Wilderness & Environmental Medicine最新文献

A 57-y-old sailor (Patient S) with a history of chronic lymphocytic leukemia departed from Hawaii on his sailboat. On the morning of his departure, he sustained a small laceration to his right foot while walking on the beach. During the next 1-2 d, this laceration became superficially infected. Four days after setting sail, a rogue wave hit the boat in bad weather, splitting the mainsail and damaging the ship's communication equipment. Over the next 3 d, Patient S experienced worsening of his wound infection to the point that by Day 7, when George Washington Maritime Medical Access was contacted to initiate medical management, Patient S had developed a full-fledged necrotizing fasciitis in his right lower extremity. Despite attempts to treat the infection while at sea, Patient S eventually required a complex medical evacuation from the middle of the Pacific Ocean.

IntroductionLimited evidence exists to guide travelers about blood pressure (BP) changes at high altitude (HA). Our primary objective compared 24-h ambulatory BP at low altitude (LA) vs HA in a cohort of tourists. Exploratory analyses compared results by sex and history of underlying hypertension.MethodsThis prospective observational cohort study measured ambulatory BP with Welch-Allyn ABPM 6100 monitors at LA (<1000 m) and HA (median 2751 m). Measurements included heart rate/BP every 30 min while awake and hourly overnight, BP≥180/100 mm Hg, sleep quality, and Lake Louise score (acute mountain sickness).ResultsAmong 33 participants (median age 61 y, 17 with hypertension, 12 on BP medication), 25 completed LA and HA measurements. Average 24-h mean arterial pressure (MAP) increased at HA by 6 mm Hg (95% CI, 2-10 mm Hg; P=0.04). When analyzed by the presence of preexisting hypertension, 24-h MAP was similar between LA and HA in those with underlying hypertension (mean difference, 4 mm Hg; 95% CI, -4 to 11 mm Hg; P=0.3) but rose at HA in those without (mean difference, 9 mm Hg; 95% CI, 5-14 mm Hg; P=0.001). At HA, 24-h MAP was similar in both groups (mean difference, 9 mm Hg; 95% CI, 0-19 mm Hg; P=0.05). Results did not differ by sex. Severe-range BP was common in all groups and asymptomatic.ConclusionsAmong this tourist cohort, we observed an increase in average 24-h MAP at HA. Altitude-related changes in BP varied greatly between individuals. This variation was related in part to underlying hypertension but not sex. Our data suggest that BP changes are not of clinical concern in HA travelers.

IntroductionA key objective of the NASA Artemis program is to establish a sustained human presence on the Moon, along with its international and commercial partners. NASA aims to establish a lunar economy, increasing the need for infrastructure to support human habitation and facilitate growth. In-space manufacturing (ISM) coupled with in situ resource utilization (ISRU) can reduce launch mass and reduce the dependency on Earth resupply for long-term habitation, enabling rapid expansion. However, the space environment introduces unique challenges compared to Earth, such as the absence of an atmosphere, reduced gravity levels, and high consequences of human-machine interactions given the barrier to evacuating an astronaut injured in a manufacturing accident on the Moon, necessitating new safety standards for ISM processes.MethodsThis study proposes the application of a modified analytical hierarchy process (AHP) to identify high-risk aspects of crew procedures in molten regolith electrolysis (MRE) for both Earth-based analog testing and lunar production.ResultsThe modified AHP assists in pinpointing areas needing hazard mitigation to protect crew members, enabling the improvement of safety standards for MRE in both environments.ConclusionFindings will inform the development of robust safety protocols for ISM, crucial for the success of NASA's Artemis missions and the broader goal of sustained human presence on the Moon and Mars.

The Department of Defense has a long history of supporting the National Aeronautics and Space Administration's (NASA) crewed missions to space. This includes the recently launched Artemis I, part of the mission that intends to send humans back to the Moon after more than 50 years. Rescue and recovery of astronauts upon splashing down at sea present logistical challenges and may exacerbate specific health concerns related to space travel and extended time spent in microgravity environments. In this article, we explore the evolution of the collaboration between the Department of Defense and NASA, and we describe the role of the US military in supporting NASA as it seeks to send humans to the Moon and beyond.

IntroductionIt is estimated that up to 94.5% of the adult population has received at least 1 Hymenoptera sting in their lifetime, which includes stings from bees, hornets, yellow jackets, or wasps. This study describes the epidemiology of oropharyngeal stings due to bees, hornets, yellow jackets, and wasps in the United States between 2004 and 2023.MethodsThis study used data from the National Electronic Injury Surveillance System to describe patients with stings who presented to US hospitals for treatment. It then contextualized these findings through a scoping review of case reports of oropharyngeal stings published on Scopus and PubMed, with particular attention to the hospital disposition of cases.ResultsThe National Electronic Injury Surveillance System analysis found that an estimated 5% of all stings involved the oropharyngeal region. The rate of oropharyngeal stings has varied over time, and an estimated 2% of victims were admitted to the hospital for any reason. This finding stands in contrast to the review of case reports, in which 64% of victims were hospitalized.ConclusionsOropharyngeal stings present a unique risk of airway compromise and merit conservative treatment, which may include hospitalization.

IntroductionAccidental hypothermia increases mortality in patients with traumatic injury, making hypothermia management essential in prehospital trauma care. Chemical heat blankets are commonly used for this purpose. These blankets require time to get warm, with agitation often used to accelerate the exothermic reaction. Many search and rescue teams use chemical heat blankets, but optimal activation of the blankets remains uncertain. This study investigated how varying oxygen exposure durations affect the thermal performance of these blankets to guide their optimal use in search and rescue scenarios.MethodsIn room-temperature conditions, a full-body manikin was wrapped in a standardized hypothermia model, including a chemical heat blanket, and evaluated under 3 conditions: 1) no shaking, 2) shaking for 2 min, and 3) shaking for 15 min before wrapping. Thermometers were placed inside the heating panel pockets and secured in place with tape to ensure consistent measurements. Temperature data were collected over 6 h, and each scenario was performed 4 times.ResultsBlankets shaken for 2 min achieved higher initial temperatures than those not shaken, with a significant difference sustained for 88 min. Shaking for 15 min resulted in higher initial temperatures than 2-min shaking, with no long-term difference. All scenarios converged to the same temperature (36°C) after 6 h.ConclusionShaking the blanket for 2 min significantly improved early heating performance, whereas longer shaking offered minimal benefit. These findings suggest that short preparation time may be adequate in optimizing thermal delivery and reducing the time to treatment for patients with prehospital accidental hypothermia.

IntroductionWilderness medicine specializes in delivering clinical care in austere environments, far from healthcare facilities, with limited resources. There is no standardized wilderness medicine training for medical students within the United Kingdom. The aim of this research was to identify what wilderness medicine training is being delivered to undergraduate medical students in the United Kingdom to guide future educational research.MethodA scoping review following a PRISMA-ScR protocol was undertaken in the Medline and Scopus databases. This was supported by a digital survey sent to all UK university medical schools wilderness medicine interest groups to identify wilderness medicine teaching both within the curriculum and extracurricularly.ResultsOf the initial 1186 articles identified, 23 met the inclusion criteria. Seven represented practices in UK universities, and 21 represented a teaching module delivered to undergraduate students. Nineteen of the articles (91%) described faculty-delivered modules; two peer-led modules were both from UK universities. Thirty-one UK based wilderness medicine interest groups members responded to the online survey representing 13 different UK universities. All had been involved with extracurricular peer-led wilderness medicine teaching compared with 10% who received curriculum-based faculty-led teaching.ConclusionMost UK wilderness medicine training is extracurricular and peer led. Current research into this field provides excellent examples of wilderness medicine within UK medical schools but no comparisons between the methodologies for outcomes or cost efficiency. This review recommends more structured investigation to determine the optimal introduction to wilderness medicine for undergraduate medical students.

IntroductionThe outdoor recreation industry in Texas has witnessed a large growth. There are no publications about the epidemiology of outdoor recreation injury and mortality in Texas. This work analyzes the Texas Parks and Wildlife Department (TPWD) outdoor injury reports to address this gap.MethodsWe analyzed TPWD injury incident reports filed from July 2012 to April 2021. Statistical analysis included descriptive statistics, Wilcoxon Rank Sum test for continuous data, χ² analysis for categorical data, Fisher exact test for small sample cross tables, and two multivariable logistic regression models for the effects of season, activity, and location on morbidity and mortality.ResultsThere were 4882 outdoor recreational events, including injuries (n = 4401, 90.1%), mortalities (n = 124, 2.5%), and search and rescue operations (n = 357, 6.4%). The injury and mortality rates were 5.20 and 0.15 per 100 000 visits, respectively. Activities preceding injury included hiking (n = 1112, 24.3%), walking/running (n = 1078, n = 23.6%), water sports (n = 533, 11.6%), biking (n = 393, 8.6%), and climbing (n = 260, 5.7%). The most common injuries were skin-related (n = 1194, 27.1%), musculoskeletal (n = 804, 18.3%), and heat injuries (n = 393, 8.9%). Activities preceding mortality included water sports (n = 52, 42.6%) and hiking (n = 20, 16.4%). Injuries contributing to mortality included respiratory events and drowning (n = 46, 37.41%), cardiac events (n = 13, 10.5%), and heat injury (n = 9, 7.3%). Most incidents occurred in Hill Country (n = 1170, 24.01%) and Prairies and Lakes (n = 1144, 23.48%) areas.ConclusionThis study evaluates outdoor recreational injuries in the state of Texas. It uncovers and summarizes important trends that may inform the development of prevention and education efforts.

Extensor mechanism injuries and multiligamentous knee injuries are rare and typically are caused by high-energy injury mechanisms. We present a case of an active-duty military service member who sustained a patellar tendon rupture with concomitant multiligamentous knee injury due to a fall while bouldering. This case report is the first to highlight this significant injury due to bouldering, in addition to the surgical steps taken to get the patient fit for full military duty. These injuries often go undiagnosed and are incredibly important to recognize given the importance of prompt evaluation and ultimate surgical care in these scenarios.