Wilderness & Environmental Medicine最新文献

IntroductionPlotosus lineatus, also known as the striped eel-tailed catfish, is a marine catfish easily identifiable with its black and white stripes and 4 pairs of barbels. This beautiful species is capable of inflicting an intensely painful sting caused by heat-labile venom toxins. Its presence has been widely confirmed, particularly in the Indo-Pacific Ocean, but cases of human envenomation are rarely reported in the medical literature.MethodsIn this report, we describe a case series of presumed envenomations by P lineatus registered in the Indian Ocean French territories of Reunion Island and Mayotte Island from 2011 to 2023.ResultsA total of 30 cases were reported, most of which involved males (n=27; 90%). Most stings occurred when fishing (n=22; 73%) and involved the hand (n=29; 97%). All individuals reported pain (100%) that was accompanied by local or extensive swelling in 12 cases (40%). Most cases were of moderate severity (persistent spinal pain syndrome type 2, n=27; 90%). The main treatment involved the use of analgesics (ie, paracetamol, tramadol, or morphine), exposure to hot water or alternating cycle of exposure to hot and cold sources, and local anesthetics. For 10 patients (33%) for whom information was available, there was full recovery within 24 h in most cases (after 7 d in 1 patient) without sequelae.ConclusionThese findings show that stings by P lineatus may occur in the Mascarene Islands and that fishermen are the most likely to be stung because of handling P lineatus.

Japanese mamushi (Gloydius blomhoffii) causes ∼3000 snakebites annually in Japan, but specific ultrasonographic findings have not been well characterized. Current severity assessment relies on visual grading systems based on local swelling and erythema, which may not provide sufficient information for timely and accurate treatment decisions. We present 3 pediatric patients (ages 7-9 y) with clinically diagnosed mamushi bites to the fingers, all presenting with Grade III envenomation (ie, swelling extending to the elbow). Point-of-care ultrasound examination revealed a remarkably consistent finding: a distinct hypoechoic band located in the deep subcutaneous layer immediately superficial to the muscle fascia. This characteristic band was most prominent at the bite site and gradually tapered off distally. Serial ultrasound examinations demonstrated progressive thinning and eventual disappearance of the hypoechoic band, correlating with clinical improvement following treatment with cepharanthine and anti-mamushi serum. Ultrasonography detected subcutaneous tissue changes beyond clinically apparent swelling in all cases, demonstrating superior sensitivity compared with visual assessment. All patients recovered without sequelae. These findings may differ from previously reported snakebite point-of-care ultrasound findings in terms of the anatomic location of the hypoechoic lesion. The hypoechoic bands observed in mamushi envenomation may serve as useful ultrasonographic markers for objective monitoring of treatment response and assisting with clinical management decisions, particularly regarding fasciotomy considerations and antivenom therapy guidance in the context of comprehensive clinical evaluation. These ultrasonographic features may not be species specific to mamushi but could represent common pathophysiologic responses to envenomation requiring validation across multiple species.

IntroductionThe municipality of Barcelos, located in the middle Rio Negro region, is home to various venomous snakes (ie, members of the Viperidae and Elapidae families). This study describes the epidemiology of incidents involving venomous animals in the remote municipality of Barcelos.MethodsWe conducted a retrospective epidemiological study to identify population groups vulnerable to envenomation by snakes, spiders, and/or scorpions in the middle Rio Negro (Barcelos) basin, Amazonas, Brazil. To determine the percentage of incidents, we calculated the occurrence and number of deaths. Data were collected from the Barcelos Reference Hospital from 2010 to 2024. The type and number of antivenom vials used in the treatment of patients were quantified according to the Strategic Inputs Information System (SIES).ResultsA total of 511 people were envenomated by venomous animals, 402 of them by snakes. Yanomami individuals were the most affected by snakebites (62.4%). Envenomations by Bothrops spp. caused 7 deaths, while those caused by spiders and scorpions were mostly mild. Among the snakebite survivors, 38 had their occupations identified at the time of the incident: 25 worked in the extraction of piassaba fibers (Leopoldinia piassaba) and 13 were chestnut fruit collectors (Bertholletia excelsa).ConclusionBetween 2010 and 2024, vulnerable groups to snakebites, such as Yanomami people, were the most affected in the middle Rio Negro region. Amerindians who sought medical care at the Barcelos referral hospital received antivenom treatment and intensive care when necessary. Emergency medical services and therapeutic serums are crucial to saving lives in the Rio Negro region.

A 54-year-old male entered a deep cave for recreational purposes. Near the bottom of the 324-meter-deep cave, he slipped and sustained an open femur fracture and a head injury. His companions stabilized him with direct pressure for bleeding control and improvised splinting and then summoned help. Medical personnel found the patient hypotensive with an altered mental status. Arriving rescuers further stabilized him, packaged him in a litter, and then transported him. While waiting for a technical rope to raise him up a 179-meter pit, he was transfused 1 unit of blood. Twenty-one hours after his injury, he exited the cave and was transported by helicopter to a trauma center. He made a full recovery.

IntroductionThe ability of a 55.9 cm parabolic microphone to increase detection range in search-and-rescue (SAR) sound sweeps for the purpose of responsive lost-person searching was examined.MethodsFive SAR personnel listened for 3 random words shouted once by persons simulating a responsive lost person at a target loudness of 88 dB (at 1 m) at various distances in coniferous lodgepole pine and deciduous aspen parkland forests. Intelligibility distance (where 50% of the shouted words were understood) and audibility distance (where 50% of the shouted words were audible but not intelligible), along with visual detection range, were determined. The lost person's unaided ear audibility of 5 whistle models and 1 portable train horn, blown at each searcher's parabolic microphone audibility distance, was also determined.ResultsThe parabolic microphone significantly increased both intelligibility and audibility distance by an average factor of 1.44 compared with the unaided ear. Intelligibility distance d_i^pmic with the parabolic microphone was well predicted by the equation $d_i^{pmic}=8805e^{-0.0978d{B}_{amb}}$, where dB_amb is ambient dB at the listening location. Only the portable train horn could be heard by all participants with the unaided ear at the audibility distance of the parabolic microphone.ConclusionsThe use of a parabolic microphone significantly increased auditory detection range. When combined with the tested portable train horn, our data suggests that SAR sound sweeps for a responsive subject with a parabolic microphone can expect area coverage rates 44% greater than with the unaided ear and approximately 20 times that of visual searching.

IntroductionThe Levantine coast is characterized by environmental and demographic factors-microtidal regime, shifting sandbars, and crowded beaches. These may shape water-sport injury patterns, yet region-specific data are lacking. We described the types, anatomical sites, and sport-specific distribution of injuries along the Levantine coast.MethodsWe conducted a prospective observational study at a single Levantine coastal emergency department. Injuries from surfing, kitesurfing, windsurfing/wing-foiling, swimming/freediving, kayaking, and motorized boards were recorded in real time, including demographics, injury type, body region, and sport.ResultsA total of 62 patients sustained 66 water-sport injuries (mean age 33.7 ± 11.6 years; 77.4% male). Surfing accounted for most injuries (48.5%), followed by kitesurfing (18.2%), swimming/freediving (15.2%), windsurfing/wing-foiling (10.6%), motorized boards (4.5%), and kayaking (3.0%). Open wounds (37.9%) and blunt trauma (36.4%) predominated; upper (34.8%) and lower limbs (28.8%) were most affected. Surfers had more upper-limb lacerations; kitesurfers, lower-limb injuries.ConclusionSurfing had the highest absolute injury count. Because participation was not measured, incidence and relative risk across sports are unknown. Local conditions (wave behavior, seabed morphology, and coastal crowding) may influence mechanisms, but whether they raise or lower injury rates versus other regions remains uncertain.

As the global population grows and access to remote environments expands, travel to high altitude destinations has become increasingly common, now attracting ∼100 million visitors annually. This trend coincides with a population that is increasingly medically complex, emphasizing the importance of understanding how preexisting medical conditions are influenced by ascent to high altitude. This narrative review summarizes the current evidence describing the physiologic and clinical implications of altitude exposure among individuals with chronic medical conditions. A comprehensive literature search was conducted across multiple databases and sources using inclusive keyword and phrase strategies related to high altitude and preexisting medical conditions. All relevant peer-reviewed studies, reviews, and consensus statements were reviewed to ensure a thorough synthesis of available data. The discussion is organized by body system, encompassing cardiovascular, pulmonary, neurologic, metabolic, hematologic, and other relevant conditions. Findings indicate that while many patients with stable, well-managed chronic illnesses can tolerate moderate or even high altitudes, those with advanced cardiopulmonary disease or cerebrovascular pathology face heightened risk and warrant individualized evaluation prior to ascent. This review provides practical, evidence-based guidance to clinicians, expedition planners, and emergency providers caring for high altitude travelers with preexisting conditions. Recommendations emphasize pretravel risk stratification, optimization of chronic disease control, and strategies to mitigate altitude-related complications, supporting safer and more informed participation in high altitude activities.

IntroductionUltramarathons are growing considerably in both popularity and distance. This study aimed to identify factors associated with performance and satisfaction in ultramarathons of 200 mi (322 km) or more.MethodsThis cross-sectional study surveyed ultramarathoners who recently competed in a 200+ mi (322+ km) race between June and September 2023. The survey assessed demographics, ultramarathon experience, training habits, sleep-related factors, sleep-related adverse events, and injuries. Logistic regression quantified associations between variables and race outcomes.ResultsA total of 117 participants (67% male; mean age 47.2 y) completed the survey. Median race distance was 217 mi (interquartile range [IQR]=203-314 mi); 349 km [IQR=327-505 km]). Median sleep during races was 5.63 h (IQR=3.25-15.75 h). The most common within-race sleep strategy was sleeping when exhausted (38%). Finishing in the top quartile was associated with being male (odds ratio [OR]=3.37, more than 3fold higher odds than females), lower body mass index (OR=0.85, 15% lower odds per body mass index unit increase), and sleeping <7 h the night before (OR=0.33, 67% lower odds vs ≥7 h). Higher Pittsburgh Sleep Quality Index score (OR=0.70, 30% lower odds per point) and Insomnia Severity Index scores (OR=0.80, 20% lower odds per point) were associated with reduced likelihood of exceeding performance expectations. Weekly alcohol consumption, compared with monthly or less, was associated with lower race satisfaction (OR=0.42, 58% lower odds).ConclusionsThis study identified several factors associated with performance and satisfaction in 200+ mi (322+ km) ultramarathons, highlighting prerace and race sleep as key modifiable factors for optimizing performance.

IntroductionPregnant individuals benefit both psychologically and physically by participating in outdoor activities.MethodsThe authors conducted a narrative review of the available literature to address unique pregnancy considerations for the wilderness adventurer. There is limited evidence behind many opinion-based recommendations on participation in wilderness activities in pregnancy.ResultsAs a result, remote or adventurous activities may be considered unsafe or restricted without significant medical literature to support these opinions. The authors reviewed the literature for the best available evidence, including observational studies, case series, limited controlled trials, and extrapolations from physiological data, as well as evaluating expert consensus statements.ConclusionThis narrative review discusses pregnancy-specific medical concerns related to participation in outdoor adventure activities.