Publications by authors named "Tracy A Cushing"

13 Publications

  • Page 1 of 1

Wilderness Medical Society Clinical Practice Guidelines for the Treatment and Prevention of Drowning: 2019 Update.

Wilderness Environ Med 2019 Dec 25;30(4S):S70-S86. Epub 2019 Oct 25.

Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA.

The Wilderness Medical Society convened a panel to review available evidence supporting practices for acute management and treatment of drowning in out-of-hospital and emergency medical care settings. Literature about definitions and terminology, epidemiology, rescue, resuscitation, acute clinical management, disposition, and drowning prevention was reviewed. The panel graded available evidence supporting practices according to the American College of Chest Physicians criteria and then made recommendations based on that evidence. Recommendations were based on the panel's collective clinical experience and judgment when published evidence was lacking. This is the first update to the original practice guidelines published in 2016.
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http://dx.doi.org/10.1016/j.wem.2019.06.007DOI Listing
December 2019

Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Drowning.

Wilderness Environ Med 2016 Jun 6;27(2):236-51. Epub 2016 Apr 6.

Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA (Dr Auerbach).

The Wilderness Medical Society convened a panel to review available evidence supporting practices for the prevention and acute management of drowning in out-of-hospital and emergency medical care settings. Literature about definition and terminology, epidemiology, rescue, resuscitation, acute clinical management, disposition, and drowning prevention was reviewed. The panel graded evidence supporting practices according to the American College of Chest Physicians criteria, then made recommendations based on that evidence. Recommendations were based on the panel's collective clinical experience and judgment when published evidence was lacking.
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http://dx.doi.org/10.1016/j.wem.2015.12.019DOI Listing
June 2016

Preparticipation Evaluation for Climbing Sports.

Wilderness Environ Med 2015 Dec;26(4 Suppl):S40-6

Division of Emergency Medicine, University of Utah Health Care, Salt Lake City, Utah (Drs Ng and McIntosh).

Climbing is a popular wilderness sport among a wide variety of professional athletes and amateur enthusiasts, and many styles are performed across many environments. Potential risks confront climbers, including personal health or exacerbation of a chronic condition, in addition to climbing-specific risks or injuries. Although it is not common to perform a preparticipation evaluation (PPE) for climbing, a climber or a guide agency may request such an evaluation before participation. Formats from traditional sports PPEs can be drawn upon, but often do not directly apply. The purpose of this article was to incorporate findings from expert opinion from professional societies in wilderness medicine and in sports medicine, with findings from the literature of both climbing epidemiology and traditional sports PPEs, into a general PPE that would be sufficient for the broad sport of climbing. The emphasis is on low altitude climbing, and an overview of different climbing styles is included. Knowledge of climbing morbidity and mortality, and a standardized approach to the PPE that involves adequate history taking and counseling have the potential for achieving risk reduction and will facilitate further study on the evaluation of the efficacy of PPEs.
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http://dx.doi.org/10.1016/j.wem.2015.09.014DOI Listing
December 2015

General Medical Considerations for the Wilderness Adventurer: Medical Conditions That May Worsen With or Present Challenges to Coping With Wilderness Exposure.

Wilderness Environ Med 2015 Dec;26(4 Suppl):S20-9

Department of Family Medicine, Georgia Regents University, Augusta, Georgia (Dr Asplund).

Participation in wilderness and adventure sports is on the rise, and as such, practitioners will see more athletes seeking clearance to participate in these events. The purpose of this article is to describe specific medical conditions that may worsen or present challenges to the athlete in a wilderness environment.
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http://dx.doi.org/10.1016/j.wem.2015.09.007DOI Listing
December 2015

Preparticipation Evaluation for Climbing Sports.

Clin J Sport Med 2015 Sep;25(5):412-7

*Family and Sports Medicine, University of Utah Health Care, Salt Lake City, Utah; †Department of Emergency Medicine, University of Colorado School of Medicine; ‡Kaiser Permanente, Department of Emergency Medicine, University of Colorado; §Division of Emergency Medicine, University of Utah Health Care, Salt Lake City, Utah; ¶Arizona Sports Medicine Center, Mesa, Arizona; and ‖Central Maine Sports Medicine (a Clinical Division of CMMC), Evergreen Sports Medicine Fellowship, Lewiston, Maine.

Climbing is a popular wilderness sport among a wide variety of professional athletes and amateur enthusiasts, and many styles are performed across many environments. Potential risks confront climbers, including personal health or exacerbation of a chronic condition, in addition to climbing-specific risks or injuries. Although it is not common to perform a preparticipation evaluation (PPE) for climbing, a climber or a guide agency may request such an evaluation before participation. Formats from traditional sports PPEs can be drawn upon, but often do not directly apply. The purpose of this article was to incorporate findings from expert opinion from professional societies in wilderness medicine and in sports medicine, with findings from the literature of both climbing epidemiology and traditional sports PPEs, into a general PPE that would be sufficient for the broad sport of climbing. The emphasis is on low altitude climbing, and an overview of different climbing styles is included. Knowledge of climbing morbidity and mortality, and a standardized approach to the PPE that involves adequate history taking and counseling have the potential for achieving risk reduction and will facilitate further study on the evaluation of the efficacy of PPEs.
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http://dx.doi.org/10.1097/JSM.0000000000000247DOI Listing
September 2015

General Medical Considerations for the Wilderness Adventurer: Medical Conditions That May Worsen With or Present Challenges to Coping With Wilderness Exposure.

Clin J Sport Med 2015 Sep;25(5):396-403

*Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado; †Department of Family Medicine and Community Health, University of Minnesota, St. Paul, Minnesota; ‡Department of Emergency Medicine, Institute for Altitude Medicine, Telluride, Colorado; §Department of Family Medicine, Tufts University School of Medicine, Boston, Massachusetts; ¶Department of Sports Medicine, The Vancouver Clinic, Vancouver, Washington; ‖Department of Orthopedics/Community & Family Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; **Department of Family Medicine, Group Health Cooperative, Everett, Washington; ††Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina; ‡‡Departments of Medicine, Pediatrics and Pathology, Oregon Health and Science University, Portland, Oregon; §§Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah; ¶¶Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado; and ‖‖Department of Family Medicine, Georgia Regents University, Augusta, Georgia.

Participation in wilderness and adventure sports is on the rise, and as such, practitioners will see more athletes seeking clearance to participate in these events. The purpose of this article is to describe specific medical conditions that may worsen or present challenges to the athlete in a wilderness environment.
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http://dx.doi.org/10.1097/JSM.0000000000000229DOI Listing
September 2015

Climbing On: Editorial Evolution.

Wilderness Environ Med 2015 Sep 31;26(3):287. Epub 2015 Jul 31.

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http://dx.doi.org/10.1016/j.wem.2015.06.019DOI Listing
September 2015

Bites, bugs, and blood.

Wilderness Environ Med 2015 Jun 18;26(2):113-4. Epub 2015 Apr 18.

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http://dx.doi.org/10.1016/j.wem.2015.03.026DOI Listing
June 2015

A review of emergency medical services events in US national parks from 2007 to 2011.

Wilderness Environ Med 2013 Sep 9;24(3):195-202. Epub 2013 May 9.

Department of Emergency Medicine, Denver Health Medical Center, Denver, CO. Electronic address:

Objective: Outdoor recreation is growing in the United States, with more than 279 million annual visitors to areas controlled by the National Park Service (NPS). Emergency medical needs in these parks are overseen by the National Park's rangers within the NPS Emergency Medical Services (EMS) system. This study examines medical and traumatic emergencies throughout the NPS over a 5-year period to better understand the types of events and fatalities rangers encounter, both regionally and on a national scale.

Methods: This is a retrospective review of the annual EMS reports published by the 7 NPS regions from 2007 to 2011. The following were compared and examined at a regional and national level: medical versus traumatic versus first aid events, cardiac events and outcomes, use of automated external defibrillators, and medical versus traumatic fatalities.

Results: The national incidence of EMS events was 45.9 events per 1 million visitors. Medical, traumatic, and first aid events composed 29%, 28%, and 43% of reports, respectively. Of medical episodes, 1.8% were cardiac arrests, of which 64.2% received automated external defibrillator treatment; 29.1% of cardiac arrests survived to hospital discharge. Of fatalities, 61.4% were traumatic in nature and the remaining 38.5% were nontraumatic (medical). Regional differences were found for all variables.

Conclusions: On a national level, the NPS experiences an equal number of medical and traumatic EMS events. This differs from past observed trends that reported a higher incidence of traumatic events than medical events in wilderness settings. Cardiac events and automated external defibrillator usage are relatively infrequent. Traumatic fatalities are more common than medical fatalities in the NPS. Regional variations in events likely reflect differences in terrain, common activities, proximity to urban areas, and access to definitive care between regions. These data can assist the NPS in targeting the regions with the greatest number of incidents and fatalities for prevention, ranger training, and visitor education.
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http://dx.doi.org/10.1016/j.wem.2013.01.009DOI Listing
September 2013

Anaphylaxis to black widow spider antivenom.

Am J Emerg Med 2012 Jun;30(5):836.e1-2

Rocky Mountain Poison and Drug Center, Denver Health, Denver, CO 80204, USA.

Black widow spider envenomation is commonly reported to poison centers. Black widow spider envenomation produces a clinical syndrome, known as latrodectism, characterized by headache, nausea, vomiting, several muscle cramping and pain, joint stiffness, hypertension, and regional diaphoresis. Black widow spider antivenom (Merck & Co, Inc, West Point, PA USA) is an effective and relatively safe treatment option. There is 1 clear case of anaphylaxis secondary to black widow spider antivenom reported in the medical literature. Here, we report a case of anaphylaxis to antivenom. A 12-year-old boy presented to the emergency department (ED) with diffuse, severe pain 2 1/2 hours after being bitten by a black widow spider on the right lower extremity. In the ED, the patient failed analgesic therapy with fentanyl and was given black widow spider antivenom. Within 45 minutes, he exhibited signs and symptoms consistent with anaphylaxis, including wheezing, chest tightness, pruritus, and urticarial rash. The patient was given standard therapy for anaphylaxis, and all of his signs and symptoms (including the pain secondary to the black widow envenomation) resolved over 6 hours of observation. Leading experts agree that the use of antivenom is indicated in cases of severe envenomation not responsive to standard therapy. Despite concern that the antivenom is an equine-derived whole IgG and can precipitate early hypersensitivity reactions, there is only 1 other reported case of anaphylaxis to the antivenom in the medical literature.
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http://dx.doi.org/10.1016/j.ajem.2011.03.017DOI Listing
June 2012

Comparison of hematoma shape and volume estimates in warfarin versus non-warfarin-related intracerebral hemorrhage.

Neurocrit Care 2010 Feb;12(1):30-4

Division of Neurology, University of Maryland Medical Center, Baltimore, MD, USA.

Background: Hematoma volume is a major determinant of outcome in patients with intracerebral hemorrhage (ICH). Accurate volume measurements are critical for predicting outcome and are thought to be more difficult in patients with oral anticoagulation-related ICH (OAT-ICH) due to a higher frequency of irregular shape. We examined hematoma shape and methods of volume assessment in patients with OAT-ICH.

Methods: We performed a case-control analysis of a prospectively identified cohort of consecutive patients with ICH. We retrospectively reviewed 50 consecutive patients with OAT-ICH and 50 location-matched non-OAT-ICH controls. Two independent readers analyzed CT scans for hematoma shape and volume using both ABC/2 and ABC/3 methods. Readers were blinded to all clinical variables including warfarin status. Gold-standard ICH volumes were determined using validated computer-assisted planimetry.

Results: Within this cohort, median INR in patients with OAT-ICH was 3.2. Initial ICH volume was not significantly different between non-OAT-ICH and OAT-ICH (35 +/- 38 cc vs. 53 +/- 56 cc, P = 0.4). ICH shape did not differ by anticoagulation status (round shape in 10% of OAT-ICH vs. 16% of non-OAT-ICH, P = 0.5). The ABC/3 calculation underestimated median volume by 9 (3-28) cc, while the ABC/2 calculation did so by 4 (0.8-12) cc.

Conclusions: Hematoma shape was not statistically significantly different in patients with OAT-ICH. Among bedside approaches, the standard ABC/2 method offers reasonable approximation of hematoma volume in OAT-ICH and non-OAT-ICH.
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http://dx.doi.org/10.1007/s12028-009-9296-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2818373PMC
February 2010
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