Wilderness & Environmental Medicine最新文献

A man attacked by a pet zebra suffers multiple bite wounds to his right arm and generalized trauma after being dragged to the ground and pinned by the animal. He was transported to the emergency department (ED) by the local emergency medical service (EMS) with a tourniquet in place for nearly 60 min. The man's injuries included extensive soft tissue damage, an open fracture and dislocation of his right elbow, and a soft tissue injury to his right ear. His clinical course was complicated by severe necrosis of the soft tissue of the right forearm requiring transhumeral amputation just above the condyles. Ongoing infection and the development of phantom limb pain complicated his recovery.

Catfish are a highly diverse group of fish comprising more than 3500 species found in both freshwater and marine ecosystems. Upon handling, they can inflict a sting, with certain species capable of inducing significant pain and injury to the affected extremity. The prevalence of aquatic activities, such as fishing by line or manual capture ("noodling"), increases the likelihood of catfish stings, making prompt identification and treatment an important aspect of managing such encounters. A case of a presumed catfish spine injury during noodling in Tallahassee, Florida, is presented. The pectoral fin penetrated the volar aspect of the patient's right hand resulting in immediate pain and numbness. Over the course of 2 weeks, the patient developed distal ulnar neuropathy with conduction block at the wrist level. Surgical exploration revealed the ulnar nerve to be grossly intact, but the area surrounding the terminal division point of the ulnar nerve in the hand displayed infiltration by fibrous tissue that entrapped the nerve and its branches. Following surgical release of the ulnar nerve and its terminal branches from the fibrous tissue, complete resolution of distal ulnar neuropathy was achieved. In this patient's case, the absence of foreign bodies and the lack of visible nerve damage suggest that the injury to the patient's hand was largely attributable to toxin-mediated proinflammatory response and fibrosis.

When dealing with drowning scenarios, time is of capital importance. In this sense, the search for innovative strategies that provide more effectiveness and safety for lifesaving professionals, as well as for bathers, is essential. The aim of this study was to systematically review the feasibility and effectiveness of unmanned aerial vehicles as a tool to assist lifeguards in performing their duties. A systematic literature search was conducted in October 2023 across the databases PubMed, Web of Science, Academic Search Complete, and Scopus, using the search terms: ((drone) OR (Unmanned Aerial Vehicles)) AND ((drowning) OR (water rescue)). A total of 5 studies were included in this review, whose quality ranged from moderate to strong, according to the EPHPP Quality Assessment Tool for Quantitative Studies. The results suggest that unmanned aerial vehicles may assist lifeguards in the prevention, detection, and rescue of drowning victims and people in distress in the water. Although preliminary, evidence suggests that lifeguards would benefit from the use of unmanned aerial vehicles regarding lifeguards' and others' safety.

This case report describes the presentation and management of a patient with an isolated right sixth nerve palsy while trekking in Nepal. Consideration is made of the anatomy of the sixth nerve and the differential diagnoses afforded to this isolated sign, including high altitude cerebral edema. The case stresses the need to exclude life-threatening pathologies for any symptoms associated with altitude and includes decision-making processes on whether to monitor the patient in the field or evacuate them to a definitive care facility.

Introduction: Epidemiologic data on hunting-related injuries is sparse. Most published studies in this arena come from case reports or case series from a trauma department or state trauma registry. Relatively few of the studies have attempted to calculate rates of injury by demographic characteristics or hunting-related activities. In this study, we summarize the epidemiologic trends in hunting-related injuries in Arkansas over the last 30 years.

Methods: A descriptive analysis of hunter injury data collected by the Arkansas Game and Fish Commission from 1993 to 2022 was performed.

Results: Analyses showed that the overall number of hunting-related injuries decreased by 0.16 per 100,000 licensees per year during the study period (P=0.0009). Projectile-related injuries decreased by 0.24 per 100,000 licensees (P=0.00001), and treestand-related injuries increased by 0.06 per 100,000 licensees (P=0.02) during the same time (both trends P<0.00001). treestand-related injuries now account for two thirds of all hunting-related injuries reported to the Arkansas Game and Fish Commission. Among hunters subject to hunter education certification mandates, compliance was 48.7%.

Conclusions: Although projectile-related hunting injuries have decreased in Arkansas in the last 30 years, treestand-related hunting injuries have increased. These injuries are largely preventable if the hunter follows treestand safety recommendations (such as using a body harness and tether at all times when off the ground), as recommended by the Treestand Manufacturers of America. In addition, implementing strategies to improve compliance with hunter education certification also may help reduce injury rates.

We present an unusual case of concomitant exercise-associated hyponatremic encephalopathy (EAHE), exertional rhabdomyolysis (ER), and acute kidney injury (AKI) in a Grand Canyon hiker. Our case patient, an adult 41-year-old male, consumed an excessive amount of water during his descent into the Canyon during hot weather. The next day, he was unable to hike out due to severe leg pain and disorientation, and ultimately evacuated by helicopter, having a grand mal seizure in flight. Despite having no serum sodium level, medics administered an intravenous (IV) bolus of 3% hypertonic saline (HTS) before transporting him to the hospital. There, he was diagnosed with EAHE (serum sodium, 114 mmol⋅L^-1), ER, bilateral compartment syndromes, and mild AKI. The life-threatening EAHE was immediately corrected with more IV HTS, the limb-threatening compartment syndromes by surgical fasciotomies, and eventually, the AKI by oral and IV fluids. This case demonstrates the seriousness of overconsumption of water, as well as the potential complications of muscle damage when a deconditioned person does prolonged, strenuous exercise. Furthermore, it also illustrates the importance of considering EAHE within the differential diagnosis for acute alterations in level of consciousness. Lastly, it shows the importance to prioritize patient treatments for conditions that are an immediate threat to life or limb.

Introduction: The North Shore Rescue (NSR) Advanced Medical Provider (AMP) program is composed of physicians and nurses based in North Vancouver who attend high acuity medical search and rescue (SAR) callouts in British Columbia, Canada. This study aimed to analyze the medical care provided by AMPs with appropriate comparisons to non-AMP callouts.

Methods: A retrospective review of all NSR callouts from January 1, 2018, to December 31, 2022, was conducted. The analysis included AMP involvement, rescue logistics, subject demographics, activity, primary cause, provisional diagnosis, treatments, medical decision-making, and extraction means. National Advisory Committee for Aeronautics (NACA) scores were assigned by physicians to evaluate medical acuity as well as under-triage and over-triage.

Results: Of the 767 NSR callouts over the 5-year span, 283 (37%) were medical, and of these, 35% (n = 99) involved AMPs. Seventy-five percent of AMP rescues involved traumatic injuries, and 31% involved nontraumatic medical illnesses. The mean NACA score for AMP callouts was significantly higher than non-AMP callouts (3.1 ± 1.3 vs 1.9 ± 1.3, p < .00001). Medications were administered in 40% of AMP rescues, procedures were performed in 54%, and 37% involved advanced medical decision-making. Over-triage occurred in 33% of AMP callouts, with under-triage in 10%.

Conclusions: The AMP program provides a useful service when advanced medical care in wilderness environments is needed. AMPs coordinate appropriate medical response and ensure safe, comfortable, and efficient transport to definitive care. The NSR AMP program may act as a model for the development of similar programs by other SAR teams.

Introduction: Individuals ascending to elevations above 2500 m are at risk of developing altitude illness. We sought to establish the incidence and to determine what risk factors, if any, increased the likelihood of developing acute mountain sickness (AMS) in adolescents at Philmont Scout Ranch (PSR) in Cimarron, New Mexico. PSR, with elevations ranging from 2011 to 3792 m, attracts thousands of adolescent participants each year, many of whom arrive from lower elevations with little or no experience ascending to high altitude.

Methods: We conducted a prospective observational study of adolescent participants aged 14 to 19 years who ascended to a minimum of 3000 m while trekking from June to July 2021. Prior to the start of each participant's trek, pretrek survey data were obtained at PSR's basecamp (2011 m). During the trek at 3048 m, the Lake Louise AMS score was used to diagnose AMS.

Results: The incidence of AMS in our study was 13.7%. Participants reporting a history of daily headaches had more than four times the risk of developing AMS. A history of gastrointestinal problems carried three times the risk of developing AMS, and a prior history of AMS increased the risk of developing AMS by 44%.

Conclusions: Our findings enhance our understanding of AMS risk in adolescents and may provide guidance to youth for developing AMS. For individuals with a history of headaches or gastrointestinal problems or a prior history of AMS, there may be an opportunity to reduce the risk of developing AMS.