A Comprehensive Review of Hirudiniasis: From Historic Uses of Leeches to Modern Treatments of Their Bites.

Exposure to leeches in the wilderness setting is common. Leeches may attach themselves to exposed skin or pass through one of the body's orifices and attach internally. The condition of leech attachment is known as hirudiniasis, which can result in serious morbidity and, rarely, mortality.

Prevention of Friction Blisters in Outdoor Pursuits: A Systematic Review.

The purpose of this systematic review was to determine if sock, antiperspirant, or barrier strategies were effective in prevention of friction blisters in wilderness and outdoor pursuits. A search of PubMed and EMBASE was conducted. Title, abstract, and full text articles were screened by 2 authors using predetermined inclusion and exclusion criteria to identify prospective controlled trials investigating prevention methods for friction blisters involving the foot.

Management of Suspected Fluid Balance Issues in Participants of Wilderness Endurance Events.

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.

Adherence to Follow-Up Recommendations by Triathlon Competitors Receiving Event Medical Care.

. We sought to investigate triathlete adherence to recommendations for follow-up for participants who received event medical care. .

Quantifying the "Slosh Stomach": A Novel Tool for Assessment of Exercise-Associated Gastroparesis Symptoms in Endurance Athletes.

. We describe a novel scale and its field use for evaluation of exercise-associated gastroparesis in the endurance athlete. .

Coca: The History and Medical Significance of an Ancient Andean Tradition.

Coca leaf products are an integral part of the lives of the Andean peoples from both a cultural and traditional medicine perspective. Coca is also the whole plant from which cocaine is derived. Coca products are thought to be a panacea for health troubles in regions of South America.

Use of the Vocera Communications Badge Improves Public Safety Response Times.

Objectives. Violence in the Emergency Department (ED) has been a long-standing issue complicated by deficiencies in staff training, ease of weapons access, and response availability of public safety officers. The Vocera Badge is being used by our staff to request public safety assistance in lieu of a formal phone call to the University Police Communications Center.

Mandatory Rest Stops Improve Athlete Safety during Event Medical Coverage for Ultramarathons.

Introduction: Provisions of medical direction and clinical services for ultramarathons require specific attention to heat illness. Heat stress can affect athlete performance negatively, and heat accumulation without acclimatization is associated with the development of exertional heat stroke (EHS). In order to potentially mitigate the risk of this safety concern, the Jungle Marathon (Para, Brazil) instituted mandatory rest periods during the first two days of this 7-day, staged, Brazilian ultramarathon.

Coca: High Altitude Remedy of the Ancient Incas.

The use of coca leaf for medicinal purposes is a centuries-old tradition of the native peoples of South America. Coca products are thought by many laypersons to provide risk-free benefits to users participating in strenuous activities at high altitude. Physiologic studies of coca have increased understanding of its possible mechanism of action as well as its potential impact on high altitude activities.

Special Considerations in Medical Screening for Participants in Remote Endurance Events.

As participation at remote endurance events increases, so does the need to screen participants for potentially problematic medical conditions, but this process has been ill-defined to date. This article aims to outline a general approach to screening and discusses common or important medical conditions that may need consideration in the screening process. Medical conditions that are considered low risk may translate to high-risk conditions in the setting of a remote and austere location.

A prospective evaluation of the contribution of ambient temperatures and transport times on infrared thermometry readings of intravenous fluids utilized in EMS patients.

Background: During cold weather months in much of the country, the temperatures in which prehospital care is delivered creates the potential for inadvertently cool intravenous fluids to be administered to patients during their transport and care by emergency medical services (EMS). There is some potential for patient harm from unintentional infusion of cool intravenous fluids. Prehospital providers in these cold weather environments are likely using fluids that are well below room temperature when prehospital intravenous fluid (IVF) warming techniques are not being employed.

Managing collapsed or seriously ill participants of ultra-endurance events in remote environments.

Increasing participation in ultramarathons and other ultra-endurance events amplifies the potential for serious medical issues during and immediately following these competitions. Since these events are often located in remote settings where access may be extremely limited; the diagnostic capabilities, treatment options, and expectations of medical care may differ from those of urban events. This work outlines a process for assessment and treatment of athletes presenting for medical attention in remote environments, with a focus on potentially serious conditions such as major trauma, acute coronary syndrome, exertional heat stroke, hypothermia, hypoglycemia, exercise-associated hyponatremic encephalopathy, severe dehydration, altitude illness, envenomation, anaphylaxis, and bronchospasm.

Do free or low-cost antibiotic promotions alter prescription filling habits?

Objective: Because free sample of prescription medications have been shown to influence prescribing habits of physicians, we sought to discern if promotional efforts of a retail pharmacy influenced prescriptions filled in our county after a free antibiotic program was initiated.

Methods: Retrospective analysis of prescription antibiotics filled throughout the county was performed. Prescriptions filled during the first 6 months of the year before the program was initiated were compared to prescriptions filled during the first 6 months of the year immediately following initiation of the promotion.

Incidence and characteristics of snakebite envenomations in the New York state between 2000 and 2010.

Objective: We sought to evaluate the incidence of reported venomous snakebites in the state of New York between 2000 and 2010.

Methods: Data were collected retrospectively from the National Poison Data System (NPDS) and then reviewed for species identification and clinical outcome while using proxy measures to determine incidence of envenomation.

Results: From 2000 to 2010 there were 473 snakebites reported to the 5 Poison Control Centers in the state of New York.

Analysis of weight change and Borg rating of perceived exertion as measurements of runner health and safety during a 6-day, multistage, remote ultramarathon.

Objective: To determine the feasibility of using weight change and Borg score as tools for monitoring runner health and safety during a multistage, remote ultramarathon.

Design: Observational cohort study of feasibility on nonblinded event participants.

Setting: Six-day, multistage, remote ultramarathon in Utah.