Wilderness & environmental medicine
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Wilderness Environ Med · Mar 2016
Portable Prehospital Methods to Treat Near-Hypothermic Shivering Cold Casualties.
To compare the effectiveness of a single-layered polyethylene survival bag (P), a single-layered polyethylene survival bag with a hot drink (P+HD), a multi-layered metalized plastic sheeting survival bag (MPS: Blizzard Survival), and a multi-layered MPS survival bag with 4 large chemical heat pads (MPS+HP: Blizzard Heat) to treat cold casualties. ⋯ Near-hypothermic cold casualties are rewarmed with less peripheral cold stress and shivering thermogenesis using a multi-layered MPS survival bag compared with a polyethylene survival bag. Prehospital rewarming is further aided by large chemical heat pads but not by hot drinks.
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Wilderness Environ Med · Mar 2016
Case ReportsDeep Vein Thrombosis and Pulmonary Embolism in a Mountain Guide: Awareness, Diagnostic Challenges, and Management Considerations at Altitude.
High intensity exercise is associated with several potentially thrombogenic risk factors, including dehydration and hemoconcentration, vascular trauma, musculoskeletal injuries, inflammation, long-distance travel, and contraceptive usage. These are well documented in case reports of venous thrombosis in track and field athletes. For mountaineers and those working at high altitude, additional risks exist. ⋯ Considerations for mitigating and managing thrombosis in addition to personalized care planning at altitude are discussed. The prevalence of thrombosis in mountain athletes is uncharted, but lowlanders increasingly go to high altitude to trek, ski, or climb. Blood clots can and do occur in physically active people, and thrombosis prevention and recognition will demand heightened awareness among participants, healthcare practitioners, and the altitude sport/leisure industry at large.
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Wilderness Environ Med · Mar 2016
Case ReportsOrbital Compartment Syndrome: Alternative Tools to Perform a Lateral Canthotomy and Cantholysis.
Orbital compartment syndrome acutely threatens vision. Lateral canthotomy and cantholysis ameliorate the compartment syndrome and, to save a patient's vision, must be performed in a timely manner. This requires appropriate tools. ⋯ As when using hemostats of varying sizes, the pressure applied to the multitool must be carefully modulated. When using a scalpel blade for the lateral canthotomy, the hemostat arm remains beneath the lateral canthus as a "backstop" to protect deeper tissues. For the cantholysis, use the back of the blade to "strum" for the ligaments, reversing its direction only to cut the ligament when it is identified.
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Wilderness Environ Med · Dec 2015
Epidemiology of Search and Rescue in Baxter State Park: Dangers of Descent and Fatigue.
The purpose of this study was to determine the epidemiology of injury in Baxter State Park, Maine, and to better tailor search and rescue (SAR) resources, personnel, and training to acute needs in the park. ⋯ Fatigue is a major factor in SAR events, both as a discreet cause and as a contributor to other injuries. Search and rescue need is more likely to occur during mountain descent, and lower extremity injuries are the most common etiology. Efforts should be focused on training rescuers in lower extremity and fatigue treatment, and more rescuers should be available when many are descending.
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Wilderness Environ Med · Dec 2015
ReviewGeneral Medical Considerations for the Wilderness Adventurer: Medical Conditions That May Worsen With or Present Challenges to Coping With Wilderness Exposure.
Participation in wilderness and adventure sports is on the rise, and as such, practitioners will see more athletes seeking clearance to participate in these events. The purpose of this article is to describe specific medical conditions that may worsen or present challenges to the athlete in a wilderness environment.