Wilderness & environmental medicine
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Wilderness Environ Med · Jan 2008
Review Case ReportsTick talk: unusually severe case of tick-borne relapsing fever with acute respiratory distress syndrome--case report and review of the literature.
Borrelia hermsii causes tick-borne relapsing fever (TBRF) in the Pacific Northwest. There are few reports of TBRF-associated acute respiratory distress syndrome. One such unusually severe case is described. Literature is reviewed including diagnosis, treatment, and prevention.
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Wilderness Environ Med · Jan 2008
Practice GuidelineThe use of extrication devices in crevasse accidents: official statement of the International Commission for Mountain Emergency Medicine and the Terrestrial Rescue Commission of the International Commission for Alpine Rescue intended for physicians, paramedics, and mountain rescuers.
Injured patients in crevasses who are suspected of having sustained spinal injuries should ideally be extricated after being immobilized in a horizontal position on a stretcher and having a cervical collar applied. Sometimes, however, horizontal stabilization is not possible, because the crevasse is too narrow, and the patient needs to be stabilized in a vertical position. ⋯ The Kendrick Extrication Device stabilizes the position of the body and maintains firm support of the head, neck, and torso. Therefore, the International Commission for Mountain Emergency Medicine supports the use of this device in narrow crevasses, if horizontal evacuation is not possible.
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Wilderness Environ Med · Jan 2008
Hypothermia and other cold-related morbidity emergency department visits: United States, 1995-2004.
Although hypothermia is preventable, little has been published on its epidemiology. This study estimates the incidence of hypothermia and other cold-related morbidity emergency department (ED) visits in the United States. ⋯ Hypothermia and other cold-related morbidity is a preventable resource-intensive condition that tends to affect the disadvantaged.
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Wilderness Environ Med · Jan 2008
Carbon monoxide exposure on Denali: comparing the 2004 and 2005 climbing seasons.
This study assessed a potential relationship between elevated carboxyhemoglobin (COHb) levels and the presence of acute mountain sickness (AMS) at 4300 m on Denali and evaluated the relationship between COHb levels, AMS, and climber characteristics and behaviors. Building on our research done in 2004, in this article we report further data gathered during the 2005 climbing season and evaluate the combined results. ⋯ No relationship between AMS symptoms and CO exposure was observed. As found in our initial study, descending climbers had higher overall COHb levels and an increased risk of CO exposure (COHb of >3% in nonsmokers and >10% in smokers). Also, increased hours of stove operation was linked to climbers who had elevated COHb levels.
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Wilderness Environ Med · Jan 2008
Case ReportsSevere exercise-associated hyponatremia on the Kokoda Trail, Papua New Guinea.
Exercise-associated hyponatremia is the most common medical complication of ultradistance exercise and is usually caused by excessive hypotonic fluid intake. We report a case of severe hyponatremia in a healthy male trekking the Kokoda Trail in the remote Southern Highlands of Papua New Guinea. A 43-year-old male collapsed and had a generalized seizure in the afternoon of the third day of a guided trek. ⋯ Early diagnosis and appropriate management is critical to avoid the potentially fatal consequences of severe hyponatremia. The diagnosis and treatment of exercise-associated hyponatremia is particularly challenging in the remote Papua New Guinea jungle. Education of trek leaders, medics, and trekkers in appropriate preventative measures and the rapid treatment of exercise-associated hyponatremia is essential to avoid recurrences of this life-threatening condition.