%, with severe acute mountain sickness of 47%. Fewer participants in the acetazolamide group (n=15, 43%) developed acute mountain sickness compared with both budesonide (n=24, 73%) (odds ratio [OR]3.5, 95% confidence interval [CI] 1.3-10.1) and placebo (n=22, 63%) (OR0.5, 95% CI 0.2-1.2). Severe acute mountain sickness was reduced with acetazolamide (n=11, 31%) compared with both budesonide (n=18, 55%) (OR2.6, 95% CI 1-7.2) and placebo (n=19, 54%) (OR0.4, 95% CI 0.1-1), with a number needed to treat of 4.CONCLUSION: Budesonide was ineffective for the prevention of acute mountain sickness, and acetazolamide was preventive of severe acute mountain sickness taken just before rapid ascent.

    View details for PubMedID 28668540

  • Exercise-Associated Hyponatremia, Hypernatremia, and Hydration Status in Multistage Ultramarathons WILDERNESS & ENVIRONMENTAL MEDICINE Krabak, B. J., Lipman, G. S., Waite, B. L., Rundell, S. D. 2017; 28 (4): 291?98

    View details for Web of Science ID 000418312900003

  • In Response to Ibuprofen vs Acetaminophen in AMS Prevention by Kanaan et al WILDERNESS & ENVIRONMENTAL MEDICINE Lipman, G. S., Hackett, P. 2017; 28 (4): 383?85

    View details for PubMedID 28943108

  • Ibuprofen versus placebo effect on acute kidney injury in ultramarathons: a randomised controlled trial EMERGENCY MEDICINE JOURNAL Lipman, G. S., Shea, K., Christensen, M., Phillips, C., Burns, P., Higbee, R., Koskenoja, V., Eifling, K., Krabak, B. J. 2017; 34 (10): 637?42

    Abstract

    Despite concerns that non-steroidal anti-inflammatory drugs (NSAIDs) contribute to acute kidney injury (AKI), up to 75% of ultramarathon runners ingest these during competition. The effect of NSAID on AKI incidence in ultramarathon runners is unclear.Multisite randomised double-blind placebo-controlled trial in the Gobi, Atacama, Ecuador and Sri Lankan deserts to determine whether ibuprofen (400?mg every 4?hours) would be non-inferior to placebo during a 50-mile (80?km) foot race. The primary outcome was incidence of AKI defined as severity categories of 'risk' of injury of 1.5× baseline creatinine (Cr) or 'injury' as 2× Cr, combined to calculate total incidence at the finish line. Non-inferiority margin for difference in AKI rates was defined as 15%.Eighty-nine participants (47% ibuprofen and 53% placebo) were enrolled with similar demographics between groups. The overall incidence of AKI was 44%. Intent-to-treat analysis found 22 (52%) ibuprofen versus 16 (34%) placebo users developed AKI (18% difference, 95%?CI -4% to 41%; OR 2.1, 95%?CI 0.9 to 5.1) with a number needed to harm of 5.5. Greater severity of AKI was seen with ibuprofen compared with placebo (risk=38% vs 26%; 95%?CI -9% to 34%; injury=14% vs 9%; 95%?CI -10% to 21%). Slower finishers were less likely to encounter AKI (OR 0.67, 95%?CI 0.47 to 0.98) and greater weight loss (-1.3%) increased AKI (OR 1.24, 95%?CI 1.00 to 1.63).There were increased rates of AKI in those who took ibuprofen, and although not statistically inferior to placebo by a small margin, there was a number needed to harm of 5.5 people to cause 1 case of AKI. Consideration should therefore be taken before ingesting NSAID during endurance running as it could exacerbate renal injury.NCT02272725.

    View details for PubMedID 28679502

  • Hydration Status as a Predictor of High-altitude Mountaineering Performance (vol 8, e918, 2016) CUREUS Ladd, E., Shea, K. M., Bagley, P., Auerbach, P. S., Pirrotta, E. A., Wang, E., Lipman, G. 2017; 9 (9): c10

    Abstract

    [This corrects the article DOI: 10.7759/cureus.918.].

    View details for PubMedID 28900588

  • Correction: Biochemistry in Endeavor Adventure Racers Study (BEARS). Cureus Wetschler, M., Radler, D., Christensen, M., Rundell, S., Lipman, G. 2017; 9 (6): c9

    Abstract

    [This corrects the article DOI: 10.7759/cureus.1024.].

    View details for PubMedID 28900586

  • A Novel Cooling Method and Comparison of Active Rewarming of Mildly Hypothermic Subjects. Wilderness & environmental medicine Christensen, M. L., Lipman, G. S., Grahn, D. A., Shea, K. M., Einhorn, J., Heller, H. C. 2017

    Abstract

    To compare the effectiveness of arteriovenous anastomosis (AVA) vs heated intravenous fluid (IVF) rewarming in hypothermic subjects. Additionally, we sought to develop a novel method of hypothermia induction.Eight subjects underwent 3 cooling trials each to a core temperature of 34.8±0.6 (32.7 to 36.3°C [mean±SD with range]) by 14°C water immersion for 30 minutes, followed by walking on a treadmill for 5 minutes. Core temperatures (?tes) and rates of cooling (°C/h) were measured. Participants were then rewarmed by 1) control: shivering only in a sleeping bag; 2) IVF: shivering in sleeping bag and infusion of 2 L normal saline warmed to 42°C at 77 mL/min; and 3) AVA: shivering in sleeping bag and circulation of 45°C warmed fluid through neoprene pads affixed to the palms and soles of the feet.Cold water immersion resulted in a decrease of 0.5±0.5°C ?tes and 1±0.3°C with exercise (P < .01); with an immersion cooling rate of 0.9±0.8°C/h vs 12.6±3.2°C/h with exercise (P < .001). Temperature nadir reached 35.0±0.5°C. There were no significant differences in rewarming rates between the 3 conditions (shivering: 1.3±0.7°C/h, R(2) = 0.683; IVF 1.3±0.7°C/h, R(2) = 0.863; and AVA 1.4±0.6°C/h, R(2) = 0.853; P = .58). Shivering inhibition was greater with AVA but was not significantly different (P = .07).This study developed a novel and efficient model of hypothermia induction through exercise-induced convective afterdrop. Although there was not a clear benefit in either of the 2 active rewarming methods, AVA rewarming showed a nonsignificant trend toward greater shivering inhibition, which may be optimized by an improved interface.

    View details for DOI 10.1016/j.wem.2017.02.009

    View details for PubMedID 28506514

  • Correction: Hydration Status as a Predictor of High-altitude Mountaineering Performance. Cureus Ladd, E., Shea, K. M., Bagley, P., Rundell, S., Auerbach, P. S., Pirrotta, E. A., Wang, E., Lipman, G. S. 2017; 9 (2): c7

    Abstract

    [This corrects the article DOI: 10.7759/cureus.918.].

    View details for PubMedID 28224062

  • Biochemistry in Endeavor Adventure Racers Study (BEARS). Cureus Wetschler, M., Radler, D., Christensen, M., Lipman, G. 2017; 9 (2)

    Abstract

     Adventure sports events consist of a combination of two or more endurance disciplines, such as orienteering, running, and rock climbing, that range from a day's to a week's duration. No studies have examined acute kidney injury (AKI) in adventure sports athletes.To describe the prevalence of AKI in participants in the Endeavor Team Challenge, a 30-hour, 40-mile adventure race.In this prospective observational study, body weights were recorded at race registration. At the finish line, blood sample results by point-of-care testing and weights were recorded. Changes in serum creatinine (Cr) from an estimated baseline value and severity of AKI were calculated, with "risk of injury" defined as 1.5 x baseline Cr, and "injury" defined as 2 x baseline Cr. These two categories of AKI were combined to calculate the total prevalence.  Results: There were 88 enrolled study participants with complete data available on 46 (52%). The mean age of those enrolled in the study was 36.8 years (+/- 7.7), 90% were males, and body mass index (BMI) was 25.7 kg/m(2) (+/- 2.4). Of the competitors who completed the study, 34 (73%) had some degree of AKI, with 27 (58%) found to be at "risk" and seven (15%) with "injury". There was a significant correlation between weight loss and elevated Cr (r = -0.29, p = 0.047), with a trend towards nonsteroidal anti-inflammatory drug (NSAID) use being correlated with AKI (p = 0.058). Acute kidney injury was observed in the majority of the Endeavor Team Challenge adventure racers, similar to what has been observed in multistage ultramarathons, and greater than after standard marathons and single-stage ultramarathons.

    View details for DOI 10.7759/cureus.1024

    View details for PubMedID 28348942

  • Biochemistry in Endeavor Adventure Racers Study (BEARS) CUREUS Wetschler, M., Radler, D., Christensen, M., Lipman, G. 2017; 9 (2)

    View details for DOI 10.7759/cureus.1024

    View details for Web of Science ID 000453619300019

  • Exercise-Associated Hyponatremia, Hypernatremia, and Hydration Status in Multistage Ultramarathons. Wilderness & environmental medicine Krabak, B. J., Lipman, G. S., Waite, B. L., Rundell, S. D. 2017; 28 (4): 291?98

    Abstract

    Dysnatremia and altered hydration status are potentially serious conditions that have not been well studied in multistage ultramarathons. The purpose of this study was to assess the incidence and prevalence of exercise-associated hyponatremia (EAH) (Na+ <135 mmol·L-1) and hypernatremia (Na+ >145 mmol·L-1) and hydration status during a multistage ultramarathon.This study involved a prospective observational cohort study of runners competing in a 250-km (155-mile) multistage ultramarathon (in the Jordan, Atacama, or Gobi Desert). Prerace body weight and poststage (stage [S] 1 [42 km], S3 [126 km], and S5 [250 km]) body weight and serum sodium concentration levels were obtained from 128 runners.The prevalence of EAH per stage was 1.6% (S1), 4.8% (S3), and 10.1% (S5) with a cumulative incidence of 14.8%. Per-stage prevalence of hypernatremia was 35.2% (S1), 20.2% (S3), and 19.3% (S5) with a cumulative incidence of 52.3%. Runners became more dehydrated (weight change <-3%) throughout the race (S1=22.1%; S3=51.2%; S5=53.5%). Body weight gain correlated with EAH (r=-0.21, P = .02). Nonfinishers of S3 were significantly more likely to have EAH compared with finishers (75% vs 5%, P = .001), but there was no difference in either EAH or hypernatremia between nonfinishers and finishers of S5.The incidence of EAH in multistage ultramarathons was similar to marathons and single-stage ultramarathons, but the cumulative incidence of hypernatremia was 3 times greater than that of EAH. EAH was associated with increased weight gain (overhydration) in early stage nonfinishers and postrace finishers.

    View details for PubMedID 28781178

  • Evidence-Based Review of Wilderness First Aid Practices JOURNAL OF OUTDOOR RECREATION EDUCATION AND LEADERSHIP Schimelpfenig, T., Johnson, D. E., Lipman, G. S., McEvoy, D. H., Bennett, B. L. 2017; 9 (2): 217?39

    View details for DOI 10.18666/JOREL-2017-V9-I2-8226

    View details for Web of Science ID 000413971700007

  • Hydration Status as a Predictor of High-altitude Mountaineering Performance CUREUS Ladd, E., Shea, K. M., Bagley, P., Auerbach, P. S., Pirrotta, E. A., Wang, E., Lipman, G. S. 2016; 8 (12)

    View details for DOI 10.7759/cureus.918

    View details for Web of Science ID 000453617500014

  • Incidence and Prevalence of Acute Kidney Injury During Multistage Ultramarathons CLINICAL JOURNAL OF SPORT MEDICINE Lipman, G. S., Krabak, B. J., Rundell, S. D., Shea, K. M., Badowski, N., Little, C. 2016; 26 (4): 314-319

    Abstract

    Determine prevalence, incidence, and risk factors of acute kidney injury (AKI) during multistage ultramarathons.Prospective observational cohort study.Jordanian Desert 2012; Atacama Desert, Chile 2012 and 2013; and Gobi Desert 2013 RacingThePlanet 250 km, 6-stage, ultramarathons.One hundred twenty-eight participants (384 measurements) from the Jordan (25, 19.5%), Gobi (35, 27.3%), 2012 Atacama (24, 18.8%), and 2013 Atacama (44, 34.4%) races.Blood samples and weights were gathered and analyzed immediately after stage 1 (40 km), 3 (120 km), and 5 (225 km).Changes in serum creatinine (Cr), cumulative incidence, and prevalence of AKI were calculated for each stage with "risk of injury" defined as 1.5 × baseline Cr and "injury" defined as 2 × Cr.Cumulative incidence of AKI was 41.4%. Stage 1 had 56 (43.8%) with risk of AKI and 24 (18.8%) with injury; in stage 3, 61 (47.7%) were at risk, 41 (32%) had injury; in stage 5, 62 (48.4%) runners were at risk and 36 (28.1%) had injury. Acute kidney injury was significantly associated with females [odds ratio (OR), 4.64; 95% confidence interval (CI), 2.07-10.37; P < 0.001], lower pack weight (OR, 0.71; 95% CI, 0.56-0.91; P < 0.007), and percentage weight loss (OR, 0.87; 95% CI, 0.78-0.97; P < 0.015). Lowest quintile of finishers was less likely to develop AKI (OR, 0.18; 95% CI, 0.04-0.78; P < 0.022).Prevalence of AKI was 63%-78% during multistage ultramarathons. Female sex, lower pack weight, and greater weight loss were associated with renal impairment.

    View details for DOI 10.1097/JSM.0000000000000253

    View details for PubMedID 26513390

  • The 6-Minute Walk Test as a Predictor of Summit Success on Denali WILDERNESS & ENVIRONMENTAL MEDICINE Shea, K. M., Ladd, E. R., Lipman, G. S., Bagley, P., Pirrotta, E. A., Vongsachang, H., Wang, N. E., Auerbach, P. S. 2016; 27 (1): 19-24

    Abstract

    To test whether the 6-minute walk test (6MWT), including postexercise vital sign measurements and distance walked, predicts summit success on Denali, AK.This was a prospective observational study of healthy volunteers between the ages of 18 and 65 years who had been at 4267 m for less than 24 hours on Denali. Physiologic measurements were made after the 6MWT. Subjects then attempted to summit at their own pace and, at the time of descent, completed a Lake Louise Acute Mountain Sickness Questionnaire and reported maximum elevation reached.One hundred twenty-one participants enrolled in the study. Data were collected on 111 subjects (92% response rate), of whom 60% summited. On univariate analysis, there was no association between any postexercise vital sign and summit success. Specifically, there was no significant difference in the mean postexercise peripheral oxygen saturation (Spo2) between summiters (75%) and nonsummiters (74%; 95% CI, -3 to 1; P = .37). The distance a subject walked in 6 minutes (6MWTD) was longer in summiters (617 m) compared with nonsummiters (560 m; 95% CI, 7.6 to 106; P = .02). However, this significance was not maintained on a multivariate analysis performed to control for age, sex, and guide status (P = .08), leading to the conclusion that 6MWTD was not a robust predictor of summit success.This study did not show a correlation between postexercise oxygen saturation or 6MWTD and summit success on Denali.

    View details for Web of Science ID 000372379000005

  • Reply. Journal of ultrasound in medicine Kanaan, N. C., Lipman, G. S., Constance, B. B., Holck, P. S., Preuss, J. F., Williams, S. R. 2016; 35 (2): 458-459

    View details for DOI 10.7863/ultra.15.11073

    View details for PubMedID 26795049

  • Reply. Journal of ultrasound in medicine Kanaan, N. C., Lipman, G. S., Constance, B. B., Holck, P. S., Preuss, J. F., Williams, S. R. 2016; 35 (2): 456-457

    View details for DOI 10.7863/ultra.15.10050

    View details for PubMedID 26795047

  • Hydration Status as a Predictor of High-altitude Mountaineering Performance. Cureus Ladd, E., Shea, K. M., Bagley, P., Rundell, S., Auerbach, P. S., Pirrotta, E. A., Wang, E., Lipman, G. S. 2016; 8 (12)

    Abstract

    Hydration status is a controversial determinant of athletic performance. This relationship has not been examined with mountaineering performance.This was a prospective observational study of mountaineers who attempted to climb Denali in Alaska. Participants' urine specific gravity (SG), and ultrasound measurements of the inferior vena cava size and collapsibility index (IVC-CI) were measured at rest prior to ascent. Upon descent, climbers reported maximum elevation gained for determination of summit success.One hundred twenty-one participants enrolled in the study. Data were collected on 111 participants (92% response rate); of those, 105 (87%) had complete hydration data. Fifty-seven percent of study participants were found to be dehydrated by IVC-CI on ultrasound, and 55% by urine SG. No significant association was found with summit success and quantitative measurements of hydration: IVC-CI (50.4% +/- 15.6 vs. 52.9% +/- 15.4, p = 0.91), IVC size (0.96 cm +/- 0.3 vs. 0.99 cm +/- 0.3, p = 0.81), and average SG (1.02 +/- 0.008 vs. 1.02 +/- 0.008, p = 0.87). Categorical measurements of urine SG found 24% more successful summiters were hydrated at 14 Camp, but this was not found to be statistically significant (p = 0.56). Summit success was associated with greater water-carrying capacity on univariate analysis only: 2.3 L, 95% confidence interval (2.1 - 2.5) vs. 2.1 L, 95% confidence interval (2 - 2.2); p < 0.01.Intravascular dehydration was found in approximately half of technical high-altitude mountaineers. Hydration status was not significantly associated with summit success, but increased water-carrying capacity may be an easy and inexpensive educational intervention to improve performance.

    View details for DOI 10.7759/cureus.918

    View details for PubMedID 28083462

  • A Chemical Heat Pack-Based Method For Consistent Heating of Intravenous Fluids WILDERNESS & ENVIRONMENTAL MEDICINE Declerck, M. P., Lipman, G. S., Grahn, D. A., Cao, V., Wieland, M., Troxel, T., Heller, H. C. 2015; 26 (3): 412-416

    Abstract

    Transfusion of cold intravenous fluids (IVF) can exacerbate hypothermia. Civilian and military guidelines recommend heated IVF for hypothermic patients; however, there is currently no ideal IVF heating system for use in resource-limited settings.Development of a system that uses flameless ration heaters (FRH) and an insulated sleeve for the consistent delivery of IVF at physiologically appropriate temperatures (40°-42°C) over the range of ambient conditions typical of the prehospital and wilderness environments.The temperatures of 0.9% normal saline (NS) 1-L bags were measured under 3 ambient conditions: 3°C, 10°C, and 20°C. The IVF was placed in an insulated pouch along with a predetermined number of activated FRH (5 FRH for 3°C, 4 FRH for 10°C, and 3 FRH for 20°C) for 10 minutes before removing the FRHs. The insulated IVF bag was drained through 280 cm of intravenous tubing at a flow rate of 77 mL/min. Raw temperature data for internal and delivery temperatures were collected and analyzed.The temperature of the IVF throughout the delivery of 1 L of NS under the 3 ambient conditions was as follows (mean ± SD): at 3°C ambient, 47° ± 2.1°C internal and 42.6°C ± 1.4°C at delivery; at 10°C ambient, 52.3° ± 2.7°C and 45.2° ± 1.6°C; and at 20°C ambient, 45.5° ± 1°C and 39.7° ± 0.7°C.The IVF heating system described here reliably delivered physiologically appropriate temperature intravenous fluids in 2 of the 3 ambient treatment conditions. With the appropriate number of FRH for the ambient conditions, this system enables the delivery of warmed IVF to provide active warming, which may be clinically beneficial in the prevention and treatment of hypothermia.

    View details for Web of Science ID 000360781100022

  • Optic Nerve Sheath Diameter Increase on Ascent to High Altitude Correlation With Acute Mountain Sickness JOURNAL OF ULTRASOUND IN MEDICINE Kanaan, N. C., Lipman, G. S., Constance, B. B., Hoick, P. S., Preuss, J. F., Williams, S. R. 2015; 34 (9): 1677-1682

    Abstract

    Elevated optic nerve sheath diameter on sonography is known to correlate with increased intracranial pressure and is observed in acute mountain sickness. This study aimed to determine whether optic nerve sheath diameter changes on ascent to high altitude are associated with acute mountain sickness incidence.Eighty-six healthy adults enrolled at 1240 m (4100 ft), drove to 3545 m (11,700 ft) and then hiked to and slept at 3810 m (12,500 ft). Lake Louise Questionnaire scores and optic nerve sheath diameter measurements were taken before, the evening of, and the morning after ascent.The incidence of acute mountain sickness was 55.8%, with a mean Lake Louise Questionnaire score ± SD of 3.81 ± 2.5. The mean maximum optic nerve sheath diameter increased on ascent from 5.58 ± 0.79 to 6.13 ± 0.73 mm, a difference of 0.91 ± 0.55 mm (P = .09). Optic nerve sheath diameter increased at high altitude regardless of acute mountain sickness diagnosis; however, compared to baseline values, we observed a significant increase in diameter only in those with a diagnosis of acute mountain sickness (0.57 ± 0.77 versus 0.21 ± 0.76 mm; P = .04). This change from baseline, or ? optic nerve sheath diameter, was associated with twice the odds of developing acute mountain sickness (95% confidence interval, 1.08-3.93).The mean optic nerve sheath diameter increased on ascent to high altitude compared to baseline values, but not to a statistically significant degree. The magnitude of the observed ? optic nerve sheath diameter was positively associated with acute mountain sickness diagnosis. No such significant association was found between acute mountain sickness and diameter elevation above standard cutoff values, limiting the utility of sonography as a diagnostic tool.

    View details for DOI 10.7863/ultra.15.14.10060

    View details for Web of Science ID 000360777600021

  • Novel Application of Chemical Cold Packs for Treatment of Exercise-Induced Hyperthermia: A Randomized Controlled Trial WILDERNESS & ENVIRONMENTAL MEDICINE Lissoway, J. B., Lipman, G. S., Grahn, D. A., Cao, V. H., Shaheen, M., Phan, S., Weiss, E. A., Heller, H. C. 2015; 26 (2): 173-179

    Abstract

    Heat-related illness is a common disease with significant morbidity and mortality. Despite no proven efficacy, application of chemical cold packs (CCP) to the skin overlying the large vessels of the neck, groin, and axillae is a traditional recommended cooling modality. The study objective was to compare the cooling rates of CCP applied to these traditional areas vs the glabrous skin surfaces of the cheeks, palms, and soles in exercise-induced hyperthermia.Ten healthy adult male volunteers walked on a treadmill in a heated room (40°±0.5°C) while wearing insulated military overgarments until their esophageal temperatures (Tes) reached 39.2°C. Each participant had three heat stress trials on separate days: no treatment followed by randomly ordered traditional (neck, groin, and axillae) cooling and glabrous skin cooling.With no treatment, Tes remained stable after the first 5 minutes of the heat trial (?Tes=0.12°±0.07°C/10 min). Traditional cooling followed a linear decline (?Tes=0.17°±0.04°C/10 min; P<.001). Glabrous cooling enhanced the treatment effect by a steeper decline (?Tes=0.30°±0.06°C/10 min; P<.001), significantly different from traditional cooling by 2-way analysis of variance (P<.001).Application of CCP to glabrous skin surfaces was more effective for treating exercise-induced heat stress than the traditional CCP cooling intervention. This novel cooling technique may be beneficial as an adjunctive treatment for heat-related illness in the prehospital environment.

    View details for PubMedID 25771030

  • Improvised Method for Increasing the Temperature of an i-STAT Analyzer and Cartridge in Cold Environments WILDERNESS & ENVIRONMENTAL MEDICINE Radler, D., Wetschler, M., Christensen, M., Lipman, G. S. 2015; 26 (2): 280?82

    View details for PubMedID 25772823

  • Blisters: the enemy of the feet. Wilderness & environmental medicine Lipman, G. S., Scheer, B. V. 2015; 26 (2): 275-276

    View details for DOI 10.1016/j.wem.2014.11.003

    View details for PubMedID 25747539

  • Study Looking at End Expiratory Pressure for Altitude Illness Decrease (SLEEP-AID) HIGH ALTITUDE MEDICINE & BIOLOGY Lipman, G. S., Kanaan, N. C., Phillips, C., Pomeranz, D., Cain, P., Fontes, K., Higbee, B., Meyer, C., Shaheen, M., Wentworth, S., Walsh, D. 2015; 16 (2): 154-161

    Abstract

    Lipman, Grant S., Nicholas C. Kanaan, Caleb Phillips, Dave Pomeranz, Patrick Cain, Kristin Fontes, Becky Higbee, Carolyn Meyer, Michael Shaheen, Sean Wentworth, and Diane Walsh. Study Looking at End Expiratory Pressure for Altitude Illness Decrease (SLEEP-AID). High Alt Med Biol 16:154-161, 2015.-Acute mountain sickness (AMS) affects 25%-70% of the tens of millions of high altitude travelers annually, with hypoxia and nocturnal desaturations as major contributing factors. This is the first double blind randomized placebo controlled trial to assess expiratory positive airway pressure (EPAP) for AMS prevention and nocturnal hypoxic events. Healthy adult participants trekking in the Khumbu region of the Himalayas were randomized to a single-use EPAP nasal strip, or a visually identical sham device (placebo) prior to first night sleeping between 4371-4530?m (14,340-14,800?ft). The primary outcome was AMS incidence, measured by Lake Louise Questionnaire (LLQ), with secondary outcomes of AMS severity (by LLQ) and physiologic sleep indices measured by continuous sleep monitor. Intent-to-treat analysis included 219 participants with comparable demographic characteristics, of which 115 received EPAP and 104 placebo. There was no decrease in AMS with EPAP intervention (14% EPAP vs. 17% placebo; p=0.65; risk difference (-)3.15%, 95% CI (-)12.85%-6.56%). While overall AMS severity was not different between groups, EPAP reported decreased incidence of headache (64% vs. 76%; p<0.05, OR 0.51, 95% CI 0.27-0.95) and dizziness (81% vs. 98%; p<0.03, OR 0.29, 95% CI 0.09-0.78). During sleep, EPAP resulted in significant improvements in average peripheral oxygenation (Spo2) (80% versus 78%; p<0.01, mean difference=2, 95% CI 0.58-3.63) and a reduced percentage of time below 80% Spo2 (31% vs. 46%; p<0.03, median difference=16, 95% CI 2.22-28.18). This lightweight and inexpensive EPAP device did not prevent acute mountain sickness, but did reduce the subgroup incidence of headache and dizziness while improving average nighttime peripheral oxygenation.

    View details for DOI 10.1089/ham.2014.1110

    View details for PubMedID 25950723

  • Correct wilderness medicine definitions and their impact on care. Sports medicine Lipman, G. S. 2015; 45 (4): 601-602

    View details for DOI 10.1007/s40279-014-0294-3

    View details for PubMedID 25520160

  • In response to: Canadian Academy of Sport and Exercise Medicine position statement: athletes at high altitude. Clinical journal of sport medicine Lipman, G. S., Kanaan, N. C. 2015; 25 (2): 173-?

    View details for DOI 10.1097/JSM.0000000000000156

    View details for PubMedID 25714259

  • Effect of an emergency department fast track on press-ganey patient satisfaction scores. The western journal of emergency medicine Hwang, C. E., Lipman, G. S., Kane, M. 2015; 16 (1): 34-38

    Abstract

    Mandated patient surveys have become an integral part of Medicare remuneration, putting hundreds of millions of dollars in funding at risk. The Centers for Medicare & Medicaid Services (CMS) recently announced a patient experience survey for the emergency department (ED). Development of an ED Fast Track, where lower acuity patients are rapidly seen, has been shown to improve many of the metrics that CMS examines. This is the first study examining if ED Fast Track implementation affects Press-Ganey scores of patient satisfaction.We analyzed returned Press-Ganey questionnaires from all ESI 4 and 5 patients seen 11AM - 1PM, August-December 2011 (pre-fast track), and during the identical hours of fast track, August-December 2012. Raw ordinal scores were converted to continuous scores for paired student t-test analysis. We calculated an odds ratio with 100% satisfaction considered a positive response.An academic ED with 52,000 annual visits had 140 pre-fast track and 85 fast track respondents. Implementation of a fast track significantly increased patient satisfaction with the following: wait times (68% satisfaction to 88%, OR 4.13, 95% CI [2.32-7.33]), doctor courtesy (90% to 95%, OR 1.97, 95% CI [1.04-3.73]), nurse courtesy (87% to 95%, OR 2.75, 95% CI [1.46-5.15]), pain control (79% to 87%, OR 2.13, 95% CI [1.16-3.92]), likelihood to recommend (81% to 90%, OR 2.62, 95% CI [1.42-4.83]), staff caring (82% to 91%, OR 2.82, 95% CI [1.54-5.19]), and staying informed about delays (66% to 83%, OR 3.00, 95% CI [1.65-5.44]).Implementation of an ED Fast Track more than doubled the odds of significant improvements in Press-Ganey patient satisfaction metrics and may play an important role in improving ED performance on CMS benchmarks.

    View details for DOI 10.5811/westjem.2014.11.21768

    View details for PubMedID 25671005

  • The 6-Minute Walk Test as a Predictor of Summit Success on Denali. Wilderness & environmental medicine Shea, K. M., Ladd, E. R., Lipman, G. S., Bagley, P., Pirrotta, E. A., Vongsachang, H., Wang, N. E., Auerbach, P. S. 2015

    Abstract

    To test whether the 6-minute walk test (6MWT), including postexercise vital sign measurements and distance walked, predicts summit success on Denali, AK.This was a prospective observational study of healthy volunteers between the ages of 18 and 65 years who had been at 4267 m for less than 24 hours on Denali. Physiologic measurements were made after the 6MWT. Subjects then attempted to summit at their own pace and, at the time of descent, completed a Lake Louise Acute Mountain Sickness Questionnaire and reported maximum elevation reached.One hundred twenty-one participants enrolled in the study. Data were collected on 111 subjects (92% response rate), of whom 60% summited. On univariate analysis, there was no association between any postexercise vital sign and summit success. Specifically, there was no significant difference in the mean postexercise peripheral oxygen saturation (Spo2) between summiters (75%) and nonsummiters (74%; 95% CI, -3 to 1; P = .37). The distance a subject walked in 6 minutes (6MWTD) was longer in summiters (617 m) compared with nonsummiters (560 m; 95% CI, 7.6 to 106; P = .02). However, this significance was not maintained on a multivariate analysis performed to control for age, sex, and guide status (P = .08), leading to the conclusion that 6MWTD was not a robust predictor of summit success.This study did not show a correlation between postexercise oxygen saturation or 6MWTD and summit success on Denali.

    View details for PubMedID 26712335

  • Wilderness medical society practice guidelines for the prevention and treatment of heat-related illness: 2014 update. Wilderness & environmental medicine Lipman, G. S., Eifling, K. P., Ellis, M. A., Gaudio, F. G., Otten, E. M., Grissom, C. K. 2014; 25 (4): S55-65

    Abstract

    The Wilderness Medical Society (WMS) convened an expert panel to develop a set of evidence-based guidelines for the recognition, prevention, and treatment of heat illness. We present a review of the classifications, pathophysiology, and evidence-based guidelines for planning and preventive measures as well as best practice recommendations for both field and hospital-based therapeutic management of heat illness. These recommendations are graded on the basis of the quality of supporting evidence, and balance between the benefits and risks or burdens for each modality. This is an updated version of the original WMS Practice Guidelines for the Prevention and Treatment of Heat-Related Illness published in Wilderness & Environmental Medicine 2013;24(4):351-361.

    View details for DOI 10.1016/j.wem.2014.07.017

    View details for PubMedID 25498263

  • Evaluation and Treatment of Injury and Illness in the Ultramarathon Athlete PHYSICAL MEDICINE AND REHABILITATION CLINICS OF NORTH AMERICA Krabak, B. J., Waite, B., Lipman, G. 2014; 25 (4): 845-?

    Abstract

    Participation in ultramarathon races and knowledge of these athletes continues to increase as the sport becomes more popular. Physicians and athletes need to better understand the impact of the unique aspects of ultramarathon races, such as race environment (temperature, humidity, and altitude), race distance, race stages, nutritional requirements and equipment, on athlete injuries and illness. Proper treatment of injuries and illnesses during an ultramarathon race is important for avoiding long-term medical issues. In this article, the evaluation and treatment of common musculoskeletal injuries and medical illnesses in ultramarathon runners are reviewed.

    View details for DOI 10.1016/j.pmr.2014.06.006

    View details for Web of Science ID 000345495900010

  • Evaluation and treatment of injury and illness in the ultramarathon athlete. Physical medicine and rehabilitation clinics of North America Krabak, B. J., Waite, B., Lipman, G. 2014; 25 (4): 845-863

    Abstract

    Participation in ultramarathon races and knowledge of these athletes continues to increase as the sport becomes more popular. Physicians and athletes need to better understand the impact of the unique aspects of ultramarathon races, such as race environment (temperature, humidity, and altitude), race distance, race stages, nutritional requirements and equipment, on athlete injuries and illness. Proper treatment of injuries and illnesses during an ultramarathon race is important for avoiding long-term medical issues. In this article, the evaluation and treatment of common musculoskeletal injuries and medical illnesses in ultramarathon runners are reviewed.

    View details for DOI 10.1016/j.pmr.2014.06.006

    View details for PubMedID 25442162

  • Medical Services at Ultra-Endurance Foot Races in Remote Environments: Medical Issues and Consensus Guidelines SPORTS MEDICINE Hoffman, M. D., Pasternak, A., Rogers, I. R., Khodaee, M., Hill, J. C., Townes, D. A., Scheer, B. V., Krabak, B. J., Basset, P., Lipman, G. S. 2014; 44 (8): 1055-1069

    Abstract

    An increasing participation in ultra-endurance foot races is cause for greater need to ensure the presence of appropriate medical care at these events. Unique medical challenges result from the extreme physical demands these events place on participants, the often remote settings spanning broad geographical areas, and the potential for extremes in weather conditions and various environmental hazards. Medical issues in these events can adversely affect race performance, and there is the potential for the presentation of life-threatening issues such as exercise-associated hyponatremia, severe altitude illnesses, and major trauma from falls or animal attacks. Organization of a medical support system for ultra-endurance foot races starts with a determination of the level of medical support that is appropriate and feasible for the event. Once that is defined, various legal considerations and organizational issues must be addressed, and medical guidelines and protocols should be developed. While there is no specific or universal standard of medical care for ultra-endurance foot races since a variety of factors determine the level and type of medical services that are appropriate and feasible, the minimum level of services that each event should have in place is a plan for emergency transport of injured or ill participants, pacers, spectators and event personnel to local medical facilities.

    View details for DOI 10.1007/s40279-014-0189-3

    View details for Web of Science ID 000344973900003

    View details for PubMedID 24748459

  • Keeping a broad perspective: Reply regarding the Wilderness Medical Society practice guidelines for the prevention and treatment of heat-related illness. Wilderness & environmental medicine Lipman, G. S., Eifling, K. P., Ellis, M. A., Gaudio, F. G., Otten, E. M., Grissom, C. K. 2014; 25 (2): 251-252

    View details for DOI 10.1016/j.wem.2014.02.004

    View details for PubMedID 24656907

  • The importance of keeping cool: Reply regarding the Wilderness Medical Society practice guidelines for the prevention and treatment of heat-related illness. Wilderness & environmental medicine Lipman, G. S., Eifling, K. P., Ellis, M. A., Gaudio, F. G., Otten, E. M., Grissom, C. K. 2014; 25 (2): 247-249

    View details for DOI 10.1016/j.wem.2014.01.019

    View details for PubMedID 24864070

  • Core Content for Wilderness Medicine Fellowship Training of Emergency Medicine Graduates ACADEMIC EMERGENCY MEDICINE Lipman, G. S., Weichenthal, L., Harris, N. S., McIntosh, S. E., Cushing, T., Caudell, M. J., Macias, D. J., Weiss, E. A., Lemery, J., Ellis, M. A., Spano, S., McDevitt, M., Tedeschi, C., Dow, J., Mazzorana, V., McGinnis, H., Gardner, A. F., Auerbach, P. S. 2014; 21 (2): 204-207

    Abstract

    Wilderness medicine is the practice of resource-limited medicine under austere conditions. In 2003, the first wilderness medicine fellowship was established, and as of March 2013, a total of 12 wilderness medicine fellowships exist. In 2009 the American College of Emergency Physicians Wilderness Medicine Section created a Fellowship Subcommittee and Taskforce to bring together fellowship directors, associate directors, and other interested stakeholders to research and develop a standardized curriculum and core content for emergency medicine (EM)-based wilderness medicine fellowships. This paper describes the process and results of what became a 4-year project to articulate a standardized curriculum for wilderness medicine fellowships. The final product specifies the minimum core content that should be covered during a 1-year wilderness medicine fellowship. It also describes the structure, length, site, and program requirements for a wilderness medicine fellowship.

    View details for DOI 10.1111/acem.12304

    View details for PubMedID 24438590

  • A Prospective Cohort Study of Acute Kidney Injury in Multi-stage Ultramarathon Runners: The Biochemistry in Endurance Runner Study (BIERS). Research in sports medicine Lipman, G. S., Krabak, B. J., Waite, B. L., Logan, S. B., Menon, A., Chan, G. K. 2014; 22 (2): 185-192

    Abstract

    The purpose of the study was to evaluate the prevalence of acute kidney injury (AKI) during a multi-stage ultramarathon foot race. A prospective observational study was taken during the Gobi 2008; Sahara 2008; and Namibia 2009 RacingThePlanet 7-day, 6-stage, 150-mile foot ultramarathons. Blood was analyzed before, and immediately after stage 1 (25 miles), 3 (75 miles), and 5 (140 miles). Creatinine (Cr), glomerular filtration rate (GFR), and incidence of AKI were calculated and defined by RIFLE criteria. Thirty participants (76% male, mean age 40 + 11 years) were enrolled. There were significant declines in GFR after each stage compared with the pre-race baseline (p < 0.001), with the majority of participants (55-80%) incurring AKI. The majority of study participants encountered significant renal impairment; however, no apparent cumulative effect was observed, with resolution of renal function to near baseline levels between stages.

    View details for DOI 10.1080/15438627.2014.881824

    View details for PubMedID 24650338

  • Two cases of paradoxical hypothermia in a Sahara desert multi-stage ultramarathon EMERGENCY CARE JOURNAL Kaufman, E. A., Lipman, G. S., Sharp, L. J., Krabak, B. J. 2014; 10 (2): 80?82

    View details for DOI 10.4081/ecj.2014.4279

    View details for Web of Science ID 000216473600008

  • A Prospective Randomized Blister Prevention Trial Assessing Paper Tape in Endurance Distances (Pre-TAPED) WILDERNESS & ENVIRONMENTAL MEDICINE Lipman, G. S., Ellis, M. A., Lewis, E. J., Waite, B. L., Lissoway, J., Chan, G. K., Krabak, B. J. 2014; 25 (4): 457-461

    Abstract

    Friction foot blisters are a common injury occurring in up to 39% of marathoners, the most common injury in adventure racing, and represent more than 70% of medical visits in multi-stage ultramarathons. The goal of the study was to determine whether paper tape could prevent foot blisters in ultramarathon runners.This prospective randomized trial was undertaken during RacingThePlanet 155-mile (250-km), 7-day self-supported ultramarathons in China, Australia, Egypt, Chile, and Nepal in 2010 and 2011. Paper tape was applied prerace to one randomly selected foot, with the untreated foot acting as the own control. The study end point was development of a hot spot or blister on any location of either foot.One hundred thirty-six participants were enrolled with 90 (66%) having completed data for analysis. There were 36% women, with a mean age of 40 ± 9.4 years (range, 25-40 years) and pack weight of 11 ± 1.8 kg (range, 8-16 kg). All participants developed blisters, with 89% occurring by day 2 and 59% located on the toes. No protective effect was observed by the intervention (47 versus 35; 52% versus 39%; P = .22), with fewer blisters occurring around the tape on the experimental foot than under the tape (23 vs 31; 25.6% versus 34.4%), yet 84% of study participants when queried would choose paper tape for blister prevention in the future.Although paper tape was not found to be significantly protective against blisters, the intervention was well tolerated with high user satisfaction.

    View details for PubMedID 25443754

  • Clinical practice guidelines for treatment of exercise-associated hyponatremia. Wilderness & environmental medicine Lipman, G. S. 2013; 24 (4): 466-468

    View details for DOI 10.1016/j.wem.2013.05.002

    View details for PubMedID 23954253

  • Ibuprofen for prevention of acute mountain sickness: is bigger really better? Wilderness & environmental medicine Lipman, G. S., Kanaan, N. C. 2013; 24 (2): 177-178

    View details for DOI 10.1016/j.wem.2012.11.007

    View details for PubMedID 23434167

  • Injury and illnesses prevention for ultramarathoners. Current sports medicine reports Krabak, B. J., Waite, B., Lipman, G. 2013; 12 (3): 183-189

    Abstract

    The popularity of ultramarathon races continue to grow with runners participating in races throughout the world. These events offer challenges unique to an ultramarathon compared to a marathon race. These challenges require the athlete to focus on factors including race distance, race stages, race environment (temperature, humidity, and altitude), appropriate training, nutritional preparation, and equipment. Athletes ill prepared for these challenges will be at risk from injury and illness. The goal of this article is to review preventive strategies for managing commonly encountered musculoskeletal injuries and medical illnesses in ultramarathon runners.

    View details for DOI 10.1249/JSR.0b013e3182913c98

    View details for PubMedID 23669089

  • Chemical Cold Packs May Provide Insufficient Enthalpy Change for Treatment of Hyperthermia WILDERNESS & ENVIRONMENTAL MEDICINE Phan, S., Lissoway, J., Lipman, G. S. 2013; 24 (1): 37-41

    Abstract

    Heat illness is a common ailment that, if left untreated, is associated with high morbidity and mortality. Chemical cold packs (CCPs) and ice packs are widely used in the pre-hospital setting and by those with limited resources, yet no controlled studies have compared the cooling of ice to that of CCPs. This study determined the theoretical cooling of CCPs on a benchtop model, comparing the results to similarly sized ice packs, and is the first known comparison of these hyperthermia treatments.The CCPs used in Stanford University's Emergency Department were activated in an insulated volume of water (2 L), and temperature was recorded at 1-second intervals in a controlled environment (41°C at 20% humidity). The procedure was repeated with 1-quart ice packs.The CCPs resulted in a 5.25°C degree temperature drop, with a time constant (time to 63% of initial temperature--a common engineering characterization metric) of 1.72 minutes for the test volume. Ice packs resulted on average in a 19.8°C temperature change, with a time constant of 26.8 minutes. The CCPs provide less overall temperature change and were shorter lived. Application of 6 CCPs on a 50th percentile male (weight 86.6 kg, height 1.7 m), assuming ideal heat transfer, would result in less than 0.5°C temperature change. Similarly configured ice packs would result in a 2.5°C change.Experiments demonstrate that CCPs are inferior to similarly sized ice packs for thermal regulation, and lose their effectiveness more quickly. These findings support the consideration of ice packs as an alternative to chemical cold packs when cooling hyperthermic patients.

    View details for PubMedID 23312558

  • Pharmacologic Prevention for Acute Mountain Sickness-Lack of Appropriate Inclusion of the Available Evidence ANNALS OF EMERGENCY MEDICINE Lipman, G. S., Gertsch, J. H. 2012; 60 (4): 538-539

    View details for DOI 10.1016/j.annemergmed.2012.03.034

    View details for Web of Science ID 000309636000028

    View details for PubMedID 23010187

  • Biochemistry In Endurance Runners Study: Electrolyte Changes During Multi-day Ultra-Endurance Running Bruso, J. R., Waite, B., Lipman, G., Menon, A., Moore, M., Krabak, B. SPRINGER. 2012: 678

    View details for Web of Science ID 000209142902589

  • Optic Nerve Sheath Diameter Changes on Ascent to High Altitude Annual Research Forum of the American-College-of-Emergency-Physicians LIPMAN, G. S., Kanaan, N., Constance, B., Holck, P., Grimm, E., Jeffrey, G., Williams, S. MOSBY-ELSEVIER. 2011: S185?S186

    View details for Web of Science ID 000295421300025

  • Biochemistry In Endurance Runners Study: Electrolyte Changes During Multi-day Ultra-Endurance Running Bruso, J. R., Waite, B., Lipman, G., Menon, A., Moore, M., Krabak, B. LIPPINCOTT WILLIAMS & WILKINS. 2011: 678

    View details for DOI 10.1249/01.MSS.0000401880.60158.0b

    View details for Web of Science ID 000209079502589

  • Prospective, Double-Blind, Randomized, Placebo-Controlled Comparison of Acetazolamide Versus Ibuprofen for Prophylaxis Against High Altitude Headache: The Headache Evaluation at Altitude Trial (HEAT) WILDERNESS & ENVIRONMENTAL MEDICINE Gertsch, J. H., Lipman, G. S., Holck, P. S., Merritt, A., Mulcahy, A., Fisher, R. S., Basnyat, B., Allison, E., Hanzelka, K., Hazan, A., Meyers, Z., Odegaard, J., Pook, B., Thompson, M., Slomovic, B., Wahlberg, H., Wilshaw, V., Weiss, E. A., Zafren, K. 2010; 21 (3): 236-243

    Abstract

    High altitude headache (HAH) is the most common neurological complaint at altitude and the defining component of acute mountain sickness (AMS). However, there is a paucity of literature concerning its prevention. Toward this end, we initiated a prospective, double-blind, randomized, placebo-controlled trial in the Nepal Himalaya designed to compare the effectiveness of ibuprofen and acetazolamide for the prevention of HAH.Three hundred forty-three healthy western trekkers were recruited at altitudes of 4280 m and 4358 m and assigned to receive ibuprofen 600 mg, acetazolamide 85 mg, or placebo 3 times daily before continued ascent to 4928 m. Outcome measures included headache incidence and severity, AMS incidence and severity on the Lake Louise AMS Questionnaire (LLQ), and visual analog scale (VAS).Two hundred sixty-five of 343 subjects completed the trial. HAH incidence was similar when treated with acetazolamide (27.1%) or ibuprofen (27.5%; P = .95), and both agents were significantly more effective than placebo (45.3%; P = .01). AMS incidence was similar when treated with acetazolamide (18.8%) or ibuprofen (13.7%; P = .34), and both agents were significantly more effective than placebo (28.6%; P = .03). In fully compliant participants, moderate or severe headache incidence was similar when treated with acetazolamide (3.8%) or ibuprofen (4.7%; P = .79), and both agents were significantly more effective than placebo (13.5%; P = .03).Ibuprofen and acetazolamide were similarly effective in preventing HAH. Ibuprofen was similar to acetazolamide in preventing symptoms of AMS, an interesting finding that implies a potentially new approach to prevention of cerebral forms of acute altitude illness.

    View details for Web of Science ID 000282163300007

    View details for PubMedID 20832701

  • Possible Unilateral Ultraviolet Keratoconjunctivitis During an Expedition-Length Desert Race WILDERNESS & ENVIRONMENTAL MEDICINE Lipman, G. S., Constance, B. B., Ladbrook, M. 2010; 21 (2): 171-172

    View details for Web of Science ID 000279235900017

    View details for PubMedID 20591383

  • Carbon monoxide toxicity at high altitude WILDERNESS & ENVIRONMENTAL MEDICINE Lipman, G. S. 2006; 17 (2): 144-145

    View details for Web of Science ID 000238243900013

    View details for PubMedID 16805152

  • Survival rates and cardiopulmonary resuscitation CRITICAL CARE MEDICINE Borzotta, A., Lipman, G., Dunn, P. M. 1998; 26 (7): 1293-1294

    View details for Web of Science ID 000074755500036

    View details for PubMedID 9671386

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