Medicine in Challenging

Download Medicine at The Extreme


Your guide to invaluable information on the field in challenging enviroments. No Wifi or Service Required.

About Us

The purpose of this app is to impart practical, evidence based, multi-specialty medical knowledge to both medical professionals and individuals who desire to enter adventure activities or believe that they may need to know about these topics for their travels/ Our focus is to provide useful information in a dynamic, affordable, hand-held App format. This App may also be useful for the sophisticated adventurer both for planning and while en route. This work is a product of the tireless contributions by many practitioners in their respective areas of expertise. All of us on the editorial team are profoundly grateful for their willingness to share their passion, enthusiasm, and wisdom with our readers, who will appreciate the practical guidance provided.

We are grateful for the expert assistance and contribution of our copy editors from Mayo Scientific Publications (Alissa Baumgartner, John Hedlund, Angie Herron, and Ann Ihrke) and Kenna Atherton, manager- Scientific Publications. We also acknowledge the excellent visual art created and formatted for this work by our media support services group artists and gifted illustrators Tom Bibby and Marvin Ruona. As editors we are grateful for the support of our colleagues, friends and most importantly the patience of our families, who have been supportive as we worked on this project ver many weekends and evenings.

The advent of devices and systems that allow for effective presentation of video, text, and image content in a highly portable electronic form has been the incentive to embark on the project to assemble the wide breadth of this work. The work before you encompasses areas of Wilderness Medicine, Aerospace Medicine, Emergency Medicine, Pediatrics, Internal Medicine, key concepts of Survival, Psychology and many other clinical specialty areas of expertise in the civilian and military realm. We hope this reference will serve the provider and interested public as a resource at the point of need in challenging environments.

This reference application will be updated on a regular basis and content will be added in future releases of the App as user need dictates.

The app is organized into three main sections, comprised of standard chapters and a keyword search capability for retrieval of pertinent information.

We are very interested to hear from our users, so we can continually improve the content to best serve the needs of our readers.

It is our hope that with this approach we can bring additional information to where it is needed, following the primary value of the Mayo Clinic:

"The needs of the patient come first"
William H. Mayo

Table of Contents

Environmental Challenges
1.2 Altitude
1.4 Hydration
1.5 Weightlessness
1.7 Spatial Disoreitnation
1.9 Radiation

Clinical Aspects of Challenging
2.1 Cardiology
2.2 Dermatology
2.3 Diabetes
2.4 DVT
2.5 ENT
2.6 Austere
2.7 Motion
2.8 Musculoskeletal
2.9 Neurology
2.10 Ophthalmology
2.11 Orthopedics
2.12 Pediatrics
2.13 Pregnancy
2.14 Pulmonary
2.15 Renal
2.16 Rheum
2.17 Pain
2.18 Minor Wound Management
2.19 Appendicitis

Special Considerations & Operational Topics
3.1 Human Factors
3.2 CAM
3.3 Certification
3.4 Psychology
3.5 Survival
3.6 Offshore
3.7 Alpine Survival
3.8 Fatigue
1.3 ID - Tracvel
1.6 Motorsports
1.10 Oxygen Systems


Let us know what content you would like to have in our book by contacting:


Dr. Stepanek

Dr. Stepanek is an Internal Medicine and Aerospace Medicine Specialist, his clinical work focusses on problems associated with high altitude, acceleration and spaceflight.
He has served in the Swiss Military in the Mountain Infantry and Flight Surgeon in the Swiss Air Force. He co-directs the Aerospace Medicine & Vestibular Research Laboratory at Mayo Clinic and teaches Aerospace Medicine to medical students, clinicians and future operational flight surgeons. He works as a consultant to NASA and
the Federal Air Surgeon and as a senior aviation medical examiner for the Federal Aviation Administration (FAA). He enjoys the outdoors by mountaineering, hiking and teaching Austere Medicine to medical trainees. He has served as medical support on expeditions to Mt. Kilimanjaro.

Dr. Blue

Dr. Blue is a physician specializing in emergency and aerospace medicine. She works as a consultant in the commercial spaceflight industry and for the Exploration Medical Capabilities Element at NASA Johnson Space Center. Dr. Blue is an active clinician, educator, and researcher, with contributions to many areas of research including: crew survivability and threats of the
high altitude environment, evaluation of commercial spaceflight passenger tolerance of acceleration forces in preparation for suborbital flight, medical system integration of spaceflight radiation and pharmaceutical health considerations, and long-duration spaceflight medical

Dr. Cevette

Dr. Cevette is Professor of Audiology, Mayo College of Medicine, and Co-Director of the Aerospace Medicine and Vestibular Research Laboratory (AMVRL).  He is active as a clinician, educator, researcher, and inventor with emphasis in human hearing, spatial orientation, sports performance, and motion sickness. He and the AMVRL team have created novel technologies to induce a perception of motion and surround sound hearing using small amounts of electrical stimulation with ultimate goals of preventing motion sickness, enhancing virtual reality fidelity, and improving hearing and balance.  He is an Ironman Florida age group champion with a long history in the realm of endurance sports and
maintaining balance at the extreme.

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