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Minerva Anestesiologica Oct 2019Our understanding of decompression physiopathology has slowly improved during this last decade and some uncertainties have disappeared. A better understanding of anatomy... (Review)
Review
Our understanding of decompression physiopathology has slowly improved during this last decade and some uncertainties have disappeared. A better understanding of anatomy and functional aspects of patent foramen ovale (PFO) have slowly resulted in a more liberal approach toward the medical fitness to dive for those bearing a PFO. Circulating vascular gas emboli (VGE) are considered the key actors in development of decompression sickness and can be considered as markers of decompression stress indicating induction of pathophysiological processes not necessarily leading to occurrence of disease symptoms. During the last decade, it has appeared possible to influence post-dive VGE by a so-called "preconditioning" as a pre-dive denitrogenation, exercise or some pharmacological agents. In the text we have deeply examined all the scientific evidence about this complicated but challenging theme. Finally, the role of the "normobaric oxygen paradox" has been clarified and it is not surprising that it could be involved in neuroprotection and cardioprotection. However, the best level of inspired oxygen and the exact time frame to achieve optimal effect is still not known. The aim of this paper was to reflect upon the most actual uncertainties and distil out of them a coherent, balanced advice towards the researchers involved in gas-bubbles-related pathologies.
Topics: Decompression Sickness; Diving; Embolism, Air; Foramen Ovale, Patent; Humans; Oxygen Inhalation Therapy
PubMed: 31238641
DOI: 10.23736/S0375-9393.19.13618-8 -
Journal of the Royal Army Medical Corps Jun 2019Blast-associated traumatic brain injury (TBI) has become one of the signature issues of modern warfare and is increasingly a concern in the civilian population due to a... (Review)
Review
Blast-associated traumatic brain injury (TBI) has become one of the signature issues of modern warfare and is increasingly a concern in the civilian population due to a rise in terrorist attacks. Despite being a recognised feature of combat since the introduction of high explosives in conventional warfare over a century ago, only recently has there been interest in understanding the biology and pathology of blast TBI and the potential long-term consequences. Progress made has been slow and there remain remarkably few robust human neuropathology studies in this field. This article provides a broad overview of the history of blast TBI and reviews the pathology described in the limitedscientific studies found in the literature.
Topics: Blast Injuries; Brain Injuries, Traumatic; History, 20th Century; History, 21st Century; Humans; Military Medicine; Military Personnel
PubMed: 29326126
DOI: 10.1136/jramc-2017-000867 -
Annals of African Medicine 2024Hyperbaric therapy is generally considered a safe therapy for the treatment of wounds, mucormycosis, and orthopedic injuries. It is fraught with complications such as... (Review)
Review
Hyperbaric therapy is generally considered a safe therapy for the treatment of wounds, mucormycosis, and orthopedic injuries. It is fraught with complications such as barotrauma, pulmonary toxicity, fire hazards, and claustrophobia. This article discusses the safety protocols and preventive aspects on usefulness of this new emerging therapy.
Topics: Humans; Hyperbaric Oxygenation; Barotrauma
PubMed: 38358163
DOI: 10.4103/aam.aam_16_22 -
Respiration; International Review of... 2019This short review focuses on pulmonary injury in breath-hold (BH) divers. When practicing their extreme leisure sport, they are exposed to increased pressure on... (Review)
Review
This short review focuses on pulmonary injury in breath-hold (BH) divers. When practicing their extreme leisure sport, they are exposed to increased pressure on pulmonary gas volumes, hypoxia, and increased partial gas pressures. Increasing ambient pressures do present a serious problem to BH deep divers, because the semi-rigid thorax prevents the deformation required by the Boyle-Mariotte law. As a result, a negative-pressure barotrauma (lung squeeze) with acute hemoptysis is not uncommon. Respiratory maneuvers such as glossopharyngeal insufflation (GI) and glossopharyngeal exsufflation (GE) are practiced to prevent lung squeeze and to permit equalizing the paranasal sinuses and the middle ear. GI not only impairs venous return, thereby provoking hypotension and even fainting, but also produces intrathoracic pressures likely to induce pulmonary barotrauma that is speculated to induce long-term injury. GE, in turn, further increases the already negative intrapulmonary pressure, thereby favoring alveolar collapse (atelectasis). Finally, hypoxia seemingly not only induces brain injury but initiates the opening of intrapulmonary shunts. These pathways are large enough to permit transpulmonary passage of venous N2 bubbles, making stroke-like phenomena in deep BH divers possible.
Topics: Acute Lung Injury; Barotrauma; Diving; Humans; Hypoxia
PubMed: 30783070
DOI: 10.1159/000495757 -
Disaster Medicine and Public Health... May 2022To compare injury patterns of different types of explosions.
OBJECTIVE
To compare injury patterns of different types of explosions.
METHODS
A retrospective study of 4508 patients hospitalized due to explosions recorded in the Israel National Trauma Registry between January 1997 and December 2018. The events were divided into 4 groups: terror-related, war-related, civilian intentional explosions, and civilian unintentional explosions. The groups were compared in terms of injuries sustained, utilization of hospital resources, and clinical outcomes.
RESULTS
Civilian intentional and terror-related explosions were found to be similar in most aspects except for factors directly influencing mortality and a larger volume of severely injured body regions among terror-victims. Comparisons between other groups produced some parallels, albeit less consistent. Civilian intentional explosions and civilian unintentional explosions were different from each other in most aspects. The latter group also differed from others by its high volume of life-threatening burns and a higher proportion of children casualties.
CONCLUSIONS
While consistent similarities between explosion casualties exist, especially between victims of intentional civilian and terror-related explosions, the general rule is that clinical experience with a type of explosion cannot be directly transferred to other types.
Topics: Child; Humans; Explosions; Blast Injuries; Retrospective Studies; Terrorism; Injury Severity Score; Israel
PubMed: 35514263
DOI: 10.1017/dmp.2022.118 -
Respiratory Medicine 2023Recent studies suggested that Macklin sign is a predictor of barotrauma in patients with acute respiratory distress syndrome (ARDS). We performed a systematic review to... (Review)
Review
INTRODUCTION
Recent studies suggested that Macklin sign is a predictor of barotrauma in patients with acute respiratory distress syndrome (ARDS). We performed a systematic review to further characterize the clinical role of Macklin.
METHODS
PubMed, Scopus, Cochrane Central Register and Embase were searched for studies reporting data on Macklin. Studies without data on chest CT, pediatric studies, non-human and cadaver studies, case reports and series including <5 patients were excluded. The primary objective was to assess the number of patients with Macklin sign and barotrauma. Secondary objectives were: occurrence of Macklin in different populations, clinical use of Macklin, prognostic impact of Macklin.
RESULTS
Seven studies enrolling 979 patients were included. Macklin was present in 4-22% of COVID-19 patients. It was associated with barotrauma in 124/138 (89.8%) of cases. Macklin sign preceded barotrauma in 65/69 cases (94.2%) 3-8 days in advance. Four studies used Macklin as pathophysiological explanation for barotrauma, two studies as a predictor of barotrauma and one as a decision-making tool. Two studies suggested that Macklin is a strong predictor of barotrauma in ARDS patients and one study used Macklin sign to candidate high-risk ARDS patients to awake extracorporeal membrane oxygenation (ECMO). A possible correlation between Macklin and worse prognosis was suggested in two studies on COVID-19 and blunt chest trauma.
CONCLUSIONS
Increasing evidence suggests that Macklin sign anticipate barotrauma in patients with ARDS and there are initial reports on use of Macklin as a decision-making tool. Further studies investigating the role of Macklin sign in ARDS are justified.
Topics: Humans; Child; Thoracic Injuries; COVID-19; Wounds, Nonpenetrating; Respiratory Distress Syndrome; Barotrauma; Respiration, Artificial
PubMed: 36863617
DOI: 10.1016/j.rmed.2023.107178 -
Diving and Hyperbaric Medicine Mar 2023Minors have been scuba diving for decades, and while the initial concerns about potential long-term complications related to bone development appear to be unfounded, the... (Review)
Review
INTRODUCTION
Minors have been scuba diving for decades, and while the initial concerns about potential long-term complications related to bone development appear to be unfounded, the incidence of scuba diving injuries among them has been poorly studied.
METHODS
We reviewed 10,159 cases recorded in the DAN Medical Services call centre database from 2014 through 2016 and identified 149 cases of injured divers younger than 18 years. Records were analysed for case categorisation on the most common dive injuries. Information about demographics, level of training, risk factors, and relevant behavioural aspects were collected when available.
RESULTS
While the most common reason for the call was to rule out decompression sickness, the majority of cases pertained to ear and sinus issues. However, 15% of the dive-related injuries involving minors had a final diagnosis of pulmonary barotrauma (PBt). While no reliable data is available on the incidence of PBt in adult divers, the authors' impression based on personal experience suggests that the number of cases of PBt in minors trends higher than in the general diving population. The narratives on some relevant records describe unmanageable levels of anxiety leading to panic.
CONCLUSIONS
Based on the results and narratives on these cases, it is reasonable to infer that psychological immaturity, suboptimal management of adverse situations, and inadequate supervision might have led to severe injuries among these minor divers.
Topics: Adult; Humans; Diving; Decompression Sickness; Barotrauma; Risk Factors; Incidence; Lung Injury
PubMed: 36966517
DOI: 10.28920/dhm53.1.7-15 -
Military Medicine Mar 2023Occupational exposure to repetitive, low-level blasts in military training and combat has been tied to subconcussive injury and poor health outcomes for service members....
INTRODUCTION
Occupational exposure to repetitive, low-level blasts in military training and combat has been tied to subconcussive injury and poor health outcomes for service members. Most low-level blast studies to date have focused on explosive breaching and firing heavy weapon systems; however, there is limited research on the repetitive blast exposure and physiological effects that mortarmen experience when firing mortar weapon systems. Motivated by anecdotal symptoms of mortarmen, the purpose of this paper is to characterize this exposure and its resulting neurocognitive effects in order to provide preliminary findings and actionable recommendations to safeguard the health of mortarmen.
MATERIALS AND METHODS
In collaboration with the U.S. Army Rangers at Fort Benning, blast exposure, symptoms, and pupillary light reflex were measured during 3 days of firing 81 mm and 120 mm mortars in training. Blast exposure analysis included the examination of the blast overpressure (BOP) and cumulative exposure by mortarman position, as well as comparison to the 4 psi safety threshold. Pupillary light reflex responses were analyzed with linear mixed effects modeling. All neurocognitive results were compared between mortarmen (n = 11) and controls (n = 4) and cross-compared with blast exposure and blast history.
RESULTS
Nearly 500 rounds were fired during the study, resulting in a high cumulative blast exposure for all mortarmen. While two mortarmen had average BOPs exceeding the 4 psi safety limit (Fig. 2), there was a high prevalence of mTBI-like symptoms among all mortarmen, with over 70% experiencing headaches, ringing in the ears, forgetfulness/poor memory, and taking longer to think during the training week (n ≥ 8/11). Mortarmen also had smaller and slower pupillary light reflex responses relative to controls, with significantly slower dilation velocity (P < 0.05) and constriction velocity (P < 0.10).
CONCLUSION
Mortarmen experienced high cumulative blast exposure coinciding with altered neurocognition that is suggestive of blast-related subconcussive injury. These neurocognitive effects occurred even in mortarmen with average BOP below the 4 psi safety threshold. While this study was limited by a small sample size, its results demonstrate a concerning health risk for mortarmen that requires additional study and immediate action. Behavioral changes like ducking and standing farther from the mortar when firing can generally help reduce mortarmen BOP exposure, but we recommend the establishment of daily cumulative safety thresholds and daily firing limits in training to reduce cumulative blast exposure, and ultimately, improve mortarmen's quality of life and longevity in service.
Topics: Humans; Military Personnel; Quality of Life; Explosions; Blast Injuries
PubMed: 34557921
DOI: 10.1093/milmed/usab394 -
Diving and Hyperbaric Medicine Sep 2022Dysbarism is a medical condition arising from change in ambient pressure which outpace the rate at which the body adapts to it. We report a case of recurrent dysbarism...
Dysbarism is a medical condition arising from change in ambient pressure which outpace the rate at which the body adapts to it. We report a case of recurrent dysbarism consistent with possible decompression illness presenting with amnesia, hypoaesthesia and other neurological manifestations in a professional breath-hold diver treated successfully with hyperbaric oxygen and fluid resuscitation.
Topics: Amnesia; Barotrauma; Decompression Sickness; Diving; Humans; Hypesthesia
PubMed: 36100933
DOI: 10.28920/dhm52.3.213-216 -
Annals of African Medicine 2022Civilian blast injuries are common during celebrations and festivities. In the intervening times, civilian nonterrorist blast events are rare. The aim of this report is... (Review)
Review
BACKGROUND
Civilian blast injuries are common during celebrations and festivities. In the intervening times, civilian nonterrorist blast events are rare. The aim of this report is to highlight the increasing occurrence of blast injuries to the dominant right hand of hunters and the ensuing crippling consequences.
METHODOLOGY
A review of incidental blast injuries to the hand among hunters was conducted. The case files, clinical photographs, and radiographs of consecutive cases of blast injuries presenting to our unit over 3½ years were studied.
RESULT
Six patients had incidental blast injuries to the hand within the period. All the patients were males and hunters by profession. The age range was 30-49 years. The dominant right hand was involved in all the six cases with high-energy soft tissue and bony injuries. Five patients had staged soft tissue coverage while the sixth patient, after initial resuscitation, discharged against medical advice due to economic constraints. Multiple joint stiffness and significant disability occurred in all the affected hands. None of the patients represented for secondary procedures.
CONCLUSION
Incidental blast injuries to the hands of local hunters are lifestyle threatening. The dominant right hand is invariably involved with attendant crippling socioeconomic consequences. Meticulous clinical care and methodical operative intervention are primal to hand salvage.
Topics: Adult; Africa; Blast Injuries; Female; Humans; Male; Middle Aged; Radiography; Retrospective Studies
PubMed: 36204909
DOI: 10.4103/aam.aam_113_20