RESUMEN
INTRODUCTION: Ski patrols are tasked with substantial challenges: distance from definitive care, complex extrications, and winter environments. Rules for US ski patrols stipulate that ≥1 persons be trained in basic first aid, but no further regulations regarding the specifics of provided medical care exist. This project investigated patroller training, patient care, and medical direction of US ski patrols through a survey of ski patrol directors and medical directors. METHODS: Participants were contacted via email, phone, and personal contacts. After consultation with known ski patrol directors and medical directors for question guidance, 2 separate institutional review board-approved surveys were designed: 1 for ski patrol directors and 1 for ski patrol medical directors, containing 28 and 15 qualitative questions, respectively. The surveys were distributed with a link to the encrypted Qualtrics survey platform. After 2 reminders and 4 mo, results were downloaded from Qualtrics into an Excel spreadsheet. RESULTS: Twenty-two responses from patrol directors and 15 from medical directors were received. The response rate is unknown. Outdoor emergency care certification was the minimum medical training required by 77% of the study participants. Twenty-seven percent of surveyed patrols belonged to an emergency medical service agency. Fifty percent of 11 surveyed ski patrols had a medical director, 6 of whom were board certified in emergency medicine. All surveyed medical directors stated that they assisted with patroller education, and 93% assisted with protocol development. CONCLUSIONS: The surveys demonstrated variability in patroller training, protocols, and medical directorship. The authors questioned whether ski patrols would benefit from increased standardization of care and training, quality improvement programs, and medical directorship.
Asunto(s)
Servicios Médicos de Urgencia , Humanos , Estados Unidos , Encuestas y Cuestionarios , Primeros Auxilios , Atención al PacienteRESUMEN
BACKGROUND Rhabdomyolysis occurs when muscle injury leads to the release of muscle cell constituents into circulation, often leading to significant systemic complications. There are many causes of rhabdomyolysis, and the etiology is often multifactorial or unclear. Current data suggest that acute COVID-19 may cause muscle injury that can lead to rhabdomyolysis, particularly in cases of severe illness requiring prolonged hospitalization; however, data on the long-term effects of COVID-19 on the musculoskeletal system are lacking. CASE REPORT We present a case of a woman with generalized weakness 1 week following discharge from the hospital after a prolonged admission for severe COVID-19. She was found to have acute kidney injury and elevated creatine kinase (CK) of 1775 U/L (normal 36-234 U/L). Her home medications, including her statin, were held, but her CK continued to rise, peaking at 15 085 U/L, and she developed renal failure necessitating renal replacement therapy. A thorough work-up for the underlying etiology of her rhabdomyolysis was pursued, including testing for autoimmune myositis, statin-associated necrotizing autoimmune myositis, and a muscle biopsy, which were all unrevealing. Ultimately, the patient's rhabdomyolysis was determined to likely be secondary to a post-viral myopathy from COVID-19. A toxic myopathy from medication use or a delayed critical illness myopathy from her recent prolonged hospitalization could have also contributed. CONCLUSIONS This case highlights the wide differential diagnosis of rhabdomyolysis in the setting of recent COVID-19 and prolonged hospitalization. It demonstrates the possibility that muscle injury and resultant rhabdomyolysis may be a late complication of COVID-19 that is not yet fully described in the literature.