Wilderness Medicine

OBJECTIVE: To measure afterdrop and rewarming in subjects placed in a hypothermia wrap immediately after extrication from 60 minutes of snow burial. METHODS: We measured esophageal core body temperature (Tes) in 6 subjects buried in compacted snow (mean density 39%) for up to 60 minutes at an altitude of 2450 m while breathing with an AvaLung (Black Diamond Equipment, Salt Lake City, UT). Mean snow temperature was -3.5 ± 1.0 °C and mean air temperature was 0 ± 2 °C...

In recent times, caving has become increasingly popular, with almost 2 million people visiting national park caves each year in the United States. Although the 2 million tourist visits are extremely low risk, smaller numbers of sport cavers are at risk for some high risk conditions, and expedition cavers are at risk for some obscure infections. Infectious diseases like histoplasmosis, rabies, leptospirosis, and tick-borne relapsing fever may be transmitted by the underground fauna. To reduce the risk of illness or injury while caving, knowledge of potential risks before engaging in this activity is important...

OBJECTIVE: To explore the use of helmets in skiers and snowboarders injured at ski runs and terrain parks in Colorado and the northeast United States and to examine differences in head injury severity in terrain parks as compared to ski runs. METHODS: This was a retrospective cohort study. We reviewed emergency department medical records of injured skiers at 9 medical facilities in Colorado, New York, and Vermont to examine the frequency of helmet use, type of terrain on which injuries occurred, and effect of injury event type and helmet use on change in mental status...

OBJECTIVE: To explore the effect of aspirin on the thermoregulatory responses of men during exposure to 12°C air (acute cold exposure) for a period of 120 minutes and recovery in 25°C air (rewarming) for 120 minutes. METHODS: Seven male subjects (26.1 ± 2.4 yr) underwent pre-experimental testing to determine peak VO(2) and body composition. Participants underwent 3 trials in which they ingested the following for 1 week prior to each experimental trial: a capsule filled with cellulose (placebo), 81 mg · day(-1) of aspirin (low-dose aspirin), or 650 mg · day(-1) of aspirin (high-dose aspirin)...

BACKGROUND: Skiing and snowboarding are popular activities that involve high kinetic energies, often at altitude, and injuries are common. As a portable imaging modality, ultrasound may be a useful adjunct for mountainside clinics. This review briefly discusses skier and snowboarder injury profiles and focuses on the role of ultrasound for each injury type. METHODS: Twenty-two sources including 17 reviews and observational studies were obtained describing skier and snowboarder injuries...

No abstract text is available yet for this article.

OBJECTIVE: To study the effectiveness of ibuprofen versus placebo in preventing acute mountain sickness (AMS) and high altitude headache (HAH). METHODS: Double-blind, randomized, placebo-controlled trial. RESULTS: Two hundred ninety-four healthy Western trekkers were recruited on the Everest approach at 4280 m or 4358 m and randomly assigned to receive either 600 mg of ibuprofen or placebo 3 times daily before and during ascent to 4928 m. One hundred eighty-three of 294 participants completed the trial...

OBJECTIVE: High altitude environments present unique medical treatment challenges. Medical providers often use small portable pulse oximetry devices to help guide their clinical decision making. A significant body of high altitude research is based on the use of these devices to monitor hypoxia, yet there is a paucity of evidence that these devices are accurate in these environments. We studied whether these devices perform accurately and reliably under true mountain conditions. METHODS: Healthy unacclimatized active-duty military volunteers participating in mountain warfare training at 2100 m (6900 feet) above sea level were evaluated with several different pulse oximetry devices while in a cold weather, high altitude field environment and then had arterial blood gases (ABG) drawn using an i-STAT for comparison...

Horner's syndrome involves a triad of eyelid ptosis, miosis, and facial anhidrosis that results from disruption of the oculosympathetic pathway. Acquired Horner's syndrome is associated with a variety of medical conditions including Pancoast tumor and carotid dissection. We report the unique case of a 47-year-old man presenting with Horner's syndrome 4 weeks after black widow spider envenomation. Workup did not reveal any alternative explanatory etiology. We hypothesize that late sequelae of black widow spider envenomation secondary to autonomic nerve injury or retrograde axonal transport after mechanical inoculation may have led to an acquired defect in the oculosympathetic pathway resulting in a Horner's syndrome...

Reports of overdue persons are common for search and rescue personnel. Search incidents for missing persons are conducted following established industry standard practices, which are continuously refined through experience and the analysis of previous search operations. Throughout this process, elements of uncertainty exist, and the knowledge and experience of the searchers and search managers may influence the outcome significantly. A sound knowledge of current search tactics will help search and rescue medical providers function more effectively during search operations...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

Anaphylaxis is a medical emergency requiring prompt action to prevent death from cardio-respiratory collapse. It can be a biphasic, unpredictable, and challenging reaction to deal with even in a hospital environment. The wilderness environments afforded by expeditions, remote health posts, and military exercises pose additional challenges often involving casualty evacuation. This article identifies and addresses some of these points using a case report from the Costa Rican jungle.

OBJECTIVE: There exist no prospectively generated analyses of the type and frequency of medical incidents in desert settings. We created a database of every illness and injury during 6 field seasons in the Gobi Desert in order to optimize expedition medical and safety planning. METHODS: Every incident presenting to the expeditions' physicians, regardless of type, magnitude, treatment, or outcome, was recorded. Incidents ranged from headache, insomnia, and diarrhea to lacerations, infection, fights, psychosis, and foreign body extraction and were thus categorized, segregating urban travel-related complaints from illness and injury occurring in the desert setting...

OBJECTIVE: Risk assessment is an important part of safe backcountry travel in avalanche terrain. The purpose of this study was to determine and compare the ability of backcountry travelers to accurately estimate the avalanche danger for their destination and time of travel. METHODS: We surveyed 353 winter backcountry users, asking them to rate the avalanche danger for their destination that day. We then compared this estimation to the Utah Avalanche Center daily advisory for that specific location, aspect, and elevation...

OBJECTIVES: The study was designed to compare effects of food deprivation (FD) and sleep deprivation (SD) on cognition during survival training. METHODS: In a cross-over design (n=12), the effects of FD (up to 66 hours followed by 500 kcal intake over 24 hours) and SD (up to 50 hours) on cognitive variables, blood glucose, and 3-OH-butyrate were studied. RESULTS: Food deprivation and SD impaired attention-dependent tasks. The FD impairment of simple reaction time was independent of blood glucose levels, which were normalized by a 500 kcal intake over 24 hours while the reaction time was not...

OBJECTIVE: Inadvertent exposure to the ubiquitous weed, Urtica dioica, called "stinging nettles" produces an immediate stinging and burning sensation on the skin. This investigation evaluates the structural effect that stinging nettle spicules may have on the clinical manifestation of these symptoms. This hypothesis was investigated by exposing murine skin to stinging nettles and then evaluating the skin using electron microscopy. It was hypothesized that the mechanism of action of stinging nettles is both biochemical and mechanical, which may have clinical significance regarding treatment for acute exposure...

INTRODUCTION: Dog attacks are a major public health concern worldwide. Dogs bite over 4 million people resulting in the hospitalization of 6000 to 13,000 people each year in the United States. Rarely deaths may occur after an attack. METHODS: This study utilized the compressed mortality files from CDC WONDER to evaluate deaths from dog attacks over the 27-year period 1979-2005. RESULTS: An average of approximately 19 deaths was reported annually from dog attacks during this time period...

OBJECTIVE: Although hypothermia is preventable, little has been published on its epidemiology. This study estimates the incidence of hypothermia and other cold-related morbidity emergency department (ED) visits in the United States. METHODS: We identified hypothermia and other cold-related morbidity ED visits from the 1995- 2004 National Hospital Ambulatory Medical Care Surveys using the International Classification of Diseases, Ninth Revision (991.6-991.9) or cause-of-injury E-codes (901...

OBJECTIVE: The purpose of this study was to compare the effects of a water + electrolyte solution versus plain water on changes in drinking behaviors, hydration status, and body temperatures during wildfire suppression. METHODS: Eight participants consumed plain water, and eight participants consumed water plus an electrolyte additive during 15 hours of wildfire suppression. Participants wore a specially outfitted backpack hydration system equipped with a digital flow meter system affixed inline to measure drinking characteristics (drinking frequency and volume)...