Hand injuries from surfing tend to be severe and require medical attention. Follow-up of a surfing injury is difficult because many patients are visiting and go home after treatment. We report a case of a surfing hand injury sustained abroad, which was treated upon the patient's return, allowing for follow-up. The mechanism of injury was traction and torsion from the surfboard leash while surfing. The patient was initially treated for nailbed injury but presented later back home after persistent pain, for which an unstable distal phalanx fracture in their right ring finger was found by x-ray. This was surgically reduced with K-wire insertion and nailbed repair. Postoperatively, the injured finger was kept in a splint, and the patient had physiotherapy. Pain was significantly reduced, and the patient regained sufficient function. Considering a fracture as a differential for finger injury caused by the surfboard leash may prevent management delays. Injury may be prevented through education and redesign of the surfboard leash.
冲浪造成的手伤往往比较严重，需要就医。冲浪受伤后很难进行后续治疗，因为很多患者都是来探望的，治疗后就回家了。我们报告了一例在国外冲浪时手部受伤的病例，患者回国后接受了治疗，并进行了随访。受伤机制是冲浪时冲浪板绳索的牵引和扭转。患者最初接受的是甲床损伤治疗，但后来回国后出现持续疼痛，X 光检查发现其右手无名指远端指骨骨折。在手术中植入了 K 型钢丝，并进行了甲床修复。术后，受伤的手指被固定在夹板上，患者接受了物理治疗。疼痛明显减轻，患者恢复了足够的功能。将骨折作为冲浪板绳索导致手指损伤的鉴别诊断，可以避免延误治疗。可以通过教育和重新设计冲浪板绳索来预防伤害。
{"title":"Acute Hand Injury in Surfing: A Case Report","authors":"Ryo Yoshimura, Rituja Kamble, Rebecca Dunlop, Justin Wormald","doi":"10.1177/10806032231223323","DOIUrl":"https://doi.org/10.1177/10806032231223323","url":null,"abstract":"Hand injuries from surfing tend to be severe and require medical attention. Follow-up of a surfing injury is difficult because many patients are visiting and go home after treatment. We report a case of a surfing hand injury sustained abroad, which was treated upon the patient's return, allowing for follow-up. The mechanism of injury was traction and torsion from the surfboard leash while surfing. The patient was initially treated for nailbed injury but presented later back home after persistent pain, for which an unstable distal phalanx fracture in their right ring finger was found by x-ray. This was surgically reduced with K-wire insertion and nailbed repair. Postoperatively, the injured finger was kept in a splint, and the patient had physiotherapy. Pain was significantly reduced, and the patient regained sufficient function. Considering a fracture as a differential for finger injury caused by the surfboard leash may prevent management delays. Injury may be prevented through education and redesign of the surfboard leash.","PeriodicalId":431977,"journal":{"name":"Wilderness & Environmental Medicine","volume":"36 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139527442","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 : 2024-01-15DOI: 10.1177/10806032231221998
Daniel L. Phillips, Jason Bowman, Ken Zafren
{"title":"In Response to Performance of a Chemical Heat Blanket by Greene et al","authors":"Daniel L. Phillips, Jason Bowman, Ken Zafren","doi":"10.1177/10806032231221998","DOIUrl":"https://doi.org/10.1177/10806032231221998","url":null,"abstract":"","PeriodicalId":431977,"journal":{"name":"Wilderness & Environmental Medicine","volume":"29 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139529406","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 : 2024-01-10DOI: 10.1177/10806032231222358
Christopher Woll
{"title":"In reply to “A symptom-driven mitigation protocol for SARS-CoV-2 in a wilderness medicine elective”","authors":"Christopher Woll","doi":"10.1177/10806032231222358","DOIUrl":"https://doi.org/10.1177/10806032231222358","url":null,"abstract":"","PeriodicalId":431977,"journal":{"name":"Wilderness & Environmental Medicine","volume":"65 35","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139534632","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 : 2024-01-10DOI: 10.1177/10806032231222353
Carlos A. Cañas, Valeria Erazo-Martínez, Valentina Pérez-Uribe, Santiago Castaño-Valencia, Fernando Castro-Herrera
Bothriechis schlegelii is a Crotaline viperid species of Central America and Northern South America. The characteristics of its envenomation have not been well established. We present clinical characteristics of human cases evaluated and treated in a hospital in southwestern Colombia. We evaluated data from patients who suffered Bothriechis schlegelii envenomation and were seen at Fundación Valle del Lili Hospital, Cali, Colombia between 2011 and 2022. Eight patients were included, with a median age of 24 years. Snakebites occurred in rural areas. Six (75%) patients were bitten on the upper extremities in relation to the arboreal habits of this animal. The most common symptoms were pain and edema ( N = 8, 100%), ecchymoses ( N = 2, 25%), and paresthesia ( N = 2, 25%). The most common systemic findings were hypofibrinogenemia ( N = 8, 100%) and prolonged prothrombin time in five patients ( N = 5, 62.5%). All were treated with polyvalent antivenom for Colombian snakes, with a good response and outcome. Most bite sites from B. schlegelii were on the upper limbs. All patients had both local manifestations, including edema, pain, and systemic effects with hypofibrinogenemia, but none had systemic bleeding. Every patient received antivenom and had favorable outcomes.
Bothriechis schlegelii 是中美洲和南美洲北部的一种蝰蛇。它的致毒特征尚未得到很好的确定。我们介绍了哥伦比亚西南部一家医院评估和治疗的人类病例的临床特征。我们评估了 2011 年至 2022 年期间在哥伦比亚卡利 Valle del Lili 基金会医院就诊的 Bothriechis schlegelii 被咬伤患者的数据。共纳入八名患者，中位年龄为 24 岁。蛇咬伤发生在农村地区。六名患者（75%）的上肢被蛇咬伤，这与蛇的树栖习性有关。最常见的症状是疼痛和水肿（8例，100%）、瘀斑（2例，25%）和麻痹（2例，25%）。最常见的全身症状是低纤维蛋白原血症（8 例，100%），5 例患者凝血酶原时间延长（5 例，62.5%）。所有患者均接受了哥伦比亚蛇多价抗蛇毒血清治疗，反应良好，疗效显著。被蛇咬伤的部位大多在上肢。所有患者都有局部表现，包括水肿、疼痛和低纤维蛋白原血症等全身症状，但没有人全身出血。每位患者都接受了抗蛇毒血清治疗，并取得了良好的疗效。
{"title":"Envenomation by Eyelash Viper Bothriechis schlegelii (Berthold, 1846) in Southwestern Colombia","authors":"Carlos A. Cañas, Valeria Erazo-Martínez, Valentina Pérez-Uribe, Santiago Castaño-Valencia, Fernando Castro-Herrera","doi":"10.1177/10806032231222353","DOIUrl":"https://doi.org/10.1177/10806032231222353","url":null,"abstract":"Bothriechis schlegelii is a Crotaline viperid species of Central America and Northern South America. The characteristics of its envenomation have not been well established. We present clinical characteristics of human cases evaluated and treated in a hospital in southwestern Colombia. We evaluated data from patients who suffered Bothriechis schlegelii envenomation and were seen at Fundación Valle del Lili Hospital, Cali, Colombia between 2011 and 2022. Eight patients were included, with a median age of 24 years. Snakebites occurred in rural areas. Six (75%) patients were bitten on the upper extremities in relation to the arboreal habits of this animal. The most common symptoms were pain and edema ( N = 8, 100%), ecchymoses ( N = 2, 25%), and paresthesia ( N = 2, 25%). The most common systemic findings were hypofibrinogenemia ( N = 8, 100%) and prolonged prothrombin time in five patients ( N = 5, 62.5%). All were treated with polyvalent antivenom for Colombian snakes, with a good response and outcome. Most bite sites from B. schlegelii were on the upper limbs. All patients had both local manifestations, including edema, pain, and systemic effects with hypofibrinogenemia, but none had systemic bleeding. Every patient received antivenom and had favorable outcomes.","PeriodicalId":431977,"journal":{"name":"Wilderness & Environmental Medicine","volume":" 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139627282","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 : 2024-01-10DOI: 10.1177/10806032231222003
Ryan Hodnick, Michael L. Cohen, Joseph B. Loehner, Jennifer Mazzanti
Treatment of high altitude pulmonary edema (HAPE) can be challenging and is further complicated in the pediatric patient in the prehospital environment. The following case presents a decompensating pediatric patient with HAPE in the prehospital aeromedical environment. It illustrates the potential benefit of continuous positive airway pressure (CPAP) as a treatment modality in the treatment of HAPE.
{"title":"Continuous Positive Airway Pressure in the Treatment of Pediatric High Altitude Pulmonary Edema: A Case Study","authors":"Ryan Hodnick, Michael L. Cohen, Joseph B. Loehner, Jennifer Mazzanti","doi":"10.1177/10806032231222003","DOIUrl":"https://doi.org/10.1177/10806032231222003","url":null,"abstract":"Treatment of high altitude pulmonary edema (HAPE) can be challenging and is further complicated in the pediatric patient in the prehospital environment. The following case presents a decompensating pediatric patient with HAPE in the prehospital aeromedical environment. It illustrates the potential benefit of continuous positive airway pressure (CPAP) as a treatment modality in the treatment of HAPE.","PeriodicalId":431977,"journal":{"name":"Wilderness & Environmental Medicine","volume":" 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139627187","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 : 2024-01-09DOI: 10.1177/10806032231222373
Jeremy R. Hardin, Emi Suzuki, Justin A. Seltzer, Raymond T. Suhandynata, Mamata Sivagnanam, Daniel R. Lasoff
Hand warmer packets are common products used to provide a portable, nonflammable heat source via the exothermic oxidation of iron. We present the first reported case of pediatric hand warmer packet ingestion in a three-year-old male who developed an elevated serum iron concentration (peak 335 ug/dL) and gastrointestinal injury after ingesting the contents of a HOTHANDS hand warmer packet. He was treated with endoscopic gastric foreign body removal and lavage, as well as proton-pump inhibitors and whole bowel irrigation. Hand warmer packs contain reduced elemental iron powder, which has been shown to have a more favorable safety profile when compared to iron salts. The mechanism of toxicity for reduced iron is unknown, though it is thought to be due to conversion to more toxic iron ions in an acidic environment. While the current adult literature suggests that ingestion of a single hand warmer packet is without significant risk, our case demonstrates that even a partial ingestion carries a significant risk of both iron toxicity and direct gastrointestinal caustic injury in a young child. This case demonstrates the need for multidisciplinary care and consideration of urgent endoscopic foreign body removal and gastric lavage followed by whole bowel irrigation to mitigate the potential of severe iron toxicity.
{"title":"Oral Ingestion of an Iron-Containing Hand Warmer in a Pediatric Patient","authors":"Jeremy R. Hardin, Emi Suzuki, Justin A. Seltzer, Raymond T. Suhandynata, Mamata Sivagnanam, Daniel R. Lasoff","doi":"10.1177/10806032231222373","DOIUrl":"https://doi.org/10.1177/10806032231222373","url":null,"abstract":"Hand warmer packets are common products used to provide a portable, nonflammable heat source via the exothermic oxidation of iron. We present the first reported case of pediatric hand warmer packet ingestion in a three-year-old male who developed an elevated serum iron concentration (peak 335 ug/dL) and gastrointestinal injury after ingesting the contents of a HOTHANDS hand warmer packet. He was treated with endoscopic gastric foreign body removal and lavage, as well as proton-pump inhibitors and whole bowel irrigation. Hand warmer packs contain reduced elemental iron powder, which has been shown to have a more favorable safety profile when compared to iron salts. The mechanism of toxicity for reduced iron is unknown, though it is thought to be due to conversion to more toxic iron ions in an acidic environment. While the current adult literature suggests that ingestion of a single hand warmer packet is without significant risk, our case demonstrates that even a partial ingestion carries a significant risk of both iron toxicity and direct gastrointestinal caustic injury in a young child. This case demonstrates the need for multidisciplinary care and consideration of urgent endoscopic foreign body removal and gastric lavage followed by whole bowel irrigation to mitigate the potential of severe iron toxicity.","PeriodicalId":431977,"journal":{"name":"Wilderness & Environmental Medicine","volume":"41 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139442369","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 : 2024-01-09DOI: 10.1177/10806032231222375
Michael Fischer, Michelle Storkan
{"title":"In Response to “Intranasal Fentanyl for On-the-Hill Analgesia by Ski Patrol”","authors":"Michael Fischer, Michelle Storkan","doi":"10.1177/10806032231222375","DOIUrl":"https://doi.org/10.1177/10806032231222375","url":null,"abstract":"","PeriodicalId":431977,"journal":{"name":"Wilderness & Environmental Medicine","volume":"46 48","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139442196","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 : 2024-01-09DOI: 10.1177/10806032231222474
Sarper Yılmaz, A. C. Tatliparmak, Rohat Ak
{"title":"START-A (Simple Triage, Rapid Treatment and Analgesia) in Mass Casualty Incidents","authors":"Sarper Yılmaz, A. C. Tatliparmak, Rohat Ak","doi":"10.1177/10806032231222474","DOIUrl":"https://doi.org/10.1177/10806032231222474","url":null,"abstract":"","PeriodicalId":431977,"journal":{"name":"Wilderness & Environmental Medicine","volume":"31 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139442933","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 : 2023-12-21DOI: 10.1177/10806032231220394
Lindsey L. Fell, Emily E. Johnston, Thomas DeLoughery
{"title":"In Reply to Dr Allen","authors":"Lindsey L. Fell, Emily E. Johnston, Thomas DeLoughery","doi":"10.1177/10806032231220394","DOIUrl":"https://doi.org/10.1177/10806032231220394","url":null,"abstract":"","PeriodicalId":431977,"journal":{"name":"Wilderness & Environmental Medicine","volume":"53 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138950905","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 : 2023-12-20DOI: 10.1177/10806032231217964
Alexandre Moser, Luca Cioccari, Sylvain Tosetti
{"title":"In reply to Dr Mohanty et al","authors":"Alexandre Moser, Luca Cioccari, Sylvain Tosetti","doi":"10.1177/10806032231217964","DOIUrl":"https://doi.org/10.1177/10806032231217964","url":null,"abstract":"","PeriodicalId":431977,"journal":{"name":"Wilderness & Environmental Medicine","volume":"112 39","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138958587","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}
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