Wilderness & Environmental Medicine最新文献

{"title":"Effect of Air Exposure Time Under Room-Temperature Conditions on the Performance of Chemical Heat Blankets Intended for Use in Prehospital Accidental Hypothermia.","authors":"Maren Helgø, Thea G Refsnes, Øyvind Thomassen, Sigurd Mydske","doi":"10.1177/10806032251325562","DOIUrl":"10.1177/10806032251325562","url":null,"abstract":"<p><p>IntroductionAccidental hypothermia increases mortality in patients with traumatic injury, making hypothermia management essential in prehospital trauma care. Chemical heat blankets are commonly used for this purpose. These blankets require time to get warm, with agitation often used to accelerate the exothermic reaction. Many search and rescue teams use chemical heat blankets, but optimal activation of the blankets remains uncertain. This study investigated how varying oxygen exposure durations affect the thermal performance of these blankets to guide their optimal use in search and rescue scenarios.MethodsIn room-temperature conditions, a full-body manikin was wrapped in a standardized hypothermia model, including a chemical heat blanket, and evaluated under 3 conditions: 1) no shaking, 2) shaking for 2 min, and 3) shaking for 15 min before wrapping. Thermometers were placed inside the heating panel pockets and secured in place with tape to ensure consistent measurements. Temperature data were collected over 6 h, and each scenario was performed 4 times.ResultsBlankets shaken for 2 min achieved higher initial temperatures than those not shaken, with a significant difference sustained for 88 min. Shaking for 15 min resulted in higher initial temperatures than 2-min shaking, with no long-term difference. All scenarios converged to the same temperature (36°C) after 6 h.ConclusionShaking the blanket for 2 min significantly improved early heating performance, whereas longer shaking offered minimal benefit. These findings suggest that short preparation time may be adequate in optimizing thermal delivery and reducing the time to treatment for patients with prehospital accidental hypothermia.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032251325562"},"PeriodicalIF":1.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732764","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}

{"title":"Status of Wilderness Medicine Education in the United Kingdom: A Survey-Based Research and Review of the Literature.","authors":"David Rm Lee","doi":"10.1177/10806032251322488","DOIUrl":"https://doi.org/10.1177/10806032251322488","url":null,"abstract":"<p><p>IntroductionWilderness medicine specializes in delivering clinical care in austere environments, far from healthcare facilities, with limited resources. There is no standardized wilderness medicine training for medical students within the United Kingdom. The aim of this research was to identify what wilderness medicine training is being delivered to undergraduate medical students in the United Kingdom to guide future educational research.MethodA scoping review following a PRISMA-ScR protocol was undertaken in the Medline and Scopus databases. This was supported by a digital survey sent to all UK university medical schools wilderness medicine interest groups to identify wilderness medicine teaching both within the curriculum and extracurricularly.ResultsOf the initial 1186 articles identified, 23 met the inclusion criteria. Seven represented practices in UK universities, and 21 represented a teaching module delivered to undergraduate students. Nineteen of the articles (91%) described faculty-delivered modules; two peer-led modules were both from UK universities. Thirty-one UK based wilderness medicine interest groups members responded to the online survey representing 13 different UK universities. All had been involved with extracurricular peer-led wilderness medicine teaching compared with 10% who received curriculum-based faculty-led teaching.ConclusionMost UK wilderness medicine training is extracurricular and peer led. Current research into this field provides excellent examples of wilderness medicine within UK medical schools but no comparisons between the methodologies for outcomes or cost efficiency. This review recommends more structured investigation to determine the optimal introduction to wilderness medicine for undergraduate medical students.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032251322488"},"PeriodicalIF":1.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701843","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}

{"title":"Extensor Mechanism Disruption with Multiligamentous Knee Injury from Bouldering.","authors":"Vivek M Abraham, Grant Cochran, Charles J Osier","doi":"10.1177/10806032251325571","DOIUrl":"https://doi.org/10.1177/10806032251325571","url":null,"abstract":"<p><p>Extensor mechanism injuries and multiligamentous knee injuries are rare and typically are caused by high-energy injury mechanisms. We present a case of an active-duty military service member who sustained a patellar tendon rupture with concomitant multiligamentous knee injury due to a fall while bouldering. This case report is the first to highlight this significant injury due to bouldering, in addition to the surgical steps taken to get the patient fit for full military duty. These injuries often go undiagnosed and are incredibly important to recognize given the importance of prompt evaluation and ultimate surgical care in these scenarios.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032251325571"},"PeriodicalIF":1.4,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674792","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}

{"title":"Regional Differences in Systemic Toxicity Following Texas Coral Snake (<i>Micrurus tener)</i> 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":"<p><p>BackgroundThe Texas coral snake, <i>Micrurus tener</i>, 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 <i>M. tener</i>. 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.Conclusion<i>Micrurus tener</i> 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.</p>","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}

{"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":"<p><p>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.</p>","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}

{"title":"<i>Thevetia peruviana</i> or Yellow Oleander (Apocynaceae) Poisoning with Myocardial Bridging: An Autopsy-Based Case Report.","authors":"Arushi Verma, Vikas Vaibhav, Raviprakash Meshram, Ashish Bhute, Dilip Vaishnav, Ravi H Phulware","doi":"10.1177/10806032251320372","DOIUrl":"https://doi.org/10.1177/10806032251320372","url":null,"abstract":"<p><p>Autopsy surgeons routinely encounter cases involving alleged use of poison. Many of these cases are due to poisonous plant species that grow wildly in different regions of the world and are readily accessible to the general population. <i>Thevetia peruviana</i> (syn. <i>Cascabela thevetia</i>) is a cardiotoxic evergreen shrub that is native to Latin America and has been introduced horticulturally to other global tropical and subtropical regions with subsequent establishment among the native flora. The cardiac glycosides found in the plant have digoxin-like effects. A 50-y-old male with an alleged history of accidental ingestion of <i>T peruviana</i> was brought for autopsy to the mortuary at the Department of Forensic Medicine and Toxicology. This case report highlights the postmortem findings in a case of <i>T peruviana</i> poisoning. It provides valuable insights for autopsy surgeons, ensuring their preparedness when confronted with similar cases.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032251320372"},"PeriodicalIF":1.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626605","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}

{"title":"Performative Activism or Measurable Progress: Goals for Gender Equity and Inclusion in the Wilderness Medical Society.","authors":"Tiffany L Brainerd, Rebecca Young","doi":"10.1177/10806032251322090","DOIUrl":"https://doi.org/10.1177/10806032251322090","url":null,"abstract":"","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032251322090"},"PeriodicalIF":1.4,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606759","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}

{"title":"Characteristics of Climbers with High Altitude Pulmonary Edema on Mount Aconcagua.","authors":"Andrew Park, Aaron Brillhart, Sameer Sethi, Bernabé Abramor, Rodrigo Duplessis, Roxana Pronce, Javier Seufferheld, Sarah Schlein","doi":"10.1177/10806032241303438","DOIUrl":"10.1177/10806032241303438","url":null,"abstract":"<p><strong>Introduction—: </strong>Mount Aconcagua (6961 m) in Argentina is the highest peak in the Americas, and more than 3000 climbers attempt to summit annually. High altitude pulmonary edema (HAPE) is a leading cause of mortality and evacuation on Aconcagua.</p><p><strong>Objective—: </strong>This study sought to describe the characteristics of climbers who developed HAPE on Aconcagua to aid in future prevention efforts.</p><p><strong>Methods—: </strong>Climbers diagnosed with HAPE in January 2024 were surveyed regarding demographics, preparation, acclimatization, and illness. Healthy climbers on Aconcagua also were surveyed for the same period, providing a control population.</p><p><strong>Results—: </strong>Seventeen climbers were diagnosed with HAPE. These climbers were similar to climbers without HAPE in age, sex, origin, home elevation, hypoxic tent use, staged ascent, recent virus exposure, fitness metrics, and ascent-rate plans. Climbers with HAPE spent fewer nights at the 4300-m base camp (3.6 vs 5.0 nights). Prior to developing HAPE, 71% of patients reported unresolved acute mountain sickness symptoms. HAPE onset median elevation was 5500 m, with a median of 8.0 days over 3000 m and a median lowest SpO₂ of 60% at diagnosis. There was a nonsignificant trend between acetazolamide use and increased HAPE. All surveyed HAPE patients descended, required helicopter evacuation, and survived.</p><p><strong>Conclusion—: </strong>This study examined climbers who developed HAPE on Mount Aconcagua, yielding implications for high altitude illness prevention efforts and further study. HAPE cases were associated with insufficient nights at the 4300-m base camp and unresolved acute mountain sickness symptoms. The relationship between acetazolamide and HAPE warrants further study on Aconcagua.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"113-118"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848187","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}

{"title":"The Intersection of Geriatrics, Climate Change, and Wilderness Medicine: Education is Critical.","authors":"Mary Schaefer Badger","doi":"10.1177/10806032241245399","DOIUrl":"10.1177/10806032241245399","url":null,"abstract":"<p><p>According to the US Census, for the first time in history, older adults are projected to exceed the number of children by 2035. These seniors are headed to the outdoors in increasing numbers and face unique risks. They benefit from careful pre-event evaluation planning to maintain their health in wilderness environments. Climate change is affecting all of us, but seniors are considered an especially vulnerable group. This vulnerability needs to be addressed not only when older adults head into the wilderness but also when the wilderness \"comes to them\" in areas where wilderness medicine and disaster medicine overlap. Education of both providers and patients is vital. This article aims to discuss the special needs of older adults/seniors /elders (defined as those over 65 unless otherwise indicated) in the wilderness as well as the vulnerability of older adults to climate change, both during planned wilderness activities and when the wilderness \"comes to them\" because of climate change, and to identify opportunities for education and adaptation of patients and education of physicians and wilderness and disaster responders to care for these older patients. The PubMed and Google Scholar Database search engines were utilized to review relevant English language publications between 2000 and 2023 that addressed individuals over 65 and explored the overlap of geriatrics (aged over 65), wilderness and disaster medicine, and climate change and create a perspective summary. Because of increased numbers of older adults heading into the wilderness for outdoor activities or having wilderness thrust upon them due to climate change, cross training of all specialties including the fields of emergency, geriatrics, wilderness medicine, and disaster medicine is needed in collaboration with other organizations and search and rescue. Response agencies must recognize that training in wilderness medicine provides a background for practitioners working in dangerous and remote settings and ought to seek out individuals with such skills when placing responders in the field. Climate change is making these intersections and the need for this education more urgent with time.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"27-34"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141288877","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}

{"title":"The Influence of Climate Change on Vector-Borne Diseases in a Wilderness Medicine Context.","authors":"Jonas E Mertens","doi":"10.1177/10806032241283704","DOIUrl":"10.1177/10806032241283704","url":null,"abstract":"<p><p>The imminent climate crisis has been labeled as the biggest health threat humanity must deal with. Vector-borne disease distribution and transmission as well as the population at risk are influenced to a great degree by environmental and climactic factors affecting both the vectors themselves and the causative pathogens. Paired with an increase in worldwide travel, urbanization, and globalization, along with population displacements and migration, elucidating the effects of anthropogenic climate change on these illnesses is therefore of the essence to stave off potential negative sequelae. Outcomes on different vector-borne diseases will be diverse, but for many of them, these developments will result in a distribution shift or expansion with the possibility of (re-)introduction of vector and pathogen species in previously nonendemic areas. The consequence will be a growing likelihood for novel human, vector, and pathogen interactions with an increased risk for infection, morbidity, and mortality. Wilderness medicine professionals commonly work in close relationship to the natural environment and therefore will experience these alterations most strongly in their practice. Hence, this article attempts to bring awareness to the subject at hand in a wilderness medicine context, with a focus on malaria, the most burdensome of arthropod-borne diseases. For prevention of the potentially dire consequences on human health induced by climate change, concerted and intensified efforts to reduce the burning of fossil fuels and thus greenhouse gas emissions will be imperative on a global scale.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"44-60"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478934","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}