Wilderness & Environmental Medicine最新文献

This case report describes iloprost infusion initiated in the prehospital setting to treat frostbite. Two cases were managed under a structured helicopter emergency medical services (HEMS) protocol during an extreme cold weather endurance race in the Yukon Territory in northern Canada. These cases demonstrate that intravenous iloprost delivery is operationally feasible in the prehospital setting. Administration was initiated on site and continued during helicopter transport following field rewarming and was completed in the hospital without complication. In remote or austere settings, field administration of iloprost can lower the time to treatment of frostbite injuries and may reduce warm ischemia time.

IntroductionPhysicians frequently take on leadership roles in many different healthcare teams and settings. Developing such leadership skills as situational control, resource utilization, and conflict management is a vital part of medical education. Wilderness medicine focuses on the delivery of care in remote environments where situations are often tenuous, resources are scarce, and effective leadership and teamwork are essential. Wilderness medicine education during medical school may provide tools and knowledge to improve leadership ability. This study evaluated the perceived effect of a 1-mo wilderness medicine elective on medical students' leadership skills.MethodsFourth year medical students taking a 1-mo wilderness medicine elective between 2019 and 2023 were asked to take pre- and postcourse surveys evaluating their perceptions of their leadership skills. A different group of students taking an art of medicine through the humanities elective were used as a control group. The results were evaluated for pre- and postsurvey differences as well as between-group differences.Results and ConclusionsSeveral pre- and post-course survey questions aimed at assessing perceived skill improvement in situational control, resource utilization, and conflict management showed statistically significant differences in the students taking the wilderness medicine elective, whereas this was not found in the control group. This suggests that students taking the wilderness medicine course perceived an improvement in their leadership skills after participating in a wilderness medicine course, whereas students taking the art of medicine through the humanities course did not perceive this improvement. This suggests that wilderness medicine education can provide value to medical student education.

IntroductionSurfing is a popular activity that also plays a crucial role in aquatic safety because surfers can act as first responders in emergencies. The objective of this brief report was to assess the feasibility of a surf-specific functional workout integrating aquatic rescue activities and cardiopulmonary resuscitation (CPR) and to examine whether CPR quality is preserved under physiologic fatigue.MethodA descriptive pilot study was conducted with 10 surf instructors who received a CPR refresher session before engaging in a CrossFit-based workout of the day using an as-many-rounds-as-possible format. This included rescue, extraction, and resuscitation activities. Variables including repetition time, heart rate, perceived exertion, and CPR quality were analyzed.ResultsSurfers maintained consistent rescue times, especially in the first 2 repetitions, with an average heart rate at 83% of their maximum and a perceived exertion of 8. CPR quality remained high, with a median CPR quality score of 89% initially and 91% in the second repetition. No significant differences were found in CPR quality between rounds.ConclusionThis pilot study showed that a surf-specific functional workout may be used as a physiologic simulation of rescue-to-resuscitation transitions, during which CPR quality can be preserved despite high perceived fatigue. These findings support the feasibility of this approach for simulating operational demands rather than demonstrating training efficacy.

IntroductionIn extreme cold weather (ECW) environments it may be beneficial to activate an auto-injector through clothing rather than against skin to minimize casualty exposure. It has been shown that popular adrenaline auto-injectors may not deliver an adequate intramuscular dose to individuals with increased subcutaneous fat, even when activated against skin. This experiment sought to build on research into auto-injector use in the ECW environment by assessing drug delivery through winter clothing combinations with varying simulated skin-to-muscle distances (STMD).MethodologyInvestigators based at the British Antarctic Survey Medical Unit (BASMU) in Plymouth, UK, tested two brands of auto-injector, EpiPen and Emerade, through commonly worn clothing sourced from the British Antarctic Survey. The experiment involved activating the auto-injector through clothing layers and different depths of silicone representing subcutaneous tissue. The volume administered through these layers was collected and its mass was measured. This mass was taken as a representation of the drug volume delivered through the various clothing layers, subcutaneous tissue, and muscle.ResultsThe EpiPen administered adrenaline through all clothing combinations tested at STMD 5 mm; however, thicker clothing combinations at STMD 10 mm prevented effective drug delivery. The Emerade auto-injectors delivered adrenaline at an acceptable dose through the thicker combinations at STMD of 10 mm and 15 mm.ConclusionsThese results suggest that adrenaline auto-injectors can successfully activate through polar clothing but that the depth of injection may be reduced. This may be more consequential in individuals with a greater STMD and should be considered when treating patients in cold environments.

IntroductionScorpion envenomation in the Amazon causes variable clinical manifestations. Data on these incidents, as well as on the demand, distribution, and use of antivenoms for treatment, are still limited in the literature. This study describes the epidemiology of scorpion envenomation and antivenom coverage in the Legal Amazon area from 2010 to 2020.MethodsData on scorpion sting victims, such as sex, age, circumstances of the incident (including location and time), and severity of the case, were obtained from an open health data system called the Notifiable Diseases Information System. The data on antivenom use to treat scorpion stings in each Amazonian state was estimated from consolidated data from the Strategic Inputs Information System.ResultsFrom 2010 to 2020, 62,388 people were envenomed by scorpions in the Legal Amazon area, resulting in 118 deaths (a fatality rate of 0.19%). The regular distribution of antivenom by the Brazilian Ministry of Health resulted in the allocation of 109,276 vials to the region. However, only 62.2% (of the regional antivenom stockpile 67,994 vials) was used. The state of Pará recorded the highest number of deaths from scorpion stings (33% of total deaths) and the highest use of antivenom per year (∼2705 vials over the 10-y period). Tocantins presented the highest incidence rate, with 119 cases per 100,000 inhabitants.ConclusionAlthough the availability of antivenom in the Legal Amazon between 2010 and 2020 exceeded actual demand, this was not enough to prevent the deaths of 118 victims of scorpion stings. These fatalities primarily affected demographic groups without referral units in their regions and point to critical failures in the spatial distribution of emergency medical services. Rural communities at risk of animal envenomation in the Amazon need timely treatment, a crucial condition for saving lives.

Anaphylaxis is a life-threatening multisystem allergic reaction that is treated with prompt intramuscular epinephrine administration. Although epinephrine autoinjectors such as the EpiPen and EpiPen Jr are widely used, they are limited to single-use doses, posing a significant challenge in austere or wilderness environments where medical evacuation may be delayed and rebound anaphylaxis may occur. Although some techniques have been described to extract residual epinephrine from adult EpiPens, mainly by deconstruction with a knife, no studies have addressed the use, safety, or mechanical specifics of disassembling the pediatric EpiPen Jr for redosing. This article presents a detailed analysis of the internal mechanism, medication concentration, and redosing potential of the EpiPen Jr, confirming that it shares the same device structure as the standard EpiPen but contains a lower concentration of epinephrine (0.15 vs 0.3 mg/0.3 mL). Instructions for mechanical disassembly and secondary dose extraction are provided, with considerations for sterility and administration technique. The article also outlines the risks of under- or overdosing in pediatric populations, cost barriers to carrying multiple devices, and the potential for adverse effects when redosing is imprecise. Further research is needed to assess the safety, reliability, and dosing accuracy of this method. Training and wilderness-specific protocols are recommended to ensure safe implementation in high-risk, resource-limited environments.

BackgroundSwimming-induced pulmonary edema (SIPE) is an underrecognized cause of acute respiratory distress in healthy individuals engaged in open-water activities. Often misdiagnosed or overlooked, SIPE poses significant risks in both athletic and military settings. This review aims to consolidate current understanding of the pathophysiology, clinical presentation, risk factors, and emergency management of SIPE, with an emphasis on evidence relevant to emergency medicine practice.MethodsA scoping literature review was conducted using PRISMA extension for scoping reviews analysis employing PubMed to identify studies, case reports, and clinical guidelines on SIPE. Data were extracted on proposed pathophysiologic mechanisms, diagnostic strategies, epidemiologic trends, and treatment modalities. Special focus was given to recent research on lung ultrasound, hemodynamic factors, and recurrence prevention.ResultsSIPE is characterized by acute dyspnea, cough, and occasionally hemoptysis during or shortly after swimming, particularly in cold water. Pathophysiology involves increased pulmonary capillary pressures from central blood pooling, cold-induced vasoconstriction, and exercise-driven cardiac output. Risk factors include hypertension, female sex, cold-water exposure, tight wetsuits, and prior episodes of SIPE. Lung ultrasound demonstrates promise as a rapid, noninvasive diagnostic tool. Current management is supportive, focusing on rapid removal from water, oxygen therapy, and, in some cases, positive airway pressure. Despite rapid resolution in most cases, recurrence rates are significant, with long-term preventive strategies still under investigation.ConclusionSIPE is a life-threatening but reversible condition requiring heightened awareness in emergency and prehospital settings. Prompt recognition, accurate differentiation from other aquatic and cardiopulmonary emergencies, and appropriate supportive care are critical to favorable outcomes. Further research is essential to develop standardized diagnostic criteria, explore genetic or physiologic predispositions, and guide evidence-based prevention and treatment protocols.

High altitude cerebral edema (HACE) is a rare but potentially fatal condition previously understudied in pediatric populations. We present a case of HACE in a previously healthy 10-y-old boy who rapidly developed neurologic symptoms at 4000 m on Mount Kilimanjaro. The child experienced headache, nausea, impaired consciousness, and ataxia before requiring assisted evacuation. Immediate descent of 2295 m resulted in complete recovery within 24 h with no long-term sequelae. A literature review of HACE in children revealed only 1 prior case series of 2 patients aged 12 and 16 y. This case report and literature review illustrate the challenges of recognizing and managing pediatric HACE in field conditions without medical support. Treatment guidelines for HACE in children suggest descent, supplemental oxygen, and dexamethasone, although these recommendations are extrapolated from adult data. Early recognition and descent remain the cornerstones of pediatric HACE management.

IntroductionThe United States Antarctic Program relies on a civilian-military partnership for medical evacuation (MEDEVAC). An attempt to comprehensively analyze US aeromedical evacuations from Antarctica, reconciling both civilian and Department of Defense records across multiple seasons, has not been described previously.MethodsWe retrospectively analyzed Antarctic MEDEVACs from 2015 to 2023 using United States Antarctic Program MEDEVAC records and Transportation Command Regulating and Command and Control Evacuation System (TRAC2ES) movement data. Deidentified aeromedical evacuation records involving a patient within/from Antarctica or labeled "Operation Deep Freeze" were obtained from the TRAC2ES database. National Science Foundation records were extracted in person at the University of Texas Medical Branch (UTMB). The authors extracted deidentified medical data, including medical history, diagnosis, medical treatments, destination, and enroute interventions. Datasets were reconciled using dates, origin/destination, diagnosis category, and narratives.ResultsSixty-nine TRAC2ES records and 93 UTMB records were included in the final analysis (n=162). Linkage identified 126 distinct movements: 36 cross-source matches, 33 TRAC2ES only, and 57 UTMB only. Patterns of MEDEVACs demonstrated austral-summer clustering with limited winter-over activity. The most common indication was musculoskeletal conditions (35 records), followed by gastrointestinal (18), genitourinary/reproductive (16), cardiac (15), neurologic (12), and respiratory (11) categories.ConclusionThis study suggests that the National Science Foundation, Department of Defense, and UTMB work cooperatively to transport patients with a wide variety of medical pathologies out of Antarctica. Dual-source reconciliation improves visibility across the evacuation continuum. Findings align with experience with disease nonbattle injuries in austere environments.