Pub Date : 2024-02-11DOI: 10.1177/10806032241227232
Seth C. Hawkins, Jason Williams, Brad L. Bennett, Arthur A. Islas, Robert Quinn
The Wilderness Medical Society reconvened an expert panel to update best practice guidelines for spinal cord protection during trauma management. This panel, with membership updated in 2023, was charged with the development of evidence-based guidelines for management of the injured or potentially injured spine in wilderness environments. Recommendations are made regarding several parameters related to spinal cord protection. These recommendations are graded based on the quality of supporting evidence and balance the benefits and risks/burdens for each parameter according to American College of Chest Physicians methodology. Key recommendations include the concept that interventions should be goal-oriented (spinal cord/column protection in the context of overall patient and provider safety) rather than technique-oriented (immobilization). An evidence-based, goal-oriented approach excludes the immobilization of suspected spinal injuries via rigid collars or backboards.
{"title":"Wilderness Medical Society Clinical Practice Guidelines for Spinal Cord Protection: 2024 Update","authors":"Seth C. Hawkins, Jason Williams, Brad L. Bennett, Arthur A. Islas, Robert Quinn","doi":"10.1177/10806032241227232","DOIUrl":"https://doi.org/10.1177/10806032241227232","url":null,"abstract":"The Wilderness Medical Society reconvened an expert panel to update best practice guidelines for spinal cord protection during trauma management. This panel, with membership updated in 2023, was charged with the development of evidence-based guidelines for management of the injured or potentially injured spine in wilderness environments. Recommendations are made regarding several parameters related to spinal cord protection. These recommendations are graded based on the quality of supporting evidence and balance the benefits and risks/burdens for each parameter according to American College of Chest Physicians methodology. Key recommendations include the concept that interventions should be goal-oriented (spinal cord/column protection in the context of overall patient and provider safety) rather than technique-oriented (immobilization). An evidence-based, goal-oriented approach excludes the immobilization of suspected spinal injuries via rigid collars or backboards.","PeriodicalId":431977,"journal":{"name":"Wilderness & Environmental Medicine","volume":"117 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139785818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-11DOI: 10.1177/10806032241230254
Timothee de Valence, Laurent Suppan
{"title":"In reply to Dr Mohanty et al","authors":"Timothee de Valence, Laurent Suppan","doi":"10.1177/10806032241230254","DOIUrl":"https://doi.org/10.1177/10806032241230254","url":null,"abstract":"","PeriodicalId":431977,"journal":{"name":"Wilderness & Environmental Medicine","volume":"19 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139845770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-11DOI: 10.1177/10806032241226691
G. Thapa, Roshan Sapkota, Anjana Thapa, Rajesh Sharma, Derek Lubetkin, Camille Lubetkin, Samuel Nesemann, Ramu Kharel
Basic life support (BLS) is an emergency skill that includes performing appropriate cardiopulmonary resuscitation (CPR). Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality worldwide and is rising in Nepal. After an OHCA event, a bystander starting CPR quickly has been shown to increase the survival rate. While the Nepali police are generally the first responders to emergencies in rural parts, they are not trained in BLS. This program assesses a pilot training of hands-only CPR and choking first aid to the Nepal Police and Nepal Army participants in rural Nepal. A community-based nonprofit organization, HAPSA-Nepal, coordinated with local government to pilot this program. The program included pre- and post-tests, lectures, videos, and small group hands-on exercises; facilitators included faculty emergency physicians, residents, and medical officers. Structured pre- andp post-test questionnaires, confidence surveys, and skills checklists were conducted. Descriptive analysis examined the respondent's characteristics, and paired t-test was used to compare pretest and post-test scores. A total of 126 participants received the training in this pilot phase. Prior to this training, 98.4% of the participants had not received any CPR training, and 100% of the participants had not received training on first aid for choking. The average pretest score was 4.4 with 95% CI ± 1.75, and the average post-test score was 8.06 with 95% CI ± 1.73 (out of a total of 11). All participants passed the skills assessment. Locally adapted BLS training programs that included hands-only CPR and choking first aid showed a significant knowledge gain and skills competence among the frontline participants.
基本生命支持（BLS）是一项急救技能，包括实施适当的心肺复苏（CPR）。院外心脏骤停（OHCA）是导致全球死亡的主要原因，在尼泊尔也呈上升趋势。在发生院外心脏骤停事件后，旁观者迅速开始心肺复苏可提高存活率。虽然尼泊尔警察通常是农村地区紧急情况的第一响应者，但他们没有接受过 BLS 培训。本项目评估了在尼泊尔农村地区对尼泊尔警察和尼泊尔军队参与者进行的心肺复苏术和窒息急救实践试点培训。HAPSA-Nepal 是一个以社区为基础的非营利组织，它与当地政府合作开展了这项试点项目。该项目包括前测和后测、讲座、视频和小组实践练习；主持人包括急诊科医生、住院医师和医务人员。项目还进行了结构化的测试前和测试后问卷调查、信心调查和技能检查表。描述性分析考察了受试者的特征，配对 t 检验比较了测试前和测试后的得分。共有 126 名参与者接受了试点阶段的培训。在培训之前，98.4% 的参与者没有接受过任何心肺复苏培训，100% 的参与者没有接受过窒息急救培训。测试前的平均得分是 4.4（95% CI ± 1.75），测试后的平均得分是 8.06（95% CI ± 1.73）（总分 11 分）。所有参与者均通过了技能评估。根据当地情况调整的 BLS 培训计划包括心肺复苏术和窒息急救，结果显示，一线参与者在知识和技能方面都有显著提高。
{"title":"Pilot Training Program on Hands-Only CPR and Choking First Aid for Frontline Police Responders in Rural Nepal","authors":"G. Thapa, Roshan Sapkota, Anjana Thapa, Rajesh Sharma, Derek Lubetkin, Camille Lubetkin, Samuel Nesemann, Ramu Kharel","doi":"10.1177/10806032241226691","DOIUrl":"https://doi.org/10.1177/10806032241226691","url":null,"abstract":"Basic life support (BLS) is an emergency skill that includes performing appropriate cardiopulmonary resuscitation (CPR). Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality worldwide and is rising in Nepal. After an OHCA event, a bystander starting CPR quickly has been shown to increase the survival rate. While the Nepali police are generally the first responders to emergencies in rural parts, they are not trained in BLS. This program assesses a pilot training of hands-only CPR and choking first aid to the Nepal Police and Nepal Army participants in rural Nepal. A community-based nonprofit organization, HAPSA-Nepal, coordinated with local government to pilot this program. The program included pre- and post-tests, lectures, videos, and small group hands-on exercises; facilitators included faculty emergency physicians, residents, and medical officers. Structured pre- andp post-test questionnaires, confidence surveys, and skills checklists were conducted. Descriptive analysis examined the respondent's characteristics, and paired t-test was used to compare pretest and post-test scores. A total of 126 participants received the training in this pilot phase. Prior to this training, 98.4% of the participants had not received any CPR training, and 100% of the participants had not received training on first aid for choking. The average pretest score was 4.4 with 95% CI ± 1.75, and the average post-test score was 8.06 with 95% CI ± 1.73 (out of a total of 11). All participants passed the skills assessment. Locally adapted BLS training programs that included hands-only CPR and choking first aid showed a significant knowledge gain and skills competence among the frontline participants.","PeriodicalId":431977,"journal":{"name":"Wilderness & Environmental Medicine","volume":"54 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139845915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although sea snakes (Elapidae) are commonly encountered by fishermen, accurately authenticated envenomings by them are uncommon in clinical literature. We report an authenticated case of Shaw's short, or spine-bellied, sea snake ( Hydrophis curtus) bite in a young fisherman from northern Sri Lanka. The patient had clinical and biochemical evidence of mild transient myotoxicity but no evidence of neuromuscular paralysis or significant renal injury. Consideration of the clinical manifestations suggests either a mild envenoming or a dry bite. The patient completely recovered without any antivenom therapy and was discharged on the fourth day. Prolonged observation may be beneficial to exclude complications of sea snake envenoming.
{"title":"A Bite by Shaw's Short Sea Snake (Hydrophis curtus): A Case of Mild Myotoxicity or a Dry Bite?","authors":"Manoj Chathuranga, Shanjeeban Ponnudurai, Pariyatha Christopher, Isuru Sanuj, Anjana Silva","doi":"10.1177/10806032241230280","DOIUrl":"https://doi.org/10.1177/10806032241230280","url":null,"abstract":"Although sea snakes (Elapidae) are commonly encountered by fishermen, accurately authenticated envenomings by them are uncommon in clinical literature. We report an authenticated case of Shaw's short, or spine-bellied, sea snake ( Hydrophis curtus) bite in a young fisherman from northern Sri Lanka. The patient had clinical and biochemical evidence of mild transient myotoxicity but no evidence of neuromuscular paralysis or significant renal injury. Consideration of the clinical manifestations suggests either a mild envenoming or a dry bite. The patient completely recovered without any antivenom therapy and was discharged on the fourth day. Prolonged observation may be beneficial to exclude complications of sea snake envenoming.","PeriodicalId":431977,"journal":{"name":"Wilderness & Environmental Medicine","volume":"99 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139845466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-11DOI: 10.1177/10806032241226691
G. Thapa, Roshan Sapkota, Anjana Thapa, Rajesh Sharma, Derek Lubetkin, Camille Lubetkin, Samuel Nesemann, Ramu Kharel
Basic life support (BLS) is an emergency skill that includes performing appropriate cardiopulmonary resuscitation (CPR). Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality worldwide and is rising in Nepal. After an OHCA event, a bystander starting CPR quickly has been shown to increase the survival rate. While the Nepali police are generally the first responders to emergencies in rural parts, they are not trained in BLS. This program assesses a pilot training of hands-only CPR and choking first aid to the Nepal Police and Nepal Army participants in rural Nepal. A community-based nonprofit organization, HAPSA-Nepal, coordinated with local government to pilot this program. The program included pre- and post-tests, lectures, videos, and small group hands-on exercises; facilitators included faculty emergency physicians, residents, and medical officers. Structured pre- andp post-test questionnaires, confidence surveys, and skills checklists were conducted. Descriptive analysis examined the respondent's characteristics, and paired t-test was used to compare pretest and post-test scores. A total of 126 participants received the training in this pilot phase. Prior to this training, 98.4% of the participants had not received any CPR training, and 100% of the participants had not received training on first aid for choking. The average pretest score was 4.4 with 95% CI ± 1.75, and the average post-test score was 8.06 with 95% CI ± 1.73 (out of a total of 11). All participants passed the skills assessment. Locally adapted BLS training programs that included hands-only CPR and choking first aid showed a significant knowledge gain and skills competence among the frontline participants.
基本生命支持（BLS）是一项急救技能，包括实施适当的心肺复苏（CPR）。院外心脏骤停（OHCA）是导致全球死亡的主要原因，在尼泊尔也呈上升趋势。在发生院外心脏骤停事件后，旁观者迅速开始心肺复苏可提高存活率。虽然尼泊尔警察通常是农村地区紧急情况的第一响应者，但他们没有接受过 BLS 培训。本项目评估了在尼泊尔农村地区对尼泊尔警察和尼泊尔军队参与者进行的心肺复苏术和窒息急救实践试点培训。HAPSA-Nepal 是一个以社区为基础的非营利组织，它与当地政府合作开展了这项试点项目。该项目包括前测和后测、讲座、视频和小组实践练习；主持人包括急诊科医生、住院医师和医务人员。项目还进行了结构化的测试前和测试后问卷调查、信心调查和技能检查表。描述性分析考察了受试者的特征，配对 t 检验比较了测试前和测试后的得分。共有 126 名参与者接受了试点阶段的培训。在培训之前，98.4% 的参与者没有接受过任何心肺复苏培训，100% 的参与者没有接受过窒息急救培训。测试前的平均得分是 4.4（95% CI ± 1.75），测试后的平均得分是 8.06（95% CI ± 1.73）（总分 11 分）。所有参与者均通过了技能评估。根据当地情况调整的 BLS 培训计划包括心肺复苏术和窒息急救，结果显示，一线参与者在知识和技能方面都有显著提高。
{"title":"Pilot Training Program on Hands-Only CPR and Choking First Aid for Frontline Police Responders in Rural Nepal","authors":"G. Thapa, Roshan Sapkota, Anjana Thapa, Rajesh Sharma, Derek Lubetkin, Camille Lubetkin, Samuel Nesemann, Ramu Kharel","doi":"10.1177/10806032241226691","DOIUrl":"https://doi.org/10.1177/10806032241226691","url":null,"abstract":"Basic life support (BLS) is an emergency skill that includes performing appropriate cardiopulmonary resuscitation (CPR). Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality worldwide and is rising in Nepal. After an OHCA event, a bystander starting CPR quickly has been shown to increase the survival rate. While the Nepali police are generally the first responders to emergencies in rural parts, they are not trained in BLS. This program assesses a pilot training of hands-only CPR and choking first aid to the Nepal Police and Nepal Army participants in rural Nepal. A community-based nonprofit organization, HAPSA-Nepal, coordinated with local government to pilot this program. The program included pre- and post-tests, lectures, videos, and small group hands-on exercises; facilitators included faculty emergency physicians, residents, and medical officers. Structured pre- andp post-test questionnaires, confidence surveys, and skills checklists were conducted. Descriptive analysis examined the respondent's characteristics, and paired t-test was used to compare pretest and post-test scores. A total of 126 participants received the training in this pilot phase. Prior to this training, 98.4% of the participants had not received any CPR training, and 100% of the participants had not received training on first aid for choking. The average pretest score was 4.4 with 95% CI ± 1.75, and the average post-test score was 8.06 with 95% CI ± 1.73 (out of a total of 11). All participants passed the skills assessment. Locally adapted BLS training programs that included hands-only CPR and choking first aid showed a significant knowledge gain and skills competence among the frontline participants.","PeriodicalId":431977,"journal":{"name":"Wilderness & Environmental Medicine","volume":"108 42","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139785884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-11DOI: 10.1177/10806032231225102
M. M. Fouad, N. Zawilla, Aiesha Ashraf Abdelsamie, Marie Manawil, Rehab Shehata Abdelhady Shehata, R. S. Mohammed, E. Khalifa, Mona Abdallah Ramadan, B. Mourad
Snakebite is a significant public health issue in which venom-induced consumption coagulopathy is a common and serious complication that results from the activation of the coagulation pathway by snake toxins. We report a male patient, 56 y old, who was thought to have been bitten by a snake on his left foot. He was transported to a nearby hospital where he received analgesics and 3 snake polyvalent antivenom vials, and then he was transported to our hospital after 12 h. He presented with 2 small puncture wounds, pain, blistering, and edema of the left foot. On the 2nd day, the patient developed gingival bleeding and hematuria. Laboratory investigations upon admission revealed prothrombin time (PT) of more than 3 min, prothrombin concentration (PC) of less than 2.5%, and an international normalized ratio (INR) of 23.43. Further investigation of urine showed more than 100 RBCs. Despite receiving 16 packs of plasma and 40 snake polyvalent antivenom vials manufactured by VACSERA over 3 days, hemoglobin concentration and platelet count decreased with the appearance of jaundice, lactate dehydrogenase was 520, and reticulocytes were 3.5%. PT was more than 300 s, and INR was still over range. Plasmapheresis and corticosteroids were provided, which improved the patient’s general condition, PT, PC, and INR, and the patient was discharged after 6 days of hospital stay. This case report indicated that plasmapheresis and corticosteroids were clinically efficient approaches in the management of snake envenomation unresponsive to antivenom.
{"title":"Successful Management of Severe Unresponsive Snake Bite Envenomation Using Plasmapheresis and Corticosteroid at Egyptian National Environmental and Clinical Toxicology Research Center: A Case Report","authors":"M. M. Fouad, N. Zawilla, Aiesha Ashraf Abdelsamie, Marie Manawil, Rehab Shehata Abdelhady Shehata, R. S. Mohammed, E. Khalifa, Mona Abdallah Ramadan, B. Mourad","doi":"10.1177/10806032231225102","DOIUrl":"https://doi.org/10.1177/10806032231225102","url":null,"abstract":"Snakebite is a significant public health issue in which venom-induced consumption coagulopathy is a common and serious complication that results from the activation of the coagulation pathway by snake toxins. We report a male patient, 56 y old, who was thought to have been bitten by a snake on his left foot. He was transported to a nearby hospital where he received analgesics and 3 snake polyvalent antivenom vials, and then he was transported to our hospital after 12 h. He presented with 2 small puncture wounds, pain, blistering, and edema of the left foot. On the 2nd day, the patient developed gingival bleeding and hematuria. Laboratory investigations upon admission revealed prothrombin time (PT) of more than 3 min, prothrombin concentration (PC) of less than 2.5%, and an international normalized ratio (INR) of 23.43. Further investigation of urine showed more than 100 RBCs. Despite receiving 16 packs of plasma and 40 snake polyvalent antivenom vials manufactured by VACSERA over 3 days, hemoglobin concentration and platelet count decreased with the appearance of jaundice, lactate dehydrogenase was 520, and reticulocytes were 3.5%. PT was more than 300 s, and INR was still over range. Plasmapheresis and corticosteroids were provided, which improved the patient’s general condition, PT, PC, and INR, and the patient was discharged after 6 days of hospital stay. This case report indicated that plasmapheresis and corticosteroids were clinically efficient approaches in the management of snake envenomation unresponsive to antivenom.","PeriodicalId":431977,"journal":{"name":"Wilderness & Environmental Medicine","volume":"34 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139845597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-11DOI: 10.1177/10806032241226680
S. Tanaka, R. Sagisaka, K. Nakagawa, Hideharu Tanaka
—The characteristics of ski- and snowboard-related fatalities at Japanese ski resorts remain unknown. We aimed to analyze the characteristics of this in the current study. —Using the Ski Resort Injury Report data for the 13-y period between the 2011–12 and 2022–23 seasons, we described the characteristics of fatal accidents due to exogenous causes. —Eighty-four subjects (48 skiers and 36 snowboarders) were analyzed. Males accounted for 73 cases of all 84 fatalities (86.9%), including 44 skiers (91.7%) and 29 snowboarders (80.6%). Skiers aged ≥50 y and snowboarders aged 20–35 y had the highest number of fatal accidents (32 and 18 cases, respectively). Regarding location, 26 fatal accidents occurred on slopes, and 58 occurred out of slopes (skiers, 11 and 37 cases; snowboarders, 15 and 21 cases, respectively). Among skiers, head and neck trauma accounted for the cause of death in 13 cases (27.1%) and asphyxiation in 11 cases (22.9%). Among snowboarders, head and neck trauma accounted for the cause of death in 14 cases (38.9%) and asphyxiation in 14 cases (38.9%). —Males, particularly those aged ≥50 among skiers and 20−35 among snowboarders, should be wary of the potential for injuries to the head, neck, and airway when skiing or snowboarding. In this study, traumatic deaths from crashing into trees and asphyxiation from deep snow immersion accidents accounted for approximately half of fatal ski accidents in Japan.
{"title":"Characteristics of Fatal Accidents due to Exogenous Causes at Ski Resorts in Japan Over the Past 13 Years: A Retrospective Descriptive Study","authors":"S. Tanaka, R. Sagisaka, K. Nakagawa, Hideharu Tanaka","doi":"10.1177/10806032241226680","DOIUrl":"https://doi.org/10.1177/10806032241226680","url":null,"abstract":"—The characteristics of ski- and snowboard-related fatalities at Japanese ski resorts remain unknown. We aimed to analyze the characteristics of this in the current study. —Using the Ski Resort Injury Report data for the 13-y period between the 2011–12 and 2022–23 seasons, we described the characteristics of fatal accidents due to exogenous causes. —Eighty-four subjects (48 skiers and 36 snowboarders) were analyzed. Males accounted for 73 cases of all 84 fatalities (86.9%), including 44 skiers (91.7%) and 29 snowboarders (80.6%). Skiers aged ≥50 y and snowboarders aged 20–35 y had the highest number of fatal accidents (32 and 18 cases, respectively). Regarding location, 26 fatal accidents occurred on slopes, and 58 occurred out of slopes (skiers, 11 and 37 cases; snowboarders, 15 and 21 cases, respectively). Among skiers, head and neck trauma accounted for the cause of death in 13 cases (27.1%) and asphyxiation in 11 cases (22.9%). Among snowboarders, head and neck trauma accounted for the cause of death in 14 cases (38.9%) and asphyxiation in 14 cases (38.9%). —Males, particularly those aged ≥50 among skiers and 20−35 among snowboarders, should be wary of the potential for injuries to the head, neck, and airway when skiing or snowboarding. In this study, traumatic deaths from crashing into trees and asphyxiation from deep snow immersion accidents accounted for approximately half of fatal ski accidents in Japan.","PeriodicalId":431977,"journal":{"name":"Wilderness & Environmental Medicine","volume":"44 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139845992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although sea snakes (Elapidae) are commonly encountered by fishermen, accurately authenticated envenomings by them are uncommon in clinical literature. We report an authenticated case of Shaw's short, or spine-bellied, sea snake ( Hydrophis curtus) bite in a young fisherman from northern Sri Lanka. The patient had clinical and biochemical evidence of mild transient myotoxicity but no evidence of neuromuscular paralysis or significant renal injury. Consideration of the clinical manifestations suggests either a mild envenoming or a dry bite. The patient completely recovered without any antivenom therapy and was discharged on the fourth day. Prolonged observation may be beneficial to exclude complications of sea snake envenoming.
{"title":"A Bite by Shaw's Short Sea Snake (Hydrophis curtus): A Case of Mild Myotoxicity or a Dry Bite?","authors":"Manoj Chathuranga, Shanjeeban Ponnudurai, Pariyatha Christopher, Isuru Sanuj, Anjana Silva","doi":"10.1177/10806032241230280","DOIUrl":"https://doi.org/10.1177/10806032241230280","url":null,"abstract":"Although sea snakes (Elapidae) are commonly encountered by fishermen, accurately authenticated envenomings by them are uncommon in clinical literature. We report an authenticated case of Shaw's short, or spine-bellied, sea snake ( Hydrophis curtus) bite in a young fisherman from northern Sri Lanka. The patient had clinical and biochemical evidence of mild transient myotoxicity but no evidence of neuromuscular paralysis or significant renal injury. Consideration of the clinical manifestations suggests either a mild envenoming or a dry bite. The patient completely recovered without any antivenom therapy and was discharged on the fourth day. Prolonged observation may be beneficial to exclude complications of sea snake envenoming.","PeriodicalId":431977,"journal":{"name":"Wilderness & Environmental Medicine","volume":"121 50","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139785548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-11DOI: 10.1177/10806032241230254
Timothee de Valence, Laurent Suppan
{"title":"In reply to Dr Mohanty et al","authors":"Timothee de Valence, Laurent Suppan","doi":"10.1177/10806032241230254","DOIUrl":"https://doi.org/10.1177/10806032241230254","url":null,"abstract":"","PeriodicalId":431977,"journal":{"name":"Wilderness & Environmental Medicine","volume":"118 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139785648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-11DOI: 10.1177/10806032241227232
Seth C. Hawkins, Jason Williams, Brad L. Bennett, Arthur A. Islas, Robert Quinn
The Wilderness Medical Society reconvened an expert panel to update best practice guidelines for spinal cord protection during trauma management. This panel, with membership updated in 2023, was charged with the development of evidence-based guidelines for management of the injured or potentially injured spine in wilderness environments. Recommendations are made regarding several parameters related to spinal cord protection. These recommendations are graded based on the quality of supporting evidence and balance the benefits and risks/burdens for each parameter according to American College of Chest Physicians methodology. Key recommendations include the concept that interventions should be goal-oriented (spinal cord/column protection in the context of overall patient and provider safety) rather than technique-oriented (immobilization). An evidence-based, goal-oriented approach excludes the immobilization of suspected spinal injuries via rigid collars or backboards.
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