Wilderness & Environmental Medicine最新文献

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.

Background: India has a high incidence of snakebite-related mortality, making effective snakebite management crucial. This study aimed to explore current practices, challenges, and opportunities for improvement in snakebite management across India.

Methods: A cross-sectional survey was conducted among physicians in India covering aspects such as scope of practice, snake identification, first aid measures, institutional management, and specific management practices for hump-nosed pit viper (Hypnale hypnale) bites. The survey included 37 questions across 5 sections, with data collected via emails, professional networks, and online platforms. Statistical analysis was performed using SPSS Statistics 23 (IBM Corp, Armonk, NY), and manual thematic analysis was applied to open-ended responses.

Results: The survey revealed a discrepancy between physicians' confidence and accuracy in snake identification, with some still reporting outdated first aid and treatment practices. Despite recognizing the importance of snake species identification, a significant portion of respondents incorrectly identified the snakes. The study highlighted variability in institutional practices for snakebite management, such as administering prophylactic antibiotics and tetanus prophylaxis and monitoring periods for asymptomatic patients. In managing H hypnale viper bites, a demand for specific guidelines and a monovalent antivenom was evident because the current polyvalent antivenom is ineffective for this species.

Conclusions: The survey emphasizes the need for improved training in snake identification, standardized treatment protocols, and the development of region-specific antivenoms. It emphasizes the necessity of updating guidelines to address the unique challenges of snakebite management in India, particularly for species not covered by existing antivenoms.

Introduction: Vital sign acquisition is a key component of modern medical care. In wilderness and space medical settings, vital sign acquisition can be a difficult process because of limitations on available personnel or lack of access to the patient. Camera-acquired vital signs could address each of these difficulties.

Methods: Healthy volunteers used software designed by Presage Technologies to acquire heart rate and respiratory rate at the HI-SEAS space-analog site in Mauna Loa, Hawai'i. Camera-acquired vital signs were compared to more conventionally acquired vital signs.

Results: Camera-acquired heart rate showed high correlation to conventionally acquired heart rate (R ∼ 0.95). Camera-acquired respiratory rate showed moderate correlation (R ∼ 0.65).

Conclusions: These results show that camera acquisition of vital signs is theoretically feasible in wilderness and space-analog environments. HR may be highly accurate even using current technology. Additional studies will be needed to further validate other types of camera sensors and other potential environments such as partial gravity and microgravity.

Introduction: Motorcyclists are particularly vulnerable to injury when encountering large animals such as deer in the roadway. The frequency of these events, factors associated with their occurrence, and the extent of injuries sustained from such crashes are not yet well described.

Methods: A review of 10 years (2012-2021) of statewide motorcycle crash reports from a single state with a large deer population was performed to ascertain the frequency of deer-associated motorcycle crashes. Environmental and roadway conditions, as well as motorcyclist age, gender, and helmet usage, were identified to determine if associations exist with the severity of injuries sustained.

Results: Statewide, 8.5% of reported motorcycle crashes involved deer. Excluding the two most densely populated counties, this rose to 10.7%, with 24.1% of crashes occurring during non-daylight hours being deer related. Factors associated with increased frequency of more severe injury and death included not wearing a helmet, female gender, and rural county crash location. Death and severe injuries were reported in more than twice as many riders who were unhelmeted compared to those wearing helmets (36.1 vs 16.6%; p < 0.01).

Conclusion: In a single midwestern state, deer represent a significant danger to motorcyclists, especially in rural settings during non-daylight hours. A cautious approach to riding during this time, utilizing available safety precautions to minimize risk of severe injury and death, and further exploration of viable interventions to reduce the likelihood of these occurrences should be considered.

Long-duration spaceflights beyond low-Earth orbit, including missions to the Moon and Mars, pose significant health risks. Although biomedical approaches commonly appear in the literature, considering psychological and social factors alongside physiologic health offers a more holistic approach to astronaut care. Integrating the biopsychosocial (BPS) framework into medical planning addresses complex spaceflight challenges and aids in developing mitigation strategies. This review examined health risks associated with long-duration spaceflight within a BPS framework. Sources included governmental space agencies, academic textbooks, and relevant publications from multiple databases. Considering the National Aeronautics and Space Administration's Human Research Program's 5 main hazards, a conceptual model was developed to highlight the multifactorial BPS effects of spaceflight. In space, astronauts face unique environments and biological adaptations, including fluid shift, plasma volume loss, bone density loss, and muscle atrophy. Noise and the absence of natural light disrupt circadian rhythms, causing sleep disturbances and fatigue, which affect physical and mental health. Studies on crews in isolated and confined extreme environments reveal psychosocial challenges, including impaired mood and cognition, interpersonal tension, and miscommunication. International collaboration in spaceflight introduces differences in communication, problem solving, and social customs due to diverse cultural backgrounds. Upcoming long-distance missions likely will amplify these challenges. This review emphasizes BPS health considerations in long-duration spaceflight. It highlights the interplay among psychological, social, and biological factors, advocating for multidisciplinary teams and a holistic approach to astronaut health and mission planning and the potential added value of BPS perspectives in considering countermeasures.

Airway devices may be scarce in limited resource situations, such as prehospital settings or austere environments. Tube tip in pharynx (TTIP) ventilation is a simple, one-handed technique that may prove valuable for ensuring airway control in a life-threatening situation. The technique only requires a standard cuffed endotracheal tube and a self-inflating bag. This case report illustrates a scenario where both bag-valve-mask (BVM) ventilation and intubation failed, and the TTIP technique was utilized successfully several times during the case management. This case report illustrates that TTIP may be a useful technique, especially in limited resource settings. It is easy to learn, takes seconds to perform, and has minimal equipment requirements. The case report is reported according to the CARE guidelines. Informed consent from the patient is obtained.