Journal of wilderness medicine最新文献

This prospective observational study was designed to assess the incidence and severity of middle ear barotrauma associated with repetitive recreational scuba diving.

Eleven healthy adult experienced scuba divers were observed performing repetitive daily scuba diving over a 15 day period. Otoscopy and tympanometry were performed on days 0, 3, 7, 11 and 15. Participants averaged 41 dives during the study period. Mild otalgia occurred at some point in 23% of ears and subsequently resolved in all but one despite continued diving. Eight-two per cent of ears demonstrated otoscopic evidence of middle ear barotrauma by day 3, and all exhibited barotrauma by day 11. Tympanic membrane perforation, hemotympanum, or evidence of inner ear barotrauma did not occur. Tympanometry revealed a significant decrease in middle ear pressures but no evidence of middle ear effusions. Gross measurements of otologic acuity and conduction remained normal. No complications or sequelae were noted at three month follow-up.

Otoscopic evidence of middle ear barotrauma and tympanometric evidence of eustachian tube dysfunction developed rapidly in a group of experienced scuba divers performing repetitive recreational diving. Symptoms were minimal and infrequent. No serious otologic dysfunction was noted despite continued repetitive diving, and it is possible that middle ear barotrauma at the degrees observed represents a more benign disorder than has been previously assumed.

Eight people developed ciguatera poisoning on a scuba diving cruise in a remote atoll in the Coral Sea. Symptoms included abdominal pain, vomiting, diarrhea, weakness, difficulty breathing, headache, myalgia, arthralgia, hypotension, bradycardia, paresthesias and pruritus. The outbreak was diagnosed by physician passengers who treated the victims during the remainder of the cruise. Intravenous mannitol on the eighth day was of no benefit. Symptoms persisted for weeks to months. Divers should be aware of ciguatera and the similarity of symptoms to those of decompression sickness. A new immunochemical method of detecting ciguatoxins in fish will be available soon in the form of a test kit.

Scorpion stings are an important cause of morbidity in children in the southwestern region of Saudi Arabia. There appear to be regional variations in the clinical effects of scorpion stings, due to the different species of scorpions found in the various regions of the Arabian Peninsula. A prospective study on 47 children following scorpion stings in the Asir province of Saudi Arabia revealed that neurological manifestations were the most prominent. These included local pain, fright, restlessness and vomiting. One patient had disseminated intravascular coagulopathy and intracranial hemorrhages demonstrated on cranial computed tomography. There was one death due to severe pulmonary edema and congestive heart failure. The complications in these two patients followed stings by Nebo hierochonticus scorpions. The commonest identified scorpion was Leiurus quinquestriatus. The others were Compsobuthus werneri, Androctonus crassicauda and Scorpio maurus. Antivenom was given in all cases with systemic manifestations of envenomation.

Brush contact with colonies of the stinging hydroid Lytocarpus philippinus by divers and snorkellers causes itchy painful weals for which no first aid measures have yet been devised. Laboratory experiments were performed using common household substances to observe whether or not they caused Lytocarpus nematocyst discharge. Fresh and salt water, distilled water, aloe vera and ‘Stingose’ caused no in vitro discharge in nematocysts in situ. Urine and vinegar caused discharge in up to 10% and 15% of polyps per mm² of colony portion, respectively. Methylated spirits caused discharge in all polyps containing mature mastigophores. The results indicate that vinegar (used to inactivate the discharge mechanism of nematocysts in cubozoan stings) activates the discharge mechanism of the nematocysts of this hydroid. Therefore, dousing thoroughly with water to dislodge adhering undischarged nematocyst material, followed by application of ice for pain relief, is advised. This is the same first aid treatment recommended for most non-cubozoan jellyfish stings.

The popular perception of rock climbing is often of a high risk sport, with serious injury a common outcome of participation. To date, little data exists to test this hypothesis. The purpose of this study was to determine injury rates and associated data in a group of Australian rock climbers. A retrospective survey was undertaken and data collected from 59 active rock climbers. Analysis of the data collected suggests that rock climbing has a relatively low injury rate, in terms of injuries sustained per 1000 h of participation, in comparison with many other popular sports.

The objective of this study was to examine hunting-related morbidity and mortality, define high risk hunting groups and activities, and outline prevention strategies.

A statewide prospective case study was conducted from September 1990 to January 1991 involving all emergency departments in Montana accredited by the Joint Commission on Accreditation of Health Care Organizations. Participants included hunters who sustained an acute injury or illness resulting from hunting or a hunting related activity. The main outcome measures were the incidence of hunting morbidity and mortality during a defined hunting season and hunting activities and weapons associated with hunting morbidity and mortality. There were six hunting-related fatalities during the five month study period. The fatality rate was 2.7 per 100 000 hunters. Four of the deaths were secondary to gunshot wounds. There were 134 non-fatal hunting injuries. The non-fatal hunter injury rate was 61 per 100 000 hunters. The most common injured area of the body was the upper extremity (n=64; 51%). The most common type of injury was a laceration (n=64; 48%). Twenty-five (19%) of the patients with non-fatal injuries were hospitalized. Post-hunting activities were associated with the most fatalities, three (50%), and the highest number of non-fatal injuries, 63 (48%). Post-hunting related activities were associated with the highest hunter morbidity and mortality. Data on hunting-related injuries have traditionally excluded events occurring while preparing to hunt or after the hunt has been completed (e.g. cleaning game). Injury prevention strategies and hunter safety courses should include all phases of hunting activity with special emphasis on post-hunting injuries.

Clinical records of healthy high altitude (HA) (4300 m [14 100 ft]; n=2875) and sea level (SL) (n=2899) miners were examined for vital capacities (VC), body weights (W), heights (H), and hemoglobin (Hb) concentrations in different age groups. In the HA population, excessive erythrocytosis (EE) was defined as Hb ≥ 21.3 g dl⁻¹; i.e., the mean Hb in the 20–29 age group plus 2 sd. This level of Hb is one of the parameters above which clinical chronic mountain sickness (CMS) becomes apparent. We found a smooth increasing prevalence of EE with age: 6.8% at age 20–29 to 33.7% at age 60–69. Height corrected VC (VC/H) decreases 3.0% between ages 20–29 and 60–69 years in SL miners and 26.5% in HA for the same age interval. In the latter, the pronounced decrease in VC/H is seen both in miners with EE (30.6%) and in those with physiological erythrocytosis (PE, 22.4%). SL miners have significantly higher W/H ratios than do HA ones. This index steadily increases with age at SL. At HA, however, miners with EE and PE show a drop in their weights after ages 40–49 years. In addition, EE miners have higher W/H ratios than do PE ones between ages 40–59 years. We suggest that increasing Hb and diminishing VC with age at HA do not represent the so-called physiological adaptation. On the contrary, these may be risk factors for the development of CMS with age among HA Andean populations.