Sea Ice Floes in the Weddell Sea
Publication date: Available online 4 February 2019Source: Wilderness & Environmental MedicineAuthor(s): (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - February 5, 2019 Category: Environmental Health Source Type: research

In Response to Metabolic Demand of Hiking in Wildland Firefighting by Sol et al
Publication date: Available online 4 February 2019Source: Wilderness & Environmental MedicineAuthor(s): Cara McAnaney, Arun Ganti (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - February 5, 2019 Category: Environmental Health Source Type: research

Camp Fire Smoke Sunset
Publication date: Available online 5 February 2019Source: Wilderness & Environmental MedicineAuthor(s): (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - February 5, 2019 Category: Environmental Health Source Type: research

Expired Drugs in the Remote Environment
ConclusionsThe results suggest that the studied drugs may be stable beyond expiry, even when not maintained in strictly temperature-controlled conditions. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - February 2, 2019 Category: Environmental Health Source Type: research

One Foot After Another—Fungal Foot Issues in Expedition Adventure Racing
We present a case with characteristic clinical manifestations, including the “sandpaper symptom.” There is limited literature exploring infectious foot complaints in expedition adventure racers. Beyond this case report, more research is needed to better understand incidence rates, risk factors, diagnostic measures, treatment, and prevention options. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - February 2, 2019 Category: Environmental Health Source Type: research

Rejection Under Peer Review
Publication date: Available online 1 February 2019Source: Wilderness & Environmental MedicineAuthor(s): Neal W. Pollock (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - February 1, 2019 Category: Environmental Health Source Type: research

Success Rates with Digital Intubation: Comparing Unassisted, Stylet, and Gum-Elastic Bougie Techniques
ConclusionsIn a manikin model, stylet-assisted digital intubation was the most successful technique tested and allowed intubation to be accomplished just as quickly as with an endotracheal tube alone. Bougie-assisted digital intubation was slower and may not be as helpful as when it is used as an adjunct with direct laryngoscopy. Further research is needed to determine the utility of these adjuncts on live subjects. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - January 31, 2019 Category: Environmental Health Source Type: research

Thrombotic Microangiopathy, Hemolytic Uremic Syndrome, and Thrombotic Thrombocytopenic Purpura Following Hump-nosed Pit Viper (Genus: Hypnale) Envenoming in Sri Lanka
We describe 4 cases of TMA following hump-nosed pit viper (Hypnale spp) bites in Sri Lanka. The first case is a typical TMA that spontaneously resolved with supportive treatments. The second and third cases are related to hemolytic uremic syndrome complicated with acute kidney injury that required hemodialysis. The fourth case is thrombotic thrombocytopenic purpura associated with acute kidney injury that required hemodialysis and therapeutic plasma exchange. For each patient we describe the circumstances of the bite, clinical features, laboratory findings, and management. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - January 31, 2019 Category: Environmental Health Source Type: research

In Reply to Drs Joob and Wiwanitkit
Publication date: Available online 18 January 2019Source: Wilderness & Environmental MedicineAuthor(s): Hiroki Nagasawa, Youichi Yanagawa (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - January 18, 2019 Category: Environmental Health Source Type: research

In Reply to Dr Podsiadło et al
Publication date: Available online 16 January 2019Source: Wilderness & Environmental MedicineAuthor(s): Gordon G. Giesbrecht (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - January 17, 2019 Category: Environmental Health Source Type: research

2018 Wilderness & Environmental Medicine Peer Reviewers
Publication date: Available online 17 January 2019Source: Wilderness & Environmental MedicineAuthor(s): (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - January 17, 2019 Category: Environmental Health Source Type: research

In Reply to Lorenzati et al
Publication date: Available online 11 January 2019Source: Wilderness & Environmental MedicineAuthor(s): Giacomo Strapazzon, Mario Milani, Hermann Brugger (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - January 12, 2019 Category: Environmental Health Source Type: research

Improvised Hydration Bladder Air Splint: A Wilderness Case Report
Publication date: Available online 11 January 2019Source: Wilderness & Environmental MedicineAuthor(s): Hans F. Hurt, Aaron J. ReillyThis case report describes the use of a hydration bladder as an improvised air splint for a left forearm fracture in an austere environment. The literature regarding the use of air splints in the prehospital and wilderness environments is scarce, and it does not appear that this technique has been previously described in the literature. Given the widespread use of hydration bladders, the adjustable nature and overall comfort of the splint, and the anecdotal success of this technique witho...
Source: Wilderness and Environmental Medicine - January 12, 2019 Category: Environmental Health Source Type: research

Delayed-Onset High Altitude Pulmonary Edema: A Case Report
We report a case of a trekker with previous high altitude experience who developed HAPE 8 d after arrival to altitude despite what was believed to be a conservative ascent profile. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - January 12, 2019 Category: Environmental Health Source Type: research

Ethnicity-Based Inequality in Heat-Related Illness Is on the Rise in California
Publication date: Available online 12 January 2019Source: Wilderness & Environmental MedicineAuthor(s): Rana Abualsaud, Grigory Ostrovskiy, Ziyad R. Mahfoud (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - January 12, 2019 Category: Environmental Health Source Type: research

Neko Harbor, Andvord Bay, Antarctic Peninsula, on a Beautiful Sunny Day
Publication date: Available online 12 January 2019Source: Wilderness & Environmental MedicineAuthor(s): (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - January 12, 2019 Category: Environmental Health Source Type: research

Bite Caused by the Assassin Bug Zelus Fabricius, 1803 (Hemiptera; Heteroptera: Reduviidae) in a Human
Publication date: Available online 9 January 2019Source: Wilderness & Environmental MedicineAuthor(s): Carlos Eduardo Pereira dos Santos, José Ricardo de Souza, Régis Adriel Zanette, Felipe Jorge da Silva, Christine StrussmannA 47-y-old man was bitten by a reduviid bug from the Zelus Fabricius, 1803 genus, which was hidden inside a rubber-coated boot. The bite caused immediate and sharp pain, followed by local edema and constant pruritus for 15 d. Pain and fever within the first 24 h were managed with analgesics as needed, and resolution was complete and without sequelae after 21 d. (Source: Wilderness an...
Source: Wilderness and Environmental Medicine - January 10, 2019 Category: Environmental Health Source Type: research

Reduced Acetazolamide Dosing in Countering Altitude Illness: A Comparison of 62.5 vs 125 mg (the RADICAL Trial)
ConclusionsThe reduced dose of acetazolamide at 62.5 mg twice daily was noninferior to the currently recommended dose of 125 mg twice daily for the prevention of AMS. Low incidence of AMS in the study population may have limited the ability to differentiate the treatment effects. Further research with more participants with greater rates of AMS would further elucidate this reduced dosage for preventing altitude illness. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - January 9, 2019 Category: Environmental Health Source Type: research

In Response to Cold Card by Giesbrecht
Publication date: Available online 4 January 2019Source: Wilderness & Environmental MedicineAuthor(s): Paweł Podsiadło, Mathieu Pasquier, Sylweriusz Kosiński, Tomasz Sanak, Robert Gałązkowski, Tomasz Darocha (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - January 5, 2019 Category: Environmental Health Source Type: research

Rock Climber Self-Rescue Skills
ConclusionsSelf-rescue skills were generally lacking in our study population. Climber confidence, experience, training, and climbing frequency did not appear to be associated with a higher level of rescue skills. Self-rescue skills should be emphasized in climbing instruction and courses to increase overall safety. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - January 5, 2019 Category: Environmental Health Source Type: research

Pedicled Abdominal Flaps for Enhanced Digital Salvage After Severe Frostbite Injury
Publication date: Available online 24 December 2018Source: Wilderness & Environmental MedicineAuthor(s): Owain L. Fisher, Ruth A. Benson, Matthew R. Venus, Christopher H.E. ImrayExtremities are the area of the body most commonly affected by frostbite, which can also affect the face, ears, perineum, or genitals. Optimum management has moved away from early amputation and debridement toward maximizing tissue preservation and delaying surgical intervention. Increasing length of digit amputation increases morbidity, in terms of loss of hand function, experienced by patients. Reconstruction of affected digits is limited by ...
Source: Wilderness and Environmental Medicine - December 25, 2018 Category: Environmental Health Source Type: research

In Response to Bite Wounds Caused by a Wild Boar by Nagasawa et al
Publication date: Available online 21 December 2018Source: Wilderness & Environmental MedicineAuthor(s): Beuy Joob, Viroj Wiwanitkit (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - December 22, 2018 Category: Environmental Health Source Type: research

Fatal Pulmonary Edema in a Child After Jellyfish Stings in Korea
Publication date: December 2018Source: Wilderness & Environmental Medicine, Volume 29, Issue 4Author(s): Ji Hye Kim, Seung Baik Han, Areum DureyJellyfish have been increasing at a global scale in recent years. These blooms not only have deleterious effects on marine ecosystems, they also increase the risk of jellyfish stings and accompanying envenomation. Here, we report a fatal case of pulmonary edema caused by jellyfish envenomation in a child in Korea. The patient died 4 h after envenomation despite cardiopulmonary resuscitation. Nemopilema nomurai was the suspected species of jellyfish encountered by the patient, a...
Source: Wilderness and Environmental Medicine - November 15, 2018 Category: Environmental Health Source Type: research

Observational Study of Grand Canyon Rim-to-Rim Day Hikers: Determining Behavior Patterns to Aid in Preventive Search and Rescue Efforts
ConclusionsCrossing R2R in a day is hazardous and associated with risk of injury and illness. The results of this study can be used by Preventive Search and Rescue to reduce these risks by educating hikers. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 2, 2018 Category: Environmental Health Source Type: research

Severe Systemic Envenomation Following Vipera berus Bite Managed with ViperaTAb Antivenom
We present a case demonstrating both severe systemic and local effects necessitating out of hospital resuscitation, vasopressor support, and prolonged rehabilitation. Hemodynamic stability was restored promptly after administration of ViperaTAb antivenom, the first published case of its use in the UK. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - October 30, 2018 Category: Environmental Health Source Type: research

In Response to AVReCh—Avalanche Resuscitation Checklist by Strapazzon et al
Publication date: Available online 24 October 2018Source: Wilderness & Environmental MedicineAuthor(s): Lorenzati Bartolomeo, Sciolla Andrea, Tortore Andrea, Lauria Giuseppe (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - October 25, 2018 Category: Environmental Health Source Type: research

Poisoning with Tasty and Sweet Seed Pods of Bird of Paradise Plant Caesalpinia gilliessii
Publication date: Available online 25 October 2018Source: Wilderness & Environmental MedicineAuthor(s): Seyed Mostafa Mirakbari, Mohammad Hadi Shirazi (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - October 25, 2018 Category: Environmental Health Source Type: research

Don't Stand So Close to Me: A Stinging Rash
Publication date: Available online 25 October 2018Source: Wilderness & Environmental MedicineAuthor(s): Kyle J. Halle, Victoria S. Klovenski, Andrew Juergens (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - October 25, 2018 Category: Environmental Health Source Type: research

The Golden Jellyfish of Ongeim'l Tketau During an Afternoon Rain
Publication date: Available online 22 October 2018Source: Wilderness & Environmental MedicineAuthor(s): Rombod Rahimian (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - October 24, 2018 Category: Environmental Health Source Type: research

Blinding and Peer Review
Publication date: Available online 14 October 2018Source: Wilderness & Environmental MedicineAuthor(s): Neal W. Pollock (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - October 14, 2018 Category: Environmental Health Source Type: research

The Effects of Acetazolamide on Exercise Performance at Sea Level and in Hypoxic Environments: A Review
Publication date: Available online 9 October 2018Source: Wilderness & Environmental MedicineAuthor(s): Alexander M. Posch, Stewart Dandorf, David C. HileLowlanders rapidly ascending to high altitude (>2500 m) often develop acute mountain sickness (AMS). While acclimatization is the most effective method of reducing symptoms of AMS (ie, headache, fatigue, nausea, gastrointestinal distress, etc.), it may take several days to become fully acclimated. Prophylactic use of acetazolamide (AZ), a carbonic anhydrase inhibitor, has become a popular alternative to staged acclimatization because it can be a less time-consuming ...
Source: Wilderness and Environmental Medicine - October 10, 2018 Category: Environmental Health Source Type: research

Russell's Viper Envenomation-Associated Addisonian Crisis
We report a case of bilateral adrenal hemorrhage in a 28-y-old man with Russell's viper bite that occurred in the Sathyamangalam forest range in the Indian state of Tamil Nadu. In this case, a combination of early bite recognition, hospital-based supportive care, corticosteroid therapy, and timely administration of polyvalent antivenom resulted in a favorable clinical outcome. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - October 10, 2018 Category: Environmental Health Source Type: research

Fatal Pulmonary Edema in a Child After Jellyfish Stings inKorea
Publication date: Available online 9 October 2018Source: Wilderness & Environmental MedicineAuthor(s): Ji Hye Kim, Seung Baik Han, Areum DureyJellyfish have been increasing at a global scale in recent years. These blooms not only have deleterious effects on marine ecosystems, they also increase the risk of jellyfish stings and accompanying envenomation. Here, we report a fatal case of pulmonary edema caused by jellyfish envenomation in a child in Korea. The patient died 4 h after envenomation despite cardiopulmonary resuscitation. Nemopilema nomurai was the suspected species of jellyfish encountered by the patient, alt...
Source: Wilderness and Environmental Medicine - October 10, 2018 Category: Environmental Health Source Type: research

“Cold Card” to Guide Responders in the Assessment and Care of Cold-Exposed Patients
ConclusionsKey elements of hypothermia evaluation and field care have been summarized on a small portable card for laypersons, trained rescuers, and first responders. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - October 10, 2018 Category: Environmental Health Source Type: research

Giant Intracranial Cystic Lesion in a Child
Publication date: Available online 9 October 2018Source: Wilderness & Environmental MedicineAuthor(s): Kais Regaieg, Mabrouk Bahloul, Olfa Turki, Brahim Kammoun, Nozha Toumi, Mounir Bouaziz (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - October 10, 2018 Category: Environmental Health Source Type: research

Emergency Medical Services and Remote Medical Oversight in Sequoia and Kings Canyon National Parks, 2011–2013
ConclusionsSEKI EMS providers encounter a wide variety of patients in various settings, including the backcountry. Resource allocation, training, and protocol development should be tailored to meet their needs. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - October 10, 2018 Category: Environmental Health Source Type: research

Medical Incidents and Evacuations on Wilderness Expeditions for the Northwest Outward Bound School
ConclusionsResults from the NWOBS database are consistent with those from other expeditionary OE programs. These findings should guide risk-management strategies and staff medical training. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - October 10, 2018 Category: Environmental Health Source Type: research

Apostle Islands National Lakeshore: A Review of Search and Rescue and Emergency Medical Services Operations, 2006–2015
ConclusionsOverall, this study highlights the hazards associated with the frigid and rough conditions of Lake Superior. The reported results aim to help APIS personnel more saliently convey risks to visitors and plan appropriately in an effort to decrease the need for future rescues. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - October 5, 2018 Category: Environmental Health Source Type: research

Case Study: Providing Nutritional Support to an Ultraendurance Runner in Preparation for a Self-Sufficient Multistage Ultramarathon: Rationed Versus Full Energy Provisions
Publication date: Available online 22 September 2018Source: Wilderness & Environmental MedicineAuthor(s): Rebekah Alcock, Alan McCubbin, Vera Camões-Costa, Ricardo J.S. CostaAbstractTo assess the impact of rationed versus full estimated energy provisions on markers of physiological strain in response to a simulated 250km multistage ultramarathon (MSUM), on two separate occasions, the ultraendurance runner performed a laboratory simulated MSUM, with rationed (RP: 3303±75 kcal⋅day-1) and full (FP: 7156±359 kcal⋅day-1) provisions. Total daily energy expenditure was determined using dual-meth...
Source: Wilderness and Environmental Medicine - October 5, 2018 Category: Environmental Health Source Type: research

Myocarditis and Early Markers of Cardiac Response Associated with Scorpion Stings in Children
Publication date: Available online 23 September 2018Source: Wilderness & Environmental MedicineAuthor(s): Sinem S. Gökay, Özlem T. Kendir, Utku U. Güllü, Tuğçe Nalbant, Faruk Ekinci, Selçuk Matyar, İlker Ünal, Sevcan Erdem, Riza D. Yildizdaş, Hayri L. YilmazIntroductionA clinical course ranging from mild local findings to life-threatening systemic findings may occur after scorpion stings. The purpose of this study was to identify priority markers indicating scorpion sting–related cardiac involvement.MethodsOur study was performed between July 2014, and September 2015 in t...
Source: Wilderness and Environmental Medicine - October 5, 2018 Category: Environmental Health Source Type: research

Environmental and Wilderness-Related Risk Factors for Histoplasmosis: More Than Bats in Caves
ConclusionsHistoplasmosis can result in considerable morbidity. Increased awareness of disease risk factors among the public and the international healthcare community will improve the timely diagnosis and treatment of histoplasmosis and prevent disease progression and dissemination. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - October 5, 2018 Category: Environmental Health Source Type: research

Evaluation of Glucomannan Powder as an Ultrasound Transmission Gel Alternative for Resource-Constrained Environments: A Prospective, Comparative Study
ConclusionDespite a high image adequacy rate, glucomannan gel proved inferior to commercial USTG for US image adequacy but produced equivalent image quality. Glucomannan USTG may be a reasonable substitute when commercial USTG is unavailable. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - October 5, 2018 Category: Environmental Health Source Type: research

Columbia Crest on the Summit of Mount Rainier
Publication date: Available online 3 October 2018Source: Wilderness & Environmental MedicineAuthor(s): (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - October 5, 2018 Category: Environmental Health Source Type: research

High Altitude Illness: Knowledge, Practice, and Attitudes of Porters in Nepal
ConclusionsPorters in the Khumbu region continue to face hazards in their working environment. Future research and health education campaigns should address knowledge deficits and help with the design of tailored interventions. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - October 5, 2018 Category: Environmental Health Source Type: research

Venomous Snakebites in Canada: A National Review of Patient Epidemiology and Antivenom Usage
ConclusionsThe absolute number of annual envenomations is small and the 3 Crotalinae species are limited to relatively narrow geographic areas in British Columbia, Alberta, Saskatchewan, and Ontario. The utilization of antivenom in the treatment of patients revealed that regions where the western and prairie rattlesnake reside forfeited a substantial amount of antivenom from 2009 to 2015. Organizations responsible for maintaining antivenom supplies on a provincial or regional level could use these data to guide antidote stocking and reduce costs. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - October 5, 2018 Category: Environmental Health Source Type: research

NR3C2 Gene is Associated with Susceptibility to High-Altitude Pulmonary Edema in Han Chinese
This study aimed to investigate the association of the polymorphisms in the NR3C2 gene with HAPE susceptibility in Han Chinese.MethodsWe enrolled 133 HAPE patients and 131 matched healthy Han Chinese from the Yushu area in Qinghai, where the altitude is greater than 3500m. Two single nucleotide polymorphisms (SNPs) of the NR3C2 gene, rs2070951 and rs5522, were genotyped by the Sequenom MassARRAY SNP assay.ResultsThe genotypic distributions and allele frequencies of NR3C2 SNP rs5522 were significantly different between the HAPE and control groups (P
Source: Wilderness and Environmental Medicine - October 5, 2018 Category: Environmental Health Source Type: research

Climbing-Related Injury Among Adults in the United States: 5-Year Analysis of the National Emergency Department Sample
ConclusionsMost persons with climbing-related injuries presenting to EDs do not require inpatient admission. Although death is rare among patients with climbing-related injuries, the costs of injuries in survivors remain high. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - September 19, 2018 Category: Environmental Health Source Type: research

Millepora species (Fire Coral) Sting: A Case Report and Review of Recommended Management
We present a case report of a 30-old recreational diver who experienced a fire coral sting of her left anterior thigh and review the recommended prevention and management of fire coral stings. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - September 18, 2018 Category: Environmental Health Source Type: research

Avalanche Safety Practices Among Backcountry Skiers and Snowboarders in Jackson Hole in 2016
ConclusionsCertain individual characteristics of backcountry skiers and snowboarders are associated with increased frequency of adherence to recommended safety practices. These findings suggest that particular categories of backcountry recreationists may benefit from further avalanche safety education. The results of this study could help direct future educational efforts among backcountry recreationists. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - September 11, 2018 Category: Environmental Health Source Type: research

A Case of Near-Fatal Drowning Caused by an Attack from a Wild Boar
Publication date: Available online 9 September 2018Source: Wilderness & Environmental MedicineAuthor(s): Hiroki Nagasawa, Kazuhiko Omori, Ikuto Takeuchi, Kei Fujiwara, Hirohisa Uehara, Kei Jitsuiki, Akihiko Kondo, Hiromichi Ohsaka, Kouhei Ishikawa, Youichi Yanagawa (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - September 9, 2018 Category: Environmental Health Source Type: research