Abstract：
OBJECTIVE:This study was designed to evaluate the effectiveness of a new protocol implemented to standardize snakebite management in Iran. METHODS:In this study, 27 patients treated according to the new protocol in 2012 (P+) were compared with 22 patients treated according to the previous modality in the year before implementation of the protocol (P-) in Mashhad Medical Toxicology Centre (MTC). Demographic characteristics and treatment details of all patients were recorded prospectively. Envenomation severity of each victim was assessed according to snakebite severity score (SSS). RESULTS:After implementation of the protocol, a smaller percentage of patients received antivenom (AV) therapy (78% vs 95%; P=.079). In spite of no significant difference in baseline severity of envenomation between the 2 groups (SSS [mean±SD], 34.8±18.1 vs 35.5±17.4; P=.801), the P+ group received significantly fewer AV vials (8.4±6.8 vs 12.1±5.6 vials; P=.042) and had a significantly shorter length of hospital stay (2.2±1.5 vs 3.2±1.8 days; P=.027). Moreover, smaller proportion of P+ patients experienced recurrence of venom-induced effects; however, the difference was not significant (18.5% vs 36%; P=.159). The reduction in use of antiallergy treatments to prevent or treat acute hypersensitivity reactions approached statistical significance (41% vs 68%; P=.051). These findings denote a reduction in AV use of approximately 4 vials and a reduction in hospital stay of 1 day for each patient, which translates to approximately $196/patient in healthcare cost savings. CONCLUSIONS:Implementation of a snakebite management protocol at MTC reduced overall antivenom usage, use of antiallergy interventions, and length of hospital stay.
journal_name
Wilderness Environ Medjournal_title
Wilderness & environmental medicineauthors
Monzavi SM,Salarian AA,Khoshdel AR,Dadpour B,Afshari Rdoi
10.1016/j.wem.2014.09.011subject
Has Abstractpub_date
2015-06-01 00:00:00pages
115-23issue
2eissn
1080-6032issn
1545-1534pii
S1080-6032(14)00292-0journal_volume
26pub_type
杂志文章abstract：OBJECTIVE:Mountaineers face a variety of health risks at altitude including pulmonary edema; portable ultrasound may be used to diagnose high altitude pulmonary edema. This report tests the functionality of electronic equipment in a hypobaric test environment and the ability of remotely guided nonexperts to use ultraso...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1580/08-WEME-BR-228R2.1
更新日期：2009-10-01 00:00:00
abstract：:A 74-year-old previously healthy woman was bitten by a hump-nosed pit viper (Hypnale hypnale) at dusk causing incoagulable blood lasting for 6 days. Further, she developed ecchymoses over her forearms, upper arms, hands, and lower back on day 4 after the snakebite, and microangiopathic hemolytic anemia (MAHA). Feature...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1016/j.wem.2017.05.005
更新日期：2017-09-01 00:00:00
abstract：OBJECTIVE:The purpose of this study was to review the patient characteristics and management of 56 cases of high altitude pulmonary edema at the Pheriche Himalayan Rescue Association Medical Aid Post, and to measure the use of medications in addition to descent and oxygen. METHODS:In a retrospective case series, we re...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1016/j.wem.2012.07.004
更新日期：2013-03-01 00:00:00
abstract：OBJECTIVE:To analyze the nature of surfing injuries in Cornwall in order to identify trends and inform clinical management. METHODS:The details of patients presenting (with injuries sustained while surfboard/bodyboard riding) to the Emergency Department (ED) of the Royal Cornwall Hospital, Truro (UK), from September 2...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1580/1080-6032-020.004.0335
更新日期：2009-01-01 00:00:00
abstract：OBJECTIVE:Our intent was to observe the effect of simulated altitude exposure on the intracranial pressure (ICP) of New Zealand white rabbits. It is theorized that the hypoxia of high altitude causes a rise in ICP, which may play a role in the pathogenesis of acute mountain sickness (AMS). Dexamethasone is a medication...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1580/1080-6032(2003)14[183:baeinz]2.0.co;2
更新日期：2003-10-01 00:00:00
abstract：OBJECTIVE:To investigate the demographics, incidence, and symptoms and signs of hydrocarbon poisoning in admitted children from the Negev Desert area of Israel. METHODS:The medical records of all children admitted for hydrocarbon poisoning from 1995 to 1999 were reviewed retrospectively. RESULTS:Of the 274 admitted c...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1580/1080-6032(2003)014[0078:hpicay]2.0.co;2
更新日期：2003-07-01 00:00:00
abstract：:Ticks are versatile vectors of infectious diseases and transmit a broad range of pathogens, including bacteria, viruses, and parasites. Ticks harbor pathogens without infection and share pathogens with other ticks while feeding together on a host. The primary objective of this review is to identify tickborne viral pat...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章,评审
doi：10.1016/j.wem.2020.06.011
更新日期：2020-12-01 00:00:00
abstract：OBJECTIVE:Antarctic expeditioners face extremes of environmental conditions along with isolation which affect normal human activity at a polar station. Diets of polar expeditioners consist of products that have been kept in storage for more than a year. Processing and preservation adversely affect the nutritive value o...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1580/06-WEME-OR-004R3.1
更新日期：2007-01-01 00:00:00
abstract：:Treating skin disorders in wilderness settings is often challenging. In this report we describe common skin conditions affecting the feet of river runners on the Colorado River in Grand Canyon National Park. These conditions are frequently referred to by river runners with a catchall term, "tolio." Several skin disord...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1016/j.wem.2019.09.003
更新日期：2020-03-01 00:00:00
abstract：INTRODUCTION:Clinical and bacteriological features of cobra (Naja) bites are still relatively unknown in Vietnam. This study aimed to characterize the clinical and bacteriological characteristics of local wounds in patients with presumed Naja spp bite, as well as their antibiotic treatment. METHODS:A cross-sectional s...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1016/j.wem.2020.01.002
更新日期：2020-06-01 00:00:00
abstract：:Exercise-associated hyponatremia (EAH) is defined by a serum or plasma sodium concentration below the normal reference range of 135 mmol/L that occurs during or up to 24 hours after prolonged physical activity. It is reported to occur in individual physical activities or during organized endurance events conducted in ...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章,实务指引
doi：10.1016/j.wem.2014.08.009
更新日期：2014-12-01 00:00:00
abstract：OBJECTIVES:To determine the incidence of femur fractures in mountain rescue in England and Wales. To investigate the attitudes of rescuers toward the use of femoral traction splints. To review the literature for evidence on the use of traction splints in prehospital medicine and test the hypothesis that femoral tractio...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1016/j.wem.2015.01.006
更新日期：2015-09-01 00:00:00
abstract：OBJECTIVE:The main goal was to explore the different toxin properties (proteolytic, hemorrhagic, and neurotoxic) of Leptodeira annulata ashmeadii Duvernoy's gland secretion (DGS). METHODS:To separate and characterize the different proteins present in L. annulata ashmeadii DGS, 20% sodium dodecyl sulfate-polyacrylamide...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1580/1080-6032(2004)015[0082:phanac]2.0.co;2
更新日期：2004-07-01 00:00:00
abstract：OBJECTIVE:The purposes of this experiment were to determine the repeatability of acute mountain sickness (AMS), AMS symptoms, and physiological responses across 2 identical hypoxic exposures. METHODS:Subjects (n = 25) spent 3 nights at simulated altitude in a normobaric hypoxia chamber: twice at a partial pressure of ...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1016/j.wem.2013.11.007
更新日期：2014-06-01 00:00:00
abstract：OBJECTIVE:Scorpionism is an endemic public health problem in Jordan encountered by health providers in all parts of the country. This study updates epidemiological data on scorpion sting encounters in Jordan. METHODS:Data on scorpion sting encounters were obtained from government and military hospitals around the coun...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1016/j.wem.2017.05.003
更新日期：2017-09-01 00:00:00
abstract：INTRODUCTION:North Carolina (NC) is home to more than 30 species of indigenous venomous and nonvenomous snakes. Snakebites can cause debilitating and potentially fatal injuries. However, there is a lack of current information available describing the incidence of snakebites in NC. Therefore, we performed this study of ...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1016/j.wem.2018.01.004
更新日期：2018-06-01 00:00:00
abstract：INTRODUCTION:The Kham Tibetans are one of several Tibetan ethnic subgroups living in the Kham area of China. Because studies on the high-altitude adaptation of the Kham people are scant, the main aim of this study is to investigate whether the response to hypoxia, especially polycythemia status, in the Kham Tibetans is...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1016/j.wem.2017.09.010
更新日期：2018-03-01 00:00:00
abstract：:Teaching emergency procedural skills in a wilderness setting can be logistically challenging. To teach these skills as part of a wilderness medicine elective for medical students, we designed an outdoor simulation session with low-fidelity models. The session involved 6 stations in which procedural skills were taught ...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1016/j.wem.2013.11.001
更新日期：2014-03-01 00:00:00
abstract：OBJECTIVE:To examine circulating hormonal responses in men competing in the Western States Endurance Run (WSER, June 23 to 24, 2012): a 161-km trail run that starts in Squaw Valley, CA, and concludes in Auburn, CA. METHODS:We examined 12 men who completed the WSER. Blood samples were obtained the morning before the ra...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1016/j.wem.2014.03.013
更新日期：2014-09-01 00:00:00
abstract：:Families are traveling with their children in increasing frequency. Travel to Asia offers children many opportunities to learn about new cultures and history. It also offers the potential for exposure to numerous infectious agents not commonly encountered in the United States. Families must begin to prepare for travel...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章,评审
doi：10.1580/06-WEME-RA-026R2.1
更新日期：2007-10-01 00:00:00
abstract：OBJECTIVE:The incidence of fatal closed head injury (CHI) and nonfatal CHI causing an altered level of consciousness in avalanche victims is unknown. The purpose of this study was to assess the incidence and potential significance of CHI in avalanche-related deaths. METHODS:The records of the state medical examiner an...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1580/1080-6032(2001)012[0244:atachi]2.0.co;2
更新日期：2001-01-01 00:00:00
abstract：INTRODUCTION:This study compared 2 commercially available beverages, an oral rehydration solution (ORS; 60.9 mM Na+; 3.4% carbohydrate) and a sports drink (SDS; 18.4 mM Na+; 5.9% carbohydrate), on hydration and metabolism during submaximal exercise in the heat. METHODS:Ten male subjects completed two 90-min exercise t...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1016/j.wem.2018.01.005
更新日期：2018-06-01 00:00:00
abstract：BACKGROUND:Minimal data exist regarding the activity, membership, training, and medical oversight of search and rescue (SAR) teams. OBJECTIVE:Our objective was to describe these characteristics in the Intermountain West SAR organizations. METHODS:A contact list was generated and electronic surveys were sent to SAR of...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1016/j.wem.2013.08.002
更新日期：2013-12-01 00:00:00
abstract：:The ability to control water-borne diseases is critical for soldiers, hikers, and others who may need to drink directly from an outdoor source. Water-borne protozoan parasites that are specifically of concern are Giardia and Cryptosporidium because of their resistance to halogen disinfection. The purpose of this study...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1580/1080-6032(1997)008[0096:eoiwpt]2.3.co;2
更新日期：1997-05-01 00:00:00
abstract：:Exposure to and consumption of brackish water are associated with an elevated risk of infection, hypernatremia, and hypothermia. Minimal data exist to support the diagnosis and treatment of patients with long-term brackish water exposure. We present a case of a patient who spent 5 to 10 d semisubmerged in the Elizabet...
journal_title：Wilderness & environmental medicine
pub_type：
doi：10.1016/j.wem.2020.04.003
更新日期：2020-09-01 00:00:00
abstract：INTRODUCTION:To compare the effectiveness of a molded fleece jacket with that of a standard cervical collar at limiting movement of the cervical spine in 3 different directions. METHODS:This is a prospective study using 24 healthy volunteers to measure cervical flexion/extension, rotation, and lateral flexion with bot...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1016/j.wem.2019.07.002
更新日期：2019-12-01 00:00:00
abstract：:Anaphylaxis is a medical emergency requiring prompt action to prevent death from cardio-respiratory collapse. It can be a biphasic, unpredictable, and challenging reaction to deal with even in a hospital environment. The wilderness environments afforded by expeditions, remote health posts, and military exercises pose ...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1016/j.wem.2011.12.002
更新日期：2012-03-01 00:00:00
abstract：:High-altitude pulmonary edema (HAPE) is a well-recognized disease entity in trekkers to the Nepal Himalayas. We present the case of a patient who had clinical features consistent with HAPE but did not descend the mountain on time, which contributed to his death. The important factors of the diagnosis, the descent, and...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1580/1080-6032(2000)011[0099:atroph]2.3.co;2
更新日期：2000-07-01 00:00:00
abstract：:Puerto Rico (PR) is home to 10 indigenous species of snake. Alsophis portorricensis has traditionally been considered harmless. In 1961, Hageman classified A portorricensis as somewhere between "venomous" and "nonvenomous." In 1966, Heatwole and Banuchi reported the only case found in the literature of a "venomous" bi...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1016/j.wem.2010.07.001
更新日期：2010-12-01 00:00:00
abstract：OBJECTIVE:To help the Mountain Rescue Association of Scotland find the best protective mountain rescue casualty bag in cold and windy conditions. The study investigated how 3 different casualty bags (labeled Bag 1, Bag 2, and Bag 3) performed in a cold (-10 degrees C, dry bulb), windy (wind speed 3.0 m x s(-1)) environ...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1580/1080-6032(2002)013[0036:acomrc]2.0.co;2
更新日期：2002-04-01 00:00:00
