Wilderness & Environmental Medicine最新文献_第5页

Tele-Ultrasound in the Wilderness: A Tutorial Experience for Medical Students. 荒野中的远程超声：医科学生的辅导体验。

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub Date : 2025-03-01 Epub Date: 2024-11-25 DOI: 10.1177/10806032241297960

Julie Kurek, Samantha A King, Naillid Felipe, Jobin Philip, Caver Haines, Stephanie A Lareau, Michelle Clinton, Doug Sward, Brian Euerle, Alexis Salerno

{"title":"Tele-Ultrasound in the Wilderness: A Tutorial Experience for Medical Students.","authors":"Julie Kurek, Samantha A King, Naillid Felipe, Jobin Philip, Caver Haines, Stephanie A Lareau, Michelle Clinton, Doug Sward, Brian Euerle, Alexis Salerno","doi":"10.1177/10806032241297960","DOIUrl":"10.1177/10806032241297960","url":null,"abstract":"Introduction: Providers can evaluate patients who sustain trauma during outdoor activities by using the extended focused assessment with sonography for trauma (FAST) and the limited knee ultrasound. Remote tele-mentored ultrasound (RTMUS) can help minimally trained providers in the wilderness if they have difficulty obtaining a view or have questions about the interpretation of an image. The goal of our study was to determine the feasibility of using RTMUS to teach the FAST exam and knee ultrasound exam to ultrasound-naive medical students during a wilderness medicine outdoor activity.Methods: Medical students from two large academic institutions were randomized to receive either in-person or RTMUS education during a wilderness activity 1 d before completion of FAST and knee ultrasound exams. All students received limited ultrasound instruction before the event. The images obtained by the students were compared. Two ultrasound-trained emergency physicians evaluated the images for their ability to identify structures and support a diagnosis from the images. Simple descriptive statistics were performed.Results: There was a statistically significant difference between the RTMUS group and the in-person group. The images captured by the in-person group were more likely to identify structures and support a diagnosis than those captured by the RTMUS group.Conclusions: In this study, ultrasound-naive medical students who received in-person education on conducting the knee exam and FAST exam obtained higher-quality images than students who received RTMUS education. This study suggests that if RTMUS is used for medical purposes, increased ultrasound training may be needed prior to initiation of RTMUS.","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"97-103"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711657","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

In Reply to Dr Jerome. 答复杰罗姆博士

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub Date : 2025-03-01 Epub Date: 2024-11-14 DOI: 10.1177/10806032241292002

Hunter Triplett, Colin Standifird, Chelsea C White

引用次数: 0

Airway Management in Austere Settings: Intubation Is Not Always the Best Option. 严峻环境下的气道管理：插管并不总是最好的选择。

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub Date : 2025-03-01 Epub Date: 2024-12-20 DOI: 10.1177/10806032241301047

Nicholas E Weinberg, Nicholas J Daniel, Stephanie A Lareau, James H Elder, Ken Zafren

引用次数: 0

In reply to Dr Davis et al. 作为对Davis博士等人的回应。

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub Date : 2025-03-01 Epub Date: 2024-12-26 DOI: 10.1177/10806032241308478

Simon Uhl Nielsen, Anders Karlsen

引用次数: 0

Proposed Standardization of Protocols for Carbon Monoxide Studies: In Response to A Field Study of Carbon Monoxide Levels in Snow Caves During Short-Term Stove Use by Nielsen and Karlsen. 一氧化碳研究协议标准化建议：针对 Nielsen 和 Karlsen 撰写的《短期使用炉灶期间雪洞中一氧化碳水平的实地研究》。

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub Date : 2025-03-01 Epub Date: 2024-11-14 DOI: 10.1177/10806032241297956

Sarah C Davis, Roger B Mortimer, Susanne J Spano

引用次数: 0

Hemoptysis During Swimming.

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub 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

Klebsiella pneumoniae Lung Abscess Due to Aspiration of Seawater During Recreational Free Diving.

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub Date : 2025-02-26 DOI: 10.1177/10806032251314741

Carisa Mariella Paraz, Mark Anthony Sandoval, Enrick Joshua Cruz

引用次数: 0

A 4-Day Exposure to High Altitude Prolongs QTc in Healthy Human Subjects.

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub 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":"https://doi.org/10.1177/10806032251314740","url":null,"abstract":"Introduction: Long 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.Methods: We 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.Results: We 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.Conclusion: High 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":"10806032251314740"},"PeriodicalIF":1.4,"publicationDate":"2025-02-24","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

Curriculum Guidelines for Wilderness Medicine Medical Student Electives: 2025 Update.

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub Date : 2025-02-21 DOI: 10.1177/10806032251318582

Walker B Plash, Daniel F Leiva, Kevin D Watkins, Justin M Gardner, Geoffrey Comp, Stephanie A Lareau

{"title":"Curriculum Guidelines for Wilderness Medicine Medical Student Electives: 2025 Update.","authors":"Walker B Plash, Daniel F Leiva, Kevin D Watkins, Justin M Gardner, Geoffrey Comp, Stephanie A Lareau","doi":"10.1177/10806032251318582","DOIUrl":"https://doi.org/10.1177/10806032251318582","url":null,"abstract":"Wilderness medicine elective rotations for graduate medical students are gaining popularity. The number of electives continues to grow, each with varying curriculum, format, and means of assessment. Previous curriculum guidelines attempted to standardize the knowledge-based competency for medical students in this field. Concurrently, medical education has evolved, emphasizing learner-centric and outcome-based observable competencies. Competencies based on individual qualities have since been complemented by practice-specific activities called entrustable professional activities (EPAs), which may consist of smaller observable practice activities (OPAs). This has allowed educators to use a holistic approach to determine that an individual can be fully entrusted to carry out an unsupervised activity. We surveyed current graduate-level wilderness medicine elective directors to determine expert panel recommendations for the EPAs of wilderness medicine for graduate medical students. The aim was to create EPAs and OPAs that experts deem fundamental for a wilderness medicine elective rotation and align them under the framework of entrustable practice in medical education. By mapping wilderness medicine EPAs and OPAs to competencies, we can better measure developmental progression and degree of entrustment in graduate wilderness medicine electives.","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032251318582"},"PeriodicalIF":1.4,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469710","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?

IF 1.4 4区医学

Wilderness & Environmental Medicine Pub 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":"https://doi.org/10.1177/10806032251315381","url":null,"abstract":"Objective: Brain 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.Methods: We compiled 11 cases of patients with severe hyponatremia who were diagnosed with HACE, verified through direct patient care or referral consultation.Results: Patients 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.Conclusions: Severe 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":"10806032251315381"},"PeriodicalIF":1.4,"publicationDate":"2025-02-17","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