- StatPearls: EMS, Management Of Traumatic And Medical Disorders In A Wilderness Environment [BOOK]StatPearls Publishing: Treasure Island (FL)BOOK
- Wilderness medicine is an amalgamation of many different medical disciplines. The base medical knowledge needed for competent practice is most closely aligned with the specialties of emergency medicine and primary care. However, familiarity with many other subspecialties such as emergency medical services (EMS), expedition medicine, tactical medicine, travel medicine, and several others may be ne…
Wilderness medicine is an amalgamation of many different medical disciplines. The base medical knowledge needed for competent practice is most closely aligned with the specialties of emergency medicine and primary care. However, familiarity with many other subspecialties such as emergency medical services (EMS), expedition medicine, tactical medicine, travel medicine, and several others may be necessary depending on individual practice circumstances. With such a broad knowledge base, an agreed-upon definition of wilderness medicine has proven difficult. Most reasonable definitions center on delayed time to definitive care and limitations of available resources. Modern wilderness medicine is a relatively new and evolving area of clinical practice. The Wilderness Medical Society (WMS) is a leading organization for promoting research and education in the field of wilderness medicine, but it has only been in existence since 1983. Several other national organizations providing wilderness medical care and education, such as the National Outdoor Leadership School (NOLS) and the National Ski Patrol (NSP), can trace their roots back several decades earlier. Since the early 2000s, there has been more interest from the mainstream medical community in wilderness medicine education and practice. This appears to coincide with increased participation in outdoor recreation by the general public during the same timeframe. With this increased focus, the practice of wilderness medicine has been changing. Many providers will be familiar with wilderness medicine teachings emphasizing impromptu care. Serious practitioners of wilderness medicine, however, understand that this method is inadequate when providing an organized medical response to patients in a wilderness setting. In recent years, the idea of incorporating wilderness medicine into the existing EMS structure has gained traction. However, many questions regarding the best way to integrate adequate wilderness response remain unanswered. Several studies have attempted to establish the incidence of medical issues in remote settings. The majority of these studies have focused on the medical response in the national parks. There are a few studies exploring incidence in other outdoor settings, such as wilderness expeditions and Everest base camp. One study explored outdoor recreational injuries presenting to emergency departments. While all these studies suffer from flaws inherent to retrospective reviews, they do establish certain trends that will prove useful in the further development of wilderness emergency medical services (WEMS). The national park data shows a relatively even split between medical and traumatic calls for service. Trauma, however, produces more fatalities. The majority of non-fatal trauma is due to athletic-type injuries and extremity fractures. Counterintuitively, the largest portion of expedition injuries occurs in camp or while hiking, not during more “high-risk activities” (climbing, mountaineering, skiing, kayaking, etc.). During expeditions, a significant portion of medical issues was due to gastrointestinal and respiratory illnesses. Mirroring data from urban EMS response, most care rendered is at the basic life support (BLS) level. A review of this data will help physicians and EMS organizations prepare for providing rational WEMS response.
- Spinal cord anaplastic astrocytoma with BRAF V600E mutation: A case report and review of literature. [Case Reports]Neuropathology 2020N
- A 17-year-old female complained of lower extremity pain that progressed to low back pain accompanied by paraparesis. Magnetic resonance imaging revealed a mass in the conus medullaris of the spinal cord at the thoracic spine 11-12 level. The patient underwent resection of the mass. The pathological diagnosis was anaplastic astrocytoma based on the densely proliferating astrocytic tumor cells with…
A 17-year-old female complained of lower extremity pain that progressed to low back pain accompanied by paraparesis. Magnetic resonance imaging revealed a mass in the conus medullaris of the spinal cord at the thoracic spine 11-12 level. The patient underwent resection of the mass. The pathological diagnosis was anaplastic astrocytoma based on the densely proliferating astrocytic tumor cells without necrosis or microvascular proliferation. The patient received chemoradiotherapy with oral temozolomide and a total of 54 Gy of local irradiation, followed by 24 courses of temozolomide as maintenance chemotherapy. The patient survived for 8 years without tumor recurrence following the initial treatment. Genetic analysis of the tumor revealed a BRAF V600E mutation that has not yet been reported in spinal cord high-grade gliomas (HGGs). In recent years, the molecular therapy targeting the BRAF V600E mutation has been applied in clinical practice for several cancer types. Although the frequency in spinal cord HGGs is uncertain, it is necessary to investigate BRAF V600E mutation as a potential therapeutic target in the future.
- Metastatic Brain Choriocarcinoma in a Postmenopausal Woman: A Case Report. [Journal Article]Am J Case Rep 2020; 21:e917656AJ
- CONCLUSIONS: Postmenopausal choriocarcinoma is rare and there are few case reports in the literature. It is a rare but possibly under-diagnosed metastatic disease in women. At present, a postmenopausal woman without a clear primary tumor should have a pregnancy test performed to rule out choriocarcinoma, as it is readily responsive to therapy.
- Visual Biofeedback and Changes in Lower Extremity Kinematics in Individuals With Medial Knee Displacement. [Journal Article]J Athl Train 2020JA
- CONCLUSIONS: Real-time visual biofeedback immediately improved faulty lower extremity kinematics related to knee-injury risk. Individuals with medial knee displacement adjusted their movement patterns after a single training session and reduced their medial knee motion during a dynamic task.
- The Muscle-Sparing Descending Branch Latissimus Dorsi Free Flap for Lower Extremity Reconstruction. [Journal Article]Plast Reconstr Surg 2020; 145(2):412e-420ePR
- CONCLUSIONS: The MSLD flap is a useful and reliable option for free flap reconstruction of the lower extremity. Advantages include an easily contourable flap, low revision rate, low complication rate, and the ability to harvest in supine position. In addition, the MSLD flap preserves donor function useful for rehabilitation and minimizes seroma risk.
- Regional Patterns of Fluid and Fat Accumulation in Patients with Lower Extremity Lymphedema Using Magnetic Resonance Angiography. [Journal Article]Plast Reconstr Surg 2020; 145(2):555-563PR
- CONCLUSIONS: The proposed magnetic resonance angiographic grading system may help stratify patients with International Society of Lymphology stage 2 lymphedema on the basis of tissue composition.
- Migraine Surgery at the Frontal Trigger Site: An Analysis of Intraoperative Anatomy. [Journal Article]Plast Reconstr Surg 2020; 145(2):523-530PR
- CONCLUSIONS: The intraoperative anatomy and cause of nerve compression at the frontal trigger site vary greatly among patients. The authors report a supraorbital nerve foramen prevalence of 50.3 percent, which is greater than in previous cadaver studies of the general population. Lastly, the presence of pain at a specific site is associated with macroscopic nerve compression.
- An Evaluation of Safety and Patient Outcomes for Hand Surgery following Prior Breast Cancer Treatment: Establishing New Recommendations in Lymphedema. [Journal Article]Plast Reconstr Surg 2020; 145(2):459-467PR
- CONCLUSIONS: Based on the available evidence, there is no increased risk of complications for elective hand surgery in patients with prior breast cancer treatment. Breast cancer patients with preexisting ipsilateral lymphedema carry slightly increased risk of postoperative infection and worsening lymphedema. It is the authors' opinion and recommendation that elective hand surgery with a tourniquet is not a contradiction in patients who have received previous breast cancer treatments.
- The Effect of Sequential Compression Devices on Fibrinolysis in Plastic Surgery Outpatients: A Randomized Trial. [Journal Article]Plast Reconstr Surg 2020; 145(2):392-401PR
- CONCLUSIONS: No significant change in systemic fibrinolytic activity occurs during outpatient plastic surgery under total intravenous anesthesia. Sequential compression devices do not affect tissue plasminogen activator or plasminogen activator inhibitor-1 levels, suggesting no fibrinolytic benefit.
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- The Charles Procedure as Part of the Modern Armamentarium Against Lymphedema. [Journal Article]Ann Plast Surg 2020AP
- CONCLUSIONS: The Charles procedure continues to have clinical utility in modern lymphedema treatment. Despite potential risks, it can be done successfully with proper planning and careful attention to technical details; it can be life changing for patients suffering from most extreme lymphedema.