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  Subjects -> ENVIRONMENTAL STUDIES (Total: 825 journals)
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ENVIRONMENTAL STUDIES (754 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  [2970 journals]
  • An Analysis of Media-Reported Venomous Snakebites in the United States,
           2011–2013
    • Abstract: Publication date: Available online 5 May 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Dennis K. Wasko, Stephan G. Bullard
      Background Venomous snakebite is a widespread natural hazard in the United States. A common perception exists that the majority of these snakebites are “illegitimate,” resulting from deliberate interaction with snakes (such as attempting to move or kill the animal), but there is little quantitative information available regarding the conditions under which bites occur. Methods To better understand the circumstances under which victims are bitten, we compiled a dataset of media-reported snakebites in the United States between 2011 and 2013. A total of 332 reported snakebites were recorded. Of these, 307 were from snakes encountered under natural circumstances and 25 were under captive-care conditions. Results Most reported victims were adult males. Although some bites occurred during intentional handling of snakes and such activity may relate to bite severity, the majority of victims reported being unaware of the snake before they were bitten. Accidentally stepping on or placing the hands near an unseen snake were the activities most frequently associated with bites under natural conditions. Conclusions Although bias in snakebite reporting patterns by the media is likely, across the United States “legitimate” bites from unseen snakes appear to be the norm.


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


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



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


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


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



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


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


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


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


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


      PubDate: 2016-05-17T18:00:21Z
       
  • In reply to Brillhart et al.
    • Abstract: Publication date: Available online 16 April 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Chris R. Welter, J. Matthew Sholl, Tania D. Strout, Ben Woodard



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


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


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



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



      PubDate: 2016-05-17T18:00:21Z
       
  • Pitviper Envenomation Guidelines Should Address Choice Between
           FDA-approved Treatments for Cases at Risk of Late Coagulopathy
    • Abstract: Publication date: Available online 11 April 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Leslie V. Boyer, Anne-Michelle Ruha



      PubDate: 2016-05-17T18:00:21Z
       
  • In Reply to Drs Boyer and Ruha
    • Abstract: Publication date: Available online 11 April 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Nicholas C. Kanaan, Jeremiah Ray, Matthew Stewart, Matthew Fuller, E. Martin Caravati, Katie W. Russell, Sean P. Bush, Michael D. Cardwell, Robert L. Norris, Scott A. Weinstein



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


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


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


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


      PubDate: 2016-05-17T18:00:21Z
       
  • Calotropis gigantea
    • Abstract: Publication date: Available online 31 March 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Tanuj Kanchan, Alok Atreya



      PubDate: 2016-05-17T18:00:21Z
       
  • 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
       
  • 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
       
  • 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
       
  • 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
       
  • 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
       
  • 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
       
  • 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
       
  • 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
       
 
 
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