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[PMID]:28411938
[Au] Autor:Dobiesz VA; Sullivan W
[Ad] Endereço:Department of Emergency Medicine, Harvard Humanitarian Initiative, Brigham & Women's Hospital, Harvard Medical School, Neville House, 75 Francis Street, Boston, MA 02115, USA. Electronic address: vdobiesz@bwh.harvard.edu.
[Ti] Título:Medicolegal Issues in Expedition and Wilderness Medicine.
[So] Source:Emerg Med Clin North Am;35(2):485-494, 2017 May.
[Is] ISSN:1558-0539
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:There is increased participation in wilderness expeditions to remote and austere environments, which increases the likelihood of an accident and/or medical emergency and the professional liability risks for trip organizers. Trip organizers, outfitters, tour guides, and health care providers must understand the medicolegal liabilities involved in and the legal protection and immunity available when rendering care in austere and challenging settings to mitigate risks and prepare for the level of medical care that may be required. There is a great deal of variability in the legal protections provided by Good Samaritan laws and interpretations may differ among jurisdictions.
[Mh] Termos MeSH primário: Serviços Médicos de Emergência/legislação & jurisprudência
Responsabilidade Legal
Medicina Selvagem/legislação & jurisprudência
[Mh] Termos MeSH secundário: Emergências
Expedições
Seres Humanos
Imperícia/legislação & jurisprudência
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170421
[Lr] Data última revisão:
170421
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170417
[St] Status:MEDLINE


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[PMID]:28411936
[Au] Autor:Donner HJ
[Ad] Endereço:National Wilderness Medicine Conferences, 3790 El Camino Real, Suite 2029, Palo Alto, CA 94306, USA; Medical Operations, NASA Johnson Space Center, 2101 NASA Road 1 (SD3), Houston, TX 77058, USA. Electronic address: hdonner24@gmail.com.
[Ti] Título:Is There a Doctor Onboard? Medical Emergencies at 40,000 Feet.
[So] Source:Emerg Med Clin North Am;35(2):443-463, 2017 May.
[Is] ISSN:1558-0539
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:It is estimated 2.75 billion people travel aboard commercial airlines every year and 44,000 in-flight medical emergencies occur worldwide each year. Wilderness medicine requires a commonsense and improvisational approach to medical issues. A sudden call for assistance in the austere and unfamiliar surroundings of an airliner cabin may present the responding medical professional with a "wilderness medicine" experience. From resource management to equipment, this article sheds light on the unique conditions, challenges, and constraints of the flight environment.
[Mh] Termos MeSH primário: Aeronaves
Emergências
Tratamento de Emergência/métodos
Viagem
[Mh] Termos MeSH secundário: Doença da Altitude/terapia
Radiação Cósmica/efeitos adversos
Cardioversão Elétrica/métodos
Exposição Ambiental/efeitos adversos
Exposição Ambiental/prevenção & controle
Seres Humanos
Hipóxia/prevenção & controle
Síndrome do Jet Lag/prevenção & controle
Medicina Selvagem/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170421
[Lr] Data última revisão:
170421
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170417
[St] Status:MEDLINE


  3 / 207 MEDLINE  
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[PMID]:28411934
[Au] Autor:Butler FK; Bennett B; Wedmore CI
[Ad] Endereço:Committee on Tactical Combat Casualty Care, Joint Trauma System, US Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234-6315, USA. Electronic address: fkb064@yahoo.com.
[Ti] Título:Tactical Combat Casualty Care and Wilderness Medicine: Advancing Trauma Care in Austere Environments.
[So] Source:Emerg Med Clin North Am;35(2):391-407, 2017 May.
[Is] ISSN:1558-0539
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Tactical Combat Casualty Care (TCCC) is a set of evidence-based, best-practice prehospital trauma care guidelines customized for use on the battlefield. Military units that have trained all of their unit members in TCCC have now documented the lowest incidence of preventable deaths in the history of modern warfare and TCCC is now the standard for battlefield trauma care in the US Military. TCCC and wilderness medicine share the goal of optimizing care for patients with trauma in austere environments that impose significant challenges in both equipment and evacuation capability. This article reviews the current battlefield trauma care recommendations in TCCC and discusses their applicability to the wilderness setting.
[Mh] Termos MeSH primário: Serviços Médicos de Emergência/métodos
Medicina Militar/métodos
Medicina Selvagem
Ferimentos e Lesões/terapia
[Mh] Termos MeSH secundário: Serviços Médicos de Emergência/organização & administração
Seres Humanos
Medicina Militar/organização & administração
Guerra
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170421
[Lr] Data última revisão:
170421
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170417
[St] Status:MEDLINE


  4 / 207 MEDLINE  
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[PMID]:28282356
[Au] Autor:Hoffman MD; Joslin J; Rogers IR
[Ad] Endereço:1Department of Physical Medicine and Rehabilitation, Department of Veterans Affairs, Northern California Health Care System, and University of California Davis Medical Center, Sacramento, CA; 2Department of Emergency Medicine, State University of New York Upstate Medical University, Syracuse, NY; 3St. John of God Murdoch Hospital & University of Notre Dame, Murdoch, WA, Australia.
[Ti] Título:Management of Suspected Fluid Balance Issues in Participants of Wilderness Endurance Events.
[So] Source:Curr Sports Med Rep;16(2):98-102, 2017 Mar/Apr.
[Is] ISSN:1537-8918
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Dehydration and exercise-associated hyponatremia (EAH) are both relatively common conditions during wilderness endurance events. Whereas dehydration is treated with fluids, EAH is appropriately managed with fluid restriction and a sodium bolus but can worsen with isotonic or hypotonic fluids. Therefore, caution is recommended in the provision of postevent rehydration in environments where EAH is a potential consideration because accurate field assessment of hydration status can be challenging, and measurement of blood sodium concentration is rarely possible in the wilderness. Dehydration management with oral rehydration is generally adequate and preferred to intravenous rehydration, which should be reserved for athletes with sustained orthostasis or inability to tolerate oral fluid ingestion after some rest. In situations where intravenous hydration is initiated without known blood sodium concentration or hydration status, an intravenous concentrated sodium solution should be available in the event of acute neurological deterioration consistent with the development of EAH encephalopathy.
[Mh] Termos MeSH primário: Desidratação/prevenção & controle
Soluções Isotônicas/uso terapêutico
Solução Salina Hipertônica/uso terapêutico
Meio Selvagem
[Mh] Termos MeSH secundário: Atletas
Desidratação/terapia
Hidratação/métodos
Seres Humanos
Equilíbrio Hidroeletrolítico
Medicina Selvagem
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Isotonic Solutions); 0 (Saline Solution, Hypertonic)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170928
[Lr] Data última revisão:
170928
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170311
[St] Status:MEDLINE
[do] DOI:10.1249/JSR.0000000000000344


  5 / 207 MEDLINE  
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[PMID]:28029455
[Au] Autor:Bitter CC; Erickson TB
[Ad] Endereço:Department of Surgery, Division of Emergency Medicine and the College of Public Health and Social Justice, Saint Louis University, St. Louis, MO (Dr Bitter); and the Department of Emergency Medicine, Division of Toxicology, Brigham & Women's Hospital, Harvard Medical School, Harvard Humanitarian Initiative, Boston MA (Dr Erickson). Electronic address: bittercc@slu.edu.
[Ti] Título:Management of Burn Injuries in the Wilderness: Lessons from Low-Resource Settings.
[So] Source:Wilderness Environ Med;27(4):519-525, 2016 Dec.
[Is] ISSN:1545-1534
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Burns are a common source of injuries worldwide, with a high burden of disease in low- and middle-income countries. Burns also account for 2%-8% of wilderness injuries. Although many are minor, the potential for serious morbidity and mortality exists, and standard treatments used in high-resource settings are not readily available in the backcountry. A literature review was performed to find evidence from low-resource settings that supports alternative or improvised therapies that may be adapted to care of burns in the wilderness. There is good evidence for use of oral rehydration to support volume status in burn patients. There is moderate evidence to support cold therapy as first aid and adjunct for pain control. Some evidence supports use of alternative dressings such as boiled potato peel, banana leaf, aloe vera, honey, sugar paste, and papaya when standard therapies are not available.
[Mh] Termos MeSH primário: Queimaduras/terapia
Crioterapia/métodos
Primeiros Socorros/métodos
Manejo da Dor/métodos
[Mh] Termos MeSH secundário: Administração Tópica
Adulto
Bandagens
Hidratação
Mel
Seres Humanos
Masculino
Medicina Selvagem/métodos
Cicatrização
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170615
[Lr] Data última revisão:
170615
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161229
[St] Status:MEDLINE


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[PMID]:27912862
[Au] Autor:Pollock NW
[Ti] Título:Ethics and Oversight in Publication.
[So] Source:Wilderness Environ Med;27(4):449, 2016 Dec.
[Is] ISSN:1545-1534
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Revisão por Pares/ética
Medicina Selvagem/normas
[Mh] Termos MeSH secundário: Publicações Seriadas
[Pt] Tipo de publicação:EDITORIAL
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161204
[St] Status:MEDLINE


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[PMID]:27793443
[Au] Autor:Luck JB; Campagne D; Falcón Banchs R; Montoya J; Spano SJ
[Ad] Endereço:University of California San Francisco Fresno, Fresno, CA (Drs Luck, Campagne, and Spano).
[Ti] Título:Pressures of Wilderness Improvised Wound Irrigation Techniques: How Do They Compare?
[So] Source:Wilderness Environ Med;27(4):476-481, 2016 Dec.
[Is] ISSN:1545-1534
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Compare the pressures measured by improvised irrigation techniques to a commercial device and to prior reports. METHODS: Devices tested included a commercial 500-mL compressible plastic bottle with splash guard, a 10-mL syringe, a 10-mL syringe with a 14-ga angiocatheter (with needle removed), a 50-mL Sawyer syringe, a plastic bag punctured with a 14-ga needle, a plastic bottle with cap punctured by a 14-ga needle, a plastic bottle with sports top, and a bladder-style hydration system. Each device was leveled on a support, manually compressed, and aimed toward a piece of glass. A high-speed camera placed behind the glass recorded the height of the stream upon impact at its highest and lowest point. Measurements were recorded 5 times for each device. Pressures in pounds per square inch (psi) were calculated. RESULTS: The syringe and angiocatheter pressures measured the highest pressures (16-49 psi). The 50-mL syringe (7-11 psi), 14-ga punctured water bottle (7-25 psi), and water bottle with sports top (3-7 psi) all measured at or above the commercial device (4-5 psi). Only the bladder-style hydration system (1-2 psi) and plastic bag with 14-ga needle puncture (2-3 psi) did not reach pressures generated by the commercial device. CONCLUSIONS: Pressures are consistent with those previously reported. All systems using compressible water bottles and all syringe-based systems provided pressures at or exceeding a commercial wound irrigation device. A 14-ga punctured plastic bag and bladder-style hydration pack failed to generate similar irrigation pressures.
[Mh] Termos MeSH primário: Irrigação Terapêutica/instrumentação
Irrigação Terapêutica/métodos
Ferimentos e Lesões/terapia
[Mh] Termos MeSH secundário: Desenho de Equipamento
Seres Humanos
Agulhas
Pressão
Seringas
Medicina Selvagem/instrumentação
Medicina Selvagem/métodos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161030
[St] Status:MEDLINE


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[PMID]:27789165
[Au] Autor:Blancher M; Colonna d'Istria J; Coste A; Saint Guilhem P; Pierre A; Clausier F; Debaty G; Bosson JL; Briot R; Bouzat P
[Ad] Endereço:Département de médecine d'urgence, Centre Hospitalier Universitaire (CHU) de Grenoble- Alpes, Grenoble, France (Drs Blancher, Saint Guilhem, Debaty, and Briot); Association Nationale des Médecins et Sauveteurs en Montagne, (ANMSM) French Mountain Rescue Association (Drs Blancher, Colonna d'Istria, a
[Ti] Título:Medical Pathologies and Hut Guardians' Ability to Provide First Aid in Mountain Huts: A Prospective Observational Study.
[So] Source:Wilderness Environ Med;27(4):468-475, 2016 Dec.
[Is] ISSN:1545-1534
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To describe the resources for medical condition management in mountain huts and the epidemiology of such events. METHODS: We conducted a 3-step study from April 2013 to August 2014 in French mountain huts. The first step consisted of collecting data regarding the first aid equipment available in mountain huts. The second step consisted of a qualitative evaluation of the mountain hut guardian's role in medical situations through semistructured interviews. Finally, a prospective observational study was conducted in the summer season to collect all medical events (MEs) that occurred during that period. RESULTS: Out of 164 hut guardians, 141 (86%) had a basic life support diploma. An automatic external defibrillator was available in 41 (26%) huts, and 148 huts (98%) were equipped with a first aid kit. According to semistructured interviews, hut guardians played a valuable role in first aid assistance. Regarding the observational study, 306 people requested the hut guardian's help for medical reasons in 87 of the 126 huts included. A total of 501 MEs for approximately 56,000 hikers (0.85%) were reported, with 280 MEs (56%) involving medical pathologies and 221 (44%) MEs involving trauma-related injuries. CONCLUSIONS: MEs had low prevalence, but the hut guardian played a valuable role as a first aid responder.
[Mh] Termos MeSH primário: Tratamento de Emergência/estatística & dados numéricos
Primeiros Socorros/instrumentação
Primeiros Socorros/estatística & dados numéricos
Montanhismo
[Mh] Termos MeSH secundário: Adulto
Idoso
Feminino
Primeiros Socorros/utilização
França
Habitação
Seres Humanos
Masculino
Meia-Idade
Estudos Prospectivos
Inquéritos e Questionários
Medicina Selvagem/estatística & dados numéricos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161030
[St] Status:MEDLINE


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[PMID]:27769777
[Au] Autor:Johnson CA; Goodwine DS; Passier I
[Ti] Título:Improvised Cricothyrotomy on a Mountain Using Hiking Gear.
[So] Source:Wilderness Environ Med;27(4):500-503, 2016 Dec.
[Is] ISSN:1545-1534
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We present a case of a 57-year-old man who fell while climbing a mountain in California and sustained severe facial trauma. Three firefighters and 2 emergency physicians witnessed the fall and resuscitated the patient. The patient ultimately required a surgical cricothyrotomy performed with a pocket knife and Platypus hydration pack. The physicians made a makeshift positive pressure airway device using the Platypus hydration pack. We believe this is the first case report describing an improvised cricothyrotomy performed in the wilderness using only hiking gear. This report also discusses indications for cricothyrotomy, the challenges of resuscitation in a low-resource environment, and special considerations in a high-altitude setting.
[Mh] Termos MeSH primário: Traumatismos Faciais/cirurgia
Traqueostomia/métodos
[Mh] Termos MeSH secundário: Resgate Aéreo
Altitude
California
Socorristas
Seres Humanos
Masculino
Meia-Idade
Montanhismo/lesões
Traqueostomia/instrumentação
Medicina Selvagem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161023
[St] Status:MEDLINE


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[PMID]:27753548
[Au] Autor:Bridgewater FH
[Ad] Endereço:The Queen Elizabeth Hospital, 11 Woodville Road, Woodville, South Australia 5011.
[Ti] Título:Forty Years on From an Event That Changed the Management of Trauma Around the World: What Actually Happened That Night Forty Years Ago?
[So] Source:Mil Med;181(10):1176-1181, 2016 Oct.
[Is] ISSN:1930-613X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The management of trauma has evolved significantly over the last 40 years. Seminal to this process was the development in Nebraska of a concept of trauma management that was promulgated as Advanced Trauma Life Support (ATLS). It has achieved global support and is considered by many to be the acme in trauma management. Every participant in an ATLS course remembers that an aviation accident in rural Nebraska was responsible for the nascence of the program but very few know the details of the crash. February 17, 2016, was the 40th anniversary of the accident. This article extracts the details of the flight, the crash, the search, the extrication, the reception at the nearby rural hospital, and the injuries from both the official report and the published, personal records of survivors of the crash. The effect of ATLS can be debated elsewhere and its future questioned. However, the article concludes by highlighting the fortitude and resilience of the human spirit that were demonstrated that night under incredible circumstances.
[Mh] Termos MeSH primário: Cuidados de Suporte Avançado de Vida no Trauma/história
Viagem Aérea
[Mh] Termos MeSH secundário: História do Século XX
Seres Humanos
Nebraska
Medicina Selvagem/métodos
Medicina Selvagem/normas
Ferimentos e Lesões/terapia
[Pt] Tipo de publicação:HISTORICAL ARTICLE; JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170713
[Lr] Data última revisão:
170713
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161019
[St] Status:MEDLINE



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