Wilderness & Environmental Medicine最新文献

IntroductionPhysicians frequently take on leadership roles in many different healthcare teams and settings. Developing such leadership skills as situational control, resource utilization, and conflict management is a vital part of medical education. Wilderness medicine focuses on the delivery of care in remote environments where situations are often tenuous, resources are scarce, and effective leadership and teamwork are essential. Wilderness medicine education during medical school may provide tools and knowledge to improve leadership ability. This study evaluated the perceived effect of a 1-mo wilderness medicine elective on medical students' leadership skills.MethodsFourth year medical students taking a 1-mo wilderness medicine elective between 2019 and 2023 were asked to take pre- and postcourse surveys evaluating their perceptions of their leadership skills. A different group of students taking an art of medicine through the humanities elective were used as a control group. The results were evaluated for pre- and postsurvey differences as well as between-group differences.Results and ConclusionsSeveral pre- and post-course survey questions aimed at assessing perceived skill improvement in situational control, resource utilization, and conflict management showed statistically significant differences in the students taking the wilderness medicine elective, whereas this was not found in the control group. This suggests that students taking the wilderness medicine course perceived an improvement in their leadership skills after participating in a wilderness medicine course, whereas students taking the art of medicine through the humanities course did not perceive this improvement. This suggests that wilderness medicine education can provide value to medical student education.

Avalanche burial occasionally precipitates pulmonary edema, yet its pathogenesis remains poorly understood. Two male back-country skiers (aged 39 and 53 years) were completely buried for 30 min and 20 min, respectively, by the same avalanche, and immobilized in a right-lateral posture without safety devices. They arrived 2 h post-extrication, conscious but hypothermic (32.4 °C and 34.2 °C, respectively), tachycardic, tachypneic, and hypoxemic (SpO₂ 88% and 83%, respectively). Chest radiography and computed tomography demonstrated extensive infiltrates or ground-glass opacities confined predominantly to the gravity-dependent right lung and no cardiomegaly. C-reactive protein and N-terminal pro-B-type natriuretic peptide values were within normal limits, and transthoracic echocardiography showed preserved biventricular function. Low-flow oxygen and passive rewarming corrected hypoxia and hypothermia; the pulmonary infiltrates resolved within 24 h, permitting discharge without sequelae. Classical mechanisms, such as negative-pressure pulmonary edema from airway obstruction, hypoxia-induced left ventricular failure, and edema secondary to regional hypoxic pulmonary vasoconstriction, do not fully explain the unilateral dependent pattern observed. We propose that excessive sympathetic nervous system activation and fluid distribution changes caused by extreme emotional stress, cold exposure, systemic hypoxia, whole-body compression by snow, and head-down posture led to an excessive cardiac load increase, resulting in gravity-enhanced cardiogenic edema despite normal intrinsic cardiac function. These cases suggest a previously unrecognized hemodynamic pathway for avalanche-related pulmonary edema. Awareness of cardiac overload as a potential contributor may refine field triage and postrescue management. Additional clinical and experimental studies are warranted to validate this hypothesis and inform preventive strategies.

IntroductionThe primary objective of this study was to assess cardiovascular risk among members of the Bulgarian Antarctic expedition and identify strategies for risk reduction. The combination of intense physical and psychological stress, prolonged cold exposure, isolation, and challenging travel conditions contributes to an increased risk of cardiovascular disease, especially given the participants' mature age, which is a key factor in greater cardiovascular disease susceptibility.MethodsThis research included 29 participants (23 males and 6 females) with average ages of 43.0±8.00 y for the males and 45.5±11.31 y for the females. All participants spent 30 d in Antarctica. They were subjected to comprehensive assessments, including anthropometric measurements, physiologic evaluations, and biochemical analyses both before departure and shortly after return. The updated SCORE2 algorithm following the European guidelines was used to estimate the 10-y cardiovascular event risk, which factored in age, blood pressure, lipid profile, and smoking status. All participants underwent the veloergometer stress test under electrocardiographic control twice, before and after the expedition.ResultsThe results indicated that while most participants fell into the moderate-risk category, some of them exhibited elevated-risk profiles, primarily influenced by obesity, cholesterol levels, systolic blood pressure, and serum ferritin levels. No critical cardiovascular events were reported during the expedition.ConclusionThis study highlights the importance of pre-expedition screening, including the conduct of an exercise stress test, targeted risk-factor management, and continuous monitoring for safeguarding the health and physiologic resilience of Antarctic expedition participants, ultimately underscoring the feasibility and necessity of cardiovascular prevention strategies in extreme environments.

We describe full neurologic recovery from an out-of-hospital cardiac arrest with a prolonged arrest time (35 min) and prehospital interval (12 h) from the Antarctic continent after the use of standard advanced cardiac life support (ACLS) protocols and thrombolytic therapy. A 61-year-old male had a witnessed collapse in the dining facility at McMurdo Station, Antarctica, resulting in prompt activation of emergency services. The responding firefighter team found the patient in ventricular fibrillation and administered defibrillations. After the defibrillations, the responding team transported the patient to the base clinic. Clinic staff in the resuscitation bay achieved return of spontaneous circulation (ROSC) after successful defibrillation and medication administration. The postarrest electrocardiogram (EKG) showed that an anterior ST-elevation myocardial infarction was the cause of the ventricular fibrillation. Clinic staff administered tenecteplase, and the patient was prepared for transport to New Zealand. The patient was transported aboard an LC-130 aircraft with a transport time of 7 h. The total time from cardiac arrest to arrival at the receiving hospital was 12 h. On arrival to definitive care, the patient underwent percutaneous coronary intervention revealing 100% occlusion of the left anterior descending artery. The vessel was opened and 2 drug-eluting stents were placed. Remarkably, the patient survived the arrest completely neurologically intact. This case highlights the effectiveness of the current ACLS algorithms and chain of survival despite austere locales and long transport times.

This case series aimed to observe the impact of a single-stage ultramarathon (50-100 km) on gastrointestinal integrity, systemic immune responses, and exercise-associated gastrointestinal symptoms in 3 adolescent (aged 12-15 y) competitors. Body mass, venous and finger-prick blood samples and fecal samples were taken before and after the race for analysis of exercise-induced body mass loss, plasma osmolality, plasma intestinal fatty acid binding protein, soluble CD14, and C-reactive protein, total and differential leukocyte counts, and fecal bacterial alpha-diversity. Gastrointestinal symptom incidence were recorded before, during, immediately after, and 24 h after the race. Food and fluid intake were recorded for the 48 h before the race and each hour during the race. Body mass decreased in Youth 1 (-0.4%) and Youth 3 (-0.9%) and increased in Youth 2 (+0.5%) from before to after the race. No youth competitor met carbohydrate intake recommendations in the lead-up to (2.8-5.1 g·kg^-1·d^-1) or during the race (24-26 g·h^-1). Pre- to post-race plasma intestinal fatty acid binding protein and C-reactive protein concentrations increased in the youth competitors, but was of no clinical significance (≤657 pg·mL^-1 and ≤3.36 micrograms·mL^-1, respectively). A pre- to postrace change in plasma soluble CD14 of clinical relevance was observed in Youth 3 (1.5 micrograms·mL^-1), but not Youth 1 (-0.1 micrograms·mL^-1). Total and differential leukocyte counts increased beyond the normal reference range in Youth 1 and Youth 2, but not Youth 3. The incidence and severity of gastrointestinal symptoms were low at all timepoints in the competitors. Large intra- and interindividual responses to ultramarathon events observed in this case series suggest that adolescent ultramarathon runners require individually tailored nutrition support.

First aid recommendations for burn injuries are not standardized around the world, and there exist a variety of conflicting guidelines. We discuss the rationale of implementing 20 min of cool running water (20CRW) within 3 h of burn injury as standard burn first aid. Animal models and human data in both adults and children have shown that 20CRW is optimal in reducing scar tissue formation and improving tissue reepithelialization. 20CRW within 3 h of injury can be implemented in urban, rural, and wilderness settings with minimal equipment or training, although some austere environments may pose challenges. We advocate incorporating 20CRW as a standard component of burn first aid, first-responder protocols, and wilderness medical training curricula wherever feasible.

IntroductionPelvic fractures pose a significant treatment challenge in the prehospital environment, often resulting from high-energy trauma and concurrently presenting with life-threatening hemorrhage necessitating immediate intervention. Commercial pelvic binders such as the Structural Aluminum Malleable (SAM) Pelvic Sling II have become commonplace in prehospital care, especially in military medicine. However, given limitations to carried equipment and the scarcity of pelvic fractures, medics in austere conditions may opt to carry just one or even no commercial pelvic binders.ObjectiveThis study explored an innovative approach using 2 Combat Application Tourniquet II (CAT II) devices tandemly connected to stabilize pelvic fractures. The primary aim was to assess whether this technique will generate comparable intrapelvic pressure to the SAM Pelvic Sling II.MethodsThis study employed a human cadaveric model for which pelvic fractures were surgically created to generate an open-book fracture. Intrapelvic pressure was measured via a Foley catheter. The SAM Pelvic Sling II was applied in standard fashion 3 times, each with intrapelvic pressure recorded. Similarly, 2 CAT IIs were applied in tandem to the pelvis 3 times to generate 3 pressure measurements.ResultsThere was a small yet statistically significant increase in intrapelvic pressure generated by the CAT II method than by the traditional method.ConclusionThe use of 2 CAT II devices connected in the fashion described in this study appears to offer a potentially feasible and effective alternative for stabilizing pelvic fractures. Yet, further investigation is required before this concept is ever applied to real patients.

IntroductionThe Mars Interventional Tool Box (MITBO) technique, a simplified drainage procedure using point-of-care ultrasound, provides a versatile solution for use in resource-limited environments, such as space missions and remote terrestrial regions. This study aims to evaluate the safety and feasibility of the MITBO technique in a clinical setting.MethodsWe conducted a retrospective analysis of 111 patients who underwent ultrasound-guided abdominal drainage using the MITBO technique between August 2022 and February 2023. The study included patients with abdominal collections (eg, intra-abdominal abscesses, gallbladder infections) as well as retroperitoneal procedures such as nephrostomies. Fluoroscopic or CT-guided cases were excluded. Feasibility was determined by the successful placement of drains under ultrasound guidance alone. Safety was assessed by documenting complications.ResultsThe overall technical success rate was 97%, with 3 cases of failure: 1 due to patient non-cooperation and 2 because of non-visualization of the collections. The complication rate was 4.5% (n = 5), all of which were minor. No major complications, such as hemorrhage or infection, were observed. Nephrostomies, accounting for 4% of the procedures, were performed exclusively by senior radiologists with 100% success.ConclusionThe MITBO technique demonstrated high success rates and a low complication profile, consistent with previous reports on standard drainage techniques. The standardized procedure is a promising alternative in environments where advanced imaging is unavailable. However, the limited sample size, especially for complex cases, and the exclusive performance of nephrostomies by experienced operators suggest the need for further studies to generalize these findings.