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  Subjects -> ENVIRONMENTAL STUDIES (Total: 829 journals)
    - ENVIRONMENTAL STUDIES (758 journals)
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ENVIRONMENTAL STUDIES (758 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  [2817 journals]
  • In response to Epidemiology of Search and Rescue in Baxter State Park:
           Dangers of Descent and Fatigue
    • Abstract: Publication date: Available online 21 March 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Aaron Brillhart, Scott McIntosh, Jennifer Dow, Colin Grissom



      PubDate: 2016-03-24T14:38:06Z
       
  • 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
       
  • Outbreaks of Gastrointestinal Disease Among Rafters
    • Abstract: Publication date: March 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 1
      Author(s): Viroj Wiwanitkit



      PubDate: 2016-03-10T14:35:40Z
       
  • Juvenile gorilla smile, framed by vegetation
    • Abstract: Publication date: March 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 1
      Author(s): Cindy Bitter



      PubDate: 2016-03-10T14:35:40Z
       
  • Subungual Hematoma in the Mountains
    • Abstract: Publication date: March 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 1
      Author(s): Harvey V. Lankford



      PubDate: 2016-03-10T14:35:40Z
       
  • The Great Earthquake in Nepal—A Personal View
    • Abstract: Publication date: March 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 1
      Author(s): Ken Zafren



      PubDate: 2016-03-10T14:35:40Z
       
  • The West Coast Trail Rescue, and 6 Lessons to Pack With You
    • Abstract: Publication date: March 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 1
      Author(s): Marissa Tsoi



      PubDate: 2016-03-10T14:35:40Z
       
  • Acetazolamide Use in an Ultra-Runner: A Complicated Treatment
           Consideration for AMS
    • Abstract: Publication date: March 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 1
      Author(s): Amy Sue Biondich, Jeremy D. Joslin



      PubDate: 2016-03-10T14:35:40Z
       
  • In Response to Management of a Pediatric Snake Envenomation After
           Presentation With a Tight Tourniquet by Bush and Kinlaw
    • Abstract: Publication date: March 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 1
      Author(s): Michael J. Matteucci



      PubDate: 2016-03-10T14:35:40Z
       
  • Poisoning by Herbs and Plants: Rapid Toxidromic Classification and
           Diagnosis
    • Abstract: Publication date: March 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 1
      Author(s): James H. Diaz
      The American Association of Poison Control Centers has continued to report approximately 50,000 telephone calls or 8% of incoming calls annually related to plant exposures, mostly in children. Although the frequency of plant ingestions in children is related to the presence of popular species in households, adolescents may experiment with hallucinogenic plants; and trekkers and foragers may misidentify poisonous plants as edible. Since plant exposures have continued at a constant rate, the objectives of this review were (1) to review the epidemiology of plant poisonings; and (2) to propose a rapid toxidromic classification system for highly toxic plant ingestions for field use by first responders in comparison to current classification systems. Internet search engines were queried to identify and select peer-reviewed articles on plant poisonings using the key words in order to classify plant poisonings into four specific toxidromes: cardiotoxic, neurotoxic, cytotoxic, and gastrointestinal-hepatotoxic. A simple toxidromic classification system of plant poisonings may permit rapid diagnoses of highly toxic versus less toxic and nontoxic plant ingestions both in households and outdoors; direct earlier management of potentially serious poisonings; and reduce costly inpatient evaluations for inconsequential plant ingestions. The current textbook classification schemes for plant poisonings were complex in comparison to the rapid classification system; and were based on chemical nomenclatures and pharmacological effects, and not on clearly presenting toxidromes. Validation of the rapid toxidromic classification system as compared to existing chemical classification systems for plant poisonings will require future adoption and implementation of the toxidromic system by its intended users.


      PubDate: 2016-03-10T14:35:40Z
       
  • A Novel Application for Cognitive Evaluation in Mountain Ultramarathons:
           Olfactory Assessment
    • Abstract: Publication date: March 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 1
      Author(s): Alessandro Tonacci, Lucia Billeci, Gennaro Tartarisco, Francesca Mastorci, Andrea Borghini, Simona Mrakic-Sposta, Sarah Moretti, Alessandra Vezzoli, Ugo Faraguna, Giovanni Pioggia, Giardini Guido, Lorenza Pratali
      Objective Olfactory function, a cognitive impairment biomarker, was evaluated in mountain ultramarathon (MUM) runners during the Tor des Géants race (332.5 km with an overall altitude gain of 24,000 m; altitude range 330–3296 m above the sea). Methods An Odor Identification Test was administered before (T0; n = 53), at 148.7 kms (T1; n = 32) and after the race (T2; n = 28). The effect of dehydration and sleep deprivation on olfactory function was assessed. Olfactory function was also assessed in non-MUM athletes and sedentary controls (C) at rest. Results A majority of the athletes completed the olfactory test at all time intervals. Olfactory function decreased throughout the race (T0: 13.8 ± 1.9, T1: 13.7 ± 1.6, T2: 13.1 ± 1.8; T0 vs T2 P = .01). There was no relationship with race time or sleep deprivation on the sense of smell throughout the competition. However, there was a combined effect with decreased olfaction during the second half of the race, while a poor relationship was seen between olfaction and total body water at midterm (T1: rs = –0.427; P = .019), but not at baseline or after the race. MUM athletes had similar olfactory scores to C (13.8 ± 1.9 vs 13.7 ± 1.4) and non-MUM (13.8 ± 1.9 vs 13.9 ± 1.6) athletes. Conclusions This pilot study showed the feasibility of olfactory evaluation as a minimally invasive cognitive impairment assessment. The test can be used in logistically difficult environments, adding scientific value to this promising method. Although olfaction decreased after prolonged physical activity, further studies are warranted to make the relationship between cognition and external factors (eg, sleep deprivation, dehydration) more clear.


      PubDate: 2016-03-10T14:35:40Z
       
  • Portable Prehospital Methods to Treat Near-Hypothermic Shivering Cold
           Casualties
    • Abstract: Publication date: March 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 1
      Author(s): Samuel J. Oliver, Jennifer L. Brierley, Philippa C. Raymond-Barker, Alberto Dolci, Neil P. Walsh
      Objective To compare the effectiveness of a single-layered polyethylene survival bag (P), a single-layered polyethylene survival bag with a hot drink (P+HD), a multi-layered metalized plastic sheeting survival bag (MPS: Blizzard Survival), and a multi-layered MPS survival bag with 4 large chemical heat pads (MPS+HP: Blizzard Heat) to treat cold casualties. Methods Portable cold casualty treatment methods were compared by examining core and skin temperature, metabolic heat production, and thermal comfort during a 3-hour, 0°C cold air exposure in 7 shivering, near-hypothermic men (35.4°C). The hot drink (70°C, ~400ml, ~28kJ) was consumed at 0, 1, and 2 hours during the cold air exposure. Results During the cold air exposure, core rewarming and thermal comfort were similar on all trials (P = .45 and P = .36, respectively). However, skin temperature was higher (10%–13%; P < .001; large effect sizes d > 2.7) and metabolic heat production lower (15%–39%; P < .05; large effect sizes d > .9) on MPS and MPS+HP than P and P+HD. The addition of heat pads further lowered metabolic heat production by 15% (MPS+HP vs MPS; P = .05; large effect size d = .9). The addition of the hot drink to polyethylene survival bag did not increase skin temperature or lower metabolic heat production. Conclusions Near-hypothermic cold casualties are rewarmed with less peripheral cold stress and shivering thermogenesis using a multi-layered MPS survival bag compared with a polyethylene survival bag. Prehospital rewarming is further aided by large chemical heat pads but not by hot drinks.


      PubDate: 2016-03-10T14:35:40Z
       
  • Estimating the Burden of Snakebite on Public Hospitals in KwaZulu Natal,
           South Africa
    • Abstract: Publication date: March 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 1
      Author(s): Wood Darryl, Benjamin Sartorius, Richard Hift
      Objective We propose a formula as a means to estimate the number and incidence of snakebites treated per annum in KwaZulu Natal (KZN), South Africa. Methods Using an unvalidated formula that includes an antivenom ratio, we crudely estimated the total number of snakebite presentations in KZN. Using antivenom supply data from the central pharmacy, we stratified a sample of 6 hospitals that were surveyed to establish an antivenom ratio, that is, the total number of patients receiving antivenom to the total number of snakebite presentations at hospitals. The antivenom ratio and the average number of antivenom vials for treated snakebites were incorporated into a formula to crudely estimate the number of snakebite presentations. This was then applied to all public hospitals and districts in the region. Results Seventy-eight percent of public hospitals were included. The mean antivenom ratio derived from the sample hospitals indicated that 12% (95% CI, 10–14%) of snakebite presentations received antivenom. We estimated an annual total of 1680 (95% CI, 1193–2357) snakebite presentations to hospitals. Two thirds of cases (1109 of 1680) were in the low-lying subtropical coastal region. Few cases were in the higher, cooler regions of KZN (87 of 1680) or the metropolitan city of Durban (93 of 1680). The overall incidence for KZN was 16/100,000. The estimated cost of snakebite in KZN was between $1,156,930 and $2,827,848. Conclusions We propose an alternative method to estimate the annual number of snakebite presentations to hospitals.


      PubDate: 2016-03-10T14:35:40Z
       
  • A New Proposal for Management of Severe Frostbite in the Austere
           Environment
    • Abstract: Publication date: March 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 1
      Author(s): Emmanuel Cauchy, Christopher B. Davis, Mathieu Pasquier, Eric F. Meyer, Peter H. Hackett
      Despite advances in outdoor clothing and medical management of frostbite, individuals still experience catastrophic amputations. This is a particular risk for those in austere environments, due to resource limitations and delayed definitive treatment. The emerging best therapies for severe frostbite are thrombolytics and iloprost. However, they must be started within 24 hours after rewarming for recombinant tissue plasminogen activator (rt-PA) and within 48 hours for iloprost. Evacuation of individuals experiencing frostbite from remote environments within 24 to 48 hours is often impossible. To date, use of these agents has been confined to hospitals, thus depriving most individuals in the austere environment of the best treatment. We propose that thrombolytics and iloprost be considered for field treatment to maximize chances for recovery and reduce amputations. Given the small but potentially serious risk of complications, rt-PA should only be used for grade 4 frostbite where amputation is inevitable, and within 24 hours of rewarming. Prostacyclin has less risk and can be used for grades 2 to 4 frostbite within 48 hours of rewarming. Until more field experience is reported with these agents, their use should probably be restricted to experienced physicians. Other modalities, such as local nerve blocks and improving oxygenation at high altitude may also be considered. We submit that it remains possible to improve frostbite outcomes despite delayed evacuation using resource-limited treatment strategies. We present 2 cases of frostbite treated with rt-PA at K2 basecamp to illustrate feasibility and important considerations.


      PubDate: 2016-03-10T14:35:40Z
       
  • Avalanche Fatalities in the United States: A Change in Demographics
    • Abstract: Publication date: March 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 1
      Author(s): Brian M. Jekich, Brandy D. Drake, Jacob Y. Nacht, Andrew Nichols, Adit A. Ginde, Christopher B. Davis
      Objective To describe demographic patterns in avalanche fatalities in the United States during the past 6 decades according to geographic location and preavalanche activity. Methods The Colorado Avalanche Information Center currently manages the National Avalanche Accident Dataset. This dataset describes deidentified avalanche fatalities beginning in 1951. Covariates included age, sex, month, state of occurrence, and preavalanche activity. Both absolute and proportional avalanche fatalities were calculated by year and by each covariate. A linear regression model was used to trend the proportion of avalanche fatalities stratified by covariate. Results There were 925 recorded avalanche fatalities in the United States between 1951 and 2013. There were an average of 15 ± 11 fatalities/y (mean ± SD; range, 0 to 40 fatalities/y). The mean (+/− SD) age was 29 ± 6.6 years (range, 6–67 years), and 86% were men. Total avalanche fatalities have increased linearly (R2 = 0.68). Despite the highest number of total deaths in Colorado (n = 253), the proportion of avalanche fatalities in Colorado decreased (–5% deaths/decade; P = .01). Snowmobilers are now the largest group among fatalities and accounted for 23% of deaths (n = 213). The proportion of snowmobile fatalities has increased (+7% deaths/decade; P < .01), as has the proportion of snowboarder fatalities (+2% deaths/decade; P < .01). Conclusions Avalanche fatalities have increased. This is most likely related to an overall rise in backcountry utilization. Fatalities have increased among snowmobilers and snowboarders. Despite a rise in backcountry utilization, avalanche fatalities in Colorado are decreasing. A strategy of focused training and education aimed toward at-risk groups could result in lower avalanche fatalities.


      PubDate: 2016-03-10T14:35:40Z
       
  • Skin Diseases Affecting High-Level Competition Sailors: Descriptive Study
           Carried Out During the 2012 AG2R Transatlantic Boat Race
    • Abstract: Publication date: March 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 1
      Author(s): Brice Loddé, Catherine Mahé, Laure Jacolot, Richard Pougnet, David Lucas, Dominique Jegaden, Jean-Dominique Dewitte, Laurent Misery, Ray Lucas
      Objectives The primary objective of this study was to identify skin disorders encountered in a population of sport sailors. Unlike merchant mariners and fishermen, there is sparse literature on this maritime population. Secondary objectives were to uncover on-board conditions that may contribute to dermatological problems in this population. Methods We conducted a prospective study during the 2012 AG2R transatlantic race. Sixteen two-man crews participated in this race, all using the same model of sailboat (Bénéteau Figaro 2). Clinical examinations were conducted, photographs taken, and questionnaires containing 34 questions were handed out before departure and on arrival, 22 to 24 days later. Results Twenty-eight of 32 skippers (88%) participated in departure data collection, and 18 (56%) completed data collection on arrival. The average age of sailors was 34 years (SD = 8). Compared with skin diseases documented on departure, there was an increased amount of folliculitis on the buttocks, fungal infections, and hyperkeratosis of the hands on arrival. Furthermore, several new skin problems were found postrace: skin scaling, skin erosions on the buttocks, dyshidrosis, thermal burns, and sunburns. The use of protective gear and sunscreen was common, but on-board hygiene was poor with infrequent bathing and clothing changes. Conclusions Skin conditions are nearly universal in this maritime population. Further assessments are needed to know if long-term use of protective gear; improved hygiene; use of barrier creams; and proper on-board care of fungal infections, wounds, and burns could reduce the number and severity of skin problems encountered in sport sailors.


      PubDate: 2016-03-10T14:35:40Z
       
  • Where’s the “E” in WEM?
    • Abstract: Publication date: March 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 1
      Author(s): Martin D. Hoffman



      PubDate: 2016-03-10T14:35:40Z
       
  • 2015 Wilderness &amp; Environmental Medicine Peer Reviewers
    • Abstract: Publication date: March 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 1




      PubDate: 2016-03-10T14:35:40Z
       
  • Is Postevent Intravenous Hydration an Appropriate Service at Endurance
           Competitions?
    • Abstract: Publication date: March 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 1
      Author(s): Martin D. Hoffman, Tamara Hew-Butler, William O. Roberts, Ian R. Rogers, Mitchell H. Rosner



      PubDate: 2016-03-10T14:35:40Z
       
  • Orbital Compartment Syndrome: Alternative Tools to Perform a Lateral
           Canthotomy and Cantholysis
    • Abstract: Publication date: March 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 1
      Author(s): Kenneth V. Iserson, Zelda Luke-Blyden, Scott Clemans
      Orbital compartment syndrome acutely threatens vision. Lateral canthotomy and cantholysis ameliorate the compartment syndrome and, to save a patient’s vision, must be performed in a timely manner. This requires appropriate tools. In resource-poor settings, the straight hemostat and iris scissors that are generally used for this procedure may be unavailable. In such situations, safe alternatives include using a multitool in place of a hemostat and a #11 scalpel blade instead of the iris scissors. As when using hemostats of varying sizes, the pressure applied to the multitool must be carefully modulated. When using a scalpel blade for the lateral canthotomy, the hemostat arm remains beneath the lateral canthus as a “backstop” to protect deeper tissues. For the cantholysis, use the back of the blade to “strum” for the ligaments, reversing its direction only to cut the ligament when it is identified.


      PubDate: 2016-03-10T14:35:40Z
       
  • Risk Determinants of Acute Mountain Sickness and Summit Success on a 6-Day
           Ascent of Mount Kilimanjaro (5895 m)
    • Abstract: Publication date: March 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 1
      Author(s): James S. Lawrence, Stephen A. Reid
      Objective The aims of this study were to assess incidence of acute mountain sickness (AMS) and summit success on a 6-day ascent profile of Mt. Kilimanjaro and evaluate potential risk factors for these outcomes. Methods All trekkers through a single Australian tour company between August 2012 and July 2014 were included. Participants ascended via the Rongai route and attempted the summit on day 6. Daily assessments were made using the self-reported Lake Louise score (LLS) questionnaire. Two different AMS diagnostic criteria (LLS ≥3 and LLS ≥5) were used for data analysis. Risk factors for development of AMS and summit success were analyzed. Results Over the 24-month period a total of 175 participants undertook the trek. Incidence of AMS was 52.6% (LLS ≥3) and 22.9% (LLS ≥5). Summit success was 88%. Age, sex, body mass index, and acetazolamide use were not associated with risk of AMS development. Age ≥40 years (P = .0002) and female sex (P = .0004) were both significantly associated with reduced summit success rate. Conclusions Our cohort found a lower incidence of AMS and better summit success on a 6-day ascent of Mt Kilimanjaro than previously described in other groups on 4- and 5-day ascents. Female sex and age ≥40 years both predicted failure to summit, but did not increase risk of developing AMS. AMS is a common cause of morbidity on Mt. Kilimanjaro, and although the risk can be mitigated by a slower ascent, there is an ongoing need for education of individual trekkers, tour companies, and local authorities.


      PubDate: 2016-03-10T14:35:40Z
       
  • Primary Care in Extreme Environments: Medical Clinic Utilization at
           Antarctic Stations, 2013–2014
    • Abstract: Publication date: March 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 1
      Author(s): James M. Pattarini, Jullian R. Scarborough, V. Lee Sombito, Scott E. Parazynski
      Objectives The unique challenges posed by the Antarctic environment include both physiological and psychological stressors to the individual as well as the limited onsite medical capabilities available to address them. This report compares medical clinic utilization among 3 US Antarctic stations to identify differences in diagnostic frequency and utilization of clinic resources under current medical prescreening regimes for summer and winter seasons. Methods Clinic data from 3 Antarctic locations (McMurdo Station, Amundsen-Scott South Pole Station, and Palmer Station) for the 2013−2014 Antarctic year were reviewed for patient encounter frequency by season, and provider-assigned visit diagnostic category. Differences between relative diagnosis frequencies among stations were analyzed, and per-capita clinic utilization was compared. Results The McMurdo clinic recorded 1555 patient encounters, with South Pole Station reporting 744 and Palmer with 128 encounters over the year. The most frequent reasons for clinic visits were orthopedic and dermatologic, with increased visits at McMurdo for respiratory illness and at the more remote locations for neurologic complaints and insomnia. Altitude-related visits were reported only at McMurdo and South Pole stations. Conclusions The clinic volume predictably correlated with station population. Insomnia and headache complaints, reported only at the South Pole Station, are likely associated with the increased elevation at that site, although they could be attributable to psychological stress from the isolated environment. Although the majority of cases could not be prevented with current screening, we suggest several changes to the current concept of operations that may decrease medical utilization and provide significant improvements to health care delivery on the ice.


      PubDate: 2016-03-10T14:35:40Z
       
  • Medical Knowledge and Preparedness of Climbers on Colorado’s
           14,000-Foot Peaks
    • Abstract: Publication date: March 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 1
      Author(s): William E. Brandenburg, Christopher B. Davis
      Objective To assess the medical knowledge and preparedness of mountain climbers on Colorado’s 14,000-foot peaks and to compare differences in knowledge and preparedness based on demographics, training, and difficulty of the climb. Methods Mountain climbers from 11 14,000-foot peaks in Colorado were surveyed at the time of summiting. These peaks represented every major mountain range and class of difficulty in Colorado. Marijuana use and demographic information including age, gender, state of residence, and income level was collected in the survey. In addition, participants were scored on medical knowledge and preparedness using a novel assessment tool. Scores were then compared and statistically analyzed. Results Mountain climbers scored 2.84 ± 1.25 and 3.92 ± 1.20 out of 6.00 on medical knowledge and preparedness, respectively. Medical training was shown to be the only significant predictor of medical knowledge, whereas age, race, income, and group status were all shown to be significant predictors of preparedness. It was shown that 9.4% of participants were using marijuana. Only 25% of individuals climbing class 3 mountains elected to wear helmets. Conclusions Most mountain climbers had no formal wilderness medicine training and did worse on the medical knowledge assessment than those who did have training. Consistent with previous studies, participants performed poorly on the medical knowledge assessment. As such, ways to improve wilderness medical knowledge among outdoor recreationalists should be sought. The low rate of helmet use on Colorado’s technical peaks represents an important area for education and injury prevention.


      PubDate: 2016-03-10T14:35:40Z
       
  • 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
       
  • Risk of Avalanche Involvement in Winter Backcountry Recreation: The
           Advantage of Small Groups
    • Abstract: Publication date: Available online 9 February 2016
      Source:Wilderness & Environmental Medicine
      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: 2016-02-11T11:59:24Z
       
  • Subtle Cognitive Dysfunction in Resolving High Altitude Cerebral Edema
           Revealed by a Clock Drawing Test
    • Abstract: Publication date: Available online 10 February 2016
      Source:Wilderness & Environmental Medicine
      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: 2016-02-11T11:59:24Z
       
  • Chemical and Plant-Based Insect Repellents: Efficacy, Safety, and Toxicity
    • Abstract: Publication date: Available online 27 January 2016
      Source:Wilderness & Environmental Medicine
      Author(s): James H. Diaz
      Most emerging infectious diseases today are arthropod-borne and cannot be prevented by vaccinations. Because insect repellents offer important topical barriers of personal protection from arthropod-borne infectious diseases, the main objectives of this article were to describe the growing threats to public health from emerging arthropod-borne infectious diseases, to define the differences between insect repellents and insecticides, and to compare the efficacies and toxicities of chemical and plant-derived insect repellents. Internet search engines were queried with key words to identify scientific articles on the efficacy, safety, and toxicity of chemical and plant-derived topical insect repellants and insecticides to meet these objectives. Data sources reviewed included case reports; case series; observational, longitudinal, and surveillance studies; and entomological and toxicological studies. Descriptive analysis of the data sources identified the most effective application of insect repellents as a combination of topical chemical repellents, either N-diethyl-3-methylbenzamide (formerly N, N-diethyl-m-toluamide, or DEET) or picaridin, and permethrin-impregnated or other pyrethroid-impregnated clothing over topically treated skin. The insecticide-treated clothing would provide contact-level insecticidal effects and provide better, longer lasting protection against malaria-transmitting mosquitoes and ticks than topical DEET or picaridin alone. In special cases, where environmental exposures to disease-transmitting ticks, biting midges, sandflies, or blackflies are anticipated, topical insect repellents containing IR3535, picaridin, or oil of lemon eucalyptus (p-menthane-3, 8-diol or PMD) would offer better topical protection than topical DEET alone.


      PubDate: 2016-01-31T11:03:05Z
       
  • The aftermath of a bushfire
    • Abstract: Publication date: Available online 27 January 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Ian Rogers



      PubDate: 2016-01-31T11:03:05Z
       
  • Ice Climbing Festival in Sochi 2014 Winter Olympics: Medical Management
           and Injury Analysis
    • Abstract: Publication date: Available online 27 January 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Evgeny Mashkovskiy, James Marc Beverly, Urs Stöcker, Sergey Bychkovskiy
      Objective Sports ice climbing (SIC) is developing rapidly as an independent sport with Olympic potentials. To date there has been no prior systematic evaluation of injury risks and injury patterns in a SIC-specific setting. Methods This paper reports injury statistics the statistics collected during the Ice Climbing Festival, which was held during the XXII Winter Olympics in Sochi, Russia. More than 2500 amateur climbers and 53 professional athletes climbed during 16 days on a dry tooling lead-difficulty, and a 17-m vertical ice wall (grade M4/M5 or Union Internationale des Associations d’Alpinisme [UIAA] V+/VI–). Results The injury incidence rates were 0.82/100 in lead-difficulty and 0.83/100 in speed ice climbing with an overall incidence rate of 0.83/100. The injury risk in amateur climbers was 248 injuries per 1000 hours of sports activities. There were no major accidents or fatalities during the event. SIC could be graded I according to UIAA Fatality Risk Classification. Penetrating and superficial soft tissue injuries (cuts and bruises) were the most common. The anteromedial aspects of the thigh and knee were the most typical injury locations. Conclusions The findings from this study provide an opportunity to compare injury patterns in SIC with what has previously been reported for traditional ice climbing. SIC has lower fatality risks, higher minor injury rates, and comparable injury severity to traditional ice climbing. The main limitation of our findings is that they were obtained on a population of amateur ice climbers with no previous experience. Further research should be performed to define injury risks in professional competitive ice climbers, and standard methodologies for reporting injuries should be considered.


      PubDate: 2016-01-31T11:03:05Z
       
  • 438 Days: An Extraordinary True Story of Survival at Sea Jonathan Franklin
           New York, NY: Atria Books, 2015 $26, 266 pages, clothbound
    • Abstract: Publication date: Available online 27 January 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Christopher Van Tilburg



      PubDate: 2016-01-31T11:03:05Z
       
  • Training for the New Alpinism: A Manual for the Climber as Athlete Steve
           House and Scott Johnston Ventura, CA: Patagonia Books, 2014 $35.00, 464
           pages, paperback
    • Abstract: Publication date: Available online 27 January 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Aaron D. Campbell



      PubDate: 2016-01-31T11:03:05Z
       
  • Barbarian Days: A Surfing Life William Finnegan New York, NY: Penguin
           Press, 2015 $27.95, 447 pages, clothbound
    • Abstract: Publication date: Available online 27 January 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Christopher Van Tilburg



      PubDate: 2016-01-31T11:03:05Z
       
  • Efficacy of Topical Treatments for Chrysaora chinensis Species: A Human
           Model in Comparison with an In Vitro Model
    • Abstract: Publication date: Available online 27 January 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Matthieu P. DeClerck, Yvonne Bailey, David Craig, Michelle Lin, Lauren J. Auerbach, Olivia Linney, Doug E Morrison, Wyatt Patry, Paul S Auerbach
      Objectives This study sought to create a model for testing topical treatment of jellyfish stings. It sought to determine which treatments 1) stimulate/inhibit nematocyst discharge; 2) decrease pain; and 3) decrease skin inflammation; it also sought to discover whether there is a clinical correlation between stimulated nematocyst discharge observed in vitro to the pain and erythema experienced by humans stung by a particular species of jellyfish, C chinensis. Methods Chrysaora chinensis stung 96 human subjects, who were then treated with isopropyl alcohol, hot water, acetic acid, papain meat tenderizer, lidocaine, or sodium bicarbonate. Pain and erythema were measured. In a separate experiment, nematocysts were examined microscopically after exposure to the same topical treatments used in the human experiment. Results Forearms treated with papain showed decreased mean pain over the first 30 minutes after being stung, relative to placebo, although only by a small amount. The other topical treatments tested did not reach statistical significance. Sodium bicarbonate may reduce erythema after 30 minutes of treatment; sodium bicarbonate and papain may reduce erythema at 60 minutes. The other topical treatments tested did not reach statistical significance. Nematocyst discharge in vitro occurred when tentacles of C chinensis were exposed to acetic acid or isopropyl alcohol. Sodium bicarbonate, papain, heated water, and lidocaine did not induce nematocyst discharge. Conclusions Papain-containing meat tenderizer used as a topical treatment for C chinensis stings may decrease pain. Although there is published experimental support for the concept that in vitro nematocyst discharge correlates with in vivo human pain perception, no definitive randomized controlled trial, including ours, has yet provided incontrovertible evidence of this assertion. Despite this study’s limitations, it presents a viable basis for future human studies looking at the efficacy of topical treatments for jellyfish stings.


      PubDate: 2016-01-31T11:03:05Z
       
  • Should AED Devices Be Routinely Included in Wilderness Medical Kits?
    • Abstract: Publication date: Available online 30 December 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Jeremy D Joslin, Amy Sue Biondich



      PubDate: 2015-12-31T02:34:09Z
       
  • Deep Vein Thrombosis and Pulmonary Embolism in a Mountain Guide:
           Awareness, Diagnostic Challenges, and Management Considerations at
           Altitude
    • Abstract: Publication date: Available online 23 December 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Claire M. Hull, Dévan Rajendran, Arturo Fernandez Barnes
      High intensity exercise is associated with several potentially thrombogenic risk factors, including dehydration and hemoconcentration, vascular trauma, musculoskeletal injuries, inflammation, long-distance travel, and contraceptive usage. These are well documented in case reports of venous thrombosis in track and field athletes. For mountaineers and those working at high altitude, additional risks exist. However, despite there being a high degree of vigilance for “classic” conditions encountered at altitude (eg, acute mountain sickness, high altitude pulmonary edema, and high altitude cerebral edema), mainstream awareness regarding thrombotic conditions and their complications in mountain athletes is relatively low. This is significant because thromboembolic events (including deep vein thrombosis, pulmonary embolism, and cerebral vascular thrombosis) are not uncommon at altitude. We describe a case of deep vein thrombosis and pulmonary embolism in a male mountain guide and discuss the diagnostic issues encountered by his medical practitioners. Potential risk factors affecting blood circulation (eg, seated car travel and compression of popliteal vein) and blood hypercoagulability (eg, hypoxia, environmental and psychological stressors [avalanche risk, extreme cold]) relevant to the subject of this report and mountain athletes in general are identified. Considerations for mitigating and managing thrombosis in addition to personalized care planning at altitude are discussed. The prevalence of thrombosis in mountain athletes is uncharted, but lowlanders increasingly go to high altitude to trek, ski, or climb. Blood clots can and do occur in physically active people, and thrombosis prevention and recognition will demand heightened awareness among participants, healthcare practitioners, and the altitude sport/leisure industry at large.


      PubDate: 2015-12-26T02:28:53Z
       
  • Shark Fears and the Media
    • Abstract: Publication date: Available online 19 December 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Benjamin Eovaldi, Pell Thompson, Kristen Eovaldi, Robert Eovaldi



      PubDate: 2015-12-21T02:22:21Z
       
  • The 6-Minute Walk Test as a Predictor of Summit Success on Denali
    • Abstract: Publication date: Available online 19 December 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Katherine M. Shea, Eric R. Ladd, Grant S. Lipman, Patrick Bagley, Elizabeth A. Pirrotta, Hurnan Vongsachang, N. Ewen Wang, Paul S. Auerbach
      Objective To test whether the 6-minute walk test (6MWT), including postexercise vital sign measurements and distance walked, predicts summit success on Denali, AK. Methods This was a prospective observational study of healthy volunteers between the ages of 18 and 65 years who had been at 4267 m for less than 24 hours on Denali. Physiologic measurements were made after the 6MWT. Subjects then attempted to summit at their own pace and, at the time of descent, completed a Lake Louise Acute Mountain Sickness Questionnaire and reported maximum elevation reached. Results One hundred twenty-one participants enrolled in the study. Data were collected on 111 subjects (92% response rate), of whom 60% summited. On univariate analysis, there was no association between any postexercise vital sign and summit success. Specifically, there was no significant difference in the mean postexercise peripheral oxygen saturation (Spo 2) between summiters (75%) and nonsummiters (74%; 95% CI, –3 to 1; P = .37). The distance a subject walked in 6 minutes (6MWTD) was longer in summiters (617 m) compared with nonsummiters (560 m; 95% CI, 7.6 to 106; P = .02). However, this significance was not maintained on a multivariate analysis performed to control for age, sex, and guide status (P = .08), leading to the conclusion that 6MWTD was not a robust predictor of summit success. Conclusions This study did not show a correlation between postexercise oxygen saturation or 6MWTD and summit success on Denali.


      PubDate: 2015-12-21T02:22:21Z
       
  • Storm over the Tetons
    • Abstract: Publication date: Available online 19 December 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Jennifer K Rossi



      PubDate: 2015-12-21T02:22:21Z
       
  • Acute Mountain Sickness (AMS) Knowledge Among High Altitude Marathon
           Runners Competing in the Everest Marathon
    • Abstract: Publication date: Available online 19 December 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Abigail Letchford, Rudra Paudel, Owen D. Thomas, Adam S. Booth, Christopher H.E. Imray
      Objective Although there are a number of studies on trekkers’ knowledge of acute mountain sickness (AMS), there is little current literature on other groups at altitude, for example, marathon runners. Increased knowledge of AMS is associated with a lower incidence of AMS. The purpose of this study was to determine AMS knowledge of marathon runners with an aim to improve AMS information distribution. Incidence of AMS was also determined. Methods Participants completed a self-assessment AMS knowledge questionnaire in Kathmandu before starting the acclimatization trek for the Tenzing Hillary Everest Marathon in Nepal. Lake Louise Scoring questionnaires were completed every day of the 12-day acclimatization trek. Results The majority (86%; 43 of 50) of participants obtained information about AMS before the marathon, with the Internet providing the most common source (50%; 25 of 50). Ninety-two percent (46 of 50) of participants rated their knowledge as average or above, and self-assessment correlated with knowledge questionnaire scores (r = .479, P < .001). However, 48% (24 of 50) did not know it was unsafe to ascend with mild AMS symptoms, and 66% (33 of 50) thought it was safe to go higher with symptoms relieved by medication. Only 50% (25 of 50) knew AMS could occur from 2500 m. Thirty-eight percent (19 of 50) of participants had AMS during the acclimatization trek, and 6% (3 of 50) experienced it during the race. Conclusions This study adds to previous literature regarding knowledge and incidence of AMS. It further highlights that more needs to be done to improve knowledge through better information dissemination, with inclusion of scenario-based information to aid application of this knowledge to practical situations.


      PubDate: 2015-12-21T02:22:21Z
       
  • Backcountry Skiers, Avalanche Trauma Mortality, and Helmet Use
    • Abstract: Publication date: Available online 19 December 2015
      Source:Wilderness & Environmental Medicine
      Author(s): George Vargyas



      PubDate: 2015-12-21T02:22:21Z
       
  • An Assessment of Coliform Bacteria in Water Sources Near Appalachian Trail
           Shelters Within the Great Smoky Mountains National Park
    • Abstract: Publication date: Available online 7 December 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Brian C. Reed, Mark S. Rasnake
      Objective Hikers and campers are exposed to risks while in the wilderness. One of these risks is the possibility of contracting an illness, including infectious diarrhea. This project tested for coliform bacteria in water samples taken near popular Appalachian Trail shelters. Methods Water was collected from access points within the Great Smoky Mountains National Park. Samples were collected in sterile bottles and inoculated on a commercially available coliform detection kit for quantitative determination of total coliform and Escherichia coli counts. Results Water samples were taken during summer and fall seasons. During summer, 7 of 10 samples were positive for coliform bacteria and 6 of those 7 for E coli. The most probable number (MPN) of colony-forming units (CFU) for coliform bacteria ranged from 0 to 489 CFU/100 mL, with the MPN for E coli varying from 0 to 123 CFU/100 mL. These data differed from the fall collection, revealing 3 of 7 samples positive for coliform bacteria and 1 of those 3 for E coli. The MPN of CFU for coliform bacteria in fall samples varied from 0 to 119 CFU/100 mL and 0 to 5 to CFU/100 mL for E coli. Conclusions Environmental Protection Agency drinking water standards set the standard of 0 CFU/100 mL to be considered safe. This analysis of water samples along the Appalachian Trail emphasizes that the majority of water access points require treatment during the summer season. Coliform burden was not as high through the fall months. These data suggest one infectious disease risk for wilderness travelers.


      PubDate: 2015-12-11T01:45:22Z
       
  • Accidents in North American Mountaineering 2015Dougald MacDonald,
           editorGolden, CO: American Alpine Club Press, 2015US $12.95 (paperback),
           128 pagesThe American Alpine Club Journal 2015Dougald MacDonald,
           editorGolden, CO: American Alpine Club Press, 2015US $35 (paperback), 400
           pages
    • Abstract: Publication date: Available online 10 December 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Christopher Van Tilburg



      PubDate: 2015-12-11T01:45:22Z
       
  • Scuba-Diving Bugs Can Inflict Envenoming Bites in Swimming Pools, Lakes,
           and Ponds
    • Abstract: Publication date: Available online 10 December 2015
      Source:Wilderness & Environmental Medicine
      Author(s): James H. Diaz



      PubDate: 2015-12-11T01:45:22Z
       
  • Injuries and Fatalities on Sailboats in the United States 2000–2011:
           An Analysis of US Coast Guard Data
    • Abstract: Publication date: Available online 7 December 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Kevin M. Ryan, Andrew T. Nathanson, Janette Baird, Jenna Wheelhouse
      Background Prior sailing injury studies have been small, focused investigations. This large, population-based study examined the mechanisms and factors contributing to sailboat-related injuries and deaths. Methods A retrospective data analysis of the Boating Accident Report Database compiled by the US Coast Guard between 2000 and 2011 was performed. The database was analyzed looking at frequency of events. For each subgroup, proportions were determined and 95% CIs were calculated. These data, used in conjunction with the 2011 US Coast Guard National Recreational Boating Survey, were used to estimate a fatality rate. Results Two hundred seventy-one sailing-related fatalities and 841 injuries were reported. A fatality rate was calculated at 1.19 deaths per million sailing person-days. Weather or hazardous waters were listed as primary contributing factors in 28.0% (95% CI, 22.7–33.4) of deaths; 70.1% (95% CI, 64.7–75.6) of deaths occurred after falling overboard or capsizing. Drowning was the most common cause of death (73.1%; 95% CI, 67.8–78.4), and 81.6% of victims were not wearing a life jacket. Alcohol intoxication contributed to 12.2% (95% CI, 8.3–16.1) of deaths. Operator- or passenger-preventable factors contributed to 52.7% (95% CI, 49.3–56.1) of all injuries; 51.6% (95% CI, 46.1–57.1) of injuries on nonmotorized sailboats were the result of capsizing, and 46.4% (95% CI, 42.1–50.7) of all injuries on motorized sailboats were the result of collisions or grounding. Conclusions The calculated fatality rate is similar to that of alpine skiing. Falls overboard and capsizing were the most common fatal accidents. Operator inattention, inexperience, and alcohol use were common preventable factors contributing to fatal and nonfatal injury.


      PubDate: 2015-12-11T01:45:22Z
       
  • Picking edible and medicinal plants: exotic “apples” and
           “pears”
    • Abstract: Publication date: Available online 10 December 2015
      Source:Wilderness & Environmental Medicine
      Author(s): James H. Diaz



      PubDate: 2015-12-11T01:45:22Z
       
  • Ski Helmets and the Backcountry
    • Abstract: Publication date: Available online 4 December 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Robert Williams



      PubDate: 2015-12-06T01:12:03Z
       
  • Can We Get There From Here?
    • Abstract: Publication date: December 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 4
      Author(s): Martin D. Hoffman



      PubDate: 2015-12-01T01:00:38Z
       
 
 
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