GEMC:Environmental Disorders

General

This the main page for the Global Emergency Medicine Curriculum Project's Environmental Disorders section. For point of care treatment information see the respective category page and non-GEMC notes.

Bites and Envenomations

Arthropods & Insects, Spiders, Mammals, Marine Organisms, Reptiles

Journal Articles - Open Access

• Management of simple insect bites: where's the evidence? Drug and Therapeutics Bulletin 2012;50:45-48 http://dtb.bmj.com/content/50/4/45.full
• Bhattacharjee C, Bradley P, et al. Do animals bite more during a full moon? Retrospective observational analysis BMJ 2000; 321 http://www.bmj.com/content/321/7276/1559
• Chen E, Hornig S, et al. Primary Closure of Mammalian Bites Academic Emergency Medicine 2000;7;2:157-161. http://onlinelibrary.wiley.com/doi/10.1111/j.1553-2712.2000.tb00519.x/abstract
• Garbutt F, and Jenner R. Wound closure in animal bites Emergency Medicine Journal 2004;21:589-590 http://emj.bmj.com/content/21/5/589.2.full
• Harris JB, Goonetilleke A. Animal poisons and the nervous system: what the neurologist needs to know J Neurol Neurosurg Psychiatry 2004;75:iii40-iii46. http://jnnp.bmj.com/content/75/suppl_3/iii40.full
• Lavonas EJ, Ruha AM, Banner W, et al. Unified treatment algorithm for the management of crotaline snakebite in the United States: results of an evidence-informed consensus workshop BMC Emergency Medicine 2011, 11:2 http://www.biomedcentral.com/1471-227X/11/2
• Lewin MR, Bickler P, Heier T, et al. Reversal of experimental paralysis in a human by intranasal neostigmine aerosol suggests a novel approach to the early treatment of neurotoxic envenomation Clinical Case Reports. 2013;1;1;7-15. http://onlinelibrary.wiley.com/doi/10.1002/ccr3.3/full
• Malhotra P, Sharma N, et al. Fatal acute disseminated encephalomyelitis following treated snake bite in India Emergency Medicine Journal 2005, 22:308-309 http://emj.bmj.com/content/22/4/308.full
• Ozanne-Smith J, Ashby K, and Stathakis VZ. Dog bite and injury prevention—analysis, critical review, and research agenda Injury Prevention 2001, 7:321-326 http://injuryprevention.bmj.com/content/7/4/321.full
• Raj N, Nayar R, et al. Once bitten, twice shy! Annals of Rheumatic Diseases 2000;59:684-687 http://ard.bmj.com/content/59/9/684.full
• Sacks JJ, Kresnow M, Houston B. Dog bites: how big a problem? Injury Prevention 1996;2:52-54 http://injuryprevention.bmj.com/content/2/1/52.full.pdf
• Smith MR, Walker A, Brenchley J. Barking up the wrong tree? A survey of dog bite wound management Emergency Medicine Journal 2003;20:253-255 http://emj.bmj.com/content/20/3/253.full
• Thong BY. Barkham TMS. Suppurative polyarthritis following a rat bite Annals of the Rheumatic Diseases 2003;62:805-806 http://ard.bmj.com/content/62/9/805.full
• Warrell DA. Treatment of bites by adders and exotic venomous snakes BMJ 2005; 331 http://www.bmj.com/content/331/7527/1244

Blogs and Websites

• Mammal Bites:Answers EM Lyceum. July 2011. http://emlyceum.com/2011/07/27/mammal-bites-answers/
• Venomous Animal Injuries Crashing Patient. http://crashingpatient.com/toxicology/venomous-animal-injuries.htm/
• Cadogan M. Top 12 deadly dangerous snakes Life in the Fast Lane. Nov 2008. http://lifeinthefastlane.com/top-12-deadliest-snakes/
• George J. A pitbull of the marine ecosystem, or just misunderstood The EMBER Project. Aug 2012. http://emberproject.org/2012/08/08/a-pitbull-of-the-marine-ecosystem-or-just-misunderstood/
• Gussow L. Brown recluse spider bite or MRSA: an important differential diagnosis? The Poison Review. Feb 2011. http://www.thepoisonreview.com/2011/02/03/2418/
• Gussow L. Case report: Wolf Spider Bite The Poison Review. April 2012. http://www.thepoisonreview.com/2012/04/03/case-report-wolf-spider-bite/
• Gussow L. Rapidly progressive, fatal sequelae of brown recluse spider bite: case report The Poison Review. Oct 2012. http://www.thepoisonreview.com/2012/10/17/rapidly-progressive-fatal-sequelae-of-brown-recluse-spider-bite-case-report/
• Gussow L. Review article: Spider Bite The Poison Review. Dec 2012. http://www.thepoisonreview.com/2011/12/22/review-article-spider-bite/
• Hensley J. Stop peeing on it! EBM Gone Wild. Aug 2013. http://ebmgonewild.com/stop-peeing-on-it
• Hensley J. Along came a spider. EBM Gone Wild. Aug 2013. http://ebmgonewild.com/along-came-spider
• Hensley J. And now for something completely different. EBM Gone Wild. Aug 2013. http://ebmgonewild.com/and-now-for-something-completely
• Hensley J. See you later, alligator. EBM Gone Wild. Aug 2013. http://ebmgonewild.com/see-you-later-alligator
• Iqbal T. Antibiotics in cat bites. BestBETs. Foex B. Last Modified: Oct 2008. http://bestbets.org/bets/bet.php?id=1021
• Levine M. New snakebite recs from an unlikely source. Emergency Physicians Monthly. Oct 2011. http://www.epmonthly.com/subspecialties/toxicology/new-snakebite-recs-from-an-unlikely-source/
• Rosengren D. ACEM Winter Symposium-Irukandji Adventure Medicine. Aug 2012. http://www.adventuremedicine.net/2012/08/acem-winter-symposium-irukandji/
• Rosengren D. ACEM Winter Symposium-Box Jellyfish Adventure Medicine. Aug 2012. http://www.adventuremedicine.net/2012/08/acem-winter-symosium-box-jellyfish-update/
• Rosengren D. What is the dose of Australian snake antivenom? Adventure Medicine. Sep 2012. http://www.adventuremedicine.net/2012/09/dose-of-australian-snake-antivenom/
• Terry P. Antibiotics in non venomous snake bite. BestBETs. Alexander M. Last Modified: March 2002. http://bestbets.org/bets/bet.php?id=155

Podcasts

• Wax P. Update on Antivenoms. 2012. From 2012 Toxicology World Congress. http://freeemergencytalks.net/2012/11/paul-wax-usa-update-on-antivenoms/ (40m43s)
• Epter M. I pulled off a tick. 2012. From AAEM Scientific Assembly 2012. http://freeemergencytalks.net/2013/01/mike-epter-i-pulled-off-a-tick/n-3-1040-i-pulled-off-a-tick-mike-epter/ (31m07s)

Videos

• Wright J, Smith L, and Castle L. Snakebite: What would Samuel do? 2013. Social Media and Critical Care. http://vimeo.com/57166701 (6m57s).
• Patwari R. Spider Bites. 2013. Academic Life in Emergency Medicine. http://youtu.be/9MhCYRFj6nI (8m31s)
• Patwari R. Hymenoptera Stings. 2013. Academic Life in Emergency Medicine. http://youtu.be/6HHxHS5_oAY (5m29s)
• Patwari R. Snakebites Intro. 2013. Academic Life in Emergency Medicine. http://youtu.be/Ew-ieJd26PU (4m10s)
• Patwari R. Rattlers. 2013. Academic Life in Emergency Medicine. http://youtu.be/DNPYHqhoGUU (5m20s)
• Patwari R. Elapid Bites. 2013. Academic Life in Emergency Medicine. http://youtu.be/5fAtkQtaKnM (5m12s)

Dysbarism: Air Embolism, Barotrauma, Decompression Syndrome

Journal Articles - Open Access

• Ahlen C, Iverson J, et al. Diver’s hand: a skin disorder common in occupational saturation diving Occupational and Environmental Medicine 1998;55:141-143 http://oem.bmj.com/content/55/2/141.abstract
• Doolette DJ, and Gorman DF. Evaluation of decompression safety in an occupational diving group using self reported diving exposure and health status Occupational and Environmental Medicine 2003;60:418-422 http://oem.bmj.com/content/60/6/418.full
• Hsu YL, Wang HC, and Yang PC. Desbaric air embolism during diving: an unusual complication of Osler-Weber-Rendu disease British Journal of Sports Medicine 2004;38:e6 http://bjsm.bmj.com/content/38/4/e6.full
• Golding FC, Griffiths P, et al. Decompression Sickness during Construction of the Dartford Tunnel British Journal of Industrial Medicine 1960;17:167-180. http://oem.bmj.com/content/17/3/167.abstract
• Levett DZH, and Millar IL. Bubble trouble: a review of diving physiology and disease Postgraduate Medical Journal 2008;84:571-578 http://pmj.bmj.com/content/84/997/571.full
• Raymond LW. Pulmonary barotrauma and related events in divers Chest 1995;107:1648-52. ../docss/1648.pdf
• Russi EW. Diving and the risk of barotrauma Thorax 1998;53:S20-S24 doi:10.1136/thx.53.2008.S20. http://thorax.bmj.com/content/53/suppl_2/S20.abstract
• Tetzlaff K, Reuter M, et al. Risk Factors for Pulmonary Barotrauma in Divers Chest 1197;112:654-59. ../docss/654.pdf
• Unsworth IP. Pulmonary barotrauma in a hyperbaric chamber Anaesthesia 1973;28:675-678. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.1973.tb00555.x/pdf
• Whelan TR. Facial nerve palsy associated with underwater barotrauma Postgraduate Medical Journal 1990;66:465-466 http://pmj.bmj.com/content/66/776/465.abstract

Blogs and Websites

• Decompression Sickness Life in the Fast Lane: Critical Care Compedium. http://lifeinthefastlane.com/education/ccc/decompression-sickness/
• Maini A. Dysbarism Made Easy... ED Trauma Critical Care Jan 2012. http://www.edtcc.com/blog/2012/1/21/dysbarism-made-easy.html

Slide Sets

• Arora, S. Dysbarism Jan 2013. http://www.intensivecarenetwork.com/index.php/icn-activities/icn-podcasts/455-59-sumesh-arora-on-dysbarism

Podcasts

• Arora, S. Dysbarism Jan 2013. http://www.intensivecarenetwork.com/index.php/icn-activities/icn-podcasts/455-59-sumesh-arora-on-dysbarism

Electrical Injury / Lightning

Journal Articles - Open Access

• Cohen MA. Clinical Pearls: Struck by Lightning. Academic Emergency Medicine 2001 Sep;8(9):893, 929-31. http://onlinelibrary.wiley.com/doi/10.1111/j.1553-2712.2001.tb01150.x/abstract Last accessed Sept 2013.
• Davis C, Engeln A, Johnson E, et al. Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Lightning Injuries. 'Wilderness & Environmental Medicine' 2012 Sep;23(3):260-9. doi: 10.1016/j.wem.2012.05.016. Epub 2012 Jul 31. http://www.wemjournal.org/article/S1080-6032(12)00180-9/fulltext Last accessed Sept 2013.

Blogs and Websites

• Lightning Injuries. WikEM. Last modified 16 Oct 2011. http://www.wikem.org/wiki/Lightning_Injuries
• Lightning Injury. Life in the Fast Lane: Critical Care Compendium. http://lifeinthefastlane.com/education/ccc/lightning-injury/
• Hensley J. What? I can't hear you! EBM Gone Wild. Sept 2013. http://ebmgonewild.com/what-i-cant-hear-you
• Rothwell S. Lightning Injuries Adventure Medicine. Sept 2012. http://www.adventuremedicine.net/2012/09/lightning-injuries/

Podcasts

• Lex J. Electrical Misadventures-Microwaves,Cords,Plugs,TASERs, and Lightning. 2010. From Giant Steps in Emergency Medicine. Accessed 8 Sept 2013. http://freeemergencytalks.net/2010/08/joe-lex-electrical-misadventures-microwaves-cords-plugs-tasers-and-lightning/ (54m20s)

High-Altitude Medicine

Acute Mountain Sickness, Barotrauma of Ascent, High-Altitude Cerebral Edema, High-Altitude Pulmonary Edema

Journal Articles - Open Access

• Austin D, Sleigh J. Prediction of Acute Mountain Sickness BMJ 1995;311:989 http://www.bmj.com/content/311/7011/989
• Bellis F. Acute Mountain Sickness: an unexpected management problem British Journal of Sports Medicine 2002;36:147 http://bjsm.bmj.com/content/36/2/147.full
• Dumont L, Mardisoff C, Tramer MR. Efficacy and harm of pharmacological prevention of acute mountain sickness: quantitative systematic review BMJ 2000;321:267 http://www.bmj.com/content/321/7256/267
• Harrison MF, Anderson PJ, et al. Physiological variables associated with the development of acute mountain sickness at the South Pole BMJ Open 2013;3:e003064 http://bmjopen.bmj.com/content/3/7/e003064.full
• Imray C, Booth A, et al. Acute altitude illness BMJ 2011;343:d4943 http://www.bmj.com/content/343/bmj.d4943
• Keller HR, Maggiorini M, et al. Simulated descent v dexamethasone in treatment of acute mountain sickness: a randomised trial BMJ 1995;310:1232 http://www.bmj.com/content/310/6989/1232
• Low E, Avery A, et al. Identifying the lowest effective dose of acetazolamide for the prophylaxis of acute mountain sickness: systematic review and meta-analysis BMJ 2012;345:e6779 http://www.bmj.com/content/345/bmj.e6779
• Maggiorini M, Bartsch P, and Oelz O. Association between raised body temperature and acute mountain sickness: cross sectional study BMJ 1997;315:403 http://www.bmj.com/content/315/7105/403
• Milledge JS. Acute Mountain Sickness Thorax 1983;38:641-645 http://thorax.bmj.com/content/38/9/641.full

Blogs and Websites

• High Altitude Illness Life in the Fast Lane: Critical Care Compendium http://lifeinthefastlane.com/education/ccc/high-altitude-illness/
• High Altitude Medicine Crashing Patient. http://crashingpatient.com/environmental/high-altitude-medicine.htm/
• Hensley J. The brain wants oxygen. EBM Gone Wild. Aug 2012. http://ebmgonewild.com/the-brain-wants-oxygen/
• Hensley J. Climbing? Trouble sleeping? EBM Gone Wild. Aug 2012. http://ebmgonewild.com/climbing-trouble-sleeping/
• Maini A. High Altitude Illness-Revision Notes ED Trauma Critical Care. Jan 2012. http://www.edtcc.com/blog/2012/1/22/high-altitude-illness-revision-notes.html
• Rosengren D. Does Ibuprofen protect against Acute Mountain Sickness? Adventure Medicine. Jan 2013. http://www.adventuremedicine.net/2013/01/does-ibuprofen-protect-against-acute-mountain-sickness/
• Rothwell S. High Altitude Illness Life in the Fast Lane. June 2010. http://lifeinthefastlane.com/high-altitude-illness/

Submersion Incidents: Cold Water Immersion, Near drowning

Videos

• • Schmidt A. Drowning: Critical Points for Care in the Field. 2013. Social Media and Critical Care. Accessed 19 Aug 2013. http://vimeo.com/57826732 (6m41s).

Temperature-Related Illness: Frostbite, Hypothermia

Journal Articles - Open Access

• Biem J, Koehncke N, et al. Out of the cold: management of hypothermia and frostbite CMAJ 2003;168;3:305-311 http://www.cmaj.ca/content/168/3/305.full
• Graham CA, Stevenson J. Frozen chips: an unusual cause of severe frostbite injury British Journal of Sports Medicine 2000;34:382-383 http://bjsm.bmj.com/content/34/5/382.full
• Harirchi I, Arvin A, et al. Frostbite: incidence and predisposing factors in mountaineers British Journal of Sports Medicine 2005;39:898-901 http://bjsm.bmj.com/content/39/12/898.full
• Woo E, Lee JW, Hur G, et al. Proposed Treatment Protocol for Frostbite: A Retrospective Analysis of 17 Cases Based on a 3-Year Single-Institution Experience Arch Plast Surg 2013 Sep;40(5):510-516. http://e-aps.org/DOIx.php?id=10.5999/aps.2013.40.5.510

Blogs and Websites

• Accidental Hypothermia Crashing Patient. http://crashingpatient.com/environmental/accidental-hypothermia.htm/
• EMCrit - Accidental Hypothermia]
• Frostbite and Cold Injuries Crashing Patient. http://crashingpatient.com/environmental/frostbite-cold-injuries.htm/
• Burns E. ECG Basics: Hypothermia Life in the Fast Lane. http://lifeinthefastlane.com/ecg-library/basics/hypothermia/

Podcasts

• Weingart S. Podcast 66-...Until they are warm and dead: Severe Accidental Hypothermia 2012. http://emcrit.org/podcasts/severe-accidental-hypothermia/ (20m54s)

Videos

• • Oosterloo M. Dead cold, winter can be murder. 2013. Social Media and Critical Care. Accessed 19 Aug 2013. http://vimeo.com/57872537 (6m24s).

Radiation Emergencies

See Also

• GEMC: Global Emergency Medicine Curriculum (Main)

Authors

Justin Hensley, Joe Lex, Vincent Chan, Michael Holtz, Ross Donaldson, Daniel Ostermayer