{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T04:14:40Z","timestamp":1741752880603,"version":"3.38.0"},"reference-count":10,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2021,6,1]],"date-time":"2021-06-01T00:00:00Z","timestamp":1622505600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Wilderness &amp; Environmental Medicine"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:p> Remote and austere medicine can be challenging when caring for healthy individuals and requires ingenuity when managing patients with unexpected, complex disease processes, whether acute or chronic. We report the case of an adult male who presented to an isolated clinic setting with acute exacerbation of chronic liver disease. Medical management was complicated by limited transportation resources, both for supplies and patient movement. There was concern that the patient\u2019s clinical status could decompensate into a life-threatening illness that might not be adequately treated in this remote setting. Through the use of collaborative decision-making with the patient and by telemedicine consultation, the patient was successfully stabilized on the island until routine transport to a higher level of care was available. Knowledge of climbing systems and alternative transportation arrangements were integral to our ability to provide prolonged care for this patient in a remote setting. Knowledge of the use of medicinal plants was key in offsetting the side effects of other medications used. We are reminded that creative and collaborative problem-solving epitomizes wilderness and austere medicine. <\/jats:p>","DOI":"10.1016\/j.wem.2021.01.013","type":"journal-article","created":{"date-parts":[[2021,5,6]],"date-time":"2021-05-06T18:52:24Z","timestamp":1620327144000},"page":"230-234","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["A Mixed Case Report of Long-Term Management of Ascites and Anasarca From Liver Disease on a Remote Pacific Island"],"prefix":"10.1177","volume":"32","author":[{"given":"Alexander B.","family":"Merkle","sequence":"first","affiliation":[{"name":"Sutter Medical Group, Sacramento, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James H.","family":"Winegarner","sequence":"additional","affiliation":[{"name":"Brooke Army Medical Center, JBSA Fort Sam, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,6,1]]},"reference":[{"issue":"18","key":"bibr1-j.wem.2021.01.013","first-page":"1719","volume":"132","author":"Arkkila P.","year":"2016","journal-title":"Duodecim"},{"key":"bibr2-j.wem.2021.01.013","doi-asserted-by":"publisher","DOI":"10.1051\/fruits\/2012002"},{"key":"bibr3-j.wem.2021.01.013","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-6757(00)90062-7"},{"key":"bibr4-j.wem.2021.01.013","doi-asserted-by":"publisher","DOI":"10.1186\/1550-2783-9-1"},{"key":"bibr5-j.wem.2021.01.013","doi-asserted-by":"publisher","DOI":"10.1002\/jsfa.1783"},{"key":"bibr6-j.wem.2021.01.013","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.160.16.2429"},{"key":"bibr7-j.wem.2021.01.013","doi-asserted-by":"publisher","DOI":"10.1002\/hep.22853"},{"key":"bibr8-j.wem.2021.01.013","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2010.05.004"},{"key":"bibr9-j.wem.2021.01.013","doi-asserted-by":"publisher","DOI":"10.1053\/ajem.2001.24477"},{"key":"bibr10-j.wem.2021.01.013","doi-asserted-by":"publisher","DOI":"10.3945\/an.112.003012"}],"container-title":["Wilderness &amp; Environmental Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1080603221000181?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1080603221000181?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1016\/j.wem.2021.01.013","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1016\/j.wem.2021.01.013","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1016\/j.wem.2021.01.013","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T04:35:33Z","timestamp":1741667733000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1016\/j.wem.2021.01.013"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6]]},"references-count":10,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,6]]}},"alternative-id":["10.1016\/j.wem.2021.01.013"],"URL":"https:\/\/doi.org\/10.1016\/j.wem.2021.01.013","relation":{},"ISSN":["1080-6032","1545-1534"],"issn-type":[{"type":"print","value":"1080-6032"},{"type":"electronic","value":"1545-1534"}],"subject":[],"published":{"date-parts":[[2021,6]]}}}