Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · May 2017
ReviewIs There a Doctor Onboard? Medical Emergencies at 40,000 Feet.
It is estimated 2.75 billion people travel aboard commercial airlines every year and 44,000 in-flight medical emergencies occur worldwide each year. Wilderness medicine requires a commonsense and improvisational approach to medical issues. A sudden call for assistance in the austere and unfamiliar surroundings of an airliner cabin may present the responding medical professional with a "wilderness medicine" experience. From resource management to equipment, this article sheds light on the unique conditions, challenges, and constraints of the flight environment.
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Venomous aquatic animals are hazardous to swimmers, surfers, divers, and fishermen. Exposures include mild stings, bites, abrasions, and lacerations. Severe envenomations can be life threatening. ⋯ Recommendations are included for cnidaria, sponges, bristle worms, crown-of-thorns starfish, sea urchins, venomous fish, stingrays, cone snails, stonefish, blue-ringed octopus, and sea snakes. Immediate and long-term treatment options and management of common sequelae are reviewed. Antivenom administration, treatment of anaphylaxis, and surgical indications are discussed.
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Emerg. Med. Clin. North Am. · May 2017
ReviewPreparing for International Travel and Global Medical Care.
Thorough pretravel preparation and medical consultation can mitigate avoidable health and safety risks. A comprehensive pretravel medical consultation should include an individualized risk assessment, immunization review, and discussion of arthropod protective measures, malaria prophylaxis, traveler's diarrhea, and injury prevention. Travel with children and jet lag reduction require additional planning and prevention strategies; travel and evacuation insurance may prove essential when traveling to less resourced countries. Consideration should also be given to other high-risk travel scenarios, including the provision of health care overseas, adventure and extreme sports, water environments and diving, high altitude, and terrorism/unstable political situations.
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Native US snakes that produce clinically significant envenomation can be divided into 2 groups, crotalids and elapids. The crotalids include rattlesnakes, cottonmouths, and copperheads. Crotalid envenomation can result in significant local tissue damage as well as thrombocytopenia and coagulopathy. ⋯ Native US elapids are all coral snakes that possess neurotoxic venom that can cause weakness, respiratory paralysis, and rarely death. Treatment of both types of envenomation revolves around general supportive care and antivenom administration when indicated. Previously advocated treatments, such as tourniquets, venom extraction, and bite site excision are not recommended.
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Arthropods (phylum Arthopoda) account for a higher percentage of morbidity and mortality to humans than do mammalian bites, snake bites, or marine envenomation. They are ubiquitous in domestic dwellings, caves, and campsites and in wilderness settings such as deserts, forests, and lakes. Although arthropods are most intrusive during warmer months, many are active throughout the winter, particularly indoors. ⋯ Encounters with humans are generally defensive, accidental, or reactive. An individual stung by an insect or bitten by an arachnid may experience pain and local swelling, an anaphylactic reaction, or life-threatening toxicity. This review discusses the clinical presentation and latest treatment recommendations for bites and stings from spiders, scorpions, bees, ants, ticks and centipedes of North America.