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  Subjects -> ENVIRONMENTAL STUDIES (Total: 756 journals)
    - ENVIRONMENTAL STUDIES (682 journals)
    - POLLUTION (22 journals)
    - TOXICOLOGY AND ENVIRONMENTAL SAFETY (41 journals)
    - WASTE MANAGEMENT (11 journals)

ENVIRONMENTAL STUDIES (682 journals)

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Journal Cover Wilderness & Environmental Medicine
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   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1080-6032
   Published by Elsevier Homepage  [2969 journals]
  • Report of a New Human Death Caused by a Giant Anteater in Brazil
    • Abstract: Publication date: Available online 23 August 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Vidal Haddad Junior, Jenerson França Nunes



      PubDate: 2016-08-24T06:22:44Z
       
  • In Response to RECCO in Avalanche Rescue by Grasegger et al
    • Abstract: Publication date: Available online 23 August 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Mathieu Pasquier, Alexandre Gnaegi, Olivier Hugli



      PubDate: 2016-08-24T06:22:44Z
       
  • Awaiting Graduation in the Torres
    • Abstract: Publication date: Available online 22 July 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Tom Califf



      PubDate: 2016-07-29T04:34:32Z
       
  • In Reply to Drs Kounis, Kounis, Soufras, and Patsouras
    • Abstract: Publication date: Available online 22 July 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Senanayake AM Kularatne



      PubDate: 2016-07-29T04:34:32Z
       
  • Association of Cognitive Performance with Time at Altitude, Sleep Quality,
           and Acute Mountain Sickness Symptoms
    • Abstract: Publication date: Available online 22 July 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Amine N. Issa, Nicole M. Herman, Robert J. Wentz, Bryan J. Taylor, Doug C. Summerfield, Bruce D. Johnson
      Objective It is well documented that cognitive performance may be altered with ascent to altitude, but the association of various cognitive performance tests with symptoms of acute mountain sickness (AMS) is not well understood. Our objective was to assess and compare cognitive performance during a high-altitude expedition using several tests and to report the association of each test with AMS, headache, and quality of sleep. Methods During an expedition to Mount Everest, 3 cognitive tests (Stroop, Trail Making, and the real-time cognitive assessment tool, an in-house developed motor accuracy test) were used along with a questionnaire to assess health and AMS. Eight team members were assessed pre-expedition, postexpedition, and at several time points during the expedition. Results There were no significant differences (P >.05) found among scores taken at 3 time points at base camp and the postexpedition scores for all 3 tests. Changes in the Stroop test scores were significantly associated with the odds of AMS (P <.05). The logistic regression results show that the percent change from baseline for Stroop score (β = −5.637; P = .032) and Stroop attempts (β = −5.269; P = .049) are significantly associated with the odds of meeting the criteria for AMS. Conclusions No significant changes were found in overall cognitive performance at altitude, but a significant relationship was found between symptoms of AMS and performance in certain cognitive tests. This research shows the need for more investigation of objective physiologic assessments to associate with self-perceived metrics of AMS to gauge effect on cognitive performance.


      PubDate: 2016-07-29T04:34:32Z
       
  • Improvising a Posterior Nasal Pack with Equipment in a Basic First Aid Kit
    • Abstract: Publication date: Available online 26 July 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Allison K. Royer, Mark C. Royer
      Posterior epistaxis is a serious condition that can be difficult to treat in a wilderness setting. The initial standard of care involves packing the affected nostril with a 7 to 9 cm nasal pack to tamponade the bleed. These packs are often unavailable outside of the emergency or operating room. This study set out to determine whether a posterior nasal pack could be constructed from the supplies present in a basic first aid kit in order to control massive nasal hemorrhage in a wilderness setting. A basic first aid kit was utilized to construct a posterior nasal pack that was inserted into an anatomical model and visibly compared with the Rapid Rhino (Posterior, 7.5 cm; Smith & Nephew, Austin, TX) nasal packing. The shape, size, and anatomical areas of compression (ie, into nasopharynx and posterior aspect of inferior turbinate) of this pack was similar to the commercially available posterior nasal pack. Placement in an anatomical model appears to provide similar compression as the commercially available posterior pack. This technique may provide short-term hemorrhage control in cases of serious posterior nasal hemorrhage where standard treatment options are not available.


      PubDate: 2016-07-29T04:34:32Z
       
  • Significant Traumatic Intracranial Hemorrhage in the Setting of Massive
           Bee Venom–Induced Coagulopathy: A Case Report
    • Abstract: Publication date: Available online 15 July 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Kelsey Stack, Lindsey Pryor
      Bees and wasps of the Hymenoptera order are encountered on a daily basis throughout the world. Some encounters prove harmless, while others can have significant morbidity and mortality. Hymenoptera venom is thought to contain an enzyme that can cleave phospholipids and cause significant coagulation abnormalities. This toxin and others can lead to reactions ranging from local inflammation to anaphylaxis. We report a single case of a previously healthy man who presented to the emergency department with altered mental status and anaphylaxis after a massive honeybee envenomation that caused a fall from standing resulting in significant head injury. He was found to have significant coagulopathy and subdural bleeding that progressed to near brain herniation requiring emergent decompression. Trauma can easily occur to individuals escaping swarms of hymenoptera. Closer attention must be paid to potential bleeding sources in these patients and in patients with massive bee envenomation.


      PubDate: 2016-07-23T04:23:32Z
       
  • Datura: The Roadside Poison
    • Abstract: Publication date: Available online 15 July 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Tanuj Kanchan, Alok Atreya



      PubDate: 2016-07-23T04:23:32Z
       
  • Ocular Jellyfish Stings: Report of 2 Cases and Literature Review
    • Abstract: Publication date: Available online 18 July 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Chen Mao, Chien-Chin Hsu, Kuo-Tai Chen
      An ocular jellyfish sting is an ophthalmic emergency and is rarely reported in the medical literature. With the evolution of aquatic activities and entertainment in recent decades, we anticipate that more patients with ocular jellyfish stings may be taken to the emergency department. However, most physicians are unaware of the typical presentations, suitable treatments, prognosis, and possible complications of ocular jellyfish stings. We reported 2 cases with ocular jellyfish stings and collected cases series from literature review. The most common clinical features of ocular jellyfish stings were pain, conjunctival injection, corneal lesion, and photophobia. All patients who sustained ocular stings did so during aquatic activities, and the best management at the scene was proper analgesics and copious irrigation of affected eyes with seawater or saline. The ocular lesions were treated with topical cycloplegics, topical steroids, topical antibiotics, topical antihistamines, and removal of nematocysts. The prognosis was good, and all patients recovered without any permanent sequelae. However, symptoms in some patients may last longer than 1 week. Reported complications included iritis, increased intraocular pressures, mydriasis, decreased accommodation, and peripheral anterior synechiae.


      PubDate: 2016-07-23T04:23:32Z
       
  • Wilderness Image
    • Abstract: Publication date: Available online 21 July 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Lindsey Ball



      PubDate: 2016-07-23T04:23:32Z
       
  • Inducing Therapeutic Hypothermia in Cardiac Arrest Caused by Lightning
           Strike
    • Abstract: Publication date: Available online 21 July 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Dane Scantling, Brian Frank, Mathew E. Pontell, Sandra Medinilla
      Only limited clinical scenarios are grounds for induction of therapeutic hypothermia. Its use in traumatic cardiac arrests, including those from lightning strikes, is not well studied. Nonshockable cardiac arrest rhythms have only recently been included in resuscitation guidelines. We report a case of full neurological recovery with therapeutic hypothermia after a lightning-induced pulseless electrical activity cardiac arrest in an 18-year-old woman. We also review the important pathophysiology of lightning-induced cardiac arrest and neurologic sequelae, elaborate upon the mechanism of therapeutic hypothermia, and add case-based evidence in favor of the use of targeted temperature management in lightning-induced cardiac arrest.


      PubDate: 2016-07-23T04:23:32Z
       
  • Electrocardiographic Responses to Deer Hunting in Men and Women
    • Abstract: Publication date: Available online 7 July 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Steven D. Verba, Brock T. Jensen, Jeffrey S. Lynn
      Objective Deer hunting includes various stimuli resulting in augmented sympathetic activity, increased heart rate (HR) response, and rhythm changes. Collectively, these superimposed stresses may increase an individual’s risk for cardiovascular events. We undertook this study to evaluate HR and rhythm responses in multiple phases of deer hunting in men and women with and without cardiovascular disease (CVD). Methods Nineteen participants age 38.3 ± 13.8 years (mean ± SD) with body mass index 29.2 ± 6.9 kg/m2 followed their normal hunting routine. HR and rhythm were recorded continuously during the hunt using a small leadless electrocardiogram (ECG) patch monitor. Results Data were collected on 13 of 19 hunters while hiking. Three hunters recorded HR ≥85% of their age-predicted heart rate maximum (HRmax) for 1 to 2 minutes. Arrhythmias were detected in both participants with CVD and in 8 without CVD. Recorded rhythms included premature atrial, junctional, and ventricular complexes. Six hunters climbed a tree stand; 3 of them recorded HR ≥85% HRmax with sustained elevated HR response for 2 to 3 minutes with premature junctional contractions. Four of 19 participants dragged deer carcasses. During the drag, 1 male hunter recorded an HR of 91% HRmax, and another male hunter without CVD recorded an exercise-induced ischemic ECG. Fifteen of 19 hunters experienced “buck fever” (acute extreme excitation), with 7 reaching ≥85% HRmax for up to 1 minute. Ventricular bigeminy and trigeminy and ventricular couplets were observed in 1 subject during buck fever. Conclusions Men and women with and without CVD recorded substantial increases in HR and clinically relevant arrhythmias while deer hunting.


      PubDate: 2016-07-11T03:54:39Z
       
  • Pathophysiologic Determination of Frostbite Under High Altitude
           Environment Simulation in Sprague-Dawley Rats
    • Abstract: Publication date: Available online 7 July 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Jie Hu, Hua Li, Xiliang Geng, Lin Jiao, Hongping Song, Lin Lou, Mingke Jiao
      Objectives Pathophysiologic changes of frostbite have been postulated but rarely understood, especially the changes caused by chilly high altitude environment. Therefore, we investigated the pathophysiologic changes of high altitude frostbite (HAF) caused by cold and hypoxia. Methods Forty Sprague-Dawley rats were randomly divided into 5 equal groups, namely, control, superficial HAF (S-HAF), partial-thickness HAF (PT-HAF), full-thickness HAF (FT-HAF), and partial-thickness normal frostbite (PT-NF) groups. The S-HAF, PT-HAF, and FT-HAF groups were fed under hypobaric hypoxic conditions simulating an altitude of 5000 m. Then, the PT-NF, S-HAF, PT-HAF, and FT-HAF models were constructed by controlling the duration of the direct freezing by liquid nitrogen. Animal vital signs were measured after the operation, and histopathologic changes were observed after routine hematoxylin and eosin staining. In addition, the microcirculation of frostbite tissues was monitored and compared by contrast ultrasonography during wound healing. Results The S-HAF, PT-HAF, and FT-HAF groups showed significant differences in the microcirculatory and histopathologic changes in the various tissue layers (P < .05). In addition, combined cold and hypoxia caused more damage to frostbite tissue than pure cold. The circulation recovery of HAF models was significantly slower relative to NF models (P < .05). Conclusions A safe and reproducible HAF model was proposed. More important, pathophysiologic determination of HAF provided the foundation and potential for developing novel and effective frostbite therapies.


      PubDate: 2016-07-11T03:54:39Z
       
  • Epidemiology of Feature-Specific Injuries Sustained by Skiers in a Snow
           Park
    • Abstract: Publication date: Available online 7 July 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Luis Carús, María Escorihuela
      Objective The objective of the present case series study was to analyze injury types and injured anatomic locations resulting from skiing in snow park (SP) features and to determine potential risk factors for ski injuries in an SP. Methods The study was conducted during the 2013–2014 winter season in the SP of a major winter resort located in the Spanish Pyrenees. Cases involved skiers who experienced feature-related injuries in the SP. A total of 113 cases met the inclusion criteria. Logistic regression was used to calculate the odds of injury types and injury to anatomic locations on aerial versus nonaerial features. Results The overall injury rate was 0.9 per 1000 skier runs. The proportion of injuries was higher for aerials (1.18% of uses) than for nonaerials (0.66% of uses). Results revealed that the upper extremities were the most commonly injured body region, and sprains/strains/dislocations and fractures were the most common injury type. Conclusions The most commonly injured anatomic location on nonaerial features was the face, while on aerial features it was the head. A higher proportion of fractures was observed on aerial features, while a higher proportion of sprains/strains/dislocations was observed on nonaerial features. Prevention strategies to reduce injury risk include SP redesign, safety and communication policies, instruction on technical skills, and promotion of the use of protective equipment.


      PubDate: 2016-07-11T03:54:39Z
       
  • Response to Risk of Avalanche Involvement in Winter Backcountry
           Recreation: The Advantage of Small Groups by Zweifel et al
    • Abstract: Publication date: Available online 5 July 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Paul Schrimpf



      PubDate: 2016-07-06T02:12:41Z
       
  • Myopic Changes in a Climber after Taking Acetazolamide and the Use of
           Corrective Lenses to Temporize Symptoms: A Case Report from Mount
           Kilimanjaro
    • Abstract: Publication date: Available online 5 July 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Adam D. Hill
      When performing detailed tasks related to climbing or hiking, accurate vision is important for safety. Acetazolamide is a medication commonly used to prevent acute mountain sickness, but it has an uncommon side effect of transient myopia. Reports of this side effect are mainly associated with its use in obstetrics, where it is often prescribed in higher doses than used in acute mountain sickness prophylaxis. We describe the case of a climber taking low-dose acetazolamide who developed transient myopia. We further describe potential mechanisms of this rare side effect as well as a novel approach of field management utilizing possible materials at hand.


      PubDate: 2016-07-06T02:12:41Z
       
  • In Response to Xylocopa tranquebarica Fatal Stinging by Kularatne et al
    • Abstract: Publication date: Available online 5 July 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Nicholas G. Kounis, George N. Kounis, George D. Soufras, Dimitrios Lianas, Nicholas Patsouras



      PubDate: 2016-07-06T02:12:41Z
       
  • HEMS in Alpine Rescue for Pediatric Emergencies
    • Abstract: Publication date: Available online 1 July 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Stefan Taubenböck, Wolfgang Lederer, Marc Kaufmann, Gunnar Kroesen
      Objective The objective of this study was to describe the pediatric emergencies encountered by the Christophorus-1 helicopter emergency medical service (HEMS) during a period of 2 years. Methods Emergency treatment of pediatric casualties by HEMS was evaluated at a helicopter base. Children up to 14 years who were treated by HEMS emergency physicians from Christophorus-1 during primary missions in the alpine region were retrospectively enrolled. Results Of the 1314 HEMS operations conducted during a 2-year investigation period, pediatric emergencies accounted for 114 (8.7%). Trauma was the most common emergency indication (91.3%) in alpine areas, and 77.5% of the indications were related to skiing and snowboarding; 11.3% of the prehospital pediatric emergencies were classified as life-threatening. Interventions on site were rendered in 46.3% of cases. Mean and SD intervals for approach were 11.0 ± 3.0 minutes; for treatment, 14.0 ± 6.0 minutes; and for transport, 8.0 ± 4.0 minutes. Intervals on site were significantly longer whenever it was necessary to search for an interim landing place (P < .001) or perform rope extrication (P < .001). Aggravating environmental conditions such as low temperature (78.8%), rocky terrain (18.8%), or precipitation (12.5%) were common. Conclusions Rapid procedures are preferred to sustained on-scene treatment, particularly when surrounding conditions are hostile. HEMS emergency physicians attempt to keep on-site intervals short and treatment and monitoring to the essential to minimize delay in rescue.


      PubDate: 2016-07-06T02:12:41Z
       
  • Subtle Cognitive Dysfunction in Resolving High Altitude Cerebral Edema
           Revealed by a Clock Drawing Test
    • Abstract: Publication date: June 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 2
      Author(s): Ian Quigley, Ken Zafren
      High altitude cerebral edema (HACE) is a life-threatening condition that can affect people who ascend to altitudes above 2500 m. Altered mental status and the presence of ataxia distinguishes HACE from acute mountain sickness (AMS). We describe a patient with subtle cognitive dysfunction, likely due to HACE that had not fully resolved. When he initially presented, the patient appeared to have normal mental status and was not ataxic. The diagnosis of HACE was missed initially but was made when further history became available. Cognitive dysfunction was then diagnosed based on abnormal performance of a clock drawing test. A formal mental status examination, using a clock drawing test, may be helpful in assessing whether a patient at high altitude with apparently normal mental status and with normal gait has HACE.


      PubDate: 2016-06-18T18:08:35Z
       
  • Outdoor Activity and High Altitude Exposure During Pregnancy: A Survey of
           459 Pregnancies
    • Abstract: Publication date: June 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 2
      Author(s): Linda E. Keyes, Peter H. Hackett, Andrew M. Luks
      Objective To evaluate whether women engage in outdoor activities and high altitude travel during pregnancy; the health care advice received regarding high altitude during pregnancy; and the association between high altitude exposure and self-reported pregnancy complications. Methods An online survey of women with at least 1 pregnancy distributed on websites and e-mail lists targeting mothers and/or mountain activities. Outcome measures were outdoor activities during pregnancy, high altitude (>2440 m) exposure during pregnancy, and pregnancy and perinatal complications. Results Hiking, running, and swimming were the most common activities performed during pregnancy. Women traveled to high altitude in over half of the pregnancies (244/459), and most did not receive counseling regarding altitude (355, 77%), although a small proportion (14, 3%) were told not to go above 2440 m. Rates of miscarriage and most other complications were similar between pregnancies with and without travel above 2440 m. Pregnancies with high altitude exposure were more likely to have preterm labor (odds ratio [OR] 2.3; 95% CI 0.97−5.4; P = .05). Babies born to women who went to high altitude during pregnancy were more likely to need oxygen at birth (OR 2.34; 95% CI 1.04−5.26; P < .05) but had similar rates of neonatal intensive care unit admission (P = not significant). Conclusions Our results suggest pregnant women who are active in outdoor sports and travel to high altitude have a low rate of complications. Given the limitations of our data, further research is necessary on the risks associated with high altitude travel and physical activity and how these apply to the general population.


      PubDate: 2016-06-18T18:08:35Z
       
  • REBUTTAL from “Yes”
    • Abstract: Publication date: June 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 2
      Author(s): Martin D. Hoffman, James D. Cotter, Éric D. Goulet, Paul B. Laursen



      PubDate: 2016-06-18T18:08:35Z
       
  • REBUTTAL from “No”
    • Abstract: Publication date: June 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 2
      Author(s): Lawrence E. Armstrong, Evan C. Johnson, Michael F. Bergeron



      PubDate: 2016-06-18T18:08:35Z
       
  • Risk of Avalanche Involvement in Winter Backcountry Recreation: The
           Advantage of Small Groups
    • Abstract: Publication date: June 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 2
      Author(s): Benjamin Zweifel, Emily Procter, Frank Techel, Giacomo Strapazzon, Roman Boutellier
      Objective Avalanches are the primary hazard for winter backcountry recreationists and cause numerous deaths and injuries annually. Although recreationists usually travel in groups, there is little empirical knowledge on group-related risk factors. This study aims to explore the relative risk of avalanche accidents with respect to group size and to discuss underlying reasons for different risk levels. Methods We compared backcountry usage data in regions in Switzerland and Italy with avalanche accident data in these regions. Results We found higher avalanche risk for groups of 4 or more people and lower risk for people traveling alone and in groups of 2. The relative risk of group size 4, 5, and 6 was higher compared with the reference group size of 2 in the Swiss and Italian dataset. The relative risk for people traveling alone was not significantly different compared with the reference group size of 2 in the Italian dataset but was lower in the Swiss dataset. Conclusions These findings are in accordance with avalanche safety recommendations regarding the higher risk of large groups but not regarding lower risks of people traveling alone in avalanche terrain, which is not recommended and requires great caution. Further studies on backcountry usage are necessary to improve our understanding of human behavior and risk factors. New techniques (eg, video monitoring) may be useful for acquiring reliable data on backcountry usage.


      PubDate: 2016-06-18T18:08:35Z
       
  • COUNTERVIEW: Is Drinking to Thirst Adequate to Appropriately Maintain
           Hydration Status During Prolonged Endurance Exercise? No
    • Abstract: Publication date: June 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 2
      Author(s): Lawrence E. Armstrong, Evan C. Johnson, Michael F. Bergeron



      PubDate: 2016-06-18T18:08:35Z
       
  • VIEW: Is Drinking to Thirst Adequate to Appropriately Maintain Hydration
           Status During Prolonged Endurance Exercise? Yes
    • Abstract: Publication date: June 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 2
      Author(s): Martin D. Hoffman, James D. Cotter, Éric D. Goulet, Paul B. Laursen



      PubDate: 2016-06-18T18:08:35Z
       
  • In Reply to Dr Sikri et al
    • Abstract: Publication date: June 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 2
      Author(s): Swati Srivastava



      PubDate: 2016-06-18T18:08:35Z
       
  • An Analysis of Media-Reported Venomous Snakebites in the United States,
           2011–2013
    • Abstract: Publication date: Available online 5 May 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Dennis K. Wasko, Stephan G. Bullard
      Background Venomous snakebite is a widespread natural hazard in the United States. A common perception exists that the majority of these snakebites are “illegitimate,” resulting from deliberate interaction with snakes (such as attempting to move or kill the animal), but there is little quantitative information available regarding the conditions under which bites occur. Methods To better understand the circumstances under which victims are bitten, we compiled a dataset of media-reported snakebites in the United States between 2011 and 2013. A total of 332 reported snakebites were recorded. Of these, 307 were from snakes encountered under natural circumstances and 25 were under captive-care conditions. Results Most reported victims were adult males. Although some bites occurred during intentional handling of snakes and such activity may relate to bite severity, the majority of victims reported being unaware of the snake before they were bitten. Accidentally stepping on or placing the hands near an unseen snake were the activities most frequently associated with bites under natural conditions. Conclusions Although bias in snakebite reporting patterns by the media is likely, across the United States “legitimate” bites from unseen snakes appear to be the norm.


      PubDate: 2016-05-17T18:00:21Z
       
  • Bitten by a Dragon
    • Abstract: Publication date: Available online 5 May 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Stephen D. Ducey, Jeffrey S. Cooper, Michael C. Wadman
      Komodo dragons (Varanus komodoensis) are large lizards known to take down prey even larger than themselves. They rarely attack humans. A 38-year-old woman was bitten by a Komodo dragon on her hand while cleaning its enclosure. She was transiently hypotensive. The wounds were extensively cleaned, and she was started on prophylactic antibiotics. Her wounds healed without any infectious sequelae. Komodo dragon bites are historically thought to be highly infectious and venomous. Based on a literature review, neither of these are likely true. As in any bite, initial stabilization followed by wound management are the main components to therapy.


      PubDate: 2016-05-17T18:00:21Z
       
  • In Response to ACE I/D Polymorphism and HAPE by Bhagi et al
    • Abstract: Publication date: Available online 4 May 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Gaurav Sikri, Srinivasa A.B., Bikalp Thapa



      PubDate: 2016-05-17T18:00:21Z
       
  • Fatal Honey Poisoning Caused by Tripterygium wilfordii Hook F in Southwest
           China: A Case Series
    • Abstract: Publication date: Available online 4 May 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Qiang Zhang, Xinguang Chen, Shunan Chen, Zhitao Liu, Rong Wan, Juanjuan Li
      Mad honey poisoning has been reported in many countries, and it seldom results in death. We describe a rare case series of fatal honey poisoning caused by Tripterygium wilfordii Hook F (TwHF) in Southwest China. Three male construction workers were delivered to the emergency department with symptoms of food poisoning after ingestion of wild raw honey. Laboratory results showed that the 3 patients were at different degrees of renal damage, and 1 patient with severe symptoms died of acute renal failure 1 day after admission. Pollen analysis indicated that the suspected honey was heavily contaminated with TwHF pollen. Early diagnosis and prompt treatment are crucial for such poisoning. Pollen analysis is a practical approach to help diagnosis in remote areas where such honey poisoning occurs.


      PubDate: 2016-05-17T18:00:21Z
       
  • Body Positioning of Buried Avalanche Victims
    • Abstract: Publication date: Available online 29 April 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Daniel K Kornhall, Spencer Logan, Thomas Dolven
      Objective The immediate medical management of buried avalanche victims will to some extent be dictated by the victim’s body positioning in the snow. Medical personnel are trained to assess and manage victims in a supine body position. Furthermore, avalanche first responders are trained to handle extricated avalanche victims carefully out of concerns for causing hemodynamic instability or for aggravating spinal injury. Thus, locating and extricating avalanche victims in positions other than supine has the potential to complicate immediate medical management. To our knowledge, the current medical literature does not detail the body positioning of buried victims. Methods In order to ascertain the most common body positioning of buried avalanche victims we reviewed the avalanche incident database of the Colorado Avalanche Information Center (CAIC). This comprehensive database strives to track over 160 fields of information for each avalanche victim, including the body and head positioning of buried victims. Results Head positioning was recorded for 159 buried victims. We found that 65% of buried avalanche victims were found with their heads in a downhill position, 23% with their heads uphill and 11% with their heads in the same level as the rest of their bodies. Body positioning was recorded in 253 victims. 45% of victims were found lying prone, 24% supine, 16% were sitting or standing and 15% were found lying on their sides. We identified 135 victims where both head and body position was registered. 40% of victims were found prone with their heads in a downhill position Conclusions The majority of victims will be extricated with their heads in a downhill position. Moreover, almost half of victims will be found prone. We believe this will have significant impact on the immediate medical management. We believe current training in avalanche medical rescue should emphasize managing victims in non-supine positions. Finally, our findings may represent another benefit of modern extrication techniques.


      PubDate: 2016-05-17T18:00:21Z
       
  • WEM Live and Embracing Differing Perspectives
    • Abstract: Publication date: Available online 29 April 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Martin D. Hoffman



      PubDate: 2016-05-17T18:00:21Z
       
  • Sildenafil and Exercise Capacity in the Elderly at Moderate Altitude
    • Abstract: Publication date: Available online 23 April 2016
      Source:Wilderness & Environmental Medicine
      Author(s): George W. Rodway, Anne J. Lovelace, Michael J. Lanspa, Scott E. McIntosh, James Bell, Ben Briggs, Lindell K. Weaver, Frank Yanowitz, Colin K. Grissom
      Objective Hypobaric hypoxia decreases exercise capacity and causes hypoxic pulmonary vasoconstriction and pulmonary hypertension. The phosphodiesterase-5 inhibitor sildenafil is a pulmonary vasodilator that may improve exercise capacity at altitude. We aimed to determine whether sildenafil improves exercise capacity, measured as maximal oxygen consumption (peak V̇o 2), at moderate altitude in adults 60 years or older. Methods The design was a randomized, double-blind, placebo-controlled, crossover study. After baseline cardiopulmonary exercise testing at 1400 m, 12 healthy participants (4 women) aged 60 years or older, who reside permanently at approximately 1400 m and are regularly active in self-propelled mountain recreation above 2000 m, performed maximal cardiopulmonary cycle exercise tests in a hypobaric chamber at a simulated altitude of 2750 m after ingesting sildenafil and after ingesting a placebo. Results After placebo, mean peak V̇o 2 was significantly lower at 2750 m than 1400 m: 37.0 mL · kg-1 · min-1 (95% CI, 32.7 to 41.3) vs 39.1 mL · kg-1 · min-1 (95% CI, 33.5 to 44.7; P = .020). After placebo, there was no difference in heart rate (HR) or maximal workload at either altitude (z = 0.182; P = .668, respectively). There was no difference between sildenafil and placebo at 2750 m in peak V̇o 2 (P = .668), O2 pulse (P = .476), cardiac index (P = .143), stroke volume index (z = 0.108), HR (z = 0.919), or maximal workload (P = .773). Transthoracic echocardiography immediately after peak exercise at 2750 m showed tricuspid annular plane systolic velocity was significantly higher after sildenafil than after placebo (P = .019), but showed no difference in tricuspid annular plane systolic excursion (P = .720). Conclusions Sildenafil (50 mg) did not improve exercise capacity in adults 60 years or older at moderate altitude in our study. This might be explained by a “dosing effect” or insufficiently high altitude.


      PubDate: 2016-05-17T18:00:21Z
       
  • Lightning Strike in Pregnancy With Fetal Injury
    • Abstract: Publication date: Available online 23 April 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Kellen Galster, Ryan Hodnick, Ross P. Berkeley
      Injuries from lightning strikes are an infrequent occurrence, and are only rarely noted to involve pregnant victims. Only 13 cases of lightning strike in pregnancy have been previously described in the medical literature, along with 7 additional cases discovered within news media reports. This case report presents a novel case of lightning-associated injury in a patient in the third trimester of pregnancy, resulting in fetal ischemic brain injury and long-term morbidity, and reviews the mechanics of lightning strikes along with common injury patterns of which emergency providers should be aware.


      PubDate: 2016-05-17T18:00:21Z
       
  • Traumatic Amputation of Finger From an Alligator Snapping Turtle Bite
    • Abstract: Publication date: Available online 23 April 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Robert D. Johnson, Cynthia L. Nielsen
      Legend states that the alligator snapping turtle (Macrochelys temminckii) should be handled with extreme caution as it has jaw strength powerful enough to bite a wooden broomstick in half. Tales of bite injuries from what is the largest freshwater turtle in North America exist anecdotally, yet there are few descriptions of medical encounters for such. The risk of infection from reptilian bites to the hand in an aquatic environment warrants thorough antibiotic treatment in conjunction with hand surgery consultation. We present the first case report of a near total amputation of an index finger in an adolescent boy who had been bitten by a wild “gator snapper.”


      PubDate: 2016-05-17T18:00:21Z
       
  • Avalanche Survival After Rescue With the RECCO Rescue System: A Case
           Report
    • Abstract: Publication date: Available online 23 April 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Katharina Grasegger, Giacomo Strapazzon, Emily Procter, Hermann Brugger, Inigo Soteras
      We report a case of survival of a completely buried avalanche victim after being located with the radar-based RECCO Rescue System. In the winter of 2015, 2 off-piste skiers were completely buried in an avalanche near the secured ski area in Baqueira Beret, Spain. The first victim was located with the RECCO Rescue System in less than 35 minutes and was alive and conscious at extrication. This system emits radio waves and requires a specific reflector. It is a portable device that is used by more than 600 rescue organizations worldwide, especially in secured ski areas. The device should be brought to the avalanche site together with electronic avalanche transceivers, a probing team, and avalanche dogs. In the hands of experienced professionals, the device may allow rapid location of victims not carrying an electronic avalanche transceiver. Although it is not the first successful extrication of a victim with the RECCO Rescue System, it is the first case published in the medical literature and is intended to encourage data collection and to increase our understanding of the effectiveness of this device in avalanche rescue.


      PubDate: 2016-05-17T18:00:21Z
       
  • Cycling Injuries in Southwest Colorado A Comparison of Road vs Trail
           Riding Injury Patterns
    • Abstract: Publication date: Available online 20 April 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Simon Kotlyar
      Objective To describe the epidemiology of injuries sustained in cyclists and compare the injury patterns in road vs trail biking accidents. Methods A retrospective chart review was performed of injured road and trail cyclists presenting to a rural mountain resort–based medical center during a 3-year study period. Results Of 304 patients, 70% were male, with 67% sustaining trail injuries and 33% sustaining road cycling injuries. There was a bimodal age distribution. Prehospital care was activated in 16% of patients. The most common injuries were lacerations and abrasions (64%), upper extremity fractures (26%), head injuries (9%), and thoracic trauma (6%). Head injury was more common in road- vs trail-related trauma (16% vs 6%; P = .005), whereas thoracic injury was more common in trail riders (7% vs 2%; P = .053). Head injury and lower extremity fracture were the most common reasons for patient transfer. Patients with head injuries who did not use a helmet were more likely to require transfer to a neurosurgical unit (38% vs 17%; P = .296); however, this difference did not meet statistical significance. Conclusions Lacerations and abrasions are the most common injuries sustained in cycling. Quantifying the role of protective extremity gear in reducing these injury patterns may be of interest for future studies. Protective helmet use may be important in reducing morbidity from cycling-related head trauma; however, more data are needed. Prehospital care providers responding to the injured trail cyclist should be equipped to manage laceration, fracture, head injury, and thoracic trauma in the field.


      PubDate: 2016-05-17T18:00:21Z
       
  • Corneal Opacity in a Participant of a 161-km Mountain Bike Race at High
           Altitude
    • Abstract: Publication date: Available online 16 April 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Morteza Khodaee, David R. Torres
      Visual dysfunction is a relatively uncommon complaint among athletes during ultraendurance races. The pathophysiology of most of these cases is unknown. Corneal opacity has been speculated as the etiology for most of reported cases. We are presenting a case of a 56-year-old man with a partial unilateral corneal opacity and edema at kilometer 150 of a 161-km mountain bike race in high altitude. He was not able to finish the race (12-hour cutoff) because of his visual symptoms. He completely recovered in 3 days with no sequelae.


      PubDate: 2016-05-17T18:00:21Z
       
  • Novel Technique for Epinephrine Removal in New Generation Autoinjectors
    • Abstract: Publication date: Available online 16 April 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Patrick E. Robinson, Stephanie A. Lareau
      Anaphylaxis is a severe, life-threatening, multisystem hypersensitivity reaction that can rapidly progress to hypotension and airway compromise. Successful management of anaphylaxis has been documented with the use of prescription intramuscular epinephrine pens that require only minimal training for safe use. The prior generations of these commercially available autoinjectors were produced for single use; however, safe removal of multiple doses has been demonstrated for use in dire situations. We aim to show a novel technique for removal and administration of additional doses of epinephrine from the new generation autoinjector, the Auvi-Q. There was a voluntary manufacturer recall of this product as of October 30, 2015, because of concerns about inaccurate dosing. However, an uncertain number of devices remain in public hands.


      PubDate: 2016-05-17T18:00:21Z
       
  • A Broken Leg in the Bugs
    • Abstract: Publication date: Available online 14 April 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Alexander J. Martin-Bates



      PubDate: 2016-05-17T18:00:21Z
       
  • Mistaken Mushroom Poisonings
    • Abstract: Publication date: Available online 13 April 2016
      Source:Wilderness & Environmental Medicine
      Author(s): James H. Diaz



      PubDate: 2016-05-17T18:00:21Z
       
  • Snakebite by the Shore Pit Viper (Trimeresurus purpureomaculatus) Treated
           With Polyvalent Antivenom
    • Abstract: Publication date: Available online 6 April 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Rupeng Mong, Hock Heng Tan
      Although snakebites are uncommon, there are several species of medically important venomous snakes native to Singapore. We present a case of envenoming by the shore pit viper (Trimeresurus purpureomaculatus) that showed clinical improvement when treated with the Indian (Haffkine) polyvalent antivenom. A 40-year-old man was bitten on his right hand by a snake, which was identified through photos and his description to be a shore pit viper, which is native to the local mangrove area. Severe swelling and pain developed immediately after the bite, which progressed up the arm. Because of the progression of local swelling, antivenom was started. He was given a total of 6 vials (60 mL) of polyvalent antivenom, with the first vial started 3 hours after the bite. He showed clinical improvement within 24 hours. His subsequent recovery was uneventful, with no other complications as a result of envenomation or antivenom use. Severe envenoming by the shore pit viper can lead to marked local effects such as extensive swelling and tissue necrosis. Antivenom is indicated in the presence of severe local envenomation. Antivenom against the shore pit viper is however not available locally. The Indian (Haffkine) polyvalent antivenom contains antibodies against 4 common venomous snakes in India, namely the Indian cobra, common krait, Russell’s viper, and sawscaled viper. The improvement seen in this patient suggests possible cross-neutralizing activity of the Indian vipers’ antivenom against the local shore pit viper venom. Further in vivo and in vitro studies should be performed to verify this clinical case.


      PubDate: 2016-05-17T18:00:21Z
       
  • Wilderness Medical Society Practice Guidelines for the Prevention and
           Treatment of Drowning
    • Abstract: Publication date: Available online 6 April 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Andrew C. Schmidt, Justin R. Sempsrott, Seth C. Hawkins, Ali S. Arastu, Tracy A. Cushing, Paul S. Auerbach
      The Wilderness Medical Society convened a panel to review available evidence supporting practices for the prevention and acute management of drowning in out-of-hospital and emergency medical care settings. Literature about definition and terminology, epidemiology, rescue, resuscitation, acute clinical management, disposition, and drowning prevention was reviewed. The panel graded evidence supporting practices according to the American College of Chest Physicians criteria, then made recommendations based on that evidence. Recommendations were based on the panel’s collective clinical experience and judgment when published evidence was lacking.


      PubDate: 2016-05-17T18:00:21Z
       
  • First Reported Case of Fatal Stinging by the Large Carpenter Bee Xylocopa
           tranquebarica
    • Abstract: Publication date: Available online 6 April 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Senanayake A.M. Kularatne, Sathasivam Raveendran, Jayanthi Edirisinghe, Inoka Karunaratne, Kosala Weerakoon
      In the order Hymenoptera, bees, hornets, and wasps are well-known stinging insects whose envenoming can be fatal. Their stinging attacks are common in rural and forested areas of Sri Lanka. However, fatal stinging by the large-bodied carpenter bees is unreported. We report the first known case of a fatal sting by the large carpenter bee, Xylocopa tranquebarica, in a forested area in Puttalam (North Western Province) in the dry zone of Sri Lanka. A 59-year-old healthy male manual laborer accompanied by a fellow worker had been fixing a fence on a coconut estate bordering a forested area when a flying insect emerged from a dead tree trunk and stung him on his face. His coworker, who was watching the incident, killed the insect. The victim complained of immediate intense pain in the face and collapsed on the ground just after resuming work after 10 minutes of resting. He was found dead on admission to the hospital 90 minutes later. Autopsy showed normal coronary arteries and heart, but the lungs were slightly congested and contained secretions in the bronchi. Acute anaphylaxis was the most likely cause of death. This case presents the habitat, morphology, attack pattern, and the medical importance of large carpenter bees.


      PubDate: 2016-05-17T18:00:21Z
       
  • Pulley Ruptures in Rock Climbers: Outcome of Conservative Treatment With
           the Pulley-Protection Splint—A Series of 47 Cases
    • Abstract: Publication date: Available online 6 April 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Micha Schneeberger, Andreas Schweizer
      Objective To evaluate the effectiveness of conservative treatment of finger flexor tendon pulley rupture with a pulley-protection splint (PPS) with regard to reduction in tendon-phalanx distance (TPD) and functional and sport-specific outcomes in a retrospective case series. Methods Tendon-phalanx distance in active forced flexion was measured before and after treatment in ultrasound records. Functional and sport-specific outcomes were evaluated by means of a questionnaire, which also contained instructions for self-measurement of finger range of motion and finger strength. Results Forty-seven complete pulley ruptures in 45 rock climbers (mean age, 33.4 years; range, 21.8–56.2 years) were included in the study. In the 39 patients who had follow-up ultrasound examination, PPS treatment decreased mean ± SD TPD from 4.4 ± 1.0 mm to 2.3 ± 0.6 mm after A2 pulley rupture and from 2.9 ± 0.7 mm to 2.1 ± 0.5 mm after A4 pulley rupture. Tendon-phalanx distance was reduced in all patients. Finger range of motion (n = 42) and finger strength (n = 22) did not differ significantly between treated and contralateral sides. Of the 43 climbers who completed questionnaires, 38 had regained their previous climbing level a mean 8.8 months after pulley rupture; 1 reported reduced finger dexterity; 39 assessed their treatment results to be good, and 4 to be very good. Conclusions The PPS is an effective conservative treatment modality for pulley ruptures, which reduces TPD and enables the patient to regain previous finger function.


      PubDate: 2016-05-17T18:00:21Z
       
  • The “Heel Hook”—A Climbing-Specific Technique to Injure
           the Leg
    • Abstract: Publication date: Available online 21 March 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Volker Schöffl, Christoph Lutter, Dominik Popp
      Acute injuries in rock climbing either come from a fall onto the lower leg or from performing a hard move and injuring the upper extremity. Further evaluations of lower leg injuries in rock climbing athletes have been performed recently finding sport characteristics such as peroneal tendon dislocations or chronic deformations of the feet. One injury mechanism described in case reports is the so-called heel hook position, which is used more frequently today compared with the beginngs of rock climbing. In addition, the number of these injuries is expected to rise with the increase in popularity of climbing and bouldering. Therefore, it is important to further analyze this pathology. We investigated 17 patients with injuries of the lower extremities after performing a heel hook.


      PubDate: 2016-03-24T14:38:06Z
       
  • A Wasp Sting and a Broken Heart
    • Abstract: Publication date: Available online 14 March 2016
      Source:Wilderness & Environmental Medicine
      Author(s): James H. Diaz



      PubDate: 2016-03-14T15:24:26Z
       
  • Acute Interstitial Nephritis Following Snake Envenomation: A Single-Center
           Experience
    • Abstract: Publication date: Available online 9 March 2016
      Source:Wilderness & Environmental Medicine
      Author(s): P.S. Priyamvada, Vijay Shankar, B.H. Srinivas, N.G. Rajesh, Sreejith Parameswaran
      Objectives To identify the clinical and histopathological characteristics of patients who develop acute interstitial nephritis (AIN) following snake envenomation. Methods A retrospective analysis of patients diagnosed with snake envenomation-induced AIN from October 2013 to November 2014. Results After snake envenomation, 88 patients developed acute kidney injury (AKI). Biopsies were performed on 7 patients due to nonrecovery of kidney function. Among these, 5 patients had AIN. Thus, AIN accounted for 5.7% of snakebite-related acute kidney injury. All patients had severe envenomation at presentation and had prolonged renal failure. Kidney biopsy found a mixed infiltrate composed of predominantly lymphocytes, with variable proportions of other cells including eosinophils neutrophils and plasma cells. The response rate to corticosteroids was 80%. Conclusions AIN after snake bite is not uncommon. AIN needs to be considered in patients with persistent renal failure after snake envenomation. Identifying this complication is of utmost importance because of the potentially reversible nature.


      PubDate: 2016-03-10T14:35:40Z
       
  • Twostriped Walkingstick Targets Human Eye With Chemical Defense Spray
    • Abstract: Publication date: Available online 5 March 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Ashley N. Ferrara, John B. Luck, Mark C. Chappell
      Stick insects are commonly known for their fascinating and functional shape, which allows them to blend with their surroundings. However, many may not be aware of another, more threatening protective feature, a toxic spray. Anisomorpha buprestoides, one of two stick insect types in the United States to use this defense, targets the eyes and can cause ocular injury, with cases ranging from conjunctivitis to corneal ulceration. We present the case of an older woman exposed to the walkingstick’s painful venom while in her home. The patient presented to an Orlando emergency department with conjunctival injection and tearing that improved with water irrigation.


      PubDate: 2016-03-10T14:35:40Z
       
  • Expanding Wilderness Medicine Fellowship Eligibility Beyond Emergency
           Medicine
    • Abstract: Publication date: Available online 5 March 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Derek J. Meyer, Megann Young



      PubDate: 2016-03-10T14:35:40Z
       
 
 
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