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Emergency Medicine Clinics of North America

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https://www.readbyqxmd.com/read/28411941/wilderness-and-environmental-medicine
#1
EDITORIAL
Eric A Weiss, Douglas G Sward
No abstract text is available yet for this article.
May 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28411940/wilderness-and-environmental-medicine
#2
EDITORIAL
Amal Mattu
No abstract text is available yet for this article.
May 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28411939/erratum
#3
(no author information available yet)
No abstract text is available yet for this article.
May 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28411938/medicolegal-issues-in-expedition-and-wilderness-medicine
#4
REVIEW
Valerie A Dobiesz, William Sullivan
There is increased participation in wilderness expeditions to remote and austere environments, which increases the likelihood of an accident and/or medical emergency and the professional liability risks for trip organizers. Trip organizers, outfitters, tour guides, and health care providers must understand the medicolegal liabilities involved in and the legal protection and immunity available when rendering care in austere and challenging settings to mitigate risks and prepare for the level of medical care that may be required...
May 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28411937/preparing-for-international-travel-and-global-medical-care
#5
REVIEW
Swaminatha V Mahadevan, Matthew C Strehlow
Thorough pretravel preparation and medical consultation can mitigate avoidable health and safety risks. A comprehensive pretravel medical consultation should include an individualized risk assessment, immunization review, and discussion of arthropod protective measures, malaria prophylaxis, traveler's diarrhea, and injury prevention. Travel with children and jet lag reduction require additional planning and prevention strategies; travel and evacuation insurance may prove essential when traveling to less resourced countries...
May 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28411936/is-there-a-doctor-onboard-medical-emergencies-at-40-000-feet
#6
REVIEW
Howard J Donner
It is estimated 2.75 billion people travel aboard commercial airlines every year and 44,000 in-flight medical emergencies occur worldwide each year. Wilderness medicine requires a commonsense and improvisational approach to medical issues. A sudden call for assistance in the austere and unfamiliar surroundings of an airliner cabin may present the responding medical professional with a "wilderness medicine" experience. From resource management to equipment, this article sheds light on the unique conditions, challenges, and constraints of the flight environment...
May 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28411935/point-of-care-ultrasound-in-austere-environments-a-complete-review-of-its-utilization-pitfalls-and-technique-for-common-applications-in-austere-settings
#7
REVIEW
Laleh Gharahbaghian, Kenton L Anderson, Viveta Lobo, Rwo-Wen Huang, Cori McClure Poffenberger, Phi D Nguyen
With the advent of portable ultrasound machines, point-of-care ultrasound (POCUS) has proven to be adaptable to a myriad of environments, including remote and austere settings, where other imaging modalities cannot be carried. Austere environments continue to pose special challenges to ultrasound equipment, but advances in equipment design and environment-specific care allow for its successful use. This article describes the technique and illustrates pathology of common POCUS applications in austere environments...
May 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28411934/tactical-combat-casualty-care-and-wilderness-medicine-advancing-trauma-care-in-austere-environments
#8
REVIEW
Frank K Butler, Brad Bennett, Colonel Ian Wedmore
Tactical Combat Casualty Care (TCCC) is a set of evidence-based, best-practice prehospital trauma care guidelines customized for use on the battlefield. Military units that have trained all of their unit members in TCCC have now documented the lowest incidence of preventable deaths in the history of modern warfare and TCCC is now the standard for battlefield trauma care in the US Military. TCCC and wilderness medicine share the goal of optimizing care for patients with trauma in austere environments that impose significant challenges in both equipment and evacuation capability...
May 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28411933/wilderness-emergency-medical-services-systems
#9
REVIEW
Michael G Millin, Seth C Hawkins
Wilderness emergency medical services (WEMS) are designed to provide high quality health care in wilderness environments. A WEMS program should have oversight by a qualified physician responsible for protocol development, education, and quality improvement. The director is also ideally fully trained as a member of that wilderness rescue program, supporting the team with real-time patient care. WEMS providers function with scopes of practice approved by the local medical director and regulatory authority. With a focus on providing quality patient care, it is time for the evolution of WEMS as an integrated element of a local emergency response system...
May 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28411932/arthropod-envenomation-in-north-america
#10
REVIEW
Timothy B Erickson, Navneet Cheema
Arthropods (phylum Arthopoda) account for a higher percentage of morbidity and mortality to humans than do mammalian bites, snake bites, or marine envenomation. They are ubiquitous in domestic dwellings, caves, and campsites and in wilderness settings such as deserts, forests, and lakes. Although arthropods are most intrusive during warmer months, many are active throughout the winter, particularly indoors. Arthropods are also nocturnal and often bite unsuspecting victims while they are sleeping. Encounters with humans are generally defensive, accidental, or reactive...
May 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28411931/north-american-snake-envenomation
#11
REVIEW
Bryan Corbett, Richard F Clark
Native US snakes that produce clinically significant envenomation can be divided into 2 groups, crotalids and elapids. The crotalids include rattlesnakes, cottonmouths, and copperheads. Crotalid envenomation can result in significant local tissue damage as well as thrombocytopenia and coagulopathy. Rarely are bites fatal. Native US elapids are all coral snakes that possess neurotoxic venom that can cause weakness, respiratory paralysis, and rarely death. Treatment of both types of envenomation revolves around general supportive care and antivenom administration when indicated...
May 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28411930/marine-envenomation
#12
REVIEW
Kirsten B Hornbeak, Paul S Auerbach
Venomous aquatic animals are hazardous to swimmers, surfers, divers, and fishermen. Exposures include mild stings, bites, abrasions, and lacerations. Severe envenomations can be life threatening. This article reviews common marine envenomations, exploring causative species, clinical presentation, and current treatment recommendations. Recommendations are included for cnidaria, sponges, bristle worms, crown-of-thorns starfish, sea urchins, venomous fish, stingrays, cone snails, stonefish, blue-ringed octopus, and sea snakes...
May 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28411929/updates-in-decompression-illness
#13
REVIEW
Neal W Pollock, Dominique Buteau
Decompression sickness and arterial gas embolism, collectively known as decompression illness (DCI), are rare but serious afflictions that can result from compressed gas diving exposures. Risk is primarily determined by the pressure-time profile but is influenced by several factors. DCI can present idiosyncratically but with a wide range of neurologic symptoms. Examination is critical for assessment in the absence of diagnostic indicators. Many conditions must be considered in the differential diagnosis. High-fraction oxygen breathing provides first aid but definitive treatment of DCI is hyperbaric oxygen...
May 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28411928/frostbite
#14
REVIEW
Charles Handford, Owen Thomas, Christopher H E Imray
Deep frostbite is a thermal injury associated with significant morbidity. Historically, this has been associated with military personnel; however, increasingly it is becoming an injury that afflicts the civilian population. The use of intravenous iloprost or intra-arterial thrombolytics has led to promising tissue salvage. This article provides an up-to-date understanding of frostbite pathophysiology, classification, prevention, and management. It also highlights the role of telemedicine in optimizing patient outcomes...
May 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28411927/out-of-hospital-evaluation-and-treatment-of-accidental-hypothermia
#15
REVIEW
Ken Zafren
Accidental hypothermia is an unintentional drop in core temperature to 35°C or below. Core temperature is best measured by esophageal probe. If core temperature cannot be measured, the degree should be estimated using clinical signs. Treatment is to protect from further heat loss, minimize afterdrop, and prevent cardiovascular collapse during rescue and resuscitation. The patient should be handled gently, kept horizontal, insulated, and actively rewarmed. Active rewarming is also beneficial in mild hypothermia but passive rewarming usually suffices...
May 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28411926/advances-in-the-prevention-and-treatment-of-high-altitude-illness
#16
REVIEW
Christopher Davis, Peter Hackett
High altitude illness encompasses a spectrum of clinical entities to include: acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema. These illnesses occur as a result of a hypobaric hypoxic environment. Although a mild case of acute mountain sickness may be self-limited, high altitude cerebral edema and high altitude pulmonary edema represent critical emergencies that require timely intervention. This article reviews recent advances in the prevention and treatment of high altitude illness, including new pharmacologic strategies for prophylaxis and revised treatment guidelines...
May 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27908342/an-introduction-to-the-most-complex-disease-in-emergency-medicine
#17
EDITORIAL
Jack Perkins, Michael E Winters
No abstract text is available yet for this article.
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27908341/severe-sepsis-care-in-the-emergency-department
#18
EDITORIAL
Amal Mattu
No abstract text is available yet for this article.
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27908340/end-points-of-sepsis-resuscitation
#19
REVIEW
John C Greenwood, Clinton J Orloski
Resuscitation goals for the patient with sepsis and septic shock are to return the patient to a physiologic state that promotes adequate end-organ perfusion along with matching metabolic supply and demand. Ideal resuscitation end points should assess the adequacy of tissue oxygen delivery and oxygen consumption, and be quantifiable and reproducible. Despite years of research, a single resuscitation end point to assess adequacy of resuscitation has yet to be found. Thus, the clinician must rely on multiple end points to assess the patient's overall response to therapy...
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27908339/vasopressors-and-inotropes-in-sepsis
#20
REVIEW
Leeanne Stratton, David A Berlin, John E Arbo
Vasopressor and inotropes are beneficial in shock states. Norepinephrine is considered the first-line vasopressor for patients with sepsis-associated hypotension. Dobutamine is considered the first-line inotrope in sepsis, and should be considered for patients with evidence of myocardial dysfunction or ongoing signs of hypoperfusion. Vasopressor and inotrope therapy has complex effects that are often difficult to predict; emergency providers should consider the physiology and clinical trial data. It is essential to continually reevaluate the patient to determine if the selected treatment is having the intended result...
February 2017: Emergency Medicine Clinics of North America
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