Wilderness & environmental medicine
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Wilderness Environ Med · Mar 2014
Novel approach to the diagnosis of fractures in an austere environment using a stethoscope and a cellular phone.
Fracture diagnosis in the austere environment where radiographic tests are not available can be a challenge. In the past, a diagnostic technique has been described using a tuning fork and stethoscope to assess decreased sound conduction in the fractured extremity. In this study, we evaluate the use of a cellular phone's vibrate function and a stethoscope to limit equipment carried by expeditionary practitioners. ⋯ The use of a cellular phone and stethoscope may be a useful tool for the diagnosis of fractures in the austere environment. However, further study is needed to validate these findings in the clinical environment.
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Wilderness Environ Med · Mar 2014
Hydration in female drivers in a 1044 km dog sled race in Finnmark.
Drinking strategies during long dog sled competitions are important to avoid dehydration. Most of the studies involving dog sled racers (mushers) refer to male subjects. The purpose of this study was to study female mushers participating in a dog sled race of 1044 km, with a focus on hydration and drinking behavior. ⋯ Dog sled racing is a strenuous activity and drinking strategies are important to avoid dehydration. It seems that the drinking strategy of our subjects was adequate to supplement the hydration loss; yet, emotional arousals occurring during the race may affect drinking behavior. The attentive assistance of the mushers' handlers is therefore important.
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Minimal data exist regarding the activity, membership, training, and medical oversight of search and rescue (SAR) teams. ⋯ Intermountain West SAR teams vary in their activity, composition, training, and level of medical oversight. This study confirms that opportunities exist for physician integration with SAR teams in the studied states and likely throughout the United States.
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Anaphylaxis is a challenging condition for any austere environment. It is unpredictable, has sudden onset and a high fatality rate, and is responsive only to epinephrine, a prescription medication. ⋯ However, auto-injectors have limitations in the wilderness environment, particularly due to their single-dose (or at most 2-dose) design. This paper describes an austere environment technique for obtaining multiple additional doses of epinephrine from auto-injectors that have already been used as designed.
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Wilderness Environ Med · Dec 2013
Case ReportsClinical effects and antivenom use for snake bite victims treated at three US hospitals in Afghanistan.
Annually, more than 100,000 US and international military and civilian personnel work in Afghanistan within terrain harboring venomous snakes. Current literature insufficiently supports Afghan antivenom treatment and stocking guidelines. We report the clinical course and treatments for snakebite victims presenting to US military hospitals in Afghanistan. ⋯ We report the largest series of snake envenomations treated by US physicians in Afghanistan. Antivenom was tolerated well with improvement of coagulopathy and symptoms. All patients survived with minimal advanced interventions other than blood transfusion.