Wilderness & Environmental Medicine最新文献

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.

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.

BackgroundHeat stroke represents a growing public health concern, exacerbated by rising temperatures and prolonged heat waves. This study examines the clinical profile, prognostic markers, and outcomes of heat stroke patients presenting to a tertiary care center in India and compares findings with previous global studies.ObjectiveTo analyze the clinical profile, prognostic markers, and outcomes of heat stroke patients presenting to a tertiary care center in India and to compare findings with previous global studies.MethodsA retrospective study was conducted between March to July 2024. Data on demographics, clinical parameters, laboratory values, and outcomes were collected and analyzed. Primary outcomes were mortality and functional recovery. Statistical tests included chi-square, Mann-Whitney U test, and multivariate logistic regression.ResultsAmong 43 patients, the mean age was 57 years, and 67% were male. The overall mortality rate was 21%. Significant predictors of mortality included hypotension (SBP <100 mm Hg, p = 0.040), tachypnea (RR >20/min, p = 0.001), Glasgow Coma Scale score <9 (p < 0.001), elevated creatinine, and multi-organ dysfunction syndrome (MODS) involving renal and CNS systems (p < 0.01). Middle-aged, active individuals were disproportionately affected due to occupational exposure to high ambient temperatures.ConclusionOur findings highlight key clinical and biochemical predictors of poor outcomes in heat stroke. Indian patients who are middle-aged individuals, possibly exposed due to outdoor occupations, may face greater exposure to high ambient temperatures.

Debate exists regarding safety and optimal technique for ski patrollers performing cardiopulmonary resuscitation (CPR) on cardiac arrest patients in a moving toboggan during rescue evacuation. Cases of successful outcomes after toboggan-transport (in-sled) manual (hands-on) or mechanical CPR by ski patrollers have not been described in the medical literature. This case series presents 3 adult resort skiers who experienced medical cardiac arrest in Vermont over the years 2024-25, and who received manual CPR in a moving rescue toboggan, leading to return of spontaneous circulation and subsequent neurologically intact hospital discharge. One case displayed signs of cognitive activity only during chest compressions, which suggests that manual CPR in a moving rescue toboggan can create brain perfusion. This study documents that after an initial period of on-scene stationary CPR and defibrillation, manual CPR may be safely continued in the appropriate circumstance by ski patrollers in a moving toboggan and can lead to successful outcomes for medical cardiac arrest. An educational opportunity exists. Practical suggestions and techniques are discussed for the implementation of safe and effective toboggan-transport CPR when indicated.