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Wilderness & Environmental Medicine

Emily A Pearce, Lucie Jelínková, Lynne Fullerton, Christian J Malcolm, Hannah L Heinrich, Evan J Norwil, Adam Plate, Meryn Hall, Christopher S Bossart, Eric Schaller, Andrew J Harrell, Jon K Femling
INTRODUCTION: Grand Canyon National Park has seen an increase in visitors traversing the canyon from rim to rim (R2R) in a single day. R2R hikers travel over 33.8 km (21 mi) over 3300 m (11,000 ft) of elevation change and endure large temperature changes. Grand Canyon emergency medical service providers provide emergency medical services to over 1100 visitors annually. Direct guidance by Preventive Search and Rescue rangers has improved safety. The objective of this study was to examine visitors attempting an R2R traverse and to enhance PSAR rangers' anticipatory guidance...
October 31, 2018: Wilderness & Environmental Medicine
Jessica Hamilton, Juliane Kause, Thomas Lamb
Bites by the European adder (Vipera berus) are a rare medical emergency in the UK with 20 to 50% of an estimated 50 to 200 cases per year necessitating treatment with antivenom. We present a case demonstrating both severe systemic and local effects necessitating out of hospital resuscitation, vasopressor support, and prolonged rehabilitation. Hemodynamic stability was restored promptly after administration of ViperaTAb antivenom, the first published case of its use in the UK.
October 29, 2018: Wilderness & Environmental Medicine
Rombod Rahimian
No abstract text is available yet for this article.
October 22, 2018: Wilderness & Environmental Medicine
Neal W Pollock
No abstract text is available yet for this article.
October 13, 2018: Wilderness & Environmental Medicine
Alexander M Posch, Stewart Dandorf, David C Hile
Lowlanders rapidly ascending to high altitude (>2500 m) often develop acute mountain sickness (AMS). While acclimatization is the most effective method of reducing symptoms of AMS (ie, headache, fatigue, nausea, gastrointestinal distress, etc.), it may take several days to become fully acclimated. Prophylactic use of acetazolamide (AZ), a carbonic anhydrase inhibitor, has become a popular alternative to staged acclimatization because it can be a less time-consuming method of reducing symptoms of AMS. While numerous studies have shown the effectiveness of AZ in mitigating the symptoms of AMS, a review of the existing literature regarding the effects of AZ on submaximal and maximal exercise performance at sea level and at altitude has not been performed...
October 9, 2018: Wilderness & Environmental Medicine
Forrest C Wells, Craig R Warden
INTRODUCTION: Outdoor education (OE) expeditions travel far from definitive care and have unique epidemiology. Most OE expedition studies have examined a single organization and results may not generalize. This study examines the injuries, illnesses, medical evacuations, and nonmedical incidents of the Northwest Outward Bound School (NWOBS) to broaden our understanding and demonstrate commonalities within the field. METHODS: This retrospective database review examined incidents and evacuations on NWOBS expeditions from June 1, 2014 through October 31, 2016...
October 8, 2018: Wilderness & Environmental Medicine
Subramanian Senthilkumaran, Ritesh G Menezes, Syed Ather Hussain, Sushil Allen Luis, Ponniah Thirumalaikolundusubramanian
Snakebite envenomation is an important public health problem in tropical countries. We report a case of bilateral adrenal hemorrhage in a 28-y-old man with Russell's viper bite that occurred in the Sathyamangalam forest range in the Indian state of Tamil Nadu. In this case, a combination of early bite recognition, hospital-based supportive care, corticosteroid therapy, and timely administration of polyvalent antivenom resulted in a favorable clinical outcome.
October 8, 2018: Wilderness & Environmental Medicine
Kais Regaieg, Mabrouk Bahloul, Olfa Turki, Brahim Kammoun, Nozha Toumi, Mounir Bouaziz
No abstract text is available yet for this article.
October 8, 2018: Wilderness & Environmental Medicine
Ji Hye Kim, Seung Baik Han, Areum Durey
Jellyfish have been increasing at a global scale in recent years. These blooms not only have deleterious effects on marine ecosystems, they also increase the risk of jellyfish stings and accompanying envenomation. Here, we report a fatal case of pulmonary edema caused by jellyfish envenomation in a child in Korea. The patient died 4 h after envenomation despite cardiopulmonary resuscitation. Nemopilema nomurai was the suspected species of jellyfish encountered by the patient, although we are unable to confirm this...
October 8, 2018: Wilderness & Environmental Medicine
Megann Young, Thomas Kim, Eli Lessard, Danielle Campagne, Susanne Spano, Leyla Farshidpour, Geoff Stroh
INTRODUCTION: The University of California San Francisco Fresno Department of Emergency Medicine provides base hospital support for the Sequoia and Kings Canyon National Parks (SEKI) emergency medical services (EMS) system. This descriptive epidemiologic study reports reasons the park EMS system is used and interventions provided, detailing the nature of patient encounters, type and frequency of injuries and interventions, reasons for base hospital contact, and patient dispositions. METHODS: Patient charts for all EMS encounters in SEKI from 2011 to 2013 were included, and relevant data were extracted by a single reviewer...
October 8, 2018: Wilderness & Environmental Medicine
Gordon G Giesbrecht
INTRODUCTION: A concise, easy-to-use decision aid "Cold Card" that can be carried in the field by wilderness search and rescue teams or medical responders to advise on assessment and care of cold-exposed patients was created. METHODS: A 2-sided card was designed to summarize the important principles established by the Wilderness Medical Society practice guidelines for hypothermia. The card was continually updated through feedback from several content experts...
October 8, 2018: Wilderness & Environmental Medicine
Elan R Small, Sarah R Burbank, Jeanette M Lorme, Karl Carlson, Timothy B Erickson, David S Young
INTRODUCTION: Apostle Islands National Lakeshore (APIS) lies at the northern tip of Wisconsin and is home to a network of 21 islands along Lake Superior. The goal of this report is to investigate search and rescue (SAR) and emergency medical services (EMS) trends at APIS in an effort to improve visitor safety and resource allocation. METHODS: This study is a retrospective analysis reviewing APIS SAR reports and annual EMS summary reports from January 1, 2006, to December 31, 2015...
October 4, 2018: Wilderness & Environmental Medicine
Pranawa Koirala, Seth E Wolpin, Janet T Peterson
INTRODUCTION: Porters working at high altitude face a number of preventable health risks ranging from frostbite to potentially fatal high-altitude pulmonary and cerebral edema. Porters are often recruited from impoverished low-altitude areas, poorly equipped in terms of protective clothing, and tasked with carrying loads that equal or exceed their body mass to high elevations. Despite a large population of porters working throughout mountainous parts of the world, there is little documentation regarding knowledge levels, attitudes, and practices related to the prevention of altitude illness in this population...
October 3, 2018: Wilderness & Environmental Medicine
Yingzhong Yang, Jin Xu, Feng Tang, Qin Ga, Yuhong Li, Wei Guan, Ri-Li Ge
INTRODUCTION: The mineralocorticoid receptor is encoded by the NR3C2 gene and plays an important role in regulating vascular tone in high-altitude pulmonary edema (HAPE). This study aimed to investigate the association of the polymorphisms in the NR3C2 gene with HAPE susceptibility in Han Chinese. METHODS: We enrolled 133 HAPE patients and 131 matched healthy Han Chinese from the Yushu area in Qinghai, where the altitude is greater than 3500m. Two single nucleotide polymorphisms (SNPs) of the NR3C2 gene, rs2070951 and rs5522, were genotyped by the Sequenom MassARRAY SNP assay...
October 3, 2018: Wilderness & Environmental Medicine
(no author information available yet)
No abstract text is available yet for this article.
October 3, 2018: Wilderness & Environmental Medicine
Gwynn Curran-Sills, Jenna Kroeker
INTRODUCTION: There are 3 pit viper species in Canada. Limited Canadian literature exists on the epidemiology of venomous snakebites and the treatment patterns with antivenom. This study described the epidemiology, the utilization of antivenom, and estimated expenditures due to forfeited antivenom for pit viper envenomations in Canada. METHODS: A retrospective review of the Health Canada Special Access Program records to generate descriptive statistics. Data are presented as mean±SD (range), as appropriate...
October 3, 2018: Wilderness & Environmental Medicine
Sandra C Milton, Aaron J Cronin, Jonathan D Monti
INTRODUCTION: Resource and logistical constraints may limit the availability of commercial ultrasound (US) transmission gel (USTG) in austere environments. Glucomannan powder, a dietary fiber supplement, can be mixed with tap water to form a gel that may be a field-expedient substitute for USTG. We compared glucomannan gel with a commercial USTG for US image adequacy and quality. METHODS: A single clinician obtained 193 US video clips from 14 different examinations on live-tissue and simulation training models using both commercial and glucomannan USTGs...
October 2, 2018: Wilderness & Environmental Medicine
James H Diaz
INTRODUCTION: Histoplasma capsulatum is a dimorphic fungus that causes histoplasmosis, a sporadic endemic mycosis with environmental, occupational, and wilderness exposure-related risk factors. The objectives of this review are to describe these risk factors, to alert clinicians to the different presenting manifestations of histoplasmosis, and to recommend effective management and prevention strategies. METHODS: Internet search engines were queried with keywords to select articles for review over the study period, 1950 to 2018...
September 25, 2018: Wilderness & Environmental Medicine
Sinem S Gökay, Özlem T Kendir, Utku U Güllü, Tuğçe Nalbant, Faruk Ekinci, Selçuk Matyar, İlker Ünal, Sevcan Erdem, Riza D Yildizdaş, Hayri L Yilmaz
INTRODUCTION: A clinical course ranging from mild local findings to life-threatening systemic findings may occur after scorpion stings. The purpose of this study was to identify priority markers indicating scorpion sting-related cardiac involvement. METHODS: Our study was performed between July 2014, and September 2015 in the Çukurova University medical faculty pediatric emergency department, in Adana, Turkey. Patients admitted with scorpion sting-related cardiac involvement and a control group consisting of patients with no scorpion sting-related cardiac involvement were included in the study...
September 23, 2018: Wilderness & Environmental Medicine
Rebekah Alcock, Alan McCubbin, Vera Camões-Costa, Ricardo J S Costa
To assess the impact of rationed versus full estimated energy provisions on markers of physiological strain in response to a simulated 250km multistage ultramarathon (MSUM), on two separate occasions, the ultraendurance runner performed a laboratory simulated MSUM, with rationed (RP: 3303±75 kcal⋅day-1 ) and full (FP: 7156±359 kcal⋅day-1 ) provisions. Total daily energy expenditure was determined using dual-method indirect calorimetry. Resting metabolic rate, iDXA, and body water were measured at baseline, day 3, and post-MSUM...
September 22, 2018: Wilderness & Environmental Medicine
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