Wilderness & Environmental Medicine最新文献

Lyme carditis, primarily caused by Borrelia burgdorferi, affects 1 to 10% of patients with untreated Lyme disease. This study reviewed 3 cases of Lyme carditis that presented to a tertiary hospital's emergency department in the northeastern United States during the summer months. The cases involved patients with varying degrees of atrioventricular (AV) block: first-degree, second-degree Type 2, and complete heart block. Case 1 involved a 19-y-old male presenting with syncope and diagnosed with first-degree AV block. He received intravenous (IV) ceftriaxone, resulting in resolution of the AV block. Case 2 was a 22-y-old male who experienced an unresponsive episode with bystander chest compressions. He had discrete erythematous patches and was diagnosed with Type 2 second-degree AV block. IV ceftriaxone followed by doxycycline resolved his condition without further incident. Case 3 described a 32-y-old male with lightheadedness and syncope, diagnosed with complete heart block. A temporary pacing lead and IV ceftriaxone were employed, transitioning to doxycycline, which effectively resolved the heart block. All three patients tested positive for Lyme antibodies with reflex Western blot. Lyme carditis presents variably, often without a clear history of tick exposure or erythema migrans. Prompt recognition and treatment in endemic areas are critical to prevent implantation of unnecessary permanent pacemakers. This paper underscores the importance of high clinical suspicion and reviews appropriate management in the emergency department setting for patients with potential Lyme carditis presenting with unexplained cardiac symptoms.

Those with an interest in the history of mountaineering are aware of the visionary achievement of the first ascent of the West Ridge of Everest-and first traverse of the mountain-by Tom Hornbein and Willi Unsoeld during the 1963 American Mount Everest expedition led by Norman Dyrunfurth. In many respects, this climb defined Hornbein (1930-2023) in the eyes of the international mountaineering community. One aspect of his career in high altitude mountaineering that also reflected his professional interests has received scant attention. This largely overlooked contribution was that of the design and development, in the years and months leading up to the American expedition to Everest, of a more capable and comfortable mask for use with an open-circuit supplemental oxygen system. The primary intent of this paper was to relate the story of what came to be known as the Maytag mask, but the authors also provide a brief backdrop to Hornbein's life and times to give perspective to his endeavors in the valleys as well as on the peaks.

Climate change presents a multifaceted challenge with profound implications across various sectors, necessitating a comprehensive response from educational institutions. This study aims to investigate the perspectives of graduate and professional students at The Ohio State University (OSU) regarding sustainability education within their curriculum and the impact of educational symposiums related to sustainability and climate change. Utilizing a questionnaire at an interprofessional sustainability-focused event, we gathered insights into students' viewpoints on climate change and sustainability, identified potential gaps in integrating these topics into higher education, and observed the role of topic-focused seminars in educational settings. Thirty-six graduate and professional students completed a 28-item questionnaire related to sustainability and climate education after a sustainability-focused event. Only 25% of students felt their academic program offered adequate engagement with climate change, and over 70% of students were either unaware of or did not believe that their specific programs' learning objectives included content related to sustainability and climate. Additionally, 47% did not feel adequately prepared to effectively navigate sustainability-related challenges within their profession. After the event, 94% of students felt that more interprofessional events are needed to better educate students on the effects of climate change on their respective careers. Additionally, 94% of students reported feeling more confident about integrating sustainability into their future professions and felt inspired to lead workshops or webinars of their own. This study highlights the pressing need for enhanced integration of sustainability and climate change education within graduate and professional curricula at academic institutions, while underscoring the importance of interdisciplinary collaboration and the role of large-scale educational events in fostering students' understanding and engagement with climate-related topics.

BackgroundThe Diploma in Mountain Medicine (DiMM) is an educational program designed to enable healthcare professionals to adapt their practice to the mountain environment. The purpose and nature of student assessment are not explained in the regulations. Understanding the intentions of the administrators who wrote the assessment regulations would enable students to be assessed more consistently and in keeping with the objectives of the program.MethodThis study used qualitative methods. Interviews were used to collect the opinions of members of the DiMM program administrative group. Thematic analysis was used to identify themes in the data and to produce a narrative description concerning the purpose, nature, and challenges of assessment.ResultsThe major themes identified included the importance of using assessment to measure student progress and outcome, the intention to assess competency, the importance of standardization in assessment, and the identification of core knowledge and skills. The need to be sensitive to cultural differences in education was a complex issue that limited the development of learning outcomes and the definition of a level of learning for the program.ConclusionsThere is variation in the content, level of learning, and outcomes assessed on DiMM courses. Cultural and educational diversity of the courses were complex issues that confounded consistent student assessment. In the future, clear statements about the aims of assessment, the academic level of study, and the content of learning would enhance the educational rigor and value of the program. The use of consensus methodology would be beneficial in achieving these objectives.

IntroductionA multifaceted approach to wilderness medicine education and training is necessary to provide a high-quality learning experience, often requiring innovative instructional techniques. Using volunteers to act as patients in medical education is a well-established practice that helps teach crucial skills. However, more is needed to know if there is potential knowledge acquisition through participation. This study examined the educational benefits for medical students serving as a simulated patient (SP), hypothesizing that these individuals will improve self-assessed knowledge and confidence and demonstrate improved performance of injury-management skills while participating in a medical education course.MethodsA descriptive feasibility pilot study was conducted with 10 SPs to assess knowledge and skill acquisition. Study participants were evaluated before and after participating as an SP in 2 scenarios involving hemorrhage control and wrist injury assessment and management, with a subjective confidence survey and an objective skill and knowledge demonstration, as measured by a critical action checklist.ResultsThe subjects all reported self-assessed knowledge improvement from the pre- to postintervention survey, with an average increase of 17 points. They also demonstrated improved objective skill and knowledge demonstration, with an average increase of 4.6 points for the wrist injury scenario and 2.5 points for the hemorrhage control scenario.ConclusionsThis study demonstrated that volunteer medical students acting as SPs in a medical training course passively acquire knowledge and improve their medical skills and self-perceived confidence. The findings contribute to a broader understanding of medical education, suggesting that participating as SPs offers educational benefits. The results encourage consideration of simulated patient roles as a valuable adjunct to medical education, warranting further scholarly exploration to substantiate and expand on these preliminary findings.

IntroductionMembers of the military are regularly exposed to austere environmental conditions that may create clothing saturation in cold conditions. This study sought to determine whether immediate ruck initiation is superior in maintaining rectal temperature (T_re), improving skin temperatures, and augmenting thermal comfort compared with remaining static and/or delayed ruck initiation when wet in cold air.MethodsEleven healthy adults (10 males and 1 female, 26±9 y old, 22.5±8.6% body fat) participated in this study. Volunteers were immersed in warm water (34.0±0.3°C) before entering the cold chamber (5.3±0.4°C) and began immediately rucking (IR) or stood statically for 60 min (Static) before rucking (delayed rucking [DR]) for 60 min.ResultsIR initiation was superior in elevating T_re compared with Static at 20 min (37.6±0.4 vs 37.3±0.2°C, P=0.033), 40 min (37.9±0.4 vs 37.5±0.2°C, P=0.012), and 60 min (37.9±0.4 vs 37.6±0.3°C, P=0.016). IR T_re was also greater than DR at 40 min (37.9±0.4 vs 37.4±0.5°C, P=0.002) and 60 min of wet-cold exposure (37.9±0.4 vs 37.5±0.5°C, P<0.001). Consequently, IR tended to improve thermal sensation ratings compared with both DR and Static. Yet, IR was no more sufficient in overcoming wet-cold decrements in skin temperatures than Static, especially at the finger (P>0.05).ConclusionsCompared with DR and Static, IR is effective at elevating deep body temperature and improving thermal perceptions but is significantly less effective at improving wet-cold skin temperatures compared with Static.

IntroductionDrowning is a global public health concern, with over 300,000 deaths annually. In Japan, approximately 700 drowning-related fatalities occur each year, increasingly involving older adults during marine leisure activities. However, limited data are available on the clinical characteristics of such incidents at tourist destinations. This study describes the characteristics and outcomes of drowning-related out-of-hospital cardiac arrest (OHCA) cases on a remote tourist island in Japan.MethodsThis retrospective, single-center descriptive case series reviewed OHCA cases due to drowning at Yaeyama Hospital between June 2021 and December 2023. Patient demographics, incident details, and outcomes were collected. Key variables included age, type of activities, bystander cardiopulmonary resuscitation (CPR), instructor presence, time to hospital arrival, and neurological outcomes based on the Cerebral Performance Category (CPC) scale.ResultsAmong 31 OHCA cases, 90% (28 cases) involved tourists. The median age was 50 years, with most incidents related to snorkeling (10 cases) or scuba diving (9 cases). Bystander CPR was performed in 14 cases; 7 patients achieved return of spontaneous circulation. Instructors were present in 9 adult cases; however, whether they performed CPR could not be confirmed. At discharge, one adult had a CPC score of 1, and one had CPC 4. All 5 pediatric patients had CPC 1. The mean time from incident recognition to hospital arrival was 52 min.ConclusionThis case series highlights demographic and situational patterns in drowning-related OHCA during marine activities. Further research is needed to identify risk factors and improve prevention strategies in resource-limited island settings.

This case report describes a unique incident involving a boar attack in a wilderness setting, resulting in a traumatic knee arthrotomy in a pediatric patient. The patient presented to the emergency department with a laceration caused by a wild boar attack while hunting. Initial assessment revealed a deep laceration over his anterior knee and radiographs demonstrated significant air within the knee joint, consistent with a traumatic knee arthrotomy. The patient was placed on empiric, broad-spectrum antibiotics and underwent urgent surgical irrigation and debridement. Intraoperative cultures were sent, and infectious disease was consulted. Intraoperative cultures obtained grew Aspergillus and Stenotrophomonas maltophilia, although the Aspergillus was ultimately thought to be a contaminant. The patient was then placed on sulfamethoxazole-trimethoprim (SMX-TMP) for targeted antibiotic treatment. The patient responded well to the treatment regimen, with no signs of infection or further complications. Follow-up examinations have demonstrated full, painless knee range of motion and no adverse postoperative events. This case demonstrates a rare but significant injury in a pediatric patient secondary to a wild boar attack. Furthermore, though a systematic review was not conducted, no similar cases were identified in the available literature describing these bacterial isolates from a wild boar tusk within a traumatic arthrotomy. These findings may assist orthopedic surgeons, emergency physicians, and infectious disease specialists in antibiotic selection when these injuries are encountered to prevent subsequent complications.

IntroductionSearch and rescue (SAR) personnel in the United States are mostly volunteers, many of whom work in nonmedical professions. Because SAR volunteers respond to missions intermittently, their opportunities to provide patient care and maintain medical skills are limited, highlighting the need for ongoing training. This study explored the effect of high-fidelity simulation training on the medical skill comfort level of SAR volunteers.MethodTwenty SAR volunteers participated in high-fidelity training scenarios in an academic medical simulation center. The scenarios included care of both a trauma and a medical patient along with dedicated time to practice perishable medical skills. Participant comfort level in performing patient assessments and medical skills was measured using a 5-point Likert scale, via surveys administered before and after the simulation training.ResultsA significant increase (P<0.05) in participants' comfort level was observed across nearly all measured medical skills when comparing pre- and post-training survey responses. Participants reported the highest comfort level in obtaining vital signs and the lowest comfort level in splinting a fractured extremity. All participants stated that they would like more SAR trainings in this format in the future and that the training modality helped identify gaps in their medical skills.ConclusionsHigh-fidelity simulation training improved the comfort level of SAR volunteers in executing medical skills. For SAR volunteers with limited opportunities to provide direct patient care, simulation training showed promise as a modality for continuing medical education to improve confidence, reinforce team dynamics, and refresh skills.