Wilderness & environmental medicine
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Wilderness Environ Med · Jan 2009
Skiing and snowboarding head injuries in 2 areas of the United States.
To explore the use of helmets in skiers and snowboarders injured at ski runs and terrain parks in Colorado and the northeast United States and to examine differences in head injury severity in terrain parks as compared to ski runs. ⋯ There is an increased risk of head injury, regardless of helmet use, at terrain parks as compared to ski runs, and helmets were notably protective in collisions with fixed objects. Regional differences in injury events were noted in that there were more fall-related head injuries and a higher incidence of collisions with fixed objects in the Northeast compared to Colorado.
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Scorpion sting envenomation is a life-threatening emergency and a common public health problem in many regions of the world, particularly in children. Children are at greater risk of developing severe cardiac, respiratory, and neurological complications. ⋯ We found no clinically useful demographic or epidemiological data to guide decision making regarding the need for PICU admission for pediatric victims of scorpion sting in our area. Decisions on transfer and admission to a PICU should be based on the development of systemic findings of envenomation.
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Wilderness Environ Med · Jan 2009
Field management of displaced ankle fractures: techniques for successful reduction.
Ankle fracture/dislocations are generally low-energy injuries most commonly seen in older adults. Prompt reduction is indicated when evacuation to definitive care would be prolonged or neurovascular compromise to the foot is suspected. Reduction restores neurovascular integrity, realigns joint contact surfaces, reduces pain, and decreases soft-tissue edema. ⋯ Improvised Quigley's traction can be built in a wilderness setting using available clothing. After successful reduction, fractured ankles should be adequately stabilized and the affected extremity should be kept nonweight bearing. The hematoma block and improvised Quigley's traction are valuable skills for the wilderness medical provider and may facilitate a successful and relatively pain-free reduction of dislocated ankle fractures in a wilderness setting.
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Mountaineers face a variety of health risks at altitude including pulmonary edema; portable ultrasound may be used to diagnose high altitude pulmonary edema. This report tests the functionality of electronic equipment in a hypobaric test environment and the ability of remotely guided nonexperts to use ultrasound to evaluate respiratory status on Mt Everest. ⋯ The tested ultrasound devices functioned nominally in cold, hypobaric conditions; acute changes in lung fluid content were noted in these conditions despite normoxia. We successfully used a satellite telemedical connection with a remote expert to guide thoracic ultrasound examinations at Advanced Base Camp on Mt Everest. Coupling portable ultrasound with remote expert guidance telemedicine provides a robust diagnostic capability in austere locations.
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The prevalence of airflow obstruction in recreational self-contained underwater breathing apparatus (SCUBA) divers is unknown. Since airflow obstruction is a relative contraindication for diving, we conducted a study to determine its prevalence and magnitude in a cohort of recreational divers in Saba, Netherlands Antilles. ⋯ The prevalence of airflow obstruction was 6% to 15% by report and 12% by spirometry, approximating the combined prevalence of asthma and chronic obstructive pulmonary disease in the general population. Study limitations include possible self-selection and low enrollment rate. Prospective lung function testing can be conducted at remote sites using nonmedical personnel as "testers." This study could guide future investigations to determine if asthma is a risk factor for decompression illness.