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Khirurgiia 2022To study the incidence and structure of combat gunshot surgical trauma received during the 2 Karabakh War and to analyze the results of treatment of these victims.
OBJECTIVE
To study the incidence and structure of combat gunshot surgical trauma received during the 2 Karabakh War and to analyze the results of treatment of these victims.
MATERIAL AND METHODS
We analyzed surgical treatment of 60 victims with combat gunshot surgical trauma received during the 2 Karabakh war. In 25 (41.7%) victims, injury occurred as a result of mine-explosive trauma. These victims were divided into 3 groups depending on mechanism of mine-explosive injury. The 1 group included 7 (28%) patients who received mine-explosive injury due to indirect (propelling) effect of blast wave. The 2 group included 14 (56%) victims in whom mine-explosive injury was caused by non-contact (distant) impact of mine fragments. The 3 group consisted of 4 (16%) patients whose mine-explosive injuries were caused by direct impact of explosion factors on various anatomical areas. Patients were also ranked into 3 groups depending on the nature and severity of mine-explosive injury: wounded with isolated injuries (=16, 64%), wounded with concomitant injuries (=2.8%), wounded with combined and multiple injuries (=7, 28%).
RESULTS
Most patients underwent organ-sparing procedures. Resections were performed only in 4 cases (splenectomy - 3, nephrectomy - 1). Postoperative complications developed in 23 (38.3%) wounded (suppuration of postoperative wounds - 13, post-traumatic pleuritis - 5, clotted hemothorax - 2, subphrenic abscess - 1, phlegmon of perineum and perianal region - 2). Mortality rate was 1.7%.
CONCLUSION
Timely sorting and evacuation of victims, early qualified surgical care and correct postoperative management with monitoring of vital functions can improve the results of treatment of victims with mine-explosive trauma. Autologous skin grafting for extensive defects and closure of colostomy with restoration of colon continuity were essential in rehabilitation of these patients.
Topics: Humans; Blast Injuries; Explosive Agents; Wounds, Gunshot; Multiple Trauma
PubMed: 36469471
DOI: 10.17116/hirurgia202212168 -
MMW Fortschritte Der Medizin May 2017
Review
Topics: Accident Prevention; Accidents; Barotrauma; Decompression Sickness; Diving; Germany; Humans; Physicians, Family
PubMed: 28509018
DOI: 10.1007/s15006-017-9648-8 -
Diving and Hyperbaric Medicine Sep 2022Respiratory injury during or following hyperbaric oxygen treatment (HBOT) is rare, but associated pressure changes can cause iatrogenic pulmonary barotrauma with... (Review)
Review
Respiratory injury during or following hyperbaric oxygen treatment (HBOT) is rare, but associated pressure changes can cause iatrogenic pulmonary barotrauma with potentially severe sequelae such as pneumothoraces. Pulmonary blebs, bullae, and other emphysematous airspace abnormalities increase the risk of respiratory complications and are prevalent in otherwise healthy adults. HBOT providers may elect to use chest X-ray routinely as a pre-treatment screening tool to identify these anomalies, particularly if a history of preceding pulmonary disease is identified, but this approach has a low sensitivity and frequently provides false negative results. Computed tomography scans offer greater sensitivity for airspace lesions, but given the high prevalence of incidental and insignificant pulmonary findings among healthy individuals, would lead to a high false positive rate because most lesions are unlikely to pose a hazard during HBOT. Post-mortem and imaging studies of airspace lesion prevalence show that a significant proportion of patients who undergo HBOT likely have pulmonary abnormalities such as blebs and bullae. Nevertheless, pulmonary barotrauma is rare, and occurs mainly in those with known underlying lung pathology. Consequently, routinely using chest X-ray or computed tomography scans as screening tools prior to HBOT for low-risk patients without a pertinent medical history or lack of clinical symptoms of cardiorespiratory disease is of low value. This review outlines published cases of patients experiencing pulmonary barotrauma while undergoing pressurised treatment/testing in a hyperbaric chamber and analyses the relationship between barotrauma and pulmonary findings on imaging prior to or following exposure. A checklist and clinical decision-making tool based on suggested low-risk and high-risk features are offered to guide the use of targeted baseline thoracic imaging prior to HBOT.
Topics: Adult; Humans; Barotrauma; Hyperbaric Oxygenation; Lung Diseases; Lung Injury
PubMed: 36100931
DOI: 10.28920/dhm52.3.197-207 -
Research in Sports Medicine (Print) 2018About 50% of scuba divers have suffered from barotrauma of the ears and about one-third from barotrauma of paranasal sinuses. The sphenoid sinuses are rarely involved.... (Review)
Review
About 50% of scuba divers have suffered from barotrauma of the ears and about one-third from barotrauma of paranasal sinuses. The sphenoid sinuses are rarely involved. Vital structures, as internal carotid artery and optic nerve, adjoin the sphenoid sinus. Thus, barotrauma could lead to serious neurologic disorders, including blindness. After searching the literature (Medline) and other sources (Internet), we present some cases of sphenoid sinus barotrauma, because these injuries may be underreported and misdiagnosed due to the lack of awareness and knowledge. Therefore, information is provided, e.g. on anatomical and pathophysiological features. Divers and physicians should have in mind that occasional headache during or after diving sometimes signals serious neurological disorders like vision loss. We show that injuries can develop from both negative and positive pressures in the sinuses. Because visual recovery depends on prompt diagnosis and proper therapy, physicians like otolaryngologists, ophthalmologists and neurologists need to closely collaborate.
Topics: Barotrauma; Diving; Humans; Sphenoid Sinus
PubMed: 28797173
DOI: 10.1080/15438627.2017.1365292 -
European Annals of Otorhinolaryngology,... Nov 2020
Topics: Barotrauma; Diving; Humans; Orbital Diseases; Pain
PubMed: 32335000
DOI: 10.1016/j.anorl.2020.03.011 -
Seminars in Neurology Nov 2014Managing patients with moderate-to-severe traumatic brain injury (TBI), particularly those with combat-related blast injury, is exceptionally challenging. Optimal care... (Review)
Review
Managing patients with moderate-to-severe traumatic brain injury (TBI), particularly those with combat-related blast injury, is exceptionally challenging. Optimal care requires the coordinated efforts of numerous providers, contributing to an interdisciplinary team. Given the complexities of TBI and the variety of physiologic, physical, cognitive, behavioral, and emotional manifestations of the injury, a holistic approach to patient care is needed throughout the entire continuum of care. In this article, the authors provide an overview of how interdisciplinary care is provided from the acute to the chronic settings, and illustrate the important role that rehabilitation plays throughout the continuum of care in facilitating maximizing recovery, functional independence, and quality of life. Common conditions associated with TBI are illustrated through a case presentation of an individual with blast-related polytrauma and help to frame a more detailed discussion of subtopics including neurointensive care, posttraumatic seizures, venous thromboembolic disease prevention, spasticity management, vestibular disorders, endocrine dysfunction, and psychological trauma.
Topics: Blast Injuries; Brain Injuries; Cognitive Behavioral Therapy; Humans; Male; Severity of Illness Index; Young Adult
PubMed: 25520028
DOI: 10.1055/s-0034-1396010 -
Aerospace Medicine and Human Performance Feb 2017Flights to high altitude can lead to exposure and unique pathology not seen in normal commercial aviation. (Review)
Review
INTRODUCTION
Flights to high altitude can lead to exposure and unique pathology not seen in normal commercial aviation.
METHODS
This paper assesses the potential for point-of-care ultrasound to aid in management and disposition of injured crewmembers from a high altitude incident. This was accomplished through a systematic literature review regarding current diagnostic and therapeutic uses of ultrasound for injuries expected in high altitude free fall and parachuting.
RESULTS
While current research supports its utility in diagnostics, therapeutic procedures, and triage decisions, little research has been done regarding its utility in high altitude specific pathology, but its potential has been demonstrated.
DISCUSSION
An algorithm was created for use in high altitude missions, in the event of an emergency descent and traumatic landing for an unconscious and hypotensive pilot, to rule out most life threatening causes. Each endpoint includes disposition, allowing concise decision-making.Galdamez LA, Clark JB, Antonsen EL. Point-of-care ultrasound utility and potential for high altitude crew recovery missions. Aerosp Med Hum Perform. 2017; 88(2):128-136.
Topics: Aerospace Medicine; Altitude; Aviation; Barotrauma; Cardiac Tamponade; Clinical Decision-Making; Contusions; Decompression Sickness; Diaphragm; Emergency Medical Services; Fractures, Bone; Humans; Pericardial Effusion; Pleural Effusion; Pneumothorax; Point-of-Care Systems; Pulmonary Atelectasis; Pulmonary Edema; Surgery, Computer-Assisted; Ultrasonography
PubMed: 28095957
DOI: 10.3357/AMHP.4640.2017 -
Diving and Hyperbaric Medicine Sep 2019There are few issues that generate as much confusion in diving medicine as the nomenclature of bubble-induced dysbaric disease. Prior to the late 1980s, the diagnosis...
There are few issues that generate as much confusion in diving medicine as the nomenclature of bubble-induced dysbaric disease. Prior to the late 1980s, the diagnosis 'decompression sickness' (DCS) was invoked for symptoms presumed to arise as a consequence of bubble formation from dissolved inert gas during or after decompression. These bubbles were known to form within tissues, and also to appear in the venous blood (presumably after forming in tissue capillaries). A second diagnosis, 'arterial gas embolism' (AGE) was invoked for symptoms presumed to arise when bubbles were introduced directly to the arterial circulation as a consequence of pulmonary barotrauma. This approach was predicated on an assumption that the underlying pathophysiology could usually be inferred from the nature and tempo of resulting symptoms. DCS was considered to exhibit a slower more progressive onset, symptoms were protean (including pain, rash, paraesthesias, subcutaneous swelling, and neurological symptoms), and the neurological manifestations were mainly attributable to spinal cord or inner ear involvement. In contrast, AGE was considered to exhibit a more precipitous onset (often immediately on surfacing), and the principal manifestation was stroke-like focal neurological impairment suggestive of cerebral involvement. In 1989 an association between a large persistent ('patent') foramen ovale (PFO) and serious neurological DCS was independently reported by two groups, and subsequently corroborated for neurological, inner ear, and cutaneous DCS by multiple studies. The assumed pathophysiological role of a PFO in this setting was to allow bubbles formed from inert gas in the venous blood to avoid removal in the pulmonary circulation and to enter the arterial circulation. These bubbles could then pass to the microcirculation of vulnerable target tissues where inward diffusion of supersaturated inert gas from the surrounding tissue could cause them to grow. This emergence of 'arterialisation' of venous bubbles as an important vector of harm in some forms of DCS resulted in a challenge to the use of traditional 'DCS/AGE' terminology. It was suggested that very early onset of cerebral symptoms after diving could be explained not only by arterial bubbles introduced by pulmonary barotrauma, but also by venous bubbles crossing a PFO into the arterial circulation. Moreover, once venous bubbles had entered the arterial circulation they were then technically 'arterial gas emboli'; thus creating confusion with arterial gas emboli from pulmonary barotrauma. To many commentators, it made little sense to use diagnostic labels (DCS and AGE) that implied a particular pathophysiology when the two disorders might be difficult to tell apart, and had mechanistic processes in common. An alternative approach derived at a UHMS workshop in 1991 was to shift from nomenclature that implied a particular pathophysiology, to a descriptive system that lumped both DCS and AGE together under the label "decompression illness" (DCI). Using this system, terms to describe the organ system(s) involved and the progression of symptoms were applied. For example, a diver with worsening upper arm pain after a dive could be suffering 'progressive musculoskeletal DCI'; and a diver who lost consciousness immediately on surfacing but regained consciousness minutes later would be considered to be suffering 'remitting cerebral DCI'. Classifying cases in this manner made considerable sense at a clinical level, particularly given that there was an emerging consensus that manifestations of DCS and AGE that potentially overlapped did not require different approaches to recompression treatment. This descriptive classification of bubble-induced dysbaric disease gained substantial traction in the community, though not always with a full appreciation by users of the intended nuances of its application. Indeed, it became increasingly common over time to see the terms DCS and DCI used interchangeably; for example, authors using the term DCI to specifically infer the consequences of bubble formation from dissolved gas. This highlights one of the shortcomings of the DCI terminology: it becomes confusing when discussing dysbaric disease at a theoretical or experimental level when the nature of the insult is known or there is a specific intent to discuss bubble formation either from dissolved gas or from pulmonary barotrauma. The potential for confusion between mechanisms and manifestations of DCS and AGE as one of the principle drivers for adopting the DCI terminology deserves further discussion. It is tempting to suggest that if venous bubbles cross a PFO into the arterial blood then any resulting symptoms should be considered a manifestation of 'AGE'. However, there seems little sense in re-naming the primary pathophysiological event (DCS caused by bubble formation from inert gas) just because the bubbles have distributed elsewhere; especially using a name that commonly infers a completely different primary event (bubble formation from pulmonary barotrauma). Moreover, there are grounds for suggesting that these two processes may not be as difficult to distinguish as previously believed. Venous inert gas bubbles are small, and of a similar size distribution to those used as bubble contrast during PFO testing. Decades of experience in testing thousands of divers (and other patients) for PFO using bubble-contrast echocardiograpy have shown that even when strongly positive (that is, large showers of bubbles enter the arterial circulation), symptoms of any sort are very rare. There are sporadic reports of evanescent visual or cerebral symptoms, but (to this author's knowledge) reports of the focal or multifocal cerebral infarctions that can be caused by large arterial bubbles introduced iatrogenically or by pulmonary barotrauma are lacking. One could argue that in the context of PFO testing the brain is not supersaturated with inert gas (which might cause small arterial bubbles to grow), but being such a 'fast tissue' nor is it likely to be after diving. Thus, while sustained showers of small inert gas bubbles crossing a PFO after diving appeal as a plausible cause of transient visual symptoms or dysexecutive syndromes after diving, they are less likely to be the cause of dramatic stroke-like events occurring early after surfacing. In the final edition of Bennett and Elliott it was suggested that one editorial approach to the terminology conundrum would be to utilise the traditional terminology (DCS and AGE) when referring specifically to the pathophysiology and manifestations of bubble formation from dissolved inert gas or pulmonary barotrauma respectively, and to utilise the descriptive (DCI) terminology in clinical discussions when a collective term is useful, or when discussing individual patients where there is either ambiguity about pathophysiology or no need to attempt a distinction. Diving and Hyperbaric Medicine recommends a similar approach. The journal is reluctant to attempt to generate or apply hard 'rules' in relation to terminology of bubble-induced dysbaric disease, but we strongly discourage use of the term 'arterial gas emboli(ism)' to characterise venous inert gas bubbles that cross a right-to-left shunt such as a PFO. The pathophysiological consequences of bubble formation from dissolved inert gas should be regarded as decompression sickness (DCS). There is an expectation that authors are cognisant of the above issues and attempt to adopt terminology that reflects these considerations and best suits the circumstances of their manuscript.
Topics: Decompression; Decompression Sickness; Diving; Embolism, Air; Foramen Ovale, Patent; Humans
PubMed: 31523788
DOI: 10.28920/dhm49.3.152-153 -
Rozhledy V Chirurgii : Mesicnik... 2023The incidence of explosions in large agglomerations is high even during peacetime and continues rising. Blast syndrome injuries are complex, with shock wave causing... (Review)
Review
The incidence of explosions in large agglomerations is high even during peacetime and continues rising. Blast syndrome injuries are complex, with shock wave causing severe injuries of multiple organ systems. In situations with large numbers of injured persons, effective triage allows an early diagnosis and treatment of the highest number of victims. Treatment is challenging, and potentially conflicting therapeutic goals may alternate. This review provides an overview of the pathophysiology of blast injuries, current diagnostic algorithms and therapeutic procedures.
Topics: Humans; Blast Injuries; Explosions; Incidence
PubMed: 38286652
DOI: 10.33699/PIS.2023.102.6.236-243 -
Aerospace Medicine and Human Performance May 2022Barometric pressure variation during dives may induce barodontalgia and barotrauma. Barodontalgia refers to oral pain resulting from a change in ambient pressure. The...
Barometric pressure variation during dives may induce barodontalgia and barotrauma. Barodontalgia refers to oral pain resulting from a change in ambient pressure. The aim of this study was to investigate the occurrence of barodontalgia and dental barotrauma among French civilian scuba divers. A nationwide cross-sectional internet-based survey was conducted among French scuba divers over 18 yr of age registered by the French Federation of Underwater Sports (FFESSM). The online questionnaire was distributed from October to December 2020. It contained questions regarding general characteristics of participants, barodontalgia and dental barotrauma occurrences, and relationship of the diver with his/her dentist. There were 684 scuba divers (65.4% men; aged 48 ± 12 yr) who participated in the study. Barodontalgia was reported by 18.7%, with some respondents reporting more than one episode. Most barodontalgia affected posterior (81.2%) and upper teeth (55.2%) with dental filling (50.0%). At least one dental barotrauma was reported by 10.1% of respondents, including mainly loss or fracture of a dental filling (4.2%). The occurrence of dental barotrauma was significantly higher among men (12.3%) than women (5.9%) and increased significantly with the age, the years of diving and the diving qualification. Information should be provided to divers on the importance of routine dental checkups.
Topics: Atmospheric Pressure; Barotrauma; Cross-Sectional Studies; Diving; Female; Humans; Male; Toothache
PubMed: 35551726
DOI: 10.3357/AMHP.6045.2022