Wilderness & environmental medicine
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Wilderness Environ Med · Jan 2006
Historical ArticleTrench foot: the medical response in the first World War 1914-18.
The approaching 90-year anniversary of United States entry into the Great War is an apt time to examine the response to trench foot (now called nonfreezing cold injury [NFCI]) in this conflict. Trench foot appeared in the winter of 1914, characterized by pedal swelling, numbness, and pain. It was quickly recognized by military-medical authorities. ⋯ Prevention involved general measures to improve the trench environment; modification of the footwear worn by the men; and the provision of greases to protect them from moisture. The medical reaction to this condition seems to have been relatively effective. The causation was identified, and prophylactic measures were introduced to fit this model; these seem to have been successful in reducing the prevalence of the condition by 1917-18.
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Wilderness Environ Med · Jan 2006
Improvised cricothyrotomy provides reliable airway access in an unembalmed human cadaver model.
Patients with injuries requiring surgical airway management occurring far from medical care might benefit from the availability of a simple, reliable, improvisational method of cricothyrotomy with materials available in a wilderness or prehospital setting. We evaluated an improvised cricothyrotomy device in an experimental, unembalmed human cadaver model. ⋯ Cricothyrotomy is the quickest and most effective method for obtaining airway access when nonsurgical methods of securing the airway are contraindicated or fail. Although frequently described, no improvised airway devices of this type have been tested in a systematic manner. We tested the reliability and utility of cricothyrotomy with a high-flow intravenous spike and drip chamber. Our results suggest that the spike and drip chamber is a plausible means of temporarily establishing airway access in patients with acute airway obstruction in a wilderness or prehospital environment.
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A patient with severe hypothermia presented with an initial rectal temperature of 28.3 degrees C coupled with a hemoglobin of 2.2 g x dL(-1) and acute pancreatitis. Although hypothermia decreases oxygen and substrate consumption by tissues and can be cerebro-protective, the ideal rewarming strategy is unclear when the oxygen-delivery system is profoundly deficient, as with severe anemia. In this patient, truncal active external rewarming with a forced-air system, heated inhalation, and slow warmed transfusion yielded a 1.5 degrees C x h(-1) rate of rewarming and a good outcome. We discuss the numerous protective and detrimental factors affecting oxygenation and ventilation during hypothermia coupled with profound anemia and the possible etiologic explanations for coexistent hypothermia and pancreatitis.
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Wilderness Environ Med · Jan 2006
Changes in injury patterns and severity in a helicopter air-rescue system over a 6-year period.
To study the influence of current trends in alpine sports on the frequency and types of injuries handled by a helicopter-based emergency medical system (HEMS) in a wilderness mountain region. ⋯ For the HEMS in this study, there has been an increasing number of calls for help from persons involved in outdoor leisure activities. As the number of life-threatening injuries declines, HEMSs more frequently serve as means of rescue rather than as providers of emergency treatment.
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Wilderness Environ Med · Jan 2006
Practice GuidelineThe use of automated external defibrillators and public access defibrillators in the mountains: official guidelines of the international commission for mountain emergency medicine ICAR-MEDCOM.
In this article we propose guidelines for rational use of automated external defibrillators and public access defibrillators in the mountains. In cases of ventricular fibrillation and pulseless ventricular tachycardia, early defibrillation is the most effective therapy. Easy access to mountainous areas permits visitation by persons with high risks for sudden cardiac death, and medical trials show the benefit of exercising in moderate altitude. ⋯ Public access defibrillators should be placed with priority in popular ski areas, in busy mountain huts and restaurants, at mass-participation events, and in remote but often-visited locations that do not have medical coverage. Automated external defibrillators should be available to first-responder groups and mountain-rescue teams. It is important that people know how to perform cardiopulmonary resuscitation and how to use public access defibrillators and automated external defibrillators.