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ENVIRONMENTAL STUDIES (694 journals)

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Journal Cover Wilderness & Environmental Medicine
  [SJR: 0.49]   [H-I: 29]   [3 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1080-6032
   Published by Elsevier Homepage  [3031 journals]
  • Media and Mountain Medicine: A Commitment: Role and Impact of Media on
           Society and with Special Reference to Newspapers’ Role in Public
           Awareness
    • Authors: Rajashekar Nanjappa
      Abstract: Publication date: March 2017
      Source:Wilderness & Environmental Medicine, Volume 28, Issue 1
      Author(s): Rajashekar Nanjappa


      PubDate: 2017-03-10T08:53:03Z
      DOI: 10.1016/j.wem.2017.01.022
       
  • Cerebrovascular CO2 Reactivity: A Potential Tool for Prevention of High
           Altitude Brain Edema
    • Authors: Jose Antonio Carmona Suazo
      Abstract: Publication date: March 2017
      Source:Wilderness & Environmental Medicine, Volume 28, Issue 1
      Author(s): Jose Antonio Carmona Suazo


      PubDate: 2017-03-10T08:53:03Z
      DOI: 10.1016/j.wem.2017.01.020
       
  • Prospective Validation of Framingham Criteria for Congestive Heart Failure
           Diagnosis in a High-Altitude Population
    • Authors: Z. Sovero; E. Capcha; W. Calderón-Gerstein
      Abstract: Publication date: March 2017
      Source:Wilderness & Environmental Medicine, Volume 28, Issue 1
      Author(s): Z. Sovero, E. Capcha, W. Calderón-Gerstein


      PubDate: 2017-03-10T08:53:03Z
      DOI: 10.1016/j.wem.2017.01.018
       
  • Neural Mechanisms Involved in Autonomic and Respiratory Changes in Rats,
           Submitted to Short-Term Sustained Hypoxia
    • Authors: Daniela Accorsi-Mendonça; Carlos E.L. Almado; Leni G.H. Bonagamba; Kauê M. Costa; Jaci A. Castania; João Henrique Costa-Silva; Daniel B. Zoccal; Davi J.A. Moraes; Benedito H. Machado
      Abstract: Publication date: March 2017
      Source:Wilderness & Environmental Medicine, Volume 28, Issue 1
      Author(s): Daniela Accorsi-Mendonça, Carlos E.L. Almado, Leni G.H. Bonagamba, Kauê M. Costa, Jaci A. Castania, João Henrique Costa-Silva, Daniel B. Zoccal, Davi J.A. Moraes, Benedito H. Machado


      PubDate: 2017-03-10T08:53:03Z
      DOI: 10.1016/j.wem.2017.01.017
       
  • Modification and Further Applications of the Adaptation to High Altitude
           Formula
    • Authors: Gustavo Zubieta-Calleja; Natalia Zubieta-DeUrioste
      Abstract: Publication date: March 2017
      Source:Wilderness & Environmental Medicine, Volume 28, Issue 1
      Author(s): Gustavo Zubieta-Calleja, Natalia Zubieta-DeUrioste


      PubDate: 2017-03-10T08:53:03Z
      DOI: 10.1016/j.wem.2017.01.016
       
  • An Assessment of Diarrhea Among Long-Distance Backpackers in the Sierra
           Nevada
    • Authors: Derek J. Meyer; Amber Costantino; Susanne Spano
      Pages: 4 - 9
      Abstract: Publication date: March 2017
      Source:Wilderness & Environmental Medicine, Volume 28, Issue 1
      Author(s): Derek J. Meyer, Amber Costantino, Susanne Spano
      Introduction Diarrhea is a common problem among long-distance backpackers, ranging in overall incidence from 11–56% as reported by previous studies on the Appalachian Trail and Long Trail. Differences in age, sex, and regularity of standard backcountry hygiene recommendations and practices have been shown to significantly affect the incidence of diarrhea. No study to date has investigated these trends among long-distance backpackers on the John Muir Trail (JMT) in the Sierra Nevada mountain range of California. Methods Retrospective analysis of online survey data gathered from long-distance backpackers who attempted a JMT trek in 2014. Data were assessed for the significance of variables that might contribute to the incidence and severity of on-trail diarrhea. Results Of 737 valid responders, 16.4% reported experiencing diarrhea (82% with minimal/mild severity; 18% with significant severity). Regular hand sanitizer use was significantly correlated with more severe diarrhea (P < .05), but had no effect on incidence. Regular hand sanitizer users followed all other recommended hygiene practices as frequently as or better than those not using hand sanitizer regularly. Of all backpackers, 88% filtered or treated their drinking water regularly, with 18% of those reporting diarrhea of any severity. Conclusions JMT backpackers have a comparatively lower incidence of diarrhea than backpackers on other major long-distance backpacking routes in the United States. Most JMT backpackers follow standard backcountry hygiene recommendations, including regular filtration or treatment of drinking water. No statistical significance was found between the incidence of diarrhea and compliance with standard hygiene recommendations. Regular hand sanitizer use was significantly correlated with more severe diarrhea but was not associated with incidence. There was no significant difference in compliance with standard backcountry hygiene practices between regular and infrequent hand sanitizer users.

      PubDate: 2017-03-10T08:53:03Z
      DOI: 10.1016/j.wem.2016.12.002
       
  • The Effects of a 36-Hour Mixed Task Ultraendurance Race on Mucosal
           Immunity Markers and Pulmonary Function
    • Authors: David Bellar; Kellie A. Murphy; Ritvik Aithal; Greggory R. Davis; Tim Piper
      Pages: 10 - 16
      Abstract: Publication date: March 2017
      Source:Wilderness & Environmental Medicine, Volume 28, Issue 1
      Author(s): David Bellar, Kellie A. Murphy, Ritvik Aithal, Greggory R. Davis, Tim Piper
      Objective The present study was conducted to assess the changes in mucosal immunity and pulmonary function among participants in a 36-hour mixed task ultraendurance race. Methods Thirteen of the 20 race participants volunteered for the investigation (age 34±5 y). The event consisted of a mixture of aerobic, strong man, and military-style exercise. Participants had a pulmonary function test and gave a finger stick capillary blood sample and unstimulated saliva samples both before the event and upon dropout or completion. The blood sample was analyzed for hematocrit, and the saliva sample was analyzed for salivary flow rate, salivary alpha amylase, salivary immunoglobulin A (IgA), and IgA type 1. Results Significant differences were noted among the finishers and those who dropped out in salivary flow rate (P = .026), salivary IgA (P = .017), and peak expiratory flow (P = .05) measurements. Salivary flow rate and IgA for the race finishers were reduced from pre- to postrace, whereas the nonfinishers showed no change or small increases. No significant differences emerged for other variables. Conclusions Based on the results of the present investigation, finishing a 36-hour mixed task ultra-endurance event results in a decline in both pulmonary function and mucosal immunity compared with competitors who do not finish.

      PubDate: 2017-03-10T08:53:03Z
      DOI: 10.1016/j.wem.2016.12.001
       
  • HMOX1 Promoter Microsatellite Polymorphism Is Not Associated With High
           Altitude Pulmonary Edema in Han Chinese
    • Authors: Xue-Feng Cao; Lan Ma; Shang Ma; Jin Xu; Ri-Li Ge
      Pages: 17 - 22
      Abstract: Publication date: March 2017
      Source:Wilderness & Environmental Medicine, Volume 28, Issue 1
      Author(s): Xue-Feng Cao, Lan Ma, Shang Ma, Jin Xu, Ri-Li Ge
      Objective To investigate the relationship between microsatellite polymorphism in the Heme oxygenase-1 (HMOX1) gene promoter and high-altitude pulmonary edema (HAPE) in Han Chinese. Methods Eighty-three construction workers who developed HAPE 2 to 7 days after arrival at Yushu (3800 m) in Qinghai, China, and 145 matched healthy subjects were included in this study. The amplification and labeling of the polymerase chain reaction products for capillary electrophoresis were performed to identify HMOX1 genotype frequency. The alleles were classified as short (S: <25 [GT]n repeats) and long (L: ≥25 [GT]n repeats) alleles. Results Patients with HAPE have significantly higher white blood cell count, heart rate, and mean pulmonary artery pressure, but lower hemoglobin and arterial oxygen saturation than healthy subjects without HAPE. The numbers of (GT)n repeats in the HMOX1 gene promoter show a bimodal distribution. However, there is no significant difference in the genotype frequency and allele frequency between patients with HAPE and healthy subjects without HAPE. Chi-square test analysis reveals that the genotype frequency of (GT)n repeats is not associated with HAPE. Conclusion The microsatellite polymorphism in the HMOX1 gene promoter is not associated with HAPE in Han Chinese in Qinghai, China.

      PubDate: 2017-03-10T08:53:03Z
      DOI: 10.1016/j.wem.2016.12.003
       
  • Wilderness Medical Society Practice Guidelines for Prevention and
           Management of Avalanche and Nonavalanche Snow Burial Accidents
    • Authors: Christopher Van Tilburg; Colin K. Grissom; Ken Zafren; Scott McIntosh; Martin I. Radwin; Peter Paal; Pascal Haegeli; William “Will” R. Smith; Albert R. Wheeler; David Weber; Bruce Tremper; Hermann Brugger
      Pages: 23 - 42
      Abstract: Publication date: March 2017
      Source:Wilderness & Environmental Medicine, Volume 28, Issue 1
      Author(s): Christopher Van Tilburg, Colin K. Grissom, Ken Zafren, Scott McIntosh, Martin I. Radwin, Peter Paal, Pascal Haegeli, William “Will” R. Smith, Albert R. Wheeler, David Weber, Bruce Tremper, Hermann Brugger
      To provide guidance to clinicians and avalanche professionals about best practices, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the prevention, rescue, and medical management of avalanche and nonavalanche snow burial victims. Recommendations are graded on the basis of quality of supporting evidence according to the classification scheme of the American College of Chest Physicians.

      PubDate: 2017-03-10T08:53:03Z
      DOI: 10.1016/j.wem.2016.10.004
       
  • A Novel Cooling Method and Comparison of Active Rewarming of Mildly
           Hypothermic Subjects
    • Authors: Mark L. Christensen; Grant S. Lipman; Dennis A. Grahn; Kate M. Shea; Joseph Einhorn; H. Craig Heller
      Abstract: Publication date: Available online 12 May 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Mark L. Christensen, Grant S. Lipman, Dennis A. Grahn, Kate M. Shea, Joseph Einhorn, H. Craig Heller
      Objective To compare the effectiveness of arteriovenous anastomosis (AVA) vs heated intravenous fluid (IVF) rewarming in hypothermic subjects. Additionally, we sought to develop a novel method of hypothermia induction. Methods Eight subjects underwent 3 cooling trials each to a mean core temperature of 34.8±0.6 (32.7 to 36.3°C) by 14°C water immersion for 30 minutes, followed by walking on a treadmill for 5 minutes. Core temperatures (Δtes) and rates of cooling (°C/h) were measured. Participants were then rewarmed by 1) control: shivering only in a sleeping bag; 2) IVF: shivering in sleeping bag and infusion of 2 L normal saline warmed to 42°C at 77 mL/min; and 3) AVA: shivering in sleeping bag and circulation of 45°C warmed fluid through neoprene pads affixed to the palms and soles of the feet. Results Cold water immersion resulted in a decrease of 0.5±0.5°C Δtes and 1±0.3°C with exercise (P < .01); with an immersion cooling rate of 0.9±0.8°C/h vs 12.6±3.2°C/h with exercise (P < .001). Temperature nadir reached 35.0±0.5°C. There were no significant differences in rewarming rates between the 3 conditions (shivering: 1.3±0.7°C/h, R 2 = 0.683; IVF 1.3±0.7°C/h, R 2 = 0.863; and AVA 1.4±0.6°C/h, R 2 = 0.853; P = .58). Shivering inhibition was greater with AVA but was not significantly different (P = .07). Conclusions This study developed a novel and efficient model of hypothermia induction through exercise-induced convective afterdrop. Although there was not a clear benefit in either of the 2 active rewarming methods, AVA rewarming showed a nonsignificant trend toward greater shivering inhibition, which may be optimized by an improved interface.

      PubDate: 2017-05-14T04:08:16Z
      DOI: 10.1016/j.wem.2017.02.009
       
  • Sudden Death in a Diver: A Diagnostic Conundrum
    • Authors: Scott Dougherty; Maziar Khorsandi; Myra Adelbai; Vipin Zamvar; James Francis
      Abstract: Publication date: Available online 10 May 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Scott Dougherty, Maziar Khorsandi, Myra Adelbai, Vipin Zamvar, James Francis
      We discuss the case of an experienced diver who ran out of air during his final ascent while scuba diving. He lost consciousness rapidly after surfacing and despite immediate cardiopulmonary resuscitation, could not be revived. On arrival at the emergency department he was noted to have copious amounts of blood in his upper airway and had developed extensive subcutaneous emphysema. Large amounts of air were observed in the central circulation following a postmortem computerized tomography scan as well as pneumomediastinum, a small right-sided hemothorax, and extensive subcutaneous emphysema. We discuss several potential pathophysiological mechanisms that might explain these findings. Finally, we end with a recommendation for an expedient whole-body postmortem computerized tomography scan and autopsy by a suitably qualified pathologist in the investigation of all dive-related fatalities, where possible.

      PubDate: 2017-05-14T04:08:16Z
      DOI: 10.1016/j.wem.2017.03.012
       
  • Managing Traumatic Brain Injury: Translating Military Guidelines to the
           Wilderness
    • Authors: Edward J. Otten; Warren C. Dorlac
      Abstract: Publication date: Available online 10 May 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Edward J. Otten, Warren C. Dorlac
      Traumatic brain injury (TBI) is a common injury on the battlefield. Much of what medics do to manage these injuries on the battlefield can be translated to other austere environments, such as wilderness or disaster settings. The recognition and diagnosis of TBI can be difficult even in the hospital, but basic understanding of how to define a TBI and prevent secondary injuries can be accomplished with relatively few resources and little training. This article outlines what a TBI is and how to manage it in the field.

      PubDate: 2017-05-14T04:08:16Z
      DOI: 10.1016/j.wem.2017.02.008
       
  • Battlefield Trauma-Induced Hypothermia: Transitioning the Preferred Method
           of Casualty Rewarming
    • Authors: Brad L. Bennett; John B. Holcomb
      Abstract: Publication date: Available online 5 May 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Brad L. Bennett, John B. Holcomb
      For centuries, cold and wet weather has affected military combat operations leading to tremendous loss of manpower caused by cold–weather-related injuries including trench foot, frostbite, and hypothermia. The initial battlefield management of hypothermia in military personnel had not advanced significantly following many wars and conflicts until 2006. The aim of this review is to: 1) provide an overview of trauma-induced hypothermia (TIH); 2) highlight the Department of Defense strategy for the implementation of a hypothermia clinical management program for battlefield (prehospital) casualties; 3) highlight the research and development of the Hypothermia Prevention and Management Kit (HPMK) as the preferred field rewarming system for battlefield TIH; and 4) emphasize how the HPMK can be easily transitioned to the civilian sector for active rewarming of both accidental and TIH patients. The HPMK is ideal for those working in civilian Emergency Medical Services and austere prehospital care environments. This kit is a low cost, lightweight, small dimension commercial product that can provide effective passive management or active rewarming for both accidental (primary) and trauma-induced (secondary) hypothermia patients.

      PubDate: 2017-05-09T02:35:06Z
      DOI: 10.1016/j.wem.2017.03.010
       
  • Interfang Distances of Rattlesnakes: Sexual, Interspecific, and Body
           Size-related Variation, and Implications for Snakebite Research and
           Management
    • Authors: William K. Hayes; Aaron G. Corbit; Michael D. Cardwell; Shelton S. Herbert
      Abstract: Publication date: Available online 5 May 2017
      Source:Wilderness & Environmental Medicine
      Author(s): William K. Hayes, Aaron G. Corbit, Michael D. Cardwell, Shelton S. Herbert
      Objectives Snakebite severity corresponds to size of snake because the amount of venom a snake injects is positively associated with snake size. Because fang marks are often present on snakebite patients, we tested whether the relationship between snake length and distance between fang puncture wounds can be generalized for rattlesnakes of genus Crotalus. Methods We measured 2 interfang distances from 79 rattlesnakes of both sexes, 5 species, and varying body length: 1) distance between fang bases in anesthetized snakes, and 2) distance between fang punctures in a membrane-covered beaker bitten defensively. Results Statistical analyses supported our 2 hypotheses, that 1) body size-related fang divergence during fang protraction (ie, anterolateral movement during fang erection), and 2) the relationship between snake length and interfang distance are similar between the sexes and among different rattlesnake species. We therefore derived a general equation to estimate snake length based on distance between fang marks, and recommended 5 snake size categories: very small (<10 mm), small (10–15 mm), medium (15–20 mm), large (20–25 mm), and very large (>25 mm). Conclusions The distance between fang marks on a snakebite patient may be used to estimate the size or size category of the offending snake, which in some cases may have predictive value for overall clinical severity of a given envenomation. Assessing interfang distance from puncture wounds can improve snakebite research and anticipation of snakebite severity.

      PubDate: 2017-05-09T02:35:06Z
      DOI: 10.1016/j.wem.2017.03.006
       
  • Bruno Ernst Durrer, MD: January 14, 1953 to December 5, 2016
    • Abstract: Publication date: Available online 5 May 2017
      Source:Wilderness & Environmental Medicine


      PubDate: 2017-05-09T02:35:06Z
       
  • Prophylactic Acetaminophen or Ibuprofen Result in Equivalent Acute
           Mountain Sickness Incidence at High Altitude: A Prospective Randomized
           Trial
    • Authors: Nicholas C. Kanaan; Alicia L. Peterson; Matiram Pun; Peter S. Holck; Jennifer Starling; Bikash Basyal; Thomas F. Freeman; Jessica R. Gehner; Linda Keyes; Dana R. Levin; Catherine J. O’Leary; Katherine E. Stuart; Ghan B. Thapa; Aditya Tiwari; Jared L. Velgersdyk; Ken Zafren; Buddha Basnyat
      Abstract: Publication date: Available online 4 May 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Nicholas C. Kanaan, Alicia L. Peterson, Matiram Pun, Peter S. Holck, Jennifer Starling, Bikash Basyal, Thomas F. Freeman, Jessica R. Gehner, Linda Keyes, Dana R. Levin, Catherine J. O’Leary, Katherine E. Stuart, Ghan B. Thapa, Aditya Tiwari, Jared L. Velgersdyk, Ken Zafren, Buddha Basnyat
      Objective Recent trials have demonstrated the usefulness of ibuprofen in the prevention of acute mountain sickness (AMS), yet the proposed anti-inflammatory mechanism remains unconfirmed. Acetaminophen and ibuprofen were tested for AMS prevention. We hypothesized that a greater clinical effect would be seen from ibuprofen due to its anti-inflammatory effects compared with acetaminophen’s mechanism of possible symptom reduction by predominantly mediating nociception in the brain. Methods A double-blind, randomized trial was conducted testing acetaminophen vs ibuprofen for the prevention of AMS. A total of 332 non-Nepali participants were recruited at Pheriche (4371 m) and Dingboche (4410 m) on the Everest Base Camp trek. The participants were randomized to either acetaminophen 1000 mg or ibuprofen 600 mg 3 times a day until they reached Lobuche (4940 m), where they were reassessed. The primary outcome was AMS incidence measured by the Lake Louise Questionnaire score. Results Data from 225 participants who met inclusion criteria were analyzed. Twenty-five participants (22.1%) in the acetaminophen group and 18 (16.1%) in the ibuprofen group developed AMS (P = .235). The combined AMS incidence was 19.1% (43 participants), 14 percentage points lower than the expected AMS incidence of untreated trekkers in prior studies at this location, suggesting that both interventions reduced the incidence of AMS. Conclusions We found little evidence of any difference between acetaminophen and ibuprofen groups in AMS incidence. This suggests that AMS prevention may be multifactorial, affected by anti-inflammatory inhibition of the arachidonic-acid pathway as well as other analgesic mechanisms that mediate nociception. Additional study is needed.

      PubDate: 2017-05-09T02:35:06Z
      DOI: 10.1016/j.wem.2016.12.011
       
  • Integration of Tactical EMS in the National Park Service
    • Authors: William “Will” R. Smith
      Abstract: Publication date: Available online 4 May 2017
      Source:Wilderness & Environmental Medicine
      Author(s): William “Will” R. Smith
      The National Park Service (NPS) has domestic responsibility for emergency medical services (EMS) in remote and sometimes tactical situations in 417 units covering over 34 million hectares (84 million acres). The crossover between conflicting patient care priorities and complex medical decision making in the tactical, technical, and wilderness/remote environments often has many similarities. Patient care in these diverse locations, when compared with military settings, has slightly different variables but often similar corresponding risks to the patients and providers. The NPS developed a Tactical EMS (TEMS) program that closely integrated many principles from: 1) Tactical Combat Casualty Care (TCCC); 2) Tactical Emergency Casualty Care (TECC); 3) and other established federal and civilian TEMS programs. Combining these best practices into the NPS TEMS Program allowed for standardized training and implementation across not only the NPS, but also paralleled other military/federal/civilian TEMS programs. This synchronization is critical when an injury occurs in a joint tactical operation, either planned (drug interdiction) or unplanned (active shooter response), so that patient care can be uniform and efficient. The components identified for a sustainable TEMS program began with strong medical oversight, protocol development with defined phases of care, identifying specialized equipment, and organized implementation with trained TEMS instructors. Ongoing TEMS program management is continuously improving situationally appropriate training and integrating current best practices as new research, equipment, and tactics are developed. The NPS TEMS Program continues to provide ongoing training to ensure optimal patient care in tactical and other NPS settings.

      PubDate: 2017-05-09T02:35:06Z
      DOI: 10.1016/j.wem.2017.03.002
       
  • Research and Research Communication
    • Authors: Neal W. Pollock
      Abstract: Publication date: Available online 4 May 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Neal W. Pollock


      PubDate: 2017-05-09T02:35:06Z
      DOI: 10.1016/j.wem.2017.04.004
       
  • Don’t Kick the Coral!
    • Authors: Peter J. Ceponis; Rebecca Cable; Lindell K. Weaver
      Abstract: Publication date: Available online 25 April 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Peter J. Ceponis, Rebecca Cable, Lindell K. Weaver


      PubDate: 2017-04-26T21:52:15Z
      DOI: 10.1016/j.wem.2017.01.025
       
  • Upper Body Compression Garment: Physiological Effects While Cycling in a
           Hot Environment
    • Authors: Iker Leoz-Abaurrea; Roberto Aguado-Jiménez
      Abstract: Publication date: Available online 25 April 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Iker Leoz-Abaurrea, Roberto Aguado-Jiménez
      Objective The purpose of the present study was to investigate the effects of an upper body compression garment (UBCG) on physiologic and perceptual responses while cycling in a hot environment. Methods Twenty recreational road cyclists were pair-matched for age, anthropometric data, and fitness level (V̇O2max) and randomly assigned to a control (CON) group (n=10) of cyclists who wore a conventional t-shirt or to a group (n=10) of cyclists who wore UBCG. Test session consisted of cycling at a fixed load (~50% V̇O2max) for 30 minutes at an ambient temperature of ~40ºC (39.9±0.4ºC), followed by 10 minutes of recovery. Results Significantly greater (P = .002) rectal temperature (T rec) was observed at the end of exercise in the UBCG group (38.3±0.2ºC) versus CON group (37.9±0.3ºC). Significantly greater heart rate (HR) was observed in the UBCG group at minute 15 (P = .01) and at the end of exercise (187±9 vs 173±10 beats/min; P = .004) for UBCG and CON, respectively. Furthermore, participants who wore UBCG perceived a significantly greater (P = .03) thermal sensation at the end of exercise. During recovery HR and T rec remained significantly greater (P < .05) in the UBCG group. Conclusions The use of an UBCG increased cardiovascular and thermoregulatory strain during cycling in a hot environment and did not aid during recovery.

      PubDate: 2017-04-26T21:52:15Z
      DOI: 10.1016/j.wem.2017.02.005
       
  • Residence at Moderate Versus Low Altitude Is Effective at Maintaining
           Higher Oxygen Saturation During Exercise and Reducing Acute Mountain
           Sickness Following Fast Ascent to 4559 m
    • Authors: Eva Bernardi; Luca Pomidori; Davide Cavallari; Gaia Mandolesi; Annalisa Cogo
      Abstract: Publication date: Available online 25 April 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Eva Bernardi, Luca Pomidori, Davide Cavallari, Gaia Mandolesi, Annalisa Cogo
      Objective To continuously monitor oxygen saturation (SpO2) by pulse oximeter and assess the development of acute mountain sickness (AMS) using the Lake Louise Score (LLS) during ascent from 1154 to 4559 m in 2 groups of subjects: 10 moderate-altitude residents (MAR; ≥1000–≤2500 m) and 34 low-altitude residents (LAR). MAR are reported to have a lower incidence of AMS during ascent to higher altitudes compared with LAR. Whether this is related to higher SpO2 is still open to debate. Methods Seventy subjects were recruited; 24-hour SpO2 monitoring with finger pulse oximetry was performed. All subjects rode a cable car from 1154 to 3275 m and then climbed to 3647 m, where 60 subjects (LAR) overnighted. The second day, 34/60 LAR reached the highest altitude. Ten subjects who lived permanently at 1100 to 1400 m (MAR) climbed directly to 4559 m without an overnight stop. Results One LAR was excluded from the analysis because he performed a preacclimatization. We compared data of 10 MAR with data of 33 LAR who reached 4559 m. Two MAR had an LLS of 3, and 8 scored <3. Six LAR had an LLS of 3 to 4, 8 scored ≥5, and 19 scored <3. SpO2 monitoring showed higher mean SpO2 in MAR during ascent above 3600 m compared with LAR (MAR, 79±4% vs LAR, 76±5%; analysis of variance, P = .03). Conclusions The results of this preliminary study suggest that residence at moderate altitude allows maintenance of higher SpO2 and reduces risk of developing AMS during rapid ascent to higher altitude.

      PubDate: 2017-04-26T21:52:15Z
      DOI: 10.1016/j.wem.2017.02.004
       
  • Erratum in Wilderness Environ Med. 2016
    • Abstract: Publication date: Available online 25 April 2017
      Source:Wilderness & Environmental Medicine


      PubDate: 2017-04-26T21:52:15Z
       
  • Traumatic Pneumothorax Associated With Penetrating Neck Injury Caused by a
           Stingray: A Case Report
    • Authors: Toshinao Suzuki; Toshihiko Takada; Junmei Fudoji
      Abstract: Publication date: Available online 25 April 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Toshinao Suzuki, Toshihiko Takada, Junmei Fudoji
      We describe a patient with missed traumatic pneumothorax due to penetrating neck injury that was presumably caused by a stingray while diving. The barb can result in significant injuries to deep structures and organs despite a deceptively small entrance wound. This case underscores the importance of performing a thorough examination and having a high suspicion of distant injury in patients with penetrating neck injuries.

      PubDate: 2017-04-26T21:52:15Z
      DOI: 10.1016/j.wem.2017.02.006
       
  • Unusual Kissing Lesions: Lessons From Rural Tanzania
    • Authors: Samantha J. Moore; Harriet J. Blundell
      Abstract: Publication date: Available online 21 April 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Samantha J. Moore, Harriet J. Blundell


      PubDate: 2017-04-26T21:52:15Z
      DOI: 10.1016/j.wem.2017.01.026
       
  • Belts Evaluated as Limb Tourniquets: BELT Study Comparing Trouser
           Supporters Used as Medical Devices in a Manikin Model of Wound Bleeding
    • Authors: Blake W. Bequette; John F. Kragh; James K. Aden; Michael A. Dubick
      Abstract: Publication date: Available online 20 April 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Blake W. Bequette, John F. Kragh, James K. Aden, Michael A. Dubick
      Objective The purpose of the present study is to compare several models of commercially designed belts as used as a tourniquet. Methods In the Belts Evaluated as Limb Tourniquets (BELT) study, an experiment was designed to test the effectiveness of pants belts as nonimprovised medical devices to control hemorrhage in a manikin. Models of belts included Tourni-belt, Tourniquet Belt, ParaBelt, and Battle Buddy. Data collected included effectiveness, time to stop bleeding, total time of application, pressure, blood loss, and composite results (score count of good results; composite outcome good if every component was good). Results Differences in effectiveness percentages among models were not statistically significant. The difference in mean between users was statistically significant for stop time, total time, pressure, blood loss, composite score, and composite outcome. Mean time to stop bleeding differed for only 1 pair of models after the Tukey-Kramer adjustment; ParaBelt was faster than Tourniquet Belt. Mean total time of application differed between ParaBelt–Tourniquet Belt and Tourni-belt–Tourniquet Belt; the former model in both pairs was faster. No significant difference in mean blood loss measured by model was found. For composite outcome score, no pairwise difference between models was significant. For composite outcome (good-bad), ParaBelt had good results in 75% of tests; the other 3 models had significantly worse results. Conclusions In a preliminary laboratory analysis of belt tourniquet models using a manikin, performance differed by model. ParaBelt performed better than other models for the composite outcome.

      PubDate: 2017-04-26T21:52:15Z
      DOI: 10.1016/j.wem.2017.01.030
       
  • The Dallol Volcano
    • Authors: Raf Aerts; Eva J.J. November
      Abstract: Publication date: Available online 18 April 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Raf Aerts, Eva J.J. November


      PubDate: 2017-04-19T20:40:40Z
      DOI: 10.1016/j.wem.2017.03.001
       
  • First described envenomation by Centruroides pococki scorpion in the
           French Caribbean Island Guadeloupe
    • Authors: Corinne Schmitt; Romain Torrents; Nicolas Simon; Luc de Haro
      Abstract: Publication date: Available online 18 April 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Corinne Schmitt, Romain Torrents, Nicolas Simon, Luc de Haro


      PubDate: 2017-04-19T20:40:40Z
      DOI: 10.1016/j.wem.2017.03.005
       
  • Translating Tactical Combat Casualty Care Lessons Learned to the
           High-Threat Civilian Setting: Tactical Emergency Casualty Care and the
           Hartford Consensus
    • Authors: David W. Callaway
      Abstract: Publication date: Available online 6 April 2017
      Source:Wilderness & Environmental Medicine
      Author(s): David W. Callaway
      Combat operations necessitate bold thought and afford the opportunity to rapidly evolve and improve trauma care. The development and maturation of Tactical Combat Casualty Care (TCCC) is an important example of a critical process improvement strategy that reduced mortality in high-threat combat-related trauma. The Committee for Tactical Emergency Casualty Care (C-TECC) adapted the lessons of TCCC to the civilian high-threat environment and provided important all-hazards response principles for austere, dynamic, and resource-limited environments. The Hartford Consensus mobilized the resources of the American College of Surgeons to drive public policy regarding a more singular focus: hemorrhage control. The combined efforts of C-TECC and Hartford Consensus have helped redefine the practice of trauma care in high-threat scenarios across the United States.

      PubDate: 2017-04-11T19:48:42Z
      DOI: 10.1016/j.wem.2016.11.008
       
  • Hypersensitivity Reaction to Yellow Jacket Sting in a Previously
           Nonallergic Patient Taking an Angiotensin Receptor Blocker
    • Authors: James H. Diaz
      Abstract: Publication date: Available online 3 April 2017
      Source:Wilderness & Environmental Medicine
      Author(s): James H. Diaz


      PubDate: 2017-04-04T18:21:42Z
      DOI: 10.1016/j.wem.2017.01.024
       
  • Texas Bull Nettle (Cnidoscolus texanus) Exposures Reported to Texas Poison
           Centers
    • Authors: Mathias B. Forrester
      Abstract: Publication date: Available online 3 April 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Mathias B. Forrester
      Objective Texas bull nettle (Cnidoscolus texanus) is covered in bristly hairs similar to stinging nettle. Contact with the plant may result in intense dermal pain, burning, itching, cellulitis, and allergic reaction. This study characterizes C texanus exposures reported to a large state-wide poison center system. Methods Cases were C texanus exposures reported to Texas poison centers during 2000−2015. The distribution of cases was determined for patient demographics, exposure circumstances, and patient outcome. Results A total of 140 C texanus exposures were identified. Twenty percent of the patients were aged ≤5 years, 21% were 6 to 12 years, 5% were 13 to 19 years, and 51% were ≥20years; and 51% of the patients were male. Eighty-one percent of the exposures occurred at the patient’s own residence, 11% in a public area, 2% at another residence, and 1% at school. Seventy-eight percent of the patients were managed on site, 13% were already at or en route to a health care facility, and 6% were referred to a health care facility. Eighty-eight percent of the exposures resulted in dermal effects: irritation or pain (56%), erythema or flushing (31%), edema (27%), pruritus (24%), rash (19%), puncture or wound (19%), and hives or welts (11%). Conclusions C texanus exposures reported to Texas poison centers were most likely to be unintentional and occur at the patient’s own residence. The outcomes of the exposures tended not to be serious and could be managed successfully outside of health care facilities.

      PubDate: 2017-04-04T18:21:42Z
      DOI: 10.1016/j.wem.2017.01.028
       
  • Bleeding Control Using Hemostatic Dressings: Lessons Learned
    • Authors: Brad L. Bennett
      Abstract: Publication date: Available online 17 March 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Brad L. Bennett
      Based on lessons learned, many military battlefield trauma advances ultimately transition to enhance civilian trauma care. However, even with major strides to enhance battlefield hemorrhage control, it is unclear how effectively these techniques and products are being translated to civilian trauma. The purpose of this brief review is to present the evidence of current hemostatic product effectiveness, determine the evidence for transitioning of this technology to prehospital civilian application, and provide recommendations about potential use in the wilderness/austere setting. It is concluded that there is adequate evidence of hemorrhage control effectiveness in both military and civilian preclinical studies and clinical case series. The Committee on Tactical Combat Casualty Care recommends implementing approved hemostatic dressings as one part of a comprehensive hemorrhage control training and clinical management program. These recommendations for hemostatic dressings use by public safety and laypersons should be applied in acute transport urban settings or during prolonged care in austere environments.

      PubDate: 2017-03-17T11:20:17Z
      DOI: 10.1016/j.wem.2016.12.005
       
  • First Report of Using Portable Unmanned Aircraft Systems (Drones) for
           Search and Rescue
    • Authors: Christopher Van Tilburg
      Abstract: Publication date: Available online 17 March 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Christopher Van Tilburg
      Unmanned aircraft systems (UAS), colloquially called drones, are used commonly for military, government, and civilian purposes, including both commercial and consumer applications. During a search and rescue mission in Oregon, a UAS was used to confirm a fatality in a slot canyon; this eliminated the need for a dangerous rappel at night by rescue personnel. A second search mission in Oregon used several UAS to clear terrain. This allowed search of areas that were not accessible or were difficult to clear by ground personnel. UAS with cameras may be useful for searching, observing, and documenting missions. It is possible that UAS might be useful for delivering equipment in difficult areas and in communication.

      PubDate: 2017-03-17T11:20:17Z
      DOI: 10.1016/j.wem.2016.12.010
       
  • Junctional Hemorrhage Control for Tactical Combat Casualty Care
    • Authors: Russ S. Kotwal; Frank K. Butler
      Abstract: Publication date: Available online 17 March 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Russ S. Kotwal, Frank K. Butler
      During historic, as well as more recent, conflicts, most combat casualties who die from their injuries do so in the prehospital setting. Although many of the injuries incurred by these casualties are nonsurvivable, a number of injuries are still potentially survivable. Of those injuries that are potentially survivable, the majority are truncal, junctional, and extremity hemorrhage. Novel and effective approaches directed toward prehospital hemorrhage control have emerged in recent years, some of which can prove useful in the management of junctional hemorrhage whether in a military or civilian setting. An initial comprehensive review of junctional tourniquets was conducted by the Department of Defense Committee on Tactical Combat Casualty Care in 2013. The objective of this article is to provide an updated review of junctional hemorrhage control efforts and devices as they apply primarily to military prehospital trauma management and Tactical Combat Casualty Care and to prompt further consideration and application of these devices in nonmilitary prehospital, austere, and wilderness environments. Four junctional tourniquets are currently cleared by the Food and Drug Administration (FDA) for junctional hemorrhage control, and 1 junctional tourniquet is also FDA-cleared for pelvic stabilization. As junctional hemorrhage control efforts progress, scientists need to continue to conduct research and clinicians need to continue to monitor the performance of junctional tourniquets, especially in conjunction with morbidity and mortality outcomes, for both military and civilian trauma patients.

      PubDate: 2017-03-17T11:20:17Z
      DOI: 10.1016/j.wem.2016.11.007
       
  • Tactical Combat Casualty Care: Transitioning Battlefield Lessons Learned
           to Other Austere Environments
    • Authors: Brad Bennett; Ian Wedmore; Frank Butler
      Abstract: Publication date: Available online 9 March 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Brad Bennett, Ian Wedmore, Frank Butler


      PubDate: 2017-03-10T08:53:03Z
      DOI: 10.1016/j.wem.2017.01.003
       
  • Tactical Combat Casualty Care: Beginnings
    • Authors: Frank K. Butler
      Abstract: Publication date: Available online 9 March 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Frank K. Butler
      Tactical Combat Casualty Care (TCCC) is a set of evidence-based, best-practice prehospital trauma care guidelines customized for use on the battlefield. The origins of TCCC were nontraditional. The TCCC program began as a Naval Special Warfare biomedical research effort launched after the realization that extremity hemorrhage, a leading cause of preventable death on the battlefield, was not being treated with a readily available and highly effective intervention: the tourniquet. This insight prompted a systematic reevaluation of all aspects of battlefield trauma care that was conducted from 1993 to 1996 as a joint effort by special operations medical personnel and the Uniformed Services University of the Health Sciences. The product of that 3-year research project was TCCC, the first-ever set of battlefield trauma care guidelines designed to combine good medicine with good small-unit tactics.

      PubDate: 2017-03-10T08:53:03Z
      DOI: 10.1016/j.wem.2016.12.004
       
  • The Transition to the Committee on Tactical Combat Casualty Care
    • Authors: Stephen D. Giebner
      Abstract: Publication date: Available online 6 March 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Stephen D. Giebner
      The original Tactical Combat Casualty Care (TCCC) guidelines were published in a special supplement to Military Medicine in 1996 as the terminal deliverable of a 2-year development project funded by the United States Special Operations Command (USSOCOM). Two years later, the USSOCOM Biomedical Initiatives Steering Committee (BISC) promulgated its Task Statement 5-98, in which it called for the formation of a panel of subject matter experts to update the TCCC guidelines. This article discusses the formation of the Committee on Tactical Combat Casualty Care (CoTCCC) and the changes to the original guidelines that constituted the first update.

      PubDate: 2017-03-10T08:53:03Z
      DOI: 10.1016/j.wem.2016.11.005
       
  • Mountains—Law—Ethics
    • Authors: KVR Tagore
      Abstract: Publication date: March 2017
      Source:Wilderness & Environmental Medicine, Volume 28, Issue 1
      Author(s): KVR Tagore


      PubDate: 2017-03-10T08:53:03Z
       
  • Vihangam Yoga Helps in High Altitude Chronic Hypoxia
    • Authors: Nam Deo
      Abstract: Publication date: March 2017
      Source:Wilderness & Environmental Medicine, Volume 28, Issue 1
      Author(s): Nam Deo


      PubDate: 2017-03-10T08:53:03Z
       
  • Development and Validation of New Sepsis Criteria at High-Altitude
    • Authors: Walter
      Abstract: Publication date: March 2017
      Source:Wilderness & Environmental Medicine, Volume 28, Issue 1
      Author(s): Walter Calderón-Gerstein


      PubDate: 2017-03-10T08:53:03Z
       
  • 2016 Wilderness &amp; Environmental Medicine Peer Reviewers
    • Authors: Alicia Byrne
      Abstract: Publication date: Available online 30 January 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Alicia Byrne


      PubDate: 2017-02-18T01:26:44Z
      DOI: 10.1016/j.wem.2017.01.001
       
  • Turning Submissions Into a Journal
    • Authors: Neal W. Pollock
      Abstract: Publication date: Available online 2 February 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Neal W. Pollock


      PubDate: 2017-02-05T23:19:28Z
      DOI: 10.1016/j.wem.2017.01.002
       
  • In reply to Drs Sikri, Bhattachar, and Thapa
    • Authors: James S. Lawrence; Stephen A. Reid
      Abstract: Publication date: Available online 1 February 2017
      Source:Wilderness & Environmental Medicine
      Author(s): James S. Lawrence, Stephen A. Reid


      PubDate: 2017-02-05T23:19:28Z
      DOI: 10.1016/j.wem.2016.11.004
       
  • Lymphangitis from Scolopendra heros Envenomation: The Texas Redheaded
           Centipede
    • Authors: Shannon E. Essler; Maneesha Julakanti; Andrew L. Juergens
      Abstract: Publication date: Available online 11 January 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Shannon E. Essler, Maneesha Julakanti, Andrew L. Juergens
      Envenomation by Scolopendra heros, the Texas redheaded centipede, can present variably. Although transient pain and erythema are often treated conservatively, complications may include cellulitis, necrosis, myocardial infarction, and rhabdomyolysis. We present a case of an elderly man who came to the emergency department with lymphangitis and dermatitis secondary to a centipede sting that awoke him from sleep. It is important to recognize the potential of centipede envenomation to have severe local and systemic manifestations.

      PubDate: 2017-01-15T21:24:29Z
      DOI: 10.1016/j.wem.2016.11.003
       
  • Severe Hemorrhagic Syndrome After Lonomia Caterpillar Envenomation in the
           Western Brazilian Amazon: How Many More Cases Are There?
    • Authors: João Hugo A. Santos; Sâmella S. Oliveira; Eliane C. Alves; Iran Mendonça-da-Silva; Jacqueline A.G. Sachett; Antonio Tavares; Luiz Carlos Ferreira; Hui Wen Fan; Marcus V.G. Lacerda; Wuelton M. Monteiro
      Abstract: Publication date: Available online 10 January 2017
      Source:Wilderness & Environmental Medicine
      Author(s): João Hugo A. Santos, Sâmella S. Oliveira, Eliane C. Alves, Iran Mendonça-da-Silva, Jacqueline A.G. Sachett, Antonio Tavares, Luiz Carlos Ferreira, Hui Wen Fan, Marcus V.G. Lacerda, Wuelton M. Monteiro
      Contact with Lonomia caterpillars can cause a hemorrhagic syndrome. In Brazil, Lonomia obliqua and Lonomia achelous are known to cause this venom-induced disease. In the Brazilian Amazon, descriptions of this kind of envenomation are scarce. Herein, we report a severe hemorrhagic syndrome caused by Lonomia envenomation in the Amazonas state, Western Brazilian Amazon. The patient showed signs of hemorrhage lasting 8 days and required Lonomia antivenom administration, which resulted in resolution of hemorrhagic syndrome. Thus, availability of Lonomia antivenom as well as early antivenom therapy administration should be addressed across remote areas in the Amazon.

      PubDate: 2017-01-15T21:24:29Z
      DOI: 10.1016/j.wem.2016.11.001
       
  • On Rope Looking Up
    • Authors: Joshua E. Lane
      Abstract: Publication date: Available online 10 January 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Joshua E. Lane


      PubDate: 2017-01-15T21:24:29Z
      DOI: 10.1016/j.wem.2016.10.003
       
  • On Trails: An Exploration, Robert Moor. Simon &amp; Schuster, New
           York, NY (2016)
    • Authors: Cindy Bitter
      Abstract: Publication date: Available online 28 December 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Cindy Bitter


      PubDate: 2017-01-06T20:22:19Z
       
  • Littered Cans—Death Trap of Snakes
    • Authors: Subhendu Mallik; Sudipta Ranjan Singh; Indramani Nath
      Abstract: Publication date: Available online 15 December 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Subhendu Mallik, Sudipta Ranjan Singh, Indramani Nath


      PubDate: 2016-12-20T13:41:56Z
      DOI: 10.1016/j.wem.2016.10.002
       
  • In Response to Risk Determinants of Acute Mountain Sickness by Lawrence
           and Reid
    • Authors: Gaurav Sikri; Srinivasa Bhattachar; Bikalp Thapa
      Abstract: Publication date: Available online 6 December 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Gaurav Sikri, Srinivasa Bhattachar, Bikalp Thapa


      PubDate: 2016-12-12T12:24:03Z
      DOI: 10.1016/j.wem.2016.10.005
       
  • Clinically Significant Envenomation From Postmortem Copperhead
           (Agkistrodon contortrix)
    • Authors: Michael P. Emswiler; F. Phillip Griffith; Kirk L. Cumpston
      Abstract: Publication date: Available online 18 November 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Michael P. Emswiler, F. Phillip Griffith, Kirk L. Cumpston
      Over 14,000 copperhead (Agkistrodon contortrix) bites were reported to United States poison centers between 1983 and 2008, and 1809 cases were reported to poison centers in 2014. The copperhead is primarily found in the southeastern United States and belongs to the pit viper subfamily Crotalinae, which also includes the water moccasin (Agkistrodon piscivorus) and rattlesnakes (Crotalus and Sistrurus genera). Postmortem rattlesnakes have been reported to cause clinically significant envenomation; we report a case of a postmortem copperhead causing clinically significant envenomation after inadvertent puncture with the deceased copperhead fang. The copperhead was transected twice, leaving the snake in 3 separate pieces. While handling the snake head, an inadvertent puncture occurred on the right index finger followed by pain and swelling in the affected extremity necessitating antivenom administration. Care should be taken when handling deceased pit vipers due to the continued risk of envenomation.

      PubDate: 2016-11-21T21:30:34Z
      DOI: 10.1016/j.wem.2016.09.007
       
  • Inclined Wind Tunnel for the Study of Human and Large Animal Flight
    • Authors: Anton Westman; Peter Georén; Johan Strömberg
      Abstract: Publication date: Available online 18 November 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Anton Westman, Peter Georén, Johan Strömberg


      PubDate: 2016-11-21T21:30:34Z
      DOI: 10.1016/j.wem.2016.08.004
       
 
 
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