Abstract：
:The use of tranexamic acid (TXA) in the treatment of trauma patients was relatively unexplored until the landmark Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage-2 (CRASH-2) trial in 2010 demonstrated a reduction in mortality with the use of TXA. Although this trial was a randomized, double-blinded, placebo-controlled study incorporating >20,000 patients, numerous limitations and weaknesses have been described. As a result, additional studies have followed, delineating the potential risks and benefits of TXA administration. A systematic review of the literature to date reveals a mortality benefit of early (ideally <1 hour and no later than 3 hours after injury) TXA administration in the treatment of severely injured trauma patients (systolic blood pressure <90 mm Hg, heart rate >110). Combined with abundant literature showing a reduction in bleeding in elective surgery, the most significant benefit may be administration of TXA before the patient goes into shock. Those trials that failed to show a mortality benefit of TXA in the treatment of hemorrhagic shock acknowledged that most patients received blood products before TXA administration, thus confounding the results. Although the use of prehospital TXA in the severely injured trauma patient will become more clear with the trauma studies currently underway, the current literature supports the use of prehospital TXA in this high-risk population. We recommend considering a 1 g TXA bolus en route to definitive care in high-risk patients and withholding subsequent doses until hyperfibrinolysis is confirmed by thromboelastography.
journal_name
Wilderness Environ Medjournal_title
Wilderness & environmental medicineauthors
Huebner BR,Dorlac WC,Cribari Cdoi
10.1016/j.wem.2016.12.006subject
Has Abstractpub_date
2017-06-01 00:00:00pages
S50-S60issue
2Seissn
1080-6032issn
1545-1534pii
S1080-6032(16)30289-7journal_volume
28pub_type
杂志文章,评审abstract：OBJECTIVE:Physical stress (exercise and/or environmental) activates the sympathetic-adrenal-medullary (SAM) and hypothalamic-pituitary-adrenocortical (HPA) axes. The combination of ultraendurance exercise in the cold presents a unique summated stress to the body. The purpose of this study was to assess the stress hormo...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1016/j.wem.2009.12.020
更新日期：2010-03-01 00:00:00
abstract：:We describe a case report of a subject suffering high-altitude cerebral and pulmonary edema successfully treated with low flow rates of supplemental oxygen administered with a breathing system designed to conserve oxygen supplies at high altitude. ...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1580/pr08-04.1
更新日期：2005-07-01 00:00:00
abstract：OBJECTIVE:Avalanches pose a life-threatening risk to participants of outdoor winter activities. Determining the causes of death in avalanche fatalities can aid rescue and resuscitation strategies and hopefully improve survival. METHODS:The study population included all avalanche fatalities in Utah from the 1989-90 to ...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1580/07-WEME-OR-092R1.1
更新日期：2007-01-01 00:00:00
abstract：:Although catfish are found worldwide and commonly consumed in the southern United States, fatal infections from catfish are rare. Edwardsiella tarda is a bacterium known to cause gastrointestinal distress most commonly, but extraintestinal infections are a rarely considered danger for those acquiring, preparing, and c...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1016/j.wem.2019.04.004
更新日期：2019-09-01 00:00:00
abstract：OBJECTIVE:The study aimed to examine the physiological responses to acute normobaric hypoxia during an intermittent walking protocol. METHODS:Twelve active healthy male participants completed a 125-minute test that involved rest and walking (50% VO(2max)) during normoxic (20.93%O(2)) and 2 hypoxic conditions (14%O(2) ...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章,随机对照试验
doi：10.1580/07-WEME-OR-143.1
更新日期：2008-01-01 00:00:00
abstract：:Despite the presence of a number of anecdotal reports in the mountaineering literature, mucociliary dysfunction at high altitude has received little scientific attention. However, the dry, cold, thin air at high altitude has the potential to undermine normal mucociliary function. This seems increasingly likely in moun...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章,评审
doi：10.1580/pr36-05.1
更新日期：2006-01-01 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：INTRODUCTION:Grand Canyon National Park has seen an increase in visitors traversing the canyon from rim to rim (R2R) in a single day. R2R hikers travel over 33.8 km (21 mi) over 3300 m (11,000 ft) of elevation change and endure large temperature changes. Grand Canyon emergency medical service providers provide emergenc...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1016/j.wem.2018.08.001
更新日期：2019-03-01 00:00:00
abstract：OBJECTIVE:Severe injuries and fatalities can occur from an alligator attack. Encounters with alligators appear to be increasing in the United States. This review provides information from alligator attacks reported in the United States as well as infections that may occur after an alligator bite. METHODS:Telephone int...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章,评审
doi：10.1016/j.wem.2010.02.002
更新日期：2010-06-01 00:00:00
abstract：OBJECTIVE:The purpose of this study was to evaluate the effects of gender and menstrual cycle on the percent of carbohydrate (CHO) utilized during cold water immersion (20 degrees C). Previous research has suggested that males and females utilize CHO differently during submaximal exercise. This study examined whether t...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1580/1080-6032(2000)011[0005:teogam]2.3.co;2
更新日期：2000-04-01 00:00:00
abstract：OBJECTIVE:We aimed to ascertain risk factors for acute mountain sickness (AMS) in miners exposed to chronic intermittent high altitude conditions. METHODS:All new hires (2009-2012) for mine employment (4000 m above sea level) were followed up for 12 months after first ascent. Demographics, physiologic data, and cigare...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1016/j.wem.2014.10.006
更新日期：2015-06-01 00:00:00
abstract：:We report the case of a previously healthy 32-year-old man presenting with severe headache on 2 separate expeditions to Cho Oyu (8201 m). No brain imaging was performed after the first expedition. On the second expedition, thrombosis of the superior sagittal sinus was detected. Investigations for hypercoagulable state...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1580/pr19-04.1
更新日期：2006-07-01 00:00:00
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 i...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1016/j.wem.2014.09.011
更新日期：2015-06-01 00:00:00
abstract：:There are many tales describing ferocious schools of piranha attacking humans, but there are few scientific data supporting such behavior. The very few documented instances of humans attacked and eaten by piranha schools include 3 that occurred after death by other causes (eg, heart failure and drowning). These predac...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1580/1080-6032(2003)14[249:paohis]2.0.co;2
更新日期：2003-01-01 00:00:00
abstract：:Injuries caused by wild boar attacks are rare. A 34-year-old male shepherd sustained injuries caused by a wild boar attack, and was brought to our emergency department. The patient had 2 skin and deep tissue lacerations on the posterior aspect of his thigh. Herein, we discuss the clinical management of a wild boar bit...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1016/j.wem.2011.06.005
更新日期：2011-09-01 00:00:00
abstract：OBJECTIVE:Cuzco, Peru, is host to a dangerous mix of high altitude and rapid access from low elevation, which results in a high prevalence of acute mountain sickness (AMS). Thus, it is important that travelers entering Cuzco understand the basics of AMS. To this end, we assessed travelers' awareness of AMS, especially ...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1580/06-weme-or-013r.1
更新日期：2007-04-01 00:00:00
abstract：:This article describes 3 incidents in which therapeutic or experimental warming of cold individuals caused first- to third-degree burns to the skin. Mechanisms for these injuries are considered. We conclude that active external rewarming of the trunk of a cold patient in the field can be administered safely and burn r...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1016/j.wem.2019.06.005
更新日期：2019-12-01 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：: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：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：OBJECTIVE:The purpose of this study was to describe the relative frequency, patterns, and mechanisms of sailing-related injuries in dinghies and keelboats. Data were also collected on risky and risk-averse behaviors of sailors, as well as on sailing-related illnesses. METHODS:A web-based, logic-driven, multiple-choice...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1016/j.wem.2010.06.006
更新日期：2010-12-01 00:00:00
abstract：OBJECTIVE:To explore the effect of aspirin on the thermoregulatory responses of men during exposure to 12°C air (acute cold exposure) for a period of 120 minutes and recovery in 25°C air (rewarming) for 120 minutes. METHODS:Seven male subjects (26.1 ± 2.4 yr) underwent pre-experimental testing to determine peak VO(2) ...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.wem.2011.06.007
更新日期：2011-12-01 00:00:00
abstract：:Anaphylaxis is a severe, life-threatening, multisystem hypersensitivity reaction that can rapidly progress to hypotension and airway compromise. Successful management of anaphylaxis has been documented with the use of prescription intramuscular epinephrine pens that require only minimal training for safe use. The prio...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1016/j.wem.2016.02.005
更新日期：2016-06-01 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：:Stingrays are found in open waters and are also kept in exhibits in many aquariums throughout the world. They are generally nonaggressive creatures by nature, but they can inflict injuries with their spines if provoked. We present a case of a 62-y-old diver who was pierced in the chest by the barb of a stingray while ...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1016/j.wem.2019.09.004
更新日期：2020-03-01 00:00:00
abstract：:Wilderness medicine training has become increasingly popular among medical professionals with numerous educational opportunities nationwide. Curricula for fellowship programs and for medical student education have previously been developed and published, but a specific curriculum for wilderness medicine education duri...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1016/j.wem.2017.10.003
更新日期：2018-03-01 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：: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:Helicopters are commonly used in search and rescue operations, and accidents have occurred during helicopter search and rescue (HSAR) missions. The purposes of this study were to investigate whether the HSAR accident rate in the United States could be determined and whether any common contributing factors or ...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章
doi：10.1016/j.wem.2015.08.001
更新日期：2015-12-01 00:00:00
abstract：:During historic, as well as more recent, conflicts, most combat casualties who die from their injuries do so in the prehospital setting. Although many of the injuries incurred by these casualties are nonsurvivable, a number of injuries are still potentially survivable. Of those injuries that are potentially survivable...
journal_title：Wilderness & environmental medicine
pub_type： 杂志文章,评审
doi：10.1016/j.wem.2016.11.007
更新日期：2017-06-01 00:00:00
