Wilderness & Environmental Medicine最新文献

Frostbite, a severe cold injury resulting from exposure to subfreezing temperatures, damages the skin and underlying tissues of the affected area and ranges in severity from first to fourth degree. This case report investigates the impact of second-degree frostbite suffered by a marine during winter training on cold-induced vasodilation (CIVD). Comparisons of CIVD before and after the injury revealed significant alterations in CIVD responses. CIVD, a physiological mechanism characterized by blood vessel dilation in response to cold exposure, plays a crucial role in operating in cold-weather environments and enhancing dexterity. The marine exhibited prolonged CIVD onset time, lower finger temperatures, increased pain sensations, and diminished dexterity after the frostbite injury during follow-up CIVD testing. The findings suggest that the frostbite-induced damage possibly compromised the microvascular function, contributing to the observed changes in CIVD. The marine reported persistent cold sensitivity and difficulty in maintaining hand warmth when assessed postinjury. This case underscores the potential long-term consequences of frostbite on CIVD and manual dexterity, emphasizing the importance of understanding these physiological changes for individuals engaged in cold-weather activities, particularly for military and occupational personnel.

The Wilderness Medical Society convened a panel to review available evidence supporting practices for medical direction of search and rescue teams. This panel included of members of the Wilderness Medical Society Search and Rescue Committee, the National Association of EMS Physicians Wilderness Committee, and leadership of the Mountain Rescue Association. Literature about definitions and terminology, epidemiology, currently accepted best practices, and regulatory and legal considerations was reviewed. The panel graded available evidence supporting practices according to the American College of Chest Physicians criteria and then made recommendations based on that evidence. Recommendations were based on the panel's collective clinical experience and judgment when published evidence was lacking.

The Himalayan Rescue Association (HRA) has operated high altitude clinics in Nepal for 50 years, with rising visitor numbers, especially from India, China, and Nepal. New roads have eased access and increased the speed of ascent in some areas. Our aim was to provide a description of the activities, clinical problems, and lecture attendees of the HRA aid post in Manang over one season. We also highlight the evolving challenges of providing healthcare and education in the high Himalayan region. We describe the clinical and educational activities of the HRA aid post in Manang from September 24 to December 1, 2023. Prospective clinical data collection included anonymized patient demographics and diagnoses. Lecture data were taken from the attendee register and by daily manual counts of lecture attendees. We saw 376 patients, 62% of whom were Nepalis. Infectious diseases (42%) and altitude illness (16%) were the most common problems. A total of 846 people from 47 countries attended the daily altitude lectures. Only 5% of attendees were Nepali. Electrical supply interruptions and limitations in medical evacuation options were among the challenges of providing care at a high altitude clinic and preventing altitude illness using educational lectures. Altitude illness remains a common and potentially life-threatening problem, with risks increased by rapid ascent enabled by new road access and by ignorance of risks of altitude among travelers, especially Nepalis. Language barriers in educational outreach call for novel approaches and interventions that will ensure the effectiveness of altitude education.

Heat illness is a condition that is sometimes seen in those undertaking physical activities. This case report focuses on a female hiker who developed heat stroke during a trek in the Dachstein region of Upper Austria. The patient's presentation was initially unclear and could only be confirmed by the use of a thermometer. This had a significant impact on the medical decision-making process during a complex rescue operation.

Griffith Pugh, MD (1909-1994), was a pioneer in altitude physiology. During World War II, he developed training protocols in Lebanon to improve soldier performance at altitude and in the cold. In 1951 he was chosen to join the British Everest team as a scientist. In preparation, he developed strategies for success on a training expedition on Cho Oyu in 1952. Results from Cho Oyu led to the use of supplemental oxygen at higher flow rates during ascent than used previously (4 L/min vs 2 L/min) and continued use (at a reduced rate of 2 L/min) during descent, enabling increased performance and improved mental acuity. Oxygen was also used during sleep, leading to improved sleep and warmth. Adequate hydration (∼3 L/day) was also stressed, and a more appealing diet led to improved nutrition and condition of the climbers. Improved hygiene practices and acclimatization protocols were also developed. These strategies contributed to the first successful summiting of Mount Everest in 1953. Pugh was then appointed as the lead scientist for a ground-breaking eight-and-a-half-month research expedition where the team was the first to overwinter at high altitude (5800 m) in the Himalayas. This current work summarizes Pugh's scientific contributions as they relate to success on Mount Everest and in inspiring future altitude research by generations of successful researchers.

Snakebites in unusual anatomical locations may lead to life-threatening consequences. Merrem's hump-nosed viper (Hypnale hypnale) is a medically important snake in Sri Lanka and India that causes many bites and envenomings. Their bites occur almost exclusively on upper and lower limbs and commonly result in local effects, with some patients developing systemic envenoming. No antivenom is available for treating envenoming by H. hypnale. We report an unusual case of H. hypnale bite on the tongue of a 10-month-old infant resulting in rapid local swelling of the tongue and floor of the mouth, requiring prompt intervention to prevent life-threatening upper airway obstruction. Early tracheostomy prevented upper airway obstruction and, along with supportive steroid therapy and antibiotics, led to a complete resolution of the local effects of the infant without permanent disability, despite the unavailability of antivenom.