Wilderness & Environmental Medicine最新文献_第10页

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

Medical Evacuations of Climbers on Mount Aconcagua, 2022-2024. 2022-2024年阿空加瓜山登山者的医疗后送。

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub Date : 2025-06-01 Epub Date: 2025-03-18 DOI: 10.1177/10806032251323504

Aaron Brillhart, Javier Seufferheld, Bernabé Abramor, Rodrigo Duplessis, Roxana Pronce, Sameer Sethi

{"title":"Medical Evacuations of Climbers on Mount Aconcagua, 2022-2024.","authors":"Aaron Brillhart, Javier Seufferheld, Bernabé Abramor, Rodrigo Duplessis, Roxana Pronce, Sameer Sethi","doi":"10.1177/10806032251323504","DOIUrl":"10.1177/10806032251323504","url":null,"abstract":"IntroductionMount Aconcagua (6961 m) is the highest peak in the Western Hemisphere and attempted by over 3000 climbers annually. Aconcagua Provincial Park (APP) and the APP medical service oversee all rescues and medical care. This study aims to describe patients and conditions requiring rescue medical evacuation on Aconcagua.MethodsDemographic, medical, and logistics data provided by APP on all park evacuations were retrospectively reviewed from the 2022-23 and 2023-24 climbing seasons.ResultsOf 6494 total Aconcagua climbers over the study period, 302 required an evacuation response from APP (mean 151 per year), yielding an evacuation rate of 4.7%. Mean age was 43.0. Male climbers had twice the risk of requiring rescue than female climbers (OR 2.01). Most evacuees were European (40%) or North American (33%), though climbers from Africa, Asia, and Australia had over twice the incidence of rescue (OR 2.26). Most frequent reasons for evacuation included altitude illness of all types (62%), high-altitude pulmonary edema (HAPE) (49%), trauma/musculoskeletal (15%), general medical (11%), and acute mountain sickness (11%). Most were flown by helicopter (95%), with flight location primarily from 4200 to 4300 m base camps (77%) and between 5300 and 5970 m (16%).ConclusionsOn Aconcagua, 4.7% of climbers required medical evacuation. Altitude illness frequently required rescue, with HAPE representing the single most common reason for evacuation. Male sex and certain continents of origin showed increased risks. Helicopter evacuation and medical oversight by APP appear to contribute to climber safety on Aconcagua. Opportunities exist for future study and climber education of risks.","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"209-215"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659479","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

Hemoptysis During Swimming. 游泳时咯血。

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub Date : 2025-06-01 Epub Date: 2025-02-28 DOI: 10.1177/10806032251318579

Nefeli Mouratidou, Dimitrios Papadopoulos, Lydia Prantalou, Iro Vrouvaki, Zoi Tsilogianni, Anthoula Psara, Stamatis Katsenos

引用次数: 0

Looking Back, Moving Forward. 回顾过去，向前迈进。

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub Date : 2025-06-01 Epub Date: 2025-03-17 DOI: 10.1177/10806032251327851

George W Rodway

引用次数: 0

Oropharyngeal Bee, Hornet, Yellow Jacket, and Wasp Stings: A National Electronic Injury Surveillance System Analysis and Scoping Review. 口咽蜜蜂、大黄蜂、黄蜂和黄蜂蜇伤：全国电子伤害监测系统分析和范围界定审查》。

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub Date : 2025-06-01 Epub Date: 2025-03-28 DOI: 10.1177/10806032251323507

Andrew Huff, Lara Phillips, Scott W Keith

{"title":"Oropharyngeal Bee, Hornet, Yellow Jacket, and Wasp Stings: A National Electronic Injury Surveillance System Analysis and Scoping Review.","authors":"Andrew Huff, Lara Phillips, Scott W Keith","doi":"10.1177/10806032251323507","DOIUrl":"10.1177/10806032251323507","url":null,"abstract":"IntroductionIt is estimated that up to 94.5% of the adult population has received at least 1 Hymenoptera sting in their lifetime, which includes stings from bees, hornets, yellow jackets, or wasps. This study describes the epidemiology of oropharyngeal stings due to bees, hornets, yellow jackets, and wasps in the United States between 2004 and 2023.MethodsThis study used data from the National Electronic Injury Surveillance System to describe patients with stings who presented to US hospitals for treatment. It then contextualized these findings through a scoping review of case reports of oropharyngeal stings published on Scopus and PubMed, with particular attention to the hospital disposition of cases.ResultsThe National Electronic Injury Surveillance System analysis found that an estimated 5% of all stings involved the oropharyngeal region. The rate of oropharyngeal stings has varied over time, and an estimated 2% of victims were admitted to the hospital for any reason. This finding stands in contrast to the review of case reports, in which 64% of victims were hospitalized.ConclusionsOropharyngeal stings present a unique risk of airway compromise and merit conservative treatment, which may include hospitalization.","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"216-222"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732697","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

Black Widow Spider Exposures: A Retrospective Review of the National Poison Data System 2012-2022. 黑寡妇蜘蛛暴露：2012-2022年国家毒物数据系统回顾。

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub Date : 2025-06-01 Epub Date: 2024-12-13 DOI: 10.1177/10806032241300134

Abigail F Kerns, Emily T Scheffel, Rita Farah, Christopher P Holstege

{"title":"Black Widow Spider Exposures: A Retrospective Review of the National Poison Data System 2012-2022.","authors":"Abigail F Kerns, Emily T Scheffel, Rita Farah, Christopher P Holstege","doi":"10.1177/10806032241300134","DOIUrl":"10.1177/10806032241300134","url":null,"abstract":"IntroductionThe black widow spider, Latrodectus mactans, stands out as one of the most medically significant arachnids due to its extensive geographic distribution in the United States and its ability to produce a potent neurotoxin, α-latrotoxin. This study aimed to describe the epidemiology of black widow spider exposures by month of exposure, geographic distribution, demographics, symptoms, treatment, and health system resource utilization between 2012 and 2022.MethodsThis was a retrospective observational study using the US National Poison Data System, the data warehouse of the 55 US poison centers. A descriptive analysis of patient demographic data, month of exposure, clinical effects, level of healthcare received, and medical outcome was performed.ResultsDuring the studied period, a total of 15,299 cases of Latrodectus spp exposures were reported to US poison centers. Exposures occurred with higher frequency in warm-weather states and during summer months. Almost half the cases were managed outside a healthcare facility (48.6%). Hospital admission was required for 10.0% of exposures. The most common therapies received were wound care (43.7%) and benzodiazepines (18.6%). Antivenom was administered in 3.4% (n=521) of exposures.ConclusionsPoison center data indicate that most black widow spider exposures result in minor consequences. Supportive care is the primary approach for black widow spider bites. Although antivenom use is infrequent, providers may seek administration guidance from toxicologists through local poison centers. This study underscores the pivotal role of poison centers in mitigating unnecessary healthcare visits and subsequent hospitalizations.","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"154-158"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820001","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