Wilderness & environmental medicine
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Wilderness Environ Med · Mar 2017
GuidelineWilderness Medical Society Practice Guidelines for Prevention and Management of Avalanche and Nonavalanche Snow Burial Accidents.
To provide guidance to clinicians and avalanche professionals about best practices, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the prevention, rescue, and medical management of avalanche and nonavalanche snow burial victims. Recommendations are graded on the basis of quality of supporting evidence according to the classification scheme of the American College of Chest Physicians.
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Wilderness Environ Med · Dec 2016
ReviewClinical and Epidemiological Aspects of Scorpionism in the World: A Systematic Review.
Scorpion stings are registered worldwide, but the incidence and the features of the envenomations vary depending on the region. The aim of this review was to summarize the epidemiological, clinical, diagnostic, and therapeutic data worldwide regarding humans stung by scorpions. ⋯ The large number of scorpion stings worldwide is concerning and reaffirms the need for new prevention measures and policies to reduce the incidence, prevalence, morbidity, and mortality rates from these poisonous arachnids.
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Wilderness Environ Med · Sep 2016
Case ReportsInducing Therapeutic Hypothermia in Cardiac Arrest Caused by Lightning Strike.
Only limited clinical scenarios are grounds for induction of therapeutic hypothermia. Its use in traumatic cardiac arrests, including those from lightning strikes, is not well studied. ⋯ We report a case of full neurological recovery with therapeutic hypothermia after a lightning-induced pulseless electrical activity cardiac arrest in an 18-year-old woman. We also review the important pathophysiology of lightning-induced cardiac arrest and neurologic sequelae, elaborate upon the mechanism of therapeutic hypothermia, and add case-based evidence in favor of the use of targeted temperature management in lightning-induced cardiac arrest.
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Wilderness Environ Med · Jun 2016
Case ReportsAvalanche Survival After Rescue With the RECCO Rescue System: A Case Report.
We report a case of survival of a completely buried avalanche victim after being located with the radar-based RECCO Rescue System. In the winter of 2015, 2 off-piste skiers were completely buried in an avalanche near the secured ski area in Baqueira Beret, Spain. The first victim was located with the RECCO Rescue System in less than 35 minutes and was alive and conscious at extrication. ⋯ The device should be brought to the avalanche site together with electronic avalanche transceivers, a probing team, and avalanche dogs. In the hands of experienced professionals, the device may allow rapid location of victims not carrying an electronic avalanche transceiver. Although it is not the first successful extrication of a victim with the RECCO Rescue System, it is the first case published in the medical literature and is intended to encourage data collection and to increase our understanding of the effectiveness of this device in avalanche rescue.
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The immediate medical management of buried avalanche victims will to some extent be dictated by the victim's body positioning in the snow. Medical personnel are trained to assess and manage victims in a supine body position. Furthermore, avalanche first responders are trained to handle extricated avalanche victims carefully out of concerns for causing hemodynamic instability or for aggravating spinal injury. Thus, locating and extricating avalanche victims in positions other than supine has the potential to complicate immediate medical management. To our knowledge, the current medical literature does not detail the body positioning of buried victims. ⋯ The majority of victims will be extricated with their heads in a downhill position. Moreover, almost half of victims will be found prone. We believe this will have significant impact on the immediate medical management. We believe current training in avalanche medical rescue should emphasize managing victims in non-supine positions. Finally, our findings may represent another benefit of modern extrication techniques.