Journal of wilderness medicine最新文献

Injuries from bison (American buffalo, Bison bison) attacks have not previously been reported in the medical literature. This study examines 56 bison-caused injuries, including two fatalities, from Yellowstone National Park over the past 15 years. Two mechanisms of injury were observed. The first was direct goring by the bison's horn, “hooking,” resulting in deep puncture wounds most often to buttocks or thighs. Abdominal injury, including evisceration, was also seen. Blunt trauma occurred as the victim was shoved or butted by the animal's head, or when the victim sustained a rapid deceleration on ground impact after being tossed into the air. Multiple sites and types of fractures, abrasions, and contusions were seen. Most patients requiring hospital care for goring wounds were treated with operative debridement and primary closure. Cultures of puncture wounds were uniformly negative. Injuries from bison exceed injuries from bears or any other wild animals in Yellowstone National Park.

Middle ear barotrauma is the most common health hazard of scuba diving. To investigate the overall incidence of middle ear barotrauma, a prospective incidence study of 51 novice divers and 46 experienced divers was conducted. Otoscopy was performed on the divers before and immediately following a single dive. The overall incidence of mild barotrauma was 40%, and the incidence of severe barotrauma was 27%. No tympanic membrane perforations were found. The most common presenting symptoms were difficulty clearing ears during descent, ear pressure, and ear pain. Barotrauma was not associated with diver age, sex, experience, otolaryngologic history, or medications. Barotrauma was associated with poor underwater visibility, difficulty clearing ears during ascent, and hearing loss after surfacing.

The objective of this case-control study was to investigate the relationship between periodic breathing (PB) and acute mountain sickness (AMS). Nine volunteers, healthy lowlanders between the age of 20 and 36 years stayed at a simulated altitude of 3700 m (485 Torr) for 24 h in a hypobaric chamber. A sleep study was carried out for more than 6 h. Arterial oxygen saturation (SaO₂) was monitored by finger oximetry on all subjects. PB was determined by a polysomnography (EEG, EOG, thoracic movement) in six subjects and was indirectly measured by studying the cyclic change of SaO₂ in three other subjects. The severity of AMS was assessed with the Environmental Symptoms Questionnaire. All subjects showed lower SaO₂ during sleep than when awake (65.0 ± 6.4% versus 72.6 ± 6.4%, p < 0.01), and symptoms of AMS were more intense the next morning. PB was observed in eight of the nine subjects; however, the time spent in PB (%PB) ranged from 0% to 57.8%. There was a positive correlation between %PB and stage 1 sleep, suggesting an important role of PB in poor sleep quality at high altitude. Percent PB, however, was not significantly correlated with the degree of sleep desaturation, the severity of AMS, and ventilatory responses to hypoxia and hypercapnia. These results suggest that PB may not be a critical factor for sleep desaturation and in the development of AMS for high-altitude newcomers.

The saw-scaled viper (Echis carinatus) is one of the principal causes of snake bites in India. For the Haffkine Institute, these snakes are procured for their venom every year from the Deogad area. A study of prevalence and distribution of these snakes was, therefore, undertaken to find out the areas where their prevalence is at the highest. Echis carinatus were invariably found under stones in open fields. Maximum numbers of snakes were collected during the rainy months. A study of output of venom by snakes procured during different months revealed that snakes collected during August produced less venom in comparison to snakes procured in October.

Information on the food intake of free living individuals during the initial stage of an expedition, when the diet is based on fresh and locally available foods, is scarce. A weighed dietary survey was carried out by 10 healthy unacclimatized male subjects who walked from an altitude of 2430 m to Everest Base Camp (5400 m) in 10 days. All food and fluids consumed during the study period were weighed using dietary scales and recorded in food record books. The mean daily energy intake was 10.03 (SE 1.26) MJ. The average body weight loss was 2.07 (SE 0.6) kg and there was no change in percentage body fat calculated from skinfold thickness measurements. The percentage energy from carbohydrates in the diet was significantly higher (p < 0.05) in the final 3 days (59%, SE 2.0) compared with the first 3 days of the study period (51%, SE 3.6). It is likely that the high carbohydrate intake reflected the availability of foods at this time. With the exception of folic acid and vitamin C, the mean daily intakes of B vitamins, iron, and zinc exceeded the UK Dietary Reference Values. However, these values refer to healthy populations but not to those exposed to high altitude when nutrient requirements may be increased.

This manuscript has been prepared as the tenth Annual Meeting of the Wilderness Medical Society approaches. It consists of a chronological history of the society from its founding in 1982 as a “Mom and Pop” organization headquartered in Dr. Edward Geehr's study to its current status as a national organization with a part-time executive director, two full-time employees, access to the resources of the American College of Sports Medicine, an international journal, a quarterly newsletter, and over 2800 members. Its educational programs now include annual summer and winter national scientific meetings plus at least one annual national specialty meeting, local and regional meetings, curricula for medical school wilderness medicine electives and prehospital wilderness emergency care courses, position papers on relevant topics, and teaching aids, including slide collections. It has an active program for sponsoring research in wilderness medicine and promotes the health of travelers and global health through its Environmental Council.