Wilderness & Environmental Medicine最新文献

IntroductionHeadache is a hallmark symptom of chronic mountain sickness (CMS), a high altitude disease thought to be induced by excessive erythrocytosis (EE) in highlanders. Nevertheless, headache characteristics related to permanent high altitude residence remain understudied, as does the association between headache occurrence and hemoglobin concentration ([Hb]) in highlanders.MethodsA pilot cross-sectional study was conducted in La Rinconada, Peru (altitude 5100 m), over a 2-y period. During all comers' medical consultations, highlanders with no known history of chronic medical conditions (except EE/CMS) were questioned regarding headache symptoms. Headache characteristics were collected as well as clinical data and [Hb].ResultsHeadache prevalence was 61% (200 of 330 highlanders). Clinical characteristics of headache attacks (ie, location, onset, intensity, quality, and duration) were similar between highlanders with and without EE. In multivariate analysis, headache occurrence was associated with lower oxygen saturation (P<0.001), higher body mass index (P<0.001), and lower self-reported sleep duration (P<0.001) but not with [Hb] or sex.ConclusionsThe absence of a statistically significant association between headache occurrence and [Hb] questions the use of headache as a symptom reflecting EE in CMS highlanders.

This case study describes adjunctive hyperbaric oxygen treatment (HBOT) of grade 3-4 frostbite, along with vasodilators and rheological agents. The patient in this study presented with established frostbite 3 days after an 11-day walk in cold, snowy, wet conditions in Tasmania, Australia. Hyperbaric oxygen treatment in this case seemed to reduce the penumbra of ischemia in both feet and thus possibly reduced the level of joint amputation in the toes. If available, HBOT is an adjuvant option for the treatment of frostbite, along with the more established treatments. More studies, however, are required to establish the best protocol for the use of HBOT in this circumstance, as this is currently unknown.

Introduction-Wilderness medical education for medical students is generally intended for senior medical students during their clinical years. Several universities have established elective rotations for clinical students or longitudinal 4-y tracks, but these opportunities are frequently restricted to a limited number of students. This novel program sought to fill a deficit of wilderness medicine curricula for preclinical medical students by creating a longitudinal course over one academic year.Methods-This curriculum includes a certification series of didactic lectures on core wilderness medical topics interspersed with hands-on skills sessions and simulated patient scenarios led by emergency medicine-trained faculty. Established medical education strategies were employed to improve learning, including spacing, interleaving, gamification, review quizzes, and frequent low-stakes assessments.Results-During the first 3 y of this innovative teaching method, 48 preclinical students completed all components of the course, with another 20 students in progress for this academic year. Postintervention surveys have yielded positive feedback, with students reporting improved confidence on patient assessment, increased wilderness medical knowledge, and the acquisition of procedural skills.Conclusions-Implementing a 1-y longitudinal wilderness medicine curriculum for preclinical medical students allows learners to gain valuable skills while building their confidence to assess and treat patients in a wilderness environment. The curriculum can be designed to incorporate best practices in medical education and adapted to a variety of practice situations and learners.

The use of potassium chlorate and other chlorates from the nineteenth century until the present is reviewed with an emphasis on use at high altitude. Chlorates that undergo high-temperature thermal decomposition are a source of supplemental oxygen for inhalation. The oral uses of potassium chlorate on mountaineering expeditions have ranged from simple lozenges for pharyngitis to the erroneous idea that oral ingestion could provide supplemental oxygen and prevent or treat mountain sickness. Furthermore, today's aircraft and spacecraft still employ chlorates and perchlorates to produce emergency supplemental oxygen for inhalation.

High altitude travel can lead to high altitude retinopathy (HAR), characterized by retinal vascular dilatation, edema, and hemorrhage, particularly in young, physically active individuals with poor acclimatization. Although it is usually asymptomatic unless it affects the macula of the eye, it sometimes may lead to permanent vision loss. This report discusses a 31-year-old Belgian male at Everest Base Camp who developed scotoma in his right eye at 5300 m. Ophthalmoscopic evaluation revealed cotton wool spots in the eye and a macular bleed in the right eye, raising the suspicion of HAR. There are no signs and symptoms suggesting acute mountain sickness or high altitude cerebral edema. After halting his ascent and descending, the patient's condition gradually improved, with scotoma persisting for up to 8 wk before fully resolving without surgical intervention. This case highlights the critical need for early recognition and treatment of HAR to prevent permanent visual impairment.

Introduction-Fourth-year medical students from the University of Kansas School of Medicine have the opportunity to complete a rotation at the Philmont Scout Ranch. To be prepared for this rotation, the students need to be taught a set of skills so that they are capable of evaluating and initiating treatment of patients in the infirmary and backcountry. We aimed to demonstrate that the training provided to the medical students improved confidence in the required skills.Methods-The training curriculum was developed by three Philmont physicians involved in medical student education and included skills videos, virtual training sessions, and an in-person training weekend. The necessary skills were identified by these physicians. Surveys on the confidence in these skills were administered to the medical students before training, after training, and after rotation. Paired t-tests were done to compare the confidence levels before and after training as well as before training and after rotation.Results-A total of 23 responses were gathered from the pre-training survey, 21 responses from the post-training survey, and 20 responses from the post-rotation survey. There was a statistically significant increase in the confidence level of all the skills from pre-training to post-training and of all the skills except suturing from pre-training to post-rotation.Conclusion-The training curriculum successfully improved the confidence of third-year medical students with unfamiliar skills and helped prepare them for their rotation at Philmont. Further refinement is needed to improve complex mastery of all the skills and standardize the training.