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Wilderness & Environmental Medicine

Francesco Adami, Peter Paganussi, Giovanna Perone, Paola Bera, Giosuè Braga, Carlo Concoreggi
We report the case of a patient who presented with respiratory failure, recurrent ventricular fibrillation, ventricular arrhythmias, and hypotension after an intentional ingestion of aconite flowers. Significant ingestion of this plant can produce life-threatening cardio- and neurotoxicity that may require evacuation from the wilderness to a medical facility capable of advanced treatment and intensive care monitoring.
July 3, 2018: Wilderness & Environmental Medicine
Alison Sheets, Dale Wang, Spencer Logan, Dale Atkins
INTRODUCTION: A better understanding of the nature of morbidity and mortality in avalanche accidents helps direct both rescue efforts as well as preventive strategies to reduce fatalities. METHODS: We reviewed all avalanche fatalities from the avalanche years beginning in 1994 to 2015 in the state of Colorado, United States, using the database maintained by the Colorado Avalanche Information Center. For each fatality, we obtained the coroner's official determination of cause of death, and autopsy records if one was performed...
June 27, 2018: Wilderness & Environmental Medicine
Sudeep Adhikari, Keshav Raj Sigdel, Buddhi Paudyal, Buddha Basnyat
No abstract text is available yet for this article.
June 26, 2018: Wilderness & Environmental Medicine
Robert K Needleman, Isabelle P Neylan, Timothy B Erickson
INTRODUCTION: Recent analyses of data show a warming trend in global average air and sea surface ocean temperatures. The atmosphere and ocean have warmed, the amounts of snow and ice have diminished, the sea level has risen, and the concentrations of greenhouse gases have increased. This article will focus on climate change and projected effects on venomous marine and amphibious creatures with the potential impact on human health. METHODS: Retrospective analysis of environmental, ecological, and medical literature with a focus on climate change, toxinology, and future modeling specific to venomous aquatic and amphibious creatures...
June 25, 2018: Wilderness & Environmental Medicine
Martin Samdal, Helge H Haugland, Cato Fjeldet, Marius Rehn, Mårten Sandberg
INTRODUCTION: Physician-staffed helicopter emergency medical services (HEMS) in Norway are an adjunct to existing search and rescue services. Our aims were to study the epidemiological, operational, and medical aspects of HEMS daylight static rope operations performed in the southeastern part of the country and to examine several quality dimensions that are characteristic of this service. METHODS: We reviewed the static rope operations performed at 3 HEMS bases during a 3-y period and applied a set of quality indicators designed for physician-staffed emergency medical services to evaluate the quality of care...
June 13, 2018: Wilderness & Environmental Medicine
Anne K Lorentzen, Luit Penninga
Greenland is not only the largest island in the world, it is also the least densely populated country on the globe. The majority of Greenland's landmass lies within the Arctic Circle. Weather conditions in Arctic areas can be extreme, thus exposing locals and visitors to a high risk of acquiring frostbite injuries. More than two thirds of Greenland is covered by a permanent ice sheet, and temperatures can drop to below -70°C. In addition, frequent storms, occupational exposure, and alcohol all contribute to an increased risk for frostbite injury...
June 12, 2018: Wilderness & Environmental Medicine
Michael N Ofori, Cindy Carol Bitter
No abstract text is available yet for this article.
June 8, 2018: Wilderness & Environmental Medicine
Ken Zafren, Anne Brants, Katie Tabner, Andrew Nyberg, Matiram Pun, Buddha Basnyat, Monika Brodmann Maeder
The Nepal Earthquake of 2015 killed over 8000 people and injured over 20,000 in Nepal. Moments after the earthquake, an avalanche of falling ice came down from above Everest Base Camp (EBC). The air blast created by the avalanche flattened the middle part of EBC, killing 15 people and injuring at least 70. The casualties were initially triaged and treated at EBC and then evacuated by air to Kathmandu for definitive care. There were intermediate stops at the villages of Pheriche and Lukla during which the casualties were offloaded, retriaged, treated, and loaded again for further transport...
June 8, 2018: Wilderness & Environmental Medicine
Gregory D Richardson, Susanne J Spano
INTRODUCTION: One of the most popular destinations in Yosemite National Park is Half Dome. Overcrowding at the turn of the 21st century prompted a restriction of hiker access to cable handrails to the summit without technical rock climbing equipment. Prior epidemiological study of Half Dome deaths is not known to the authors. Our goal was to identify trends among all Half Dome-related fatalities in Yosemite National Park. METHODS: Multimedia sources were searched for deaths involving the cable handrails, subdome, summit, technical climbing, or base jumping...
June 7, 2018: Wilderness & Environmental Medicine
Prativa Pandey, Ravi Vadlamudi, Rashila Pradhan, Kishore R Pandey, Alex Kumar, Peter Hackett
Severe frostbite occurs frequently at extreme altitude in the Himalayas, often resulting in amputations. Recent advances in treatment of frostbite injuries with either intravenous or intra-arterial tissue plasminogen activator, or with iloprost, have improved outcomes in frostbite injuries, but only if the patient has access to these within 24 to 48 h postinjury, and ideally even sooner. Frostbitten Himalayan climbers are seldom able to reach medical care in this time frame. We wished to see if delayed iloprost use (up to 72 h) would help reduce tissue loss in grade 3 to 4 frostbite...
June 7, 2018: Wilderness & Environmental Medicine
Joseph A Sol, Brent C Ruby, Steven E Gaskill, Charles L Dumke, Joseph W Domitrovich
INTRODUCTION: The objective of this study was to document characteristics of hiking during wildland firefighter (WLFF) training and wildfire suppression. For the first time, the overall physical demands during wildland firefighting were evaluated in the field using global positioning systems coupled with wireless physiological monitoring and load carriage prediction models. METHODS: Male (n=116) and female (n=15) interagency hotshot crew and type II WLFFs on wildfires volunteered for this direct observation study...
June 7, 2018: Wilderness & Environmental Medicine
Vincent J Calleo, Patrick O Curtin, Amy S Biondich
Animal bites are a major source of morbidity and mortality worldwide. In the United States, the majority of animal bites come from domestic pets, including dogs, cats, and rodents. Camel bites, on the other hand, are exceedingly rare in the United States and are poorly described in the western medical literature. Special considerations must be made when camel bite injuries occur, as they may be therapeutically challenging. Although some clinical features of camel bites resemble those of the more common animal bite injuries, the camel's unique dentition and bite force must be taken into account when managing these wounds...
June 4, 2018: Wilderness & Environmental Medicine
Pablo Deschepper, Bert Jonckheere, Jasper Matthys
No abstract text is available yet for this article.
June 4, 2018: Wilderness & Environmental Medicine
Christian H Simpson, William H Richardson, Greg S Swartzentruber, Vincent J Lloyd
Cardiac ischemia or myocardial infarction after pit viper envenomation is rare. Few case reports have been published, none describing cases reported after crotaline snake envenomation in the United States. We report a case of ST-segment elevation myocardial infarction (STEMI) occurring in a 73-year-old man after an envenomation by a juvenile canebrake rattlesnake (Crotalus horridus). The man was bitten on the left index finger and subsequently developed localized edema followed by hypotension, chest pain, and altered mental status...
May 30, 2018: Wilderness & Environmental Medicine
Daniel Tritz, Kody Dormire, Travis Brachtenbach, Joshua Gordon, Donald Sanders, David Gearheart, Julia Crawford, Matt Vassar
INTRODUCTION: Wilderness medicine involves the treatment of individuals in remote, austere environments. Given the high potential for injuries as well as the unique treatment modalities required in wilderness medicine, evidence-based clinical practice guidelines are necessary to provide optimal care. In this study, we identify evidence gaps from low-quality recommendations in wilderness medicine clinical practice guidelines and identify new/ongoing research addressing them. METHODS: We included relevant clinical practice guidelines from the Wilderness Medical Society and obtained all 1C or 2C level recommendations...
May 18, 2018: Wilderness & Environmental Medicine
Ichiro Okano, Yuki Midorikawa, Nobumasa Kushima, Yui Watanabe, Takuya Sugiyama, Katsutaka Mitachi, Kazuaki Shinohara, Takatoshi Sawada, Katsunori Inagaki
Wild boar attacks have rarely been reported in the medical literature. This is the case of an 83-year-old male farmer who was assaulted from behind by an injured adult wild boar. He presented with hemorrhagic shock after sustaining injuries to the right profunda femoris artery and right sciatic nerve as well as significant soft-tissue injuries, bilateral iliac wing fractures, an open pneumothorax, and an anorectal injury. The anorectal injury was treated with fecal diversion but was complicated by soft-tissue infection in the surrounding dead space...
May 3, 2018: Wilderness & Environmental Medicine
(no author information available yet)
No abstract text is available yet for this article.
June 2018: Wilderness & Environmental Medicine
Emiliano Petrucci, Barbara Pizzi, Paolo Scimia, Giuseppe Conti, Stefano Di Carlo, Antonella Santini, Pierfrancesco Fusco
Trauma care in cave rescue is a unique situation that requires an advanced and organized approach with medical and technical assistance because of the extreme environmental conditions and logistical factors. In caving accidents, the most common injuries involve lower limbs. We describe an advanced medical rescue performed by the Italian Corpo Nazionale del Soccorso Alpino e Speleologico, in which extended focused assessment with sonography for trauma and an ultrasound-guided adductor canal block were performed on a patient with a knee distortion directly in the cave...
June 2018: Wilderness & Environmental Medicine
Susanne J Spano, Arla G Hile, Ratnali Jain, Philip R Stalcup
INTRODUCTION: The baseline characteristics and medical morbidity of hikers on the 354 km (220 mi) John Muir Trail (JMT) have not been previously reported. METHODS: Using online and on-site recruitment, hikers completing the JMT in 2014 were directed to an online 83-question survey. Pearson correlations, regression models, and descriptive statistics were applied to data, reported as mean±SD (range). Statistical significance was set at P<0.05. RESULTS: Of 771 respondents, 57% were men aged 43±14 (13-76) y; they hiked 15...
June 2018: Wilderness & Environmental Medicine
Xue-Feng Cao, Ri-Li Ge
No abstract text is available yet for this article.
June 2018: Wilderness & Environmental Medicine
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