Wilderness & environmental medicine
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Wilderness Environ Med · Mar 2018
Review Comparative StudyAn Effective Treatment in the Austere Environment? A Critical Appraisal into the Use of Intra-Articular Local Anesthetic to Facilitate Reduction in Acute Shoulder Dislocation.
Acute shoulder dislocation is a common injury in the outdoor environment. The objective of this systematic review of the literature was to determine if intra-articular local anesthetic (IAL) is an effective treatment that could have prehospital application. A methodical search of MEDLINE, PubMed, and EMBASE databases targeted publications from January 1, 1990 until January 1, 2017. ⋯ One trial found a clinically relevant reduction in visual analogue pain scores when comparing IAL against no additional analgesia in the first minute (IAL 21±13 mm; control 49±15 mm; P<0.001) and fifth minute (IAL 10±10 mm; control 40±14 mm, P<0.001) after reduction. The results suggest that IAL is an effective intervention for acute anterior shoulder dislocation that would have a place in the repertoire of the remote physician. Further research might be beneficial in determining the outcomes of performing IAL in the prehospital setting.
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Wilderness Environ Med · Dec 2017
Exercise-Associated Hyponatremia, Hypernatremia, and Hydration Status in Multistage Ultramarathons.
Dysnatremia and altered hydration status are potentially serious conditions that have not been well studied in multistage ultramarathons. The purpose of this study was to assess the incidence and prevalence of exercise-associated hyponatremia (EAH) (Na+ <135 mmol·L-1) and hypernatremia (Na+ >145 mmol·L-1) and hydration status during a multistage ultramarathon. ⋯ The incidence of EAH in multistage ultramarathons was similar to marathons and single-stage ultramarathons, but the cumulative incidence of hypernatremia was 3 times greater than that of EAH. EAH was associated with increased weight gain (overhydration) in early stage nonfinishers and postrace finishers.
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Scorpionism is an endemic public health problem in Jordan encountered by health providers in all parts of the country. This study updates epidemiological data on scorpion sting encounters in Jordan. ⋯ Scorpion stings remain a medical problem in Jordan that requires more attention by health providers. Reporting of scorpion sting cases should be enforced from all healthcare centers throughout the country to better understand the epidemiology and health implications of human encounters.
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Prolonged field care (PFC) has emerged as a recent area of focus for US military Special Operations Forces (SOF) medical experts. Focused on the current reality of providing medical care to military forces often deployed in remote and austere locations far from medical support or a robust casualty evacuation chain, PFC encompasses evolving operational situations not unlike many wilderness medicine practice environments. SOF currently operates in all areas of the world and on a variety of different missions, which finds these small teams far from the accustomed practice environment of robust deployed medical infrastructure commonly seen during the last 15 years of military conflicts. ⋯ The approach to training and educating SOF medics on PFC is based on defined capabilities and operational situations that incorporate best medical practices and seeks to place advance resuscitative capabilities into the hands of providers closest to the point of injury. By transitioning from an approach solely driven by acute trauma aide, incorporating the best practices of Tactical Combat Casualty Care (TCCC), PFC builds upon best practices for the continuing management of both medical and trauma patients in wilderness environments. PFC incorporates best practices in generally hospital-based management of serious and critical casualties to decrease both mortality and morbidity in austere, prehospital operational settings.
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Wilderness Environ Med · Jun 2017
ReviewThe Care of Thermally Injured Patients in Operational, Austere, and Mass Casualty Situations.
Burn injury affects a half million people in the United States annually. The severe thermal injury can have long-term debilitating effects. The management of burn patients in austere and operational environments is more complex. ⋯ The care of burn patients in austere, operational, and mass casualty situations can tax resources and manpower. The care of these patients will require creativity and ingenuity. Burn patients can be difficult to manage under normal circumstances but the care of these patients under the above situations complicates the management severalfold.