JournalTOCs

Wilderness & Environmental Medicine

Subscription journal
ISSN (Print) 1080-6032
Published by Elsevier

[2556 journals]

An Analysis of Hiker Preparedness: A Survey of Hiker Habits in New Hampshire
- Abstract: Publication date: Available online 16 May 2013
  Source:Wilderness & Environmental Medicine
  Author(s): Ryan C. Mason , Selim Suner , Kenneth A. Williams
  Objective.— Describe hiking habits in a heavily used wilderness area to better target injury prevention and reduce search-and-rescue events. Methods.— A cross-sectional, convenience survey was conducted at 3 trailheads in the White Mountain National Forest of New Hampshire during summer 2011. The study group consisted of hikers who consented to a questionnaire before their trip that assessed demographics, experience, hiking gear, pretrip planning, and communication devices. Results.— A total of 199 hikers were surveyed. The most common age group was 20 to 29 years at 29.2% (n = 195). The most common hike was less than 12 hours at 78.5% (n = 191). All 10 items deemed essential were carried by 17.8% (n = 197) of hikers. The most common omission reason was “short trip” at 32.2% (n = 162). Defined as greater than 7 items, the 50- to 59-year-old age group was the most prepared at 56.9% (n = 51). Hiker preparedness increased with experience and fitness levels. Hikers planning trips of less than 12 hours were less prepared compared with hikers planning longer trips, at 39.3% (n = 150) and 48.8% (n = 41), respectively. GPS devices were carried by 122 of 193 hikers. Phone GPS users were less prepared than GPS-only device users at 35.8% (34 of 95) and 55.6% (15 of 27), respectively. Conclusions.— One factor that may help reduce rescues is better-prepared individuals able to avoid emergency medical services activation. Most neglect of preparation results from hikers perceiving short trips as less risky. The groups most often underprepared tend to be younger, less fit, and inexperienced. Therefore, education should target younger groups and stress that all hikes, regardless of duration, carry an inherent risk.
  
  PubDate: 2013-05-16T14:00:46Z
A Review of Emergency Medical Services Events in US National Parks From 2007 to 2011
- Abstract: Publication date: Available online 9 May 2013
  Source:Wilderness & Environmental Medicine
  Author(s): Matthieu P. DeClerck , Laurie M. Atterton , Thomas Seibert , Tracy A. Cushing
  Objective.— Outdoor recreation is growing in the United States, with more than 279 million annual visitors to areas controlled by the National Park Service (NPS). Emergency medical needs in these parks are overseen by the National Park's rangers within the NPS Emergency Medical Services (EMS) system. This study examines medical and traumatic emergencies throughout the NPS over a 5-year period to better understand the types of events and fatalities rangers encounter, both regionally and on a national scale. Methods.— This is a retrospective review of the annual EMS reports published by the 7 NPS regions from 2007 to 2011. The following were compared and examined at a regional and national level: medical versus traumatic versus first aid events, cardiac events and outcomes, use of automated external defibrillators, and medical versus traumatic fatalities. Results.— The national incidence of EMS events was 45.9 events per 1 million visitors. Medical, traumatic, and first aid events composed 29%, 28%, and 43% of reports, respectively. Of medical episodes, 1.8% were cardiac arrests, of which 64.2% received automated external defibrillator treatment; 29.1% of cardiac arrests survived to hospital discharge. Of fatalities, 61.4% were traumatic in nature and the remaining 38.5% were nontraumatic (medical). Regional differences were found for all variables. Conclusions.— On a national level, the NPS experiences an equal number of medical and traumatic EMS events. This differs from past observed trends that reported a higher incidence of traumatic events than medical events in wilderness settings. Cardiac events and automated external defibrillator usage are relatively infrequent. Traumatic fatalities are more common than medical fatalities in the NPS. Regional variations in events likely reflect differences in terrain, common activities, proximity to urban areas, and access to definitive care between regions. These data can assist the NPS in targeting the regions with the greatest number of incidents and fatalities for prevention, ranger training, and visitor education.
  
  PubDate: 2013-05-12T13:03:47Z
First Authenticated Case of Sri Lankan Flying Snake (Chrysopelea taprobanica) Bite
- Abstract: Publication date: Available online 13 April 2013
  Source:Wilderness & Environmental Medicine
  Author(s): Anjana Silva , Prasanna Weerawansa , Senaka Pilapitiya , Thilina Maduwage , Sisira Siribaddana
  Flying snakes (Genus Chrysopelea) are a group of ophisthoglyphous colubrids in South and South East Asia known for gliding in the air. Of the five species of flying snakes, Sri Lankan flying snake, Chrysopelea taprobanica, is endemic to Sri Lanka. Authenticated bites and the venom characteristics of this uncommon snake remain unknown. We report the first authenticated case of C taprobanica bite, in which a 45-year-old woman had signs of mild local envenoming after the bite, with no evidence of systemic envenoming.
  
  PubDate: 2013-04-14T12:45:19Z
Participation of Iatrogenically Coagulopathic Patients in Wilderness Activities
- Abstract: Publication date: Available online 13 April 2013
  Source:Wilderness & Environmental Medicine
  Author(s): Seth C. Hawkins , Michael J. Caudell , Thomas G. Deloughery , William Murray
  An increasing number of patients routinely undergo long-term anticoagulation with warfarin or other pharmacological agents. There is little evidence and no consensus documents in the literature regarding the appropriateness and relative risk of their participation in wilderness activities. We present a case report, conduct an analysis of the limited literature that is available, and make recommendations for wilderness medicine practitioners and screening personnel.
  
  PubDate: 2013-04-14T12:45:19Z
Wilderness Medical Society Practice Guidelines for Treatment of Exercise-Associated Hyponatremia
- Abstract: Publication date: Available online 13 April 2013
  Source:Wilderness & Environmental Medicine
  Author(s): Brad L. Bennett , Tamara Hew-Butler , Martin D. Hoffman , Ian R. Rogers , Mitchell H. Rosner
  Exercise-associated hyponatremia (EAH) typically occurs during or up to 24 hours after prolonged physical activity, and is defined by a serum or plasma sodium concentration below the normal reference range of 135 mEq/L. It is also reported to occur in individual physical activities or during organized endurance events conducted in austere environments in which medical care is limited or often not available, and patient evacuation to definitive care is often greatly delayed. Rapid recognition and appropriate treatment are essential in the severe form to ensure a positive outcome. Failure in this regard is a recognized cause of event-related fatality. In an effort to produce best practice guidelines for EAH in the austere environment, the Wilderness Medical Society convened an expert panel. The panel was charged with the development of evidence-based guidelines for management of EAH. Recommendations are made regarding the situations when sodium concentration can be assessed in the field and when these values are not known. These recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks/burdens for each parameter according to the methodology stipulated by the American College of Chest Physicians.
  
  PubDate: 2013-04-14T12:45:19Z
Reply to Dr Jay Zimmermann's Letter
- Abstract: Publication date: Available online 9 April 2013
  Source:Wilderness & Environmental Medicine
  
  PubDate: 2013-04-10T14:13:47Z
Jumping Sturgeon in the Suwannee River
- Abstract: Publication date: Available online 9 April 2013
  Source:Wilderness & Environmental Medicine
  
  PubDate: 2013-04-10T14:13:47Z
Out-of-Body Experience in the Karakorum
- Abstract: Available online 29 March 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine
  
  PubDate: 2013-03-29T12:05:16Z
Phalloides Syndrome Poisoning After Ingestion of Lepiota Mushrooms
- Abstract: Available online 13 March 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine
  
  PubDate: 2013-03-17T12:04:35Z
Factors Associated With the Ability to Estimate Actual Speeds in Recreational Alpine Skiers
- Abstract: Available online 13 March 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine
  
  Objective.— To measure on-slope speeds of alpine skiers and to compare their ability to accurately estimate their actual speed with regard to measured speed, age, sex, skill level, helmet use, and risk-taking behavior. Methods.— Skiing speeds of 416 adult skiers (62% men, 38% women) were measured with a radar speed gun. Skiers were interviewed about their age, sex, skiing ability, helmet use, and risk-taking behavior. Additionally, skiers had to estimate their measured speed as accurately as possible. The difference between estimated and measured speed was described as error of estimation (EE). Results.— Mean measured speed (±SD) of all participants was 48.2 (±14.3) km/h. Pearson correlation coefficient between the actual speed and the estimated speed was 0.57 (P < .001) for all participants. Skiers underestimated their measured speed on average by 5.8 km/h or 8.1%. A multiple hierarchical linear regression analysis revealed that when skiing speed is increased by 1 km/h the EE significantly decreases by 0.5 km/h. Male sex, higher skill level, risky skiing behavior, and younger age groups showed a significantly better ability to estimate skiing speed, whereas ski helmet use did not. Conclusions.— Skiing speed, age, sex, skill level, and risk-taking behavior seem to influence the ability to estimate actual speeds in recreational alpine skiers.
  
  PubDate: 2013-03-17T12:04:35Z
Acute Acalculous Cholecystitis: A Rare Complication of Snake Bite
- Abstract: Available online 6 March 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine
  
  Snake bite is an environmental and occupational hazard in many tropical and subtropical countries. It demands a high level of knowledge and skill in managing the envenomation syndrome. Herein, we describe a rare case of acute acalculous cholecystitis (AAC) that developed in a 36-year-old man after an Indian cobra (Naja naja) bite in the absence of any other predisposing factors for AAC. The probable mechanisms for the occurrence of AAC have been highlighted. Recognizing the possibility of such a complication after envenomation will definitely aid in early diagnosis and, subsequently, a better outcome.
  
  PubDate: 2013-03-08T22:41:34Z
A Novel Mouse Model for Frostbite Injury
- Abstract: Available online 5 March 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine
  
  Background.— Frostbite injury occurs when exposure to cold results in frozen tissue. To screen drugs and other field therapies that might improve the outcome for a frostbite victim, it would be helpful to have a reliable and cost-effective preclinical in vivo model. Objective.— We sought to create a novel mouse skin model of induced frostbite injury. This model would allow quantification of the surface area of involved skin, histology of the wound, rate of wound healing, and skin loss in a standardized fashion after the frostbite injury. Methods.— Thirty-six mice were studied. Standardized 2.9-cm diameter circles were tattooed on the mouse dorsum. Magnets frozen in dry ice (−78.5°C) were used to create a frostbite injury on skin within the circle, either as a continuous 5-minute freeze or as 3 repeated freeze (1-minute) and thaw (3-minute) cycles. Appearance, healing rate, skin surface area loss, and histology were recorded until the wounds were healed. Results.— The amount of skin surface area loss was approximately 50% for both freeze methods. Although the time to surface skin healing was similar for both freeze methods, the initial healing rate was significantly (P = .001) slower in mice exposed to the freeze-thaw cycles compared with the continuous freeze model. Histopathology reflected inflammatory changes, cell death, and necrosis. Conclusions.— This novel in vivo mouse model for frostbite allows quantification of affected skin surface area, histology, healing rate, and skin loss and has the potential of being utilized to screen future treatment modalities.
  
  PubDate: 2013-03-08T22:41:34Z
Kite Skier's Toe: An Unusual Case of Frostbite
- Abstract: Available online 6 March 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine
  
  Frostbite is a well-known occurrence in outdoor winter activity and exploration. We report the first documented case of frostbite associated with kite skiing. Kite skiing is an emerging sport that uses a kite to harness wind power for recreation and to travel long distances on skis. Certain characteristics of this sport may predispose athletes to frostbite injury. The stance required to resist and redirect the force created by the wind and kite puts constant pressure and repetitive trauma on the downwind great toe. This can compromise blood flow and increase risk of cold injury. Future kite skier expeditions should focus on specific prevention methods including properly fitting boots, adequate boot insulation, and frequent rest periods to inspect and warm toes.
  
  PubDate: 2013-03-08T22:41:34Z
Contact Dermatitis From Eriodictyon parryi: A Novel Cause of Contact Dermatitis in California
- Abstract: Available online 6 March 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine
  
  Allergic contact dermatitis caused by Eriodictyon parryi, better known as poodle-dog bush, is a growing cause of contact dermatitis in California. Blooming after a large fire, E parryi is a threat to reforestation workers as well as countless outdoor enthusiasts across the state. This paper focuses on the epidemiology, identification, immunochemistry, pathophysiology, prevention, and treatment of contact dermatitis from this little-researched plant.
  
  PubDate: 2013-03-08T22:41:34Z
Rates of Motorcycle-Animal Collisions in the Midwest
- Abstract: March 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine, Volume 24, Issue 1
  
  PubDate: 2013-02-17T12:38:25Z
Fatalities and Injuries Due to Motorcycle-Deer Collisions in Michigan
- Abstract: March 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine, Volume 24, Issue 1
  
  PubDate: 2013-02-17T12:38:25Z
HowieGarberUtah's Wasatch Range: Four Seasons Refuge—25 Years of Photographs2012Peter E. Randall PublishersPortsmouth, NHUS$39.95, 224 pages, softcover
- Abstract: March 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine, Volume 24, Issue 1
  
  PubDate: 2013-02-17T12:38:25Z
Intraocular Pressure During Acute Exposure to High Altitude
- Abstract: March 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine, Volume 24, Issue 1
  
  PubDate: 2013-02-17T12:38:25Z
Hypoxia in the Eye—Retinal Changes in Correlation to Acute Mountain Sickness
- Abstract: March 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine, Volume 24, Issue 1
  
  PubDate: 2013-02-17T12:38:25Z
Burning Man 2011: Mass Gathering Medical Care in a Hostile and Austere Environment
- Abstract: March 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine, Volume 24, Issue 1
  
  PubDate: 2013-02-17T12:38:25Z
The Who and Why of Wilderness Medicine Conference Attendance
- Abstract: March 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine, Volume 24, Issue 1
  
  PubDate: 2013-02-17T12:38:25Z
Tourist Mountain: Mountain Casualties in Snowdonia
- Abstract: March 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine, Volume 24, Issue 1
  
  PubDate: 2013-02-17T12:38:25Z
A Prospective Analysis of Lifeguard Medical Team Interventions in Ecuador During 2011 Carnaval
- Abstract: March 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine, Volume 24, Issue 1
  
  PubDate: 2013-02-17T12:38:25Z
Medicine & Science in Sports & Exercise
- Abstract: March 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine, Volume 24, Issue 1
  
  PubDate: 2013-02-17T12:38:25Z
Annals of Emergency Medicine
- Abstract: March 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine, Volume 24, Issue 1
  
  PubDate: 2013-02-17T12:38:25Z
Considering Uncommon Cases
- Abstract: March 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine, Volume 24, Issue 1
  
  PubDate: 2013-02-17T12:38:25Z
PLoS Medicine
- Abstract: March 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine, Volume 24, Issue 1
  
  PubDate: 2013-02-17T12:38:25Z
Emergency Medicine International
- Abstract: March 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine, Volume 24, Issue 1
  
  PubDate: 2013-02-17T12:38:25Z
Realigning Educational Curriculum and the Realities of Clinical Practice in Wilderness Rangers
- Abstract: March 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine, Volume 24, Issue 1
  
  PubDate: 2013-02-17T12:38:25Z
Physiological and LLCS Measurements of 11 Nepali Guides and 2 Westerners in Fast Ascents to Very High Altitudes: A Controlled Study
- Abstract: March 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine, Volume 24, Issue 1
  
  PubDate: 2013-02-17T12:38:25Z
Skiing and Snowboarding–related Head Injuries in the United States: A Retrospective Analysis From 2004–2010
- Abstract: March 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine, Volume 24, Issue 1
  
  PubDate: 2013-02-17T12:38:25Z
Brokeback Mountain: Spinal Injuries in Mountain Casualties in Snowdonia
- Abstract: March 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine, Volume 24, Issue 1
  
  PubDate: 2013-02-17T12:38:25Z
International Journal of Sport Nutrition and Exercise Metabolism
- Abstract: March 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine, Volume 24, Issue 1
  
  PubDate: 2013-02-17T12:38:25Z
Scorpion Stings Presenting to an Emergency Department in Singapore With Special Reference to Isometrus Maculatus
- Abstract: Available online 9 January 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine
  
  Objective.— We describe the epidemiology and clinical features of scorpion stings presenting to an emergency department in Singapore, including that of the venomous species Isometrus maculatus. A management approach to scorpion stings is proposed. Methods.— A retrospective study was done for patients from 2004 to 2009. Cases were identified by searching through emergency department records with ICD code E905, inpatient records, and the hospital toxicology service records. Identification of species was assisted by the Venom and Toxin research program at the National University of Singapore. Results.— A total of 13 cases of scorpion stings were identified. Eleven stings occurred locally, and the remaining 2 stings occurred in neighboring countries. The most common presenting symptoms were pain (92%), numbness (31%), and weakness (23%) confined to the region of the sting. The most common clinical signs recorded were redness (77%), tenderness (77%), and swelling (46%). Only 2 patients had significant alterations of vital signs: 1 had hypertension and the other had hypotension from anaphylaxis. Three patients experienced complications (abscess formation, anaphylaxis, cellulitis) requiring inpatient management. There were no fatalities, and all patients made a good recovery. Three cases were identified to be stings from I maculatus. These cases occurred locally, and mainly had clinical features of pain, redness, and mild regional numbness. Conclusions.— Scorpion stings are uncommon presentations to the emergency department. Most stings cause local reactions that can be managed with supportive treatment. Stings by I maculatus were observed to cause mild, self-limiting effects.
  
  PubDate: 2013-01-20T15:57:09Z
Chemical Cold Packs May Provide Insufficient Enthalpy Change for Treatment of Hyperthermia
- Abstract: Available online 9 January 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine
  
  Objective.— Heat illness is a common ailment that, if left untreated, is associated with high morbidity and mortality. Chemical cold packs (CCPs) and ice packs are widely used in the pre-hospital setting and by those with limited resources, yet no controlled studies have compared the cooling of ice to that of CCPs. This study determined the theoretical cooling of CCPs on a benchtop model, comparing the results to similarly sized ice packs, and is the first known comparison of these hyperthermia treatments. Methods.— The CCPs used in Stanford University's Emergency Department were activated in an insulated volume of water (2 L), and temperature was recorded at 1-second intervals in a controlled environment (41°C at 20% humidity). The procedure was repeated with 1-quart ice packs. Results.— The CCPs resulted in a 5.25°C degree temperature drop, with a time constant (time to 63% of initial temperature—a common engineering characterization metric) of 1.72 minutes for the test volume. Ice packs resulted on average in a 19.8°C temperature change, with a time constant of 26.8 minutes. The CCPs provide less overall temperature change and were shorter lived. Application of 6 CCPs on a 50th percentile male (weight 86.6 kg, height 1.7 m), assuming ideal heat transfer, would result in less than 0.5°C temperature change. Similarly configured ice packs would result in a 2.5°C change. Conclusions.— Experiments demonstrate that CCPs are inferior to similarly sized ice packs for thermal regulation, and lose their effectiveness more quickly. These findings support the consideration of ice packs as an alternative to chemical cold packs when cooling hyperthermic patients.
  
  PubDate: 2013-01-20T15:57:09Z
Use of Handheld Sonar to Locate a Missing Diver
- Abstract: Available online 2 January 2013
  Publication year: 2013
  Source:Wilderness & Environmental Medicine
  
  Objective.— The purpose of this study was to investigate whether a handheld sonar device significantly reduces the mean time needed to locate a missing diver. Methods.— This institutional review board approved, prospective, crossover study used a voluntary convenience sample of 10 scuba divers. Participants conducted both a standard and modified search to locate a simulated missing diver. The standard search utilized a conventional search pattern starting at the point where the missing diver (simulated) was last seen. The modified search used a sonar beacon to augment the search. For each search method, successful completion of the search was defined as locating the missing diver within 40 minutes. Results.— Twenty total dives were completed. Using a standard search pattern, the missing diver was found by only 1 diver (10%), taking 18 minutes and 45 seconds. In the sonar-assisted search group, the missing diver was found by all 10 participants (100%), taking an average of 2 minutes and 47 seconds (SD 1 minute, 20 seconds). Using the nonparametric related samples Wilcoxon signed rank test, actual times between the sonar group and the standard group were significant (P < .01). Using paired samples t tests, the sonar group's self-assessed confidence increased significantly after using the sonar (P < .001), whereas the standard group decreased in confidence (not statistically significant, P = .111). Conclusions.— Handheld sonar significantly reduces the mean duration to locate a missing diver as well as increasing users' confidence in their ability to find a missing diver when compared with standard search techniques.
  
  PubDate: 2013-01-04T15:17:28Z
Lethal Brain Edema, Shock, and Coagulopathy After Scorpion Envenomation
- Abstract: Available online 29 December 2012
  Publication year: 2012
  Source:Wilderness & Environmental Medicine
  
  We report the case of a 2-year-old Bedouin boy in whom developed severe and unusual complications after being stung, most probably, by the yellow scorpion Leiurus quinquestriatus hebraeus. Five hours after arrival to the emergency department, the boy had multisystem organ failure involving the central nervous system (seizure activity followed by coma with dilated, nonreactive pupils, and severe brain edema), shock (noncardiogenic), disseminated intravascular coagulation, renal failure, hepatic failure, and watery diarrhea, causing his death. In view of the relevant literature, we discuss the pathophysiologic events ultimately leading to his death.
  
  PubDate: 2012-12-31T10:46:20Z
Wilderness Images
- Abstract: Available online 20 December 2012
  Publication year: 2012
  Source:Wilderness & Environmental Medicine
  
  PubDate: 2012-12-25T09:18:52Z
Influenza B Infection Complicated by Patent Foramen Ovale and High Altitude Pulmonary Edema
- Abstract: Available online 27 September 2012
  Publication year: 2012
  Source:Wilderness & Environmental Medicine
  
  A 34-year-old man presented to a clinic at a ski resort in the Rocky Mountains at 9000 feet (2743 m) with shortness of breath and fatigue, a few days after arriving to altitude from sea level. He was found to be hypoxic with radiographic findings consistent with high altitude pulmonary edema (HAPE). He was treated with high flow oxygen, steroids, and calcium channel blockers and transferred to a lower altitude tertiary care hospital for intensive care unit monitoring and further treatment. During his diagnostic evaluation, he was found to have both a patent foramen ovale and influenza B infection. While patent foramen ovale is a known risk factor for HAPE, there is also some evidence that upper respiratory tract infections in general and influenza in particular may also be risk factors for HAPE. The 2 diseases may share an underlying pulmonary pathophysiology, as both cause noncardiogenic pulmonary edema and alveolar hemorrhage. We report an unusual case of influenza B virus compounded by previously undiagnosed patent foramen ovale, travel to high altitude, and subsequent development of HAPE.
  
  PubDate: 2012-12-20T09:24:59Z
Optimizing Emergent Surgical Cricothyrotomy for use in Austere Environments
- Abstract: Available online 9 October 2012
  Publication year: 2012
  Source:Wilderness & Environmental Medicine
  
  Emergent cricothyrotomy is an infrequently performed procedure used in the direst of circumstances on the most severely injured patients. Austere environments present further unique challenges to effective emergency medical practice. Recently, military trauma registry data were searched for the frequency of cricothyrotomy use and success rates during a 22-month period. These data revealed that cricothyrotomy performed in the most rigorous austere environment (ie, battlefield) had many successes, but also a large number of failed (33%) attempts by medics owing to many factors. Thus, the aim of this review article is to present what is known about cricothyrotomy and apply this knowledge to any austere environment for qualified providers. The National Library of Medicine's PubMed was used to conduct a thorough search using the terms “prehospital,” “cricothyroidotomy,” “cricothyrotomy,” and “surgical airway.” The findings were further narrowed by applicability to the austere environment. This review presents relevant airway anatomy, incidences, indications, contraindications, procedures, and equipment, including improvised devices, success rates, complications, and training methods. Recommendations are proffered for ways to optimize procedures, equipment, and training for successful application of this emergent skill set in the austere environment.
  
  PubDate: 2012-12-20T09:24:59Z
Increase in Older Adults Reporting Mountaineering-Related Injury or Illness in the United States, 1973–2010
- Abstract: Available online 3 November 2012
  Publication year: 2012
  Source:Wilderness & Environmental Medicine
  
  PubDate: 2012-12-20T09:24:59Z
Management of High Altitude Pulmonary Edema in the Himalaya: A Review of 56 Cases Presenting at Pheriche Medical Aid Post (4240 m)
- Abstract: Available online 9 October 2012
  Publication year: 2012
  Source:Wilderness & Environmental Medicine
  
  Objective.— The purpose of this study was to review the patient characteristics and management of 56 cases of high altitude pulmonary edema at the Pheriche Himalayan Rescue Association Medical Aid Post, and to measure the use of medications in addition to descent and oxygen. Methods.— In a retrospective case series, we reviewed all patients diagnosed clinically with high altitude pulmonary edema during the 2010 Spring and Fall seasons. Nationality, altitude at onset of symptoms, physical examination findings, therapies administered, and evacuation methods were evaluated. Results.— Of all patients, 23% were Nepalese, with no difference in clinical features compared with non-Nepalese patients; 28% of all patients were also suspected of having high altitude cerebral edema. Symptoms developed in 91% of all patients at an altitude higher than the aid post (median altitude of onset of 4834 m); 83% received oxygen therapy, and 87% received nifedipine, 44% sildenafil, 32% dexamethasone, and 39% acetazolamide. Patients who were administered sildenafil, dexamethasone, or acetazolamide had presented with significantly lower initial oxygen saturations (P ≤ .05). After treatment, 93% of all patients descended; 38% descended on foot without a supply of oxygen. Conclusions.— A significant number of patients presenting to the Pheriche medical aid post with high altitude pulmonary edema were given dexamethasone, sildenafil, or acetazolamide in addition to oxygen, nifedipine, and descent. This finding may be related to perceived severity of illness and evacuation limitations. Although no adverse effects were observed, the use of multiple medications is not supported by current evidence and should not be widely adopted without further study.
  
  PubDate: 2012-12-20T09:24:59Z
Cyanoacrylate Glues for Wilderness and Remote Travel Medical Care
- Abstract: Available online 3 November 2012
  Publication year: 2012
  Source:Wilderness & Environmental Medicine
  
  Cyanoacrylate (CA) glues are commonly used in medical and household repairs. Their chemical compositions have been refined over half a century, making some more suitable than others for creative applications. In remote settings where advanced medical care is not accessible, readily available CAs of differing chemical composition may possess an important therapeutic function. Within this paper we critically examine the published therapeutic risks and benefits of both pharmaceutical and hardware grade CAs when applied in acute care situations. Topics discussed include wound closure as well as the treatment of burns, abrasions, and blisters. Also considered are their chemical properties, toxicities, and potential off-label uses.
  
  PubDate: 2012-12-20T09:24:59Z
Initial Assessment of the Ability of Ivermectin to Kill Ixodes scapularis and Dermacentor variabilis Ticks Feeding on Humans
- Abstract: Available online 3 November 2012
  Publication year: 2012
  Source:Wilderness & Environmental Medicine
  
  Objective.— The purpose of this study was to determine Ixodes scapularis and Dermacentor variabilis tick mortality when fed on humans who have consumed 400 μg/kg oral ivermectin. Methods.— Six study subjects, 3 in each group, were randomly assigned to receive either 400 μg/kg ivermectin or placebo in a blinded manner. After consuming either ivermectin or placebo, each study subject had 2 colostomy bags attached to his or her abdomen. One of the colostomy bags contained 7 I scapularis nymphs and 7 adults. The other colostomy bag contained 7 D variabilis nymphs and 7 adults. Tick mortality was recorded over the next 24 hours. Results.— Fifty-five percent (6 of 11) of the attached I scapularis nymphs exposed to ivermectin had morbidity (3 of 11) or died (3 of 11), compared with 0% morbidity and mortality in the 2 I scapularis nymphs that attached in the placebo group. No I scapularis adults or D variabilis nymphs attached to feed. Among D variabilis adults that attached to feed, there was a 0% mortality rate for both the placebo group (0 of 6) and the ivermectin group (0 of 8). Conclusions.— We demonstrate a novel method to confine ticks to human subjects to study tick-borne diseases. While there was a trend toward I scapularis morbidity and mortality in the ivermectin arm, the low number of ticks that attached in the placebo group limited our analysis. Most ticks began feeding in the last 12 hours of the experiment, significantly limiting their exposure to ivermectin. Ivermectin does not cause early death in D variabilis adults.
  
  PubDate: 2012-12-20T09:24:59Z
Surgical Cricothyrotomy in the Wilderness: A Case Report
- Abstract: Available online 5 November 2012
  Publication year: 2012
  Source:Wilderness & Environmental Medicine
  
  Although the surgical cricothyrotomy procedure is used on combat casualties in the most challenging environments, we are unaware of any published report in the United States of surgical cricothyrotomy performed in a wilderness recreational setting. We describe a 31-year-old male rock climber who fell 24.4 m (80 feet), sustaining serious injuries and requiring rescue from the base of the cliff by a cave/cliff rescue team. Ultimately, a surgical cricothyrotomy proved necessary because of ongoing oropharyngeal bleeding, facial fractures creating an unstable airway, and the need to place the patient in the litter. The patient survived a prolonged and arduous evacuation. This report presents the management of the patient during the rescue and the challenges faced by the rescue team physician and others that led to the decision to perform an improvised surgical cricothyrotomy.
  
  PubDate: 2012-12-20T09:24:59Z
Pituitary Apoplexy Masquerading as Acute Mountain Sickness
- Abstract: Available online 14 December 2012
  Publication year: 2012
  Source:Wilderness & Environmental Medicine
  
  PubDate: 2012-12-20T09:24:59Z
Wristwatch-Associated Ski Injury
- Abstract: Available online 14 December 2012
  Publication year: 2012
  Source:Wilderness & Environmental Medicine
  
  Upper limb injuries are a common occurrence in snowboarders, and these may be reduced by wearing wrist guards that transmit the force of the fall across the forearm. We present a case of a 26-year-old man who experienced a displaced left radial and ulnar fracture related to wearing a wristwatch while snowboarding. The wristwatch acted as a fulcrum around which the arm was fractured, serving as a stress riser that focused the force of the fall. The fracture was treated using open reduction and internal fixation.
  
  PubDate: 2012-12-20T09:24:59Z
Palsy in the Desert
- Abstract: Available online 5 December 2012
  Publication year: 2012
  Source:Wilderness & Environmental Medicine
  
  PubDate: 2012-12-20T09:24:59Z
Simple and Effective Field Extraction of Human Botfly, Dermatobia Hominis, Using a Venom Extractor
- Abstract: Available online 14 December 2012
  Publication year: 2012
  Source:Wilderness & Environmental Medicine
  
  After a trip to Belize, a 25-year-old man noticed an erythematous papule on his upper right chest that enlarged over a 6-week period and formed a central aperture. The patient reported feeling movement and intermittent lancinating pains under the skin. The history and examination were consistent with cutaneous myiasis, likely secondary to the human botfly, Dermatobia hominis. The objective of reporting this case is to present a simple method of extraction of a botfly larva using a commercial venom extractor. The patient's upper chest was prepared, and an occlusive dressing was placed over the lesion for 30 minutes. The Extractor Pump (Sawyer Products, Safety Harbor, FL) was applied and activated, and the larva was rapidly extracted completely intact with no significant discomfort to the patient. The wound fully healed without complication. D hominis is a common etiology of cutaneous myiasis endemic to Belize. The larva burrows under the skin of mammals where it develops for a period of weeks before erupting and falling to the soil to pupate. The diagnosis and treatment of botfly infestation is pertinent to doctors in the United States as Central and South America are common travel destinations for North Americans. In this case, a commercially available venom extractor was demonstrated to be a safe, noninvasive, and painless method for botfly extraction in the field without use of hospital resources.
  
  PubDate: 2012-12-20T09:24:59Z
Ten Years of Search and Rescue in Yosemite National Park: Examining the Past for Future Prevention
- Abstract: Available online 14 December 2012
  Publication year: 2012
  Source:Wilderness & Environmental Medicine
  
  Objective.— To identify trends in demographics of search and rescue incidents in Yosemite National Park and to ascertain patient opinions regarding incident prevention. Methods.— Retrospective data on backcountry incidents from Yosemite Search and Rescue Patient Care Reports from 2000 to 2009 was examined, and a statistical description of data was completed to determine patient demographics. Patients assisted in the backcountry from 2007 to 2009 were surveyed, and a statistical description of data elicited factors that contributed to the incident. Results.— Yosemite Search and Rescue received 1088 backcountry medical calls in 10 years. Of these calls, 55% of patients were male, 46% of incidents occurred while hiking on a trail, and extremity pain was the chief complaint in 53% of cases. The gender of patients was found to be associated with the activity causing the incident. Patient surveys reported that 79% of incidents occurred on clear days, 13% of patients felt that better gear would have helped prevent the incident, and 14.4% of patients felt they were underprepared. Fifty-four percent of patients reported that they were experts at the activity they were participating in. Appropriate footwear and sufficient water were suggested by most patients as items that would have prevented or minimized the incident. Conclusions.— Many patients reported that they were experienced, well-prepared, and physically fit at the time of the incident. An educational effort regarding appropriate gear, trail conditions, and patient demographics may help decrease injury and illness in the Yosemite backcountry in the future.
  
  PubDate: 2012-12-20T09:24:59Z