Wilderness & Environmental Medicine最新文献_第2页

Regional Differences in Systemic Toxicity Following Texas Coral Snake (Micrurus tener) Envenomations.

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub Date : 2025-03-19 DOI: 10.1177/10806032251327124

Spencer Greene, Amber Anderson, Misty Wilcken, Dietrich Jehle, Shawn Varney

{"title":"Regional Differences in Systemic Toxicity Following Texas Coral Snake (Micrurus tener) Envenomations.","authors":"Spencer Greene, Amber Anderson, Misty Wilcken, Dietrich Jehle, Shawn Varney","doi":"10.1177/10806032251327124","DOIUrl":"https://doi.org/10.1177/10806032251327124","url":null,"abstract":"BackgroundThe Texas coral snake, Micrurus tener, is one of three elapid species native to the continental United States. The purpose of the study was to describe the clinical features of their envenomation.MethodsWe reviewed all human coral snake bites reported to the Texas Poison Center Network between January 2000 and December 2023. We excluded informational calls and cases in which the snake responsible for the bite was not confirmed as M. tener. Finally, we excluded bite victims who did not seek medical attention and those for whom no clinical information was available. The data collected included patient demographics, the county in which the patient was treated, clinical features, and treatment.ResultsThere were 501 human bites. In 472 (94.2%) cases, symptoms were limited to pain and paresthesias. Systemic toxicity, for example, weakness, dysphagia, and ptosis, was observed in 18 (3.6%) patients. Eleven (2.2%) patients had no clinical findings. Antivenom was administered in 126 (25.1%) cases. Antivenom use decreased over time; in the 5-year period from 2000-2007, antivenom was administered to 74 (55.6%) patients. Conversely, only 8 (4.1%) of patients from 2016-2023 received antivenom. Systemic findings were observed in 13 (6.5%) cases in Northeast and Central Texas compared to 5 (1.6%) in Southeast and South Texas.ConclusionMicrurus tener envenomations were characterized primarily by pain and paresthesias. Additional systemic findings may be observed, particularly in Northeast and Central Texas. Antivenom was administered to a minority of Texas coral snake envenomation victims.","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032251327124"},"PeriodicalIF":1.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659496","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.

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub 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":"10806032251323504"},"PeriodicalIF":1.4,"publicationDate":"2025-03-18","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

An Improvised Reduction Method for Anterior Shoulder Dislocation in a Waterborne Environment.

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub Date : 2025-03-17 DOI: 10.1177/10806032251323501

Matthew J Christensen, Thomas Renner, William Bianchi, Andrew J Medenbach, Eric S Pittman

{"title":"An Improvised Reduction Method for Anterior Shoulder Dislocation in a Waterborne Environment.","authors":"Matthew J Christensen, Thomas Renner, William Bianchi, Andrew J Medenbach, Eric S Pittman","doi":"10.1177/10806032251323501","DOIUrl":"https://doi.org/10.1177/10806032251323501","url":null,"abstract":"Anterior glenohumeral joint (shoulder) dislocations are common orthopedic injuries that require timely recognition and effective reduction to prevent long-term complications. Traditional reduction techniques are typically performed on land where inherent mechanical advantage is present. This case study explores a novel in-water, prehospital technique used to reduce a shoulder dislocation during a high surf event in San Diego, California. The case involves a 36-year-old male who sustained an anterior shoulder dislocation while surfing. After initial reduction attempts using commonly described techniques were unsuccessful due to an inability to achieve adequate leverage while afloat, an improvised reduction technique was implemented, which successfully reduced the joint while floating on the ocean surface. The novel maneuver and subsequent clinical course are outlined in this case report. This technique has applications in neutral buoyancy or low-gravity environments in which the typical reduction maneuvers that require gravity or friction as leverage may not be feasible.","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032251323501"},"PeriodicalIF":1.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651789","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

Looking Back, Moving Forward.

IF 1.4 4区医学

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

George W Rodway

引用次数: 0

Establishment of Ultrasound Evaluation of Bubble Load in Rabbit Model with Decompression Sickness.

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub 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":"https://doi.org/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":"10806032251320081"},"PeriodicalIF":1.4,"publicationDate":"2025-03-16","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

Provision of End-of-Life Care in Austere Environments.

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub 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":"https://doi.org/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":"10806032241308833"},"PeriodicalIF":1.4,"publicationDate":"2025-03-13","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

Thevetia peruviana or Yellow Oleander (Apocynaceae) Poisoning with Myocardial Bridging: An Autopsy-Based Case Report.

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub Date : 2025-03-13 DOI: 10.1177/10806032251320372

Arushi Verma, Vikas Vaibhav, Raviprakash Meshram, Ashish Bhute, Dilip Vaishnav, Ravi H Phulware

引用次数: 0

Performative Activism or Measurable Progress: Goals for Gender Equity and Inclusion in the Wilderness Medical Society.

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub Date : 2025-03-12 DOI: 10.1177/10806032251322090

Tiffany L Brainerd, Rebecca Young

引用次数: 0

Survey of Pathologic Microorganisms in the Streams Along the Tahoe Rim Trail.

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub Date : 2025-03-11 DOI: 10.1177/10806032251318228

Hannah A Miller, Robby S Boparai, Joshua J Warner, Stephen F Mowery, Anna C Smith, Anthony P Cummins, Jennifer L Wittmann, David C Fiore

{"title":"Survey of Pathologic Microorganisms in the Streams Along the Tahoe Rim Trail.","authors":"Hannah A Miller, Robby S Boparai, Joshua J Warner, Stephen F Mowery, Anna C Smith, Anthony P Cummins, Jennifer L Wittmann, David C Fiore","doi":"10.1177/10806032251318228","DOIUrl":"https://doi.org/10.1177/10806032251318228","url":null,"abstract":"IntroductionThis study aimed to estimate the contamination of water sources along the Tahoe Rim Trail (TRT) through evaluation of the presence and concentration of Escherichia coli, Giardia, and Cryptosporidium spp.MethodsSample sites were selected from 6 of the 8 sections of the TRT. Each stream was sampled 3 or 4 times during the summer and early fall of 2023. Samples were collected and analyzed for E. coli using Standard Methods 9223B and Giardia and Cryptosporidium spp. using EPA Method 1623.ResultsE. coli counts ranged from <1 to 29.2 most probable number (MPN)/100 mL. There was no difference in contamination with E. coli between streams (P=0.287) or sampling rounds (P=0.413). Giardia counts ranged from 0 to 7 count/10 L. There was a difference in contamination with Giardia between the highest and lowest concentration streams (P=0.028) but no difference in contamination between other streams or between sampling rounds (P=0.924). Cryptosporidium counts ranged from 0 to 1 count/10 L. There was no difference in contamination with Cryptosporidium between streams (P=0.589) or between sampling rounds (P=0.888).ConclusionsE. coli, Giardia, and Cryptosporidium are present in the streams along the TRT. Results from this study show that the risk of illness from occasional direct consumption of water from the streams sampled is low; however, it is always advisable to filter or treat water from any backcountry source prior to consumption. More extensive studies are recommended to evaluate backcountry water sources in the Tahoe Basin to further evaluate the risk to human health from direct consumption.","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032251318228"},"PeriodicalIF":1.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606906","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.

IF 1.4 4区医学

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

Oscar Barnés-Valldejuly, Adrianne Wurzl, Benjamin Church

引用次数: 0