Wilderness & Environmental Medicine最新文献

Incidence and Outcomes of Tree Stand Injuries in Rural Pennsylvania. 宾夕法尼亚州农村林分伤害的发生率和结果。

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub Date : 2025-06-01 Epub Date: 2025-02-13 DOI: 10.1177/10806032251316793

Andrew Lachance, Michael Oravic, Roman Steika, Colt Crymes, Stephan Aynaszyan, Alexia Gagliardi, Joseph Choi

{"title":"Incidence and Outcomes of Tree Stand Injuries in Rural Pennsylvania.","authors":"Andrew Lachance, Michael Oravic, Roman Steika, Colt Crymes, Stephan Aynaszyan, Alexia Gagliardi, Joseph Choi","doi":"10.1177/10806032251316793","DOIUrl":"10.1177/10806032251316793","url":null,"abstract":"IntroductionIn the United States, more than 11.5 million people participate in hunting. Deer hunters commonly use tree stands as tall as 8 m. Falls from tree stands can cause injury and even death. Previous studies have investigated the types of injuries sustained from tree stand falls, but few have investigated patient outcomes. This study investigated patient outcomes related to tree stand falls and analyzed injury types resulting from tree stand falls, and this paper discusses factors that may lead to tree stand falls.MethodsThis study used a retrospective chart review of patients at the same institution between January 1, 2012, and August 31, 2022. Patient information, injury type, fall height, and interventions were collected.ResultsA total of 38 patients were included in the study, 36 males (94.70%) and 2 females (5.30%). The average fall height from a tree stand was 4.22±1.62 m (13.86±5.30 ft). Of the 38 patients, 19 had sustained orthopedic injuries to their upper extremity, lower extremity, spine/pelvis, or multiple areas; the average fall height of this subgroup was 4.51±1.76 m (14.79±5.76 ft). Nonoperative management was the highest used intervention because 12 patients did not require surgery. Orthopedic surgery was used to treat 6 patients, and 1 patient had nonorthopedic surgery.ConclusionsAlthough tree stand falls are rare, the injuries they cause can be fatal. Injury severity and outcome are determined by a multitude of factors. This study highlights the significance of these injuries and the importance of practicing safe guidelines while hunting.","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"190-193"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A 4-Day Exposure to High Altitude Prolongs QTc in Healthy Human Subjects. 暴露于高海拔4天会延长健康人群的QTc

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub Date : 2025-06-01 Epub Date: 2025-02-24 DOI: 10.1177/10806032251314740

Koa Gudelunas, Gregory A Chinn, Odmara L Barreto-Chang, Leah Campbell, Jeffrey W Sall

{"title":"A 4-Day Exposure to High Altitude Prolongs QTc in Healthy Human Subjects.","authors":"Koa Gudelunas, Gregory A Chinn, Odmara L Barreto-Chang, Leah Campbell, Jeffrey W Sall","doi":"10.1177/10806032251314740","DOIUrl":"10.1177/10806032251314740","url":null,"abstract":"IntroductionLong QTc syndrome can predispose patients to fatal ventricular arrhythmias. We studied the effects of a rapid ascent and a multiday stay at high altitude on QTc interval.MethodsWe recorded electrocardiograms (ECGs) on study subjects at sea level and then again after a 1-d ascent to 3800 m. Two sea-level ECGs were recorded at the initial screening visit (SL1) and 14 days later (SL2). Altitude ECGs were recorded at approximately 16 and 86 h after arrival. SpO2 was recorded prior to each ECG measurement. We defined prolonged QTc as a QTc interval >450 ms for men and >470 ms for women. We used multivariate analysis to analyze the QTc interval for the effect of drugs, altitude, and changes in electrolytes.ResultsWe enrolled 107 subjects: 61 males and 46 females between the ages of 19 and 54 y, with a median age of 34 y. QTcF (QT interval for varying heart rates using Fridericia's formula) at SL1 was 405±17 ms; at SL2, 404±17 ms; at 16 h, 411±18 ms; and at 86 h, 427±24 ms. After 86 h at altitude, 12 participants met the criteria for prolonged QT syndrome, and 61% of subjects had QTc prolongation of >20 ms from sea-level values. This was independent of changes in serum electrolyte levels, (i.e., sodium, potassium, and calcium), bicarbonate levels, and SpO2.ConclusionHigh altitude exposure can lengthen a healthy adult's QTc interval by more than 20 ms. It remains unknown whether this increase might raise the risk of torsades de pointes in people with long QT intervals at baseline.","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"176-181"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical Risk Assessment and Treatment of a Man Attacked by a Rabid North American Beaver (Castor canadensis) in the Connecticut River: Case Report. 在康涅狄格河被北美海狸（Castor canadensis）袭击的一名男子的临床风险评估和治疗：病例报告。

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub Date : 2025-06-01 Epub Date: 2025-03-04 DOI: 10.1177/10806032241310387

Oscar Barnés-Valldejuly, Adrianne Wurzl, Benjamin Church

引用次数: 0

Suspected Stonefish Envenomation in Reunion Island: 15 Years Later. 留尼旺岛疑似石鱼中毒：15年后。

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub Date : 2025-06-01 Epub Date: 2025-01-22 DOI: 10.1177/10806032241308477

Louis Renson, François Maillet, Corentin Bonnet

{"title":"Suspected Stonefish Envenomation in Reunion Island: 15 Years Later.","authors":"Louis Renson, François Maillet, Corentin Bonnet","doi":"10.1177/10806032241308477","DOIUrl":"10.1177/10806032241308477","url":null,"abstract":"IntroductionAlthough marine envenomations are a reason for consultation in tropical emergency departments, stonefish stings are particularly feared. Immediate management focuses on pain control, whereas late management addresses cutaneous complications. This study presents a new series and compares the management of these patients and their outcomes at our center over the past 20 years.MethodsThis study presents a new series of 53 patients treated between 2016 and 2020 at the South Hospital of the University Hospital Center of Réunion following a sting attributed to the stonefish. We compared this new series with a previous series of patients treated at the same center for the same reason between 2001 and 2005.ResultsThe series are comparable. Regarding early management, the use of regional anesthesia was more frequent (47 vs 3.5%). Half the patients received a strong opioid. Prescription of nonsteroidal anti-inflammatory drugs and corticosteroids persisted. Exposure to a heat source remained common. Prophylactic antibiotics were prescribed more frequently (64 vs 35%) and more uniformly with amoxicillin/clavulanate. Regarding late management, the average duration of hospitalization decreased (1.8 vs 2.6 d). Cutaneous complications were less frequent (9 vs 25%). No patient managed with regional anesthesia presented cutaneous complications.ConclusionsThe management of patients in Réunion following Scorpaenidae stings has evolved over time. Regional anesthesia has become more widespread, and the prescription of probabilistic preventive antibiotic therapy is more homogeneous. These changes are associated with a shorter hospital stay and fewer cutaneous complications.","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"171-175"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Solanum erianthum Poisoning Causing Speech Disturbance: A Case Series. 龙葵中毒引起语言障碍：一个案例系列。

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub Date : 2025-06-01 Epub Date: 2024-12-20 DOI: 10.1177/10806032241304734

Lee Kee Choon, Ain Izzati Khiruddin

{"title":"Solanum erianthum Poisoning Causing Speech Disturbance: A Case Series.","authors":"Lee Kee Choon, Ain Izzati Khiruddin","doi":"10.1177/10806032241304734","DOIUrl":"10.1177/10806032241304734","url":null,"abstract":"The Solanaceae plant family (Solanum), such as capsicum, eggplant, potato, and tomato, is made up of common plants consumed by humans. Despite having medicinal benefits, these plants can produce toxic alkaloid compounds. We report 2 cases of uncommon Solanum erianthum poisoning after consuming the berries as a meal. Both patients presented with slurring of speech, which is easily mistaken for a stroke. Symptoms developed 19 h after consuming the wild berries and resolved spontaneously 12 h after onset. Both patients recovered with no neurologic deficit. No antidote was given in either case. The Solanaceae plant family is a common group of plants consumed by humans and is considered one of the largest genera. The phytochemical profile showed that the leaves and berries contain toxic glycoalkaloid levels, which can cause gastrointestinal and neurologic symptoms in poisoning cases. Reports have shown that the toxic glycoalkaloids can inhibit the cholinesterase enzyme, thus producing cholinergic effects. Theoretically, atropine is the choice of antidote, but no case report of atropine use has been documented. Treatment of S erianthum poisoning remains supportive care. These cases highlight the rare occurrence of poisoning from S erianthum and emphasize the necessity for considering toxicologic causes in nonlocalizing neurologic symptoms.","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"251-256"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Encephalopathy at High Altitude: Hyponatremia or High Altitude Cerebral Edema? 高原脑病：低钠血症还是高原脑水肿？

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub Date : 2025-06-01 Epub Date: 2025-02-17 DOI: 10.1177/10806032251315381

Graham Brant-Zawadzki, Tamara Hew-Butler, Drew C Youngquist, David Fiore, Peter Hackett

{"title":"Encephalopathy at High Altitude: Hyponatremia or High Altitude Cerebral Edema?","authors":"Graham Brant-Zawadzki, Tamara Hew-Butler, Drew C Youngquist, David Fiore, Peter Hackett","doi":"10.1177/10806032251315381","DOIUrl":"10.1177/10806032251315381","url":null,"abstract":"ObjectiveBrain dysfunction at high altitudes can be caused by both high altitude cerebral edema (HACE) and hyponatremic encephalopathy. Differentiating them is important for proper treatment but can be difficult. We present a case series of 11 patients with hyponatremic encephalopathy, all initially misdiagnosed as HACE, and we discuss key signs and symptoms that will help clinicians differentiate the 2 pathologies.MethodsWe compiled 11 cases of patients with severe hyponatremia who were diagnosed with HACE, verified through direct patient care or referral consultation.ResultsPatients included 5 males and 6 females aged 19 to 65 y, exercising between 2100 and 4300 m. Serum Na+ concentration ranged from 112 to 127 mmol·L-1. Features included ataxia, confusion, and progression to coma without the hallmark imaging features of HACE. Clinically, the rapid progression of symptoms, moderate altitude, short duration of altitude exposure, and seizure activity suggested hyponatremia rather than HACE. All but 1 patient shared classic risk factors for exercise-associated hyponatremia: moderate to extreme exercise, rapid high volume (>5 L) fluid intake, clamminess, pallor, and nausea. Five patients suffered seizures, 4 used nonsteroidal anti-inflammatory medications, 4 had pulmonary edema, and 3 showed features of the syndrome of antidiuretic hormone secretion.ConclusionsSevere hyponatremia should be considered in persons with encephalopathy at high altitudes. Although there is no established causal link between hypobaric hypoxia and hyponatremia, the potential for high altitude exposure to exacerbate exercise-associated hyponatremia warrants further investigation because the consequences of developing or misdiagnosing this process may be severe.","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"182-189"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Provision of End-of-Life Care in Austere Environments. 在严峻的环境中提供临终关怀。

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub Date : 2025-06-01 Epub Date: 2025-03-13 DOI: 10.1177/10806032241308833

Jason W David, Hui Z Feng, Danny Lammers, Russell Day

{"title":"Provision of End-of-Life Care in Austere Environments.","authors":"Jason W David, Hui Z Feng, Danny Lammers, Russell Day","doi":"10.1177/10806032241308833","DOIUrl":"10.1177/10806032241308833","url":null,"abstract":"End-of-life care presents unique challenges in austere or resource-limited environments where traditional medical resources are scarce or absent. This review explores the complexities of providing end-of-life care under such constraints, including recognition of the dying patient and techniques to alleviate suffering and allow death with dignity in under-resourced or expeditionary environments. Moreover, it presents these techniques in an accessible manner for providers without formal hospice training to use. Based on a literature review of hospice and palliative medicine, insights from the body of literature in wilderness and austere medicine, and the authors' experiences in practicing in austere environments, this paper discusses practical approaches to symptom management, ethical considerations in end-of-life decision making, and accessible interventions with limited resources. By addressing these challenges and offering management recommendations, this review aims to enrich the literature and provide guidance for general medical providers who may lack formal palliative and hospice care training and yet find themselves in the situation of navigating end-of-life care in challenging and austere environments.","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"234-240"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Corrigendum to Tele-Ultrasound in the Wilderness: A Tutorial Experience for Medical Students. 野外远程超声的勘误表：医学生的教学经验。

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub Date : 2025-06-01 Epub Date: 2025-03-19 DOI: 10.1177/10806032251329157

引用次数: 0

Scorpionism in the State of Bahia, Brazil: A More Neglected Problem During the Pandemic? 巴西巴伊亚州的蝎子病：大流行期间一个更被忽视的问题？

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub Date : 2025-06-01 Epub Date: 2025-01-12 DOI: 10.1177/10806032241300163

Jacqueline Ramos Machado Braga, Luís Vinícius Sena Dos Santos, Amanda Cristina de Souza Mata, Isabel Cristina Moraes

{"title":"Scorpionism in the State of Bahia, Brazil: A More Neglected Problem During the Pandemic?","authors":"Jacqueline Ramos Machado Braga, Luís Vinícius Sena Dos Santos, Amanda Cristina de Souza Mata, Isabel Cristina Moraes","doi":"10.1177/10806032241300163","DOIUrl":"10.1177/10806032241300163","url":null,"abstract":"IntroductionDuring the confinement in the COVID-19 pandemic, there was an increase in the production of urban waste, increasing the risk of accidents caused by scorpions. We sought to determine the clinical and epidemiologic aspects of scorpionism records in the 7 mesoregions of the State of Bahia, Brazil, examining differences in periods before and during the pandemic.MethodsData were obtained from SINAN, Brazil's Notifiable Diseases Information System (January 2010-December 2021). Measures of morbidity (incidence and lethality) and mortality were evaluated, comparing the averages before (2018 and 2019) and during the pandemic (2020 and 2021). Sociodemographic data (ie, gender, age group, and race) and conditions of care (ie, time, classification, and evolution) were compared by mesoregion.ResultsA total of 159,982 cases of scorpionism were registered, with a higher proportion in the prepandemic period (P<0.05) and a higher average incidence in the Center South of Bahia (267.32; n=82,059; 51.29%). Most cases occurred in mixed-race individuals (61.73%), females (n=81,292; 51.22%), and individuals between 20 and 39 y of age (n=48,876; 30.55%) and most cases were classified as mild (n=136,816; 85.52%), were attended in <1 h (n=81,941; 51.22%), and progresses to cure (n=142,082; 88.81%). There were 263 deaths (0.16%), with a mortality rate of 1.77/100,000 inhabitants and a lethality of 0.16%.ConclusionIt is suggested that during the COVID-19 pandemic, despite the upward curve of accidents, social isolation measures and collective fear may have decreased the search for medical care after a scorpion sting, reducing notifications of the condition in the State of Bahia.","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"241-250"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Establishment of Ultrasound Evaluation of Bubble Load in Rabbit Model with Decompression Sickness. 兔减压病模型气泡负荷超声评价方法的建立。

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub Date : 2025-06-01 Epub Date: 2025-03-16 DOI: 10.1177/10806032251320081

Qunyan Wu, Jiaxin Chen, Qing Ye, Yongquan Huang, Shuqing Wang, Yuhong Lin, Shushan Zhang, Zhongzhen Su

{"title":"Establishment of Ultrasound Evaluation of Bubble Load in Rabbit Model with Decompression Sickness.","authors":"Qunyan Wu, Jiaxin Chen, Qing Ye, Yongquan Huang, Shuqing Wang, Yuhong Lin, Shushan Zhang, Zhongzhen Su","doi":"10.1177/10806032251320081","DOIUrl":"10.1177/10806032251320081","url":null,"abstract":"IntroductionTo establish a decompression sickness (DCS) model in New Zealand white rabbits and a quantitative method for assessing bubble load in DCS by ultrasound.MethodsFifteen male New Zealand white rabbits were exposed in a hyperbaric chamber for 60 min with air compressed to 500 kPa (absolute pressure) at 100 kPa/min, followed by decompression at a rate of 200 kPa/min back to normal pressure. Behavioral changes were observed 10 min after removing the rabbits from the chamber to assess whether a model with DCS was successfully established. Bubbles in the inferior vena cava (IVC) and right ventricle (RV) were detected by ultrasound and semi-quantitatively graded using the Eftedal-Brubakk (EB) grade. One hour after exiting the chamber, the rabbits underwent autopsy to observe macroscopic bubbles in vessels and tissues for postmortem (PM) scoring. Correlations between EB grading by ultrasound and PM bubble scores were analyzed.ResultsThe decompression protocol yielded a 100% DCS incidence (15/15) with 13.3% mortality (2/15) within 1 h after the rabbits were removed from the chamber. Ultrasound revealed bubble-like hyperechoic foci in the IVC and RV after decompression, with significantly higher EB grades in the IVC (p < 0.05). IVC's EB grades exhibited a stronger correlation with its PM bubble scores (r = 0.921, p < 0.01) compared to RV grades (r = 0.573, p < 0.05).ConclusionA reliable DCS model was established in New Zealand white rabbits. EB grading of the IVC and RV by ultrasound demonstrated a robust correlation with their PM bubble scores, suggesting potential for clinical translation in assessing bubble loads in DCS.","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"201-208"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0