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2.
Nursing ; 54(7): 6, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38913916
3.
Emerg Med Clin North Am ; 42(3): 597-611, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38925777

RESUMO

This review highlights the causative organisms, clinical features, diagnosis, and treatment of the most common tick-borne illnesses in the United States, including Lyme disease, Rocky Mountain spotted fever, anaplasmosis, ehrlichiosis, tularemia, Powassan virus, and alpha-gal syndrome. Tick bite prevention strategies and some basic tick removal recommendations are also provided.


Assuntos
Doenças Transmitidas por Carrapatos , Humanos , Doenças Transmitidas por Carrapatos/diagnóstico , Doenças Transmitidas por Carrapatos/terapia , Doenças Transmitidas por Carrapatos/epidemiologia , Animais , Medicina Selvagem , Doença de Lyme/diagnóstico , Doença de Lyme/terapia , Doença de Lyme/epidemiologia , Febre Maculosa das Montanhas Rochosas/diagnóstico , Febre Maculosa das Montanhas Rochosas/terapia , Febre Maculosa das Montanhas Rochosas/epidemiologia , Estados Unidos/epidemiologia , Carrapatos/virologia , Picadas de Carrapatos/terapia , Ehrlichiose/diagnóstico , Ehrlichiose/epidemiologia , Ehrlichiose/terapia , Ehrlichiose/tratamento farmacológico , Anaplasmose/diagnóstico , Anaplasmose/epidemiologia , Anaplasmose/terapia
4.
Emerg Med Clin North Am ; 42(3): xiii-xiv, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38925784
5.
Wilderness Environ Med ; 35(2): 183-197, 2024 06.
Artigo em Inglês | MEDLINE | ID: mdl-38577729

RESUMO

The Wilderness Medical Society convened an expert panel to develop a set of evidence-based guidelines for the prevention and treatment of frostbite. We present a review of pertinent pathophysiology. We then discuss primary and secondary prevention measures and therapeutic management. Recommendations are made regarding each treatment and its role in management. These recommendations are graded on the basis of the quality of supporting evidence and balance between the benefits and risks or burdens for each modality according to methodology stipulated by the American College of Chest Physicians. This is an updated version of the guidelines published in 2019.


Assuntos
Congelamento das Extremidades , Sociedades Médicas , Medicina Selvagem , Congelamento das Extremidades/terapia , Congelamento das Extremidades/prevenção & controle , Medicina Selvagem/normas , Medicina Selvagem/métodos , Humanos
7.
Wilderness Environ Med ; 35(2): 198-218, 2024 06.
Artigo em Inglês | MEDLINE | ID: mdl-38651342

RESUMO

The Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the management of pain in austere environments. Recommendations are graded based on the quality of supporting evidence as defined by criteria put forth by the American College of Chest Physicians. This is an update of the 2014 version of the "WMS Practice Guidelines for the Treatment of Acute Pain in Remote Environments" published in Wilderness & Environmental Medicine 2014; 25:41-49.


Assuntos
Dor Aguda , Manejo da Dor , Sociedades Médicas , Medicina Selvagem , Medicina Selvagem/normas , Medicina Selvagem/métodos , Humanos , Dor Aguda/terapia , Dor Aguda/tratamento farmacológico , Manejo da Dor/métodos , Manejo da Dor/normas , Região de Recursos Limitados
8.
Wilderness Environ Med ; 35(1_suppl): 112S-127S, 2024 03.
Artigo em Inglês | MEDLINE | ID: mdl-38425235

RESUMO

The Wilderness Medical Society (WMS) convened an expert panel in 2011 to develop a set of evidence-based guidelines for the recognition, prevention, and treatment of heat illness. The current panel retained 5 original members and welcomed 2 new members, all of whom collaborated remotely to provide an updated review of the classifications, pathophysiology, evidence-based guidelines for planning and preventive measures, and recommendations for field- and hospital-based therapeutic management of heat illness. These recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks or burdens for each modality. This is an updated version of the WMS clinical practice guidelines for the prevention and treatment of heat illness published in Wilderness & Environmental Medicine. 2019;30(4):S33-S46.


Assuntos
Transtornos de Estresse por Calor , Medicina Selvagem , Humanos , Medicina Ambiental , Transtornos de Estresse por Calor/prevenção & controle , Sociedades Médicas
9.
Wilderness Environ Med ; 35(1_suppl): 67S-77S, 2024 03.
Artigo em Inglês | MEDLINE | ID: mdl-38425236

RESUMO

A panel convened to develop an evidence-based set of guidelines for the recognition and treatment of eye injuries and illnesses that may occur in the wilderness. These guidelines are meant to serve as a tool to help wilderness providers accurately identify and subsequently treat or evacuate for a variety of ophthalmologic complaints. Recommendations are graded based on the quality of their supporting evidence and the balance between risks and benefits according to criteria developed by the American College of Chest Physicians.


Assuntos
Traumatismos Oculares , Medicina Selvagem , Humanos , Traumatismos Oculares/etiologia , Traumatismos Oculares/terapia , Sociedades Médicas
10.
11.
Wilderness Environ Med ; 35(1_suppl): 45S-66S, 2024 03.
Artigo em Inglês | MEDLINE | ID: mdl-38379474

RESUMO

To provide guidance to medical providers, wilderness users, and travelers, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for treating water in situations where the potability of available water is not assured, including wilderness and international travel, areas impacted by disaster, and other areas without adequate sanitation. The guidelines present the available methods for reducing or eliminating microbiological contamination of water for individuals, groups, or households; evaluation of their effectiveness; and practical considerations. The evidence base includes both laboratory and clinical publications. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according to the criteria published by the American College of Chest Physicians.


Assuntos
Desastres , Medicina Selvagem , Humanos , Sociedades Médicas
14.
Wilderness Environ Med ; 35(1_suppl): 94S-111S, 2024 03.
Artigo em Inglês | MEDLINE | ID: mdl-38379489

RESUMO

The Wilderness Medical Society convened a panel to review available evidence supporting practices for acute management of drowning in out-of-hospital and emergency care settings. Literature about definitions and terminology, epidemiology, rescue, resuscitation, acute clinical management, disposition, and drowning prevention was reviewed. The panel graded available evidence supporting practices according to the American College of Chest Physicians criteria and then made recommendations based on that evidence. Recommendations were based on the panel's collective clinical experience and judgment when published evidence was lacking. This is the second update to the original practice guidelines published in 2016 and updated in 2019.


Assuntos
Afogamento , Medicina Selvagem , Humanos , Afogamento/prevenção & controle , Serviços Médicos de Emergência , Ressuscitação , Sociedades Médicas
15.
Wilderness Environ Med ; 35(1_suppl): 78S-93S, 2024 03.
Artigo em Inglês | MEDLINE | ID: mdl-38379496

RESUMO

The Wilderness Medical Society reconvened an expert panel to update best practice guidelines for spinal cord protection during trauma management. This panel, with membership updated in 2023, was charged with the development of evidence-based guidelines for management of the injured or potentially injured spine in wilderness environments. Recommendations are made regarding several parameters related to spinal cord protection. These recommendations are graded based on the quality of supporting evidence and balance the benefits and risks/burdens for each parameter according to American College of Chest Physicians methodology. Key recommendations include the concept that interventions should be goal-oriented (spinal cord/column protection in the context of overall patient and provider safety) rather than technique-oriented (immobilization). An evidence-based, goal-oriented approach excludes the immobilization of suspected spinal injuries via rigid collars or backboards.


Assuntos
Medula Espinal , Medicina Selvagem , Humanos , Sociedades Médicas
16.
Wilderness Environ Med ; 35(2): 234-242, 2024 06.
Artigo em Inglês | MEDLINE | ID: mdl-38380990

RESUMO

INTRODUCTION: Pain management for trauma in the extreme environment is vital for both casualty comfort and aiding safe extrication. However, adequate pain management in a resource-limited environment can be challenging and is often limited. We conducted a scoping review of the use of regional anesthesia in the prehospital environment, evaluating which regional anesthetic procedure was performed for various indications, their efficacy, and the type of healthcare provider delivering the anesthetic. METHODS: A PRISMA-guided systematic literature review was conducted of Medline, Embase, and Cochrane databases for studies reporting the use of regional anesthesia in the prehospital environment published before June 30, 2022. RESULTS: Thirty studies met the criteria and were included in the review. The most common types of regional anesthesia were fascia-iliaca compartment block (n = 317, from 12 studies) and femoral nerve block (n = 210, from 8 studies), along with various other blocks for a range of indications. These blocks had good efficacy and a low-risk profile and could be delivered by a wide range of healthcare providers. CONCLUSIONS: Regional anesthesia is an effective and non-resource-heavy pain management tool in prehospital environments, which may be applicable to austere settings. It can cover a wide range of injuries and can avoid systemic complications for casualties that may already be challenging to manage in out-of-hospital settings. Additionally, regional anesthesia can be effectively delivered by a wide range of providers. This review provides a holistic summary of pain management using regional anesthesia in the prehospital environment, with a discussion on its potential use in more extreme settings.


Assuntos
Anestesia por Condução , Serviços Médicos de Emergência , Humanos , Anestesia por Condução/métodos , Serviços Médicos de Emergência/métodos , Manejo da Dor/métodos , Medicina Selvagem/métodos , Ferimentos e Lesões/terapia , Ferimentos e Lesões/cirurgia , Região de Recursos Limitados
18.
Can Med Educ J ; 14(3): 111-112, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-37465728

RESUMO

Wilderness medicine education is interesting to medical students, yet not widely implemented in Canadian medical curricula. We describe a curriculum for a pre-clerkship wilderness medicine elective at a Canadian medical school. Our study reports increased student awareness of career opportunities in wilderness medicine after elective completion, and interest in hands-on learning for wilderness medicine topics. Medical schools may benefit from incorporating feedback from our elective towards a successful wilderness medicine curriculum in their own programs.


La médecine en milieu sauvage est un domaine que les étudiants trouvent intéressant, mais dont l'enseignement est peu répandu dans les programmes d'études médicales au Canada. Nous décrivons le contenu d'un stage au choix de médecine en milieu sauvage offert au pré-externat dans une faculté de médecine canadienne. Notre étude montre qu'à la suite du stage, les étudiants sont mieux informés des possibilités de carrière en médecine en milieu sauvage et qu'ils manifestent un intérêt pour l'apprentissage pratique dans ce domaine médical. Les commentaires recueillis sur notre stage peuvent être utiles à d'autres facultés souhaitant introduire une formation en médecine en milieu sauvage dans leur programme.


Assuntos
Educação de Graduação em Medicina , Estudantes de Medicina , Medicina Selvagem , Humanos , Medicina Selvagem/educação , Canadá , Currículo
19.
Wilderness Environ Med ; 34(2): 172-181, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37130771

RESUMO

We convened an expert panel to develop evidence-based guidelines for the evaluation, treatment, and prevention of nonfreezing cold injuries (NFCIs; trench foot and immersion foot) and warm water immersion injuries (warm water immersion foot and tropical immersion foot) in prehospital and hospital settings. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according to the criteria published by the American College of Chest Physicians. Treatment is more difficult with NFCIs than with warm water immersion injuries. In contrast to warm water immersion injuries that usually resolve without sequelae, NFCIs may cause prolonged debilitating symptoms, including neuropathic pain and cold sensitivity.


Assuntos
Congelamento das Extremidades , Pé de Imersão , Medicina Selvagem , Humanos , Água , Pé de Imersão/prevenção & controle , Imersão , Padrões de Prática Médica , Congelamento das Extremidades/prevenção & controle , Sociedades Médicas , Temperatura Baixa
20.
Wilderness Environ Med ; 34(2): 193-200, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37031073

RESUMO

INTRODUCTION: Wilderness medicine education is one of the fastest growing facets of both graduate and undergraduate medical education. Currently, there are curriculum guidelines for both student electives and fellowships in wilderness medicine. However, there are no guidelines for resident elective curricula. The student/resident education committee of the Wilderness Medical Society (WMS) convened a task force to develop curriculum guidelines for these electives. METHODS: A survey of previously described core wilderness medicine topics was sent to a cohort of educators involved in wilderness medicine resident electives. They were asked to rank topics on the basis of their importance of being included on a Likert scale. Multivariate analysis of medians was used to distinguish among topics to determine which topics were voted most and least necessary for a curriculum. RESULTS: Of the database members contacted, 35 responded to the survey. The described current state of residency electives was that 16 institutions offered their own elective (46%). For subject preferences, multivariate analysis of scoring distribution medians demonstrated a significantly higher pattern of responses (P<0.01) for subjects with a median of 3 (must include) than for the lowest-scoring subjects that had a median of 1 (can include). Every topic was rated "must" by at least 1 respondent. Topics were further subdivided into an educational framework reflecting a common approach to education of wilderness medicine fellows focusing on education, leadership, knowledge, and skills. CONCLUSIONS: There was a wide variety in the ranking of topics; however, there were multiple topics on which a consensus for inclusion was reached. These topics are organized and presented here as a suggested curriculum by the student/resident education committee of the WMS.


Assuntos
Internato e Residência , Medicina Selvagem , Humanos , Medicina Selvagem/educação , Consenso , Currículo , Inquéritos e Questionários
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