First Aid and Management of Rattlesnake Bites (Part 2 of 2)

In brief: Rattlesnake bites are rarely fatal, but prevention is the best treatment. People who live in areas indigenous to rattlesnakes should take routine precautionary measures such as wearing boots and long pants. A person who encounters or is bitten by a snake should get away from it as soon as possible. First aid includes applying a constricting band and suction; incisions are not recommended. The victim should be transported to a medical facility as soon as possible. Medical management includes a history and physical examination and laboratory data, including blood coagulation studies and urinalysis. Intravenous antivenom is the mainstay of treatment.     

Balance,Muscle Strength,and Fear of Falling in Older Adults

This study examined balance ability, lower-extremity muscle strength, fear of falling and their inter-relationships in 40 community-dwelling older adults (>65 years). Subjects who self-identified either as being fearful offalling or not (no concern) were screened to exclude those with known risk factors for falling. Limits of stability, maximal isometric strength, gait speed, and fear of falling were contrasted between groups (27 control subjects, 13 fearful subjects). Those fearful of falling demonstrated smaller center of pressure (COP) excursions in anterior, left, and right directions ( p <.0001) and used a smaller percentage of their base of support during maximal weight shifting in combined anterior-posterior and right-left directions ( p <.001) compared to the control group. Strength did not differ between groups, but was associated with the ability to shift the COP in the anterior-posterior direction ( p <.05). Fear of falling also related to weight shifting ability ( p <.017). Seniors fearful of falling demonstrated limitations in balance ability and balance confidence that could not be explained by muscle weakness.     

Clinical Research Risk Assessment Among Individuals With Mild Cognitive Impairment

OBJECTIVE:: To determine whether individuals with mild cognitive impairment (MCI) differ from cognitively normal (NC) elders on a risk assessment task and whether participants and their study partners evaluate risk and benefit similarly. DESIGN:: Cross-sectional. SETTING:: University medical setting. PARTICIPANTS:: Seventy-nine participants (NC, n = 40; MCI, n = 39), age 60-90 years (73 ± 7 years; 53% women), and 64 study partners (NC, n = 36; MCI, n = 28), age 38-84 years (68 ± 10 years; 67% women). MEASUREMENTS:: Participants and study partners completed a risk assessment task that involved ranking from least to most risk four hypothetical vignettes for memory loss research (brain autopsy, blood draw, oral medication, neurosurgery). Participants also completed decisional capacity for research and neuropsychological protocols. RESULTS:: MCI participants' risk rankings differed from NC risk rankings (p <0.001) with MCI participants ranking brain autopsy higher and an oral medication trial lower. Demographic, decisional capacity, and neuropsychological variables could not explain MCI participant performances. Participants and their study partners had comparable risk assessment performance (p = 1.0). MCI study partners performed similar to their MCI participant counterparts but were different from NC study partners (p = 0.002; i.e., ranking autopsy higher and oral medication lower). CONCLUSION:: Findings suggest that individuals with MCI assess risk differently than NC peers by overestimating the risk (or underestimating the benefit) of brain autopsy and underestimating the risk (or overestimating the benefit) of oral medication. Study partners display a similar pattern. These observations may be secondary to MCI participants' (and their study partners') personal connection to the potential benefits of an experimental medication for memory loss.