Wilderness & environmental medicine
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Wilderness Environ Med · Jan 2006
Practice GuidelineThe use of automated external defibrillators and public access defibrillators in the mountains: official guidelines of the international commission for mountain emergency medicine ICAR-MEDCOM.
In this article we propose guidelines for rational use of automated external defibrillators and public access defibrillators in the mountains. In cases of ventricular fibrillation and pulseless ventricular tachycardia, early defibrillation is the most effective therapy. Easy access to mountainous areas permits visitation by persons with high risks for sudden cardiac death, and medical trials show the benefit of exercising in moderate altitude. ⋯ Public access defibrillators should be placed with priority in popular ski areas, in busy mountain huts and restaurants, at mass-participation events, and in remote but often-visited locations that do not have medical coverage. Automated external defibrillators should be available to first-responder groups and mountain-rescue teams. It is important that people know how to perform cardiopulmonary resuscitation and how to use public access defibrillators and automated external defibrillators.
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Wilderness Environ Med · Jan 2005
Change in differential diagnosis and patient management with the use of portable ultrasound in a remote setting.
Physicians practicing in remote areas are typically limited in their choice of diagnostic tools. The goal of this study was to determine whether the use of a portable ultrasound (US) device on selected patients in a remote setting would alter physician diagnosis and management. ⋯ When used in a remote location, portable US provides a significant benefit that can dramatically alter disposition and treatment.
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Glacial sports continue to be a popular form of wilderness activity, but no published studies have commented on this type of sport or focused on the injury patterns of glacial accidents. The objectives of this study were to investigate the types and frequency of injuries associated with a glacial-crevasse or ice-field fall. ⋯ A wide spectrum of injuries is associated with glacial accidents. They range from common extremity injuries with fracture or joint instability and peripheral frostbite to potentially life-threatening nonorthopedic trauma, which requires intensive clinical and radiological work-up. Injury prevention strategies should focus on wearing helmets to reduce head injuries and adequate clothing to forestall or prevent hypothermia, for these are the most severe and life-threatening injuries.
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Wilderness Environ Med · Jan 2005
Case ReportsResuscitation from hemorrhagic shock using rectally administered fluids in a wilderness environment.
We report the successful use in a wilderness environment of rectally administered oral rehydation fluid to resuscitate a patient who was in shock. The subject was a 21-year-old Nepali man who had experienced a major upper gastrointestinal hemorrhage.
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Wilderness Environ Med · Jan 2005
Autonomic nervous system and adrenal response to cold in man at Antarctica.
To evaluate the role of the autonomic nervous system and adrenal system in acclimatization to cold in tropical men during short or prolonged sojourns at Antarctica. ⋯ These observations suggest that Antarctic residency during austral summer results in gradual attenuation of sympathetic tone and a shift of autonomic balance toward the parasympathetic side. However, WOT members showed a predominance of sympathetic and adrenal activity compared with initial responses of ST members, suggesting deconditioning or possible resetting of the autonomic nervous system.