Wilderness & environmental medicine
-
Wilderness Environ Med · Jan 2009
Field management of displaced ankle fractures: techniques for successful reduction.
Ankle fracture/dislocations are generally low-energy injuries most commonly seen in older adults. Prompt reduction is indicated when evacuation to definitive care would be prolonged or neurovascular compromise to the foot is suspected. Reduction restores neurovascular integrity, realigns joint contact surfaces, reduces pain, and decreases soft-tissue edema. ⋯ Improvised Quigley's traction can be built in a wilderness setting using available clothing. After successful reduction, fractured ankles should be adequately stabilized and the affected extremity should be kept nonweight bearing. The hematoma block and improvised Quigley's traction are valuable skills for the wilderness medical provider and may facilitate a successful and relatively pain-free reduction of dislocated ankle fractures in a wilderness setting.
-
Scorpion sting envenomation is a life-threatening emergency and a common public health problem in many regions of the world, particularly in children. Children are at greater risk of developing severe cardiac, respiratory, and neurological complications. ⋯ We found no clinically useful demographic or epidemiological data to guide decision making regarding the need for PICU admission for pediatric victims of scorpion sting in our area. Decisions on transfer and admission to a PICU should be based on the development of systemic findings of envenomation.
-
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.
-
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.
-
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.