-
Pneumologie (Stuttgart, Germany) Sep 2016Decompression injuries occur on account of the special hyperbaric effects during the emerge phase and require superior therapeutic knowledge. Vitally important is... (Review)
Review
Decompression injuries occur on account of the special hyperbaric effects during the emerge phase and require superior therapeutic knowledge. Vitally important is emergency treatment with high concentrated oxygen at an early stage. Sever decompression injuries require oxygenation in a hyperbaric treatment chamber.
Topics: Decompression Sickness; Diving; Emergency Medical Services; Evidence-Based Medicine; Humans; Hyperbaric Oxygenation; Treatment Outcome
PubMed: 27603947
DOI: 10.1055/s-0042-111704 -
Journal of Visceral Surgery Dec 2017Wounds due to gunshot and explosions, while usually observed during battlefield combat, are no longer an exceptional occurrence in civilian practice in France. The... (Review)
Review
Wounds due to gunshot and explosions, while usually observed during battlefield combat, are no longer an exceptional occurrence in civilian practice in France. The principles of wound ballistics are based on the interaction between the projectile and the human body as well as the transfer of energy from the projectile to tissues. The treatment of ballistic wounds relies on several principles: extremity wound debridement and absence of initial closure, complementary medical treatment, routine immobilization, revision surgery and secondary closure. Victims of explosions usually present with a complex clinical picture since injuries are directly or indirectly related to the shock wave (blast) originating from the explosion. These injuries depend on the type of explosive device, the environment and the situation of the victim at the time of the explosion, and are classed as primary, secondary, tertiary or quaternary. Secondary injuries due to flying debris and bomb fragments are generally the predominant presenting symptoms while isolated primary injuries (blast) are rare. The resulting complexity of the clinical picture explains why triage of these victims is particularly difficult. Certain myths, such as inevitable necrosis of the soft tissues that are displaced by the formation of the temporary cavitation by the projectile, or sterilization of the wounds by heat generated by the projectile should be forgotten. Ballistic-protective body armor and helmets are not infallible, even when they are not perforated, and can even be at the origin of injuries, either due to missile impact, or to the blast.
Topics: Blast Injuries; Forensic Ballistics; Humans; Wounds, Gunshot
PubMed: 28941569
DOI: 10.1016/j.jviscsurg.2017.07.005 -
Chinese Medical Journal May 2018Mechanical ventilation (MV) has long been used as a life-sustaining approach for several decades. However, researchers realized that MV not only brings benefits to... (Review)
Review
OBJECTIVE
Mechanical ventilation (MV) has long been used as a life-sustaining approach for several decades. However, researchers realized that MV not only brings benefits to patients but also cause lung injury if used improperly, which is termed as ventilator-induced lung injury (VILI). This review aimed to discuss the pathogenesis of VILI and the underlying molecular mechanisms.
DATA SOURCES
This review was based on articles in the PubMed database up to December 2017 using the following keywords: "ventilator-induced lung injury", "pathogenesis", "mechanism", and "biotrauma".
STUDY SELECTION
Original articles and reviews pertaining to mechanisms of VILI were included and reviewed.
RESULTS
The pathogenesis of VILI was defined gradually, from traditional pathological mechanisms (barotrauma, volutrauma, and atelectrauma) to biotrauma. High airway pressure and transpulmonary pressure or cyclic opening and collapse of alveoli were thought to be the mechanisms of barotraumas, volutrauma, and atelectrauma. In the past two decades, accumulating evidence have addressed the importance of biotrauma during VILI, the molecular mechanism underlying biotrauma included but not limited to proinflammatory cytokines release, reactive oxygen species production, complement activation as well as mechanotransduction.
CONCLUSIONS
Barotrauma, volutrauma, atelectrauma, and biotrauma contribute to VILI, and the molecular mechanisms are being clarified gradually. More studies are warranted to figure out how to minimize lung injury induced by MV.
Topics: Animals; Barotrauma; Humans; Reactive Oxygen Species; Ventilator-Induced Lung Injury; Wounds and Injuries
PubMed: 29553050
DOI: 10.4103/0366-6999.226840 -
British Journal of Anaesthesia Mar 2017Bomb or explosion-blast injuries are likely to be increasingly encountered as terrorist activity increases and pre-hospital medical care improves. We therefore reviewed... (Review)
Review
Bomb or explosion-blast injuries are likely to be increasingly encountered as terrorist activity increases and pre-hospital medical care improves. We therefore reviewed the epidemiology, pathophysiology and treatment of primary blast lung injury. In addition to contemporary military publications and expert recommendation, an EMBASE and MEDLINE search of English speaking journals was undertaken using the medical subject headings (MeSHs) ‘blast injury’ and ‘lung injury’. Review articles, retrospective case series, and controlled animal modelling studies published since 2000 were evaluated. 6-11% of military casualties in recent conflicts have suffered primary blast lung injury but the incidence increases to more than 90% in terrorist attacks occurring in enclosed spaces such as trains. The majority of victims require mechanical ventilation and intensive care management. Specific therapies do not exist and treatment is supportive utilizing current best practice. Understanding the consequences and supportive therapies available to treat primary blast lung injury are important for anaesthetists.
Topics: Blast Injuries; Humans; Lung; Lung Injury
PubMed: 28203741
DOI: 10.1093/bja/aew385 -
Chinese Journal of Traumatology =... 2015Explosive blast injury has become the most prevalent injury in recent military conflicts and terrorist attacks. The magnitude of this kind of polytrauma is complex due... (Review)
Review
Explosive blast injury has become the most prevalent injury in recent military conflicts and terrorist attacks. The magnitude of this kind of polytrauma is complex due to the basic physics of blast and the surrounding environments. Therefore, development of stable, reproducible and controllable animal model using an ideal blast simulation device is the key of blast injury research. The present review addresses the modeling of blast injury and applications of shock tubes.
Topics: Animals; Blast Injuries; Disease Models, Animal; High-Energy Shock Waves; Research
PubMed: 26764538
DOI: 10.1016/j.cjtee.2015.04.005 -
Deutsches Arzteblatt International Feb 2015Diving is a popular sport, and some recreational divers have medical risk factors. Their health can be endangered by high extracorporeal (ambient) pressure and its many... (Review)
Review
BACKGROUND
Diving is a popular sport, and some recreational divers have medical risk factors. Their health can be endangered by high extracorporeal (ambient) pressure and its many systemic effects.
METHODS
We review relevant publications on free (breath-hold) diving, scuba diving, medical evaluation for diving, barotrauma, decompression sickness, and diving with medical risk factors, which were retrieved by a selective search of PubMed.
RESULTS
Free diving or scuba diving, even at seemingly innocuous depths, puts considerable stress on the cardio - vascular system, ears, and lungs. Unexpected events while diving, diminished functional reserve, and pre-existing medical illnesses increase the risk of a diving accident. An international survey revealed that minor incidents occur in 1.3% of all dives, and decompression accidents in 2 of every 10 000 dives. A properly conducted medical examination to determine diving fitness, followed by appropriate counseling, can make a life-threatening diving accident less likely.
CONCLUSION
To be able to certify diving fitness and give competent medical advice about diving, physicians must be well informed about the physical and physiological changes of diving and the associated risks to health, and they need to know how to perform a medical evaluation of prospective divers. In Germany, any licensed physician may judge a person fit to dive. It is recommended that this be done in adherence to the relevant evaluation standards and recommendations of the medical specialty associations. Randomized controlled trials on the effect of preventive behavior would be desirable, as would a central registry of diving accidents.
Topics: Decompression Sickness; Diving; Foramen Ovale, Patent; Humans; Physical Examination
PubMed: 25797514
DOI: 10.3238/arztebl.2015.0147 -
Acta Neuropathologica Communications Sep 2023Mild traumatic brain injury (mTBI) induced by low-intensity blast (LIB) is a serious health problem affecting military service members and veterans. Our previous reports...
Mild traumatic brain injury (mTBI) induced by low-intensity blast (LIB) is a serious health problem affecting military service members and veterans. Our previous reports using a single open-field LIB mouse model showed the absence of gross microscopic damage or necrosis in the brain, while transmission electron microscopy (TEM) identified ultrastructural abnormalities of myelin sheaths, mitochondria, and synapses. The neurovascular unit (NVU), an anatomical and functional system with multiple components, is vital for the regulation of cerebral blood flow and cellular interactions. In this study, we delineated ultrastructural abnormalities affecting the NVU in mice with LIB exposure quantitatively and qualitatively. Luminal constrictive irregularities were identified at 7 days post-injury (DPI) followed by dilation at 30 DPI along with degeneration of pericytes. Quantitative proteomic analysis identified significantly altered vasomotor-related proteins at 24 h post-injury. Endothelial cell, basement membrane and astrocyte end-foot swellings, as well as vacuole formations, occurred in LIB-exposed mice, indicating cellular edema. Structural abnormalities of tight junctions and astrocyte end-foot detachment from basement membranes were also noted. These ultrastructural findings demonstrate that LIB induces multiple-component NVU damage. Prevention of NVU damage may aid in identifying therapeutic targets to mitigate the effects of primary brain blast injury.
Topics: Animals; Mice; Proteomics; Blast Injuries; Brain Concussion; Arvicolinae; Basement Membrane; Brain Injuries
PubMed: 37674234
DOI: 10.1186/s40478-023-01636-4 -
Intensive Care Medicine Mar 2022
Topics: Barotrauma; COVID-19; Humans; Respiration, Artificial; SARS-CoV-2
PubMed: 35089408
DOI: 10.1007/s00134-022-06630-3 -
Diving and Hyperbaric Medicine Jun 2018Norway has a long tradition of quality research within the field of baromedicine. With the discovery of oil in the North Sea, it became important to establish scientific...
Norway has a long tradition of quality research within the field of baromedicine. With the discovery of oil in the North Sea, it became important to establish scientific research facilities to overcome immediate challenges, but also to work towards long-term goals. For the diving community, an understanding of the pathophysiology of decompression sickness (DCS) has been one of the major forces to maintain focus on the importance of scientific research in this field. In addition to oil, the aquaculture and fish farming industries are increasing in size and are Norway's second biggest export industry today. It also requires underwater workers for the inspection and repair of underwater structures and fishnets. The importance of health and safety for the underwater worker was identified early on by the offshore industry. The Norwegian Petroleum Safety Authority publishes a yearly report that identifies all offshore diving activity. The last reported incident of DCS was in 2002, whilst the last fatal saturation diving accident was in 1987. In-shore diving operations in Norway are regulated through the Norwegian Labour Inspection Authority and here the track record is different; since 1979 there have been 28 fatalities, and they continue to occur. At the Norwegian University of Science and Technology (NTNU), there has been a research group investigating barophysiology since the early 1980s. Led by Professor Alf O Brubakk, this research has been recognized internationally and has provided ground-breaking insights into the pathophysiology of DCS. This has included the identification of vascular gas bubbles through the use of ultrasound and identifying the importance of both protecting the vascular endothelium to maintain fitness to dive and also regular physical activity to reduce the risk of the adverse effects of diving. The group has educated many students, physiologists, engineers, medical doctors and researchers, all in the spirit of Professor Brubakk who considered that education was at least as important as the research itself. In 2008, Professor Brubakk was concerned about the future, as he was soon to retire. Great effort was put into perpetuating his position but this process ended when the University axed the only professorial position in environmental physiology in Norway. Today, there is only one non-permanent barophysiology research position at NTNU. This position and all research activity is dependent on external funding, so the education and research environment has changed drastically. Whilst there are clinicians in Norway working at different hyperbaric centres who participate in research related to barophysiology, this is not their primary task. With the lack of funding to include education and students in research, the rich history of barophysiological research at NTNU will be at an end. In Norway, the majority of grant-funded scientific programmes last only three years, so it has not been easy to recruit or to keep expertise between grants. So, who is planning for long-term research efforts in Norway? Whilst there are obvious challenges left to study in barophysiology, there is a lack of understanding amongst those responsible for decision-making and funding of the importance of having an academic-based research centre for diving research. NTNU, one of the world's most advanced hyperbaric laboratories, built up at considerable capital expense to investigate the pathophysiology of diving and decompression, is about to be closed and dismantled. At a time when the off-shore industry is putting greater focus on finding better solutions for safer underwater work environments, and in-shore diving is facing huge challenges due to a worrying level of serious accidents and increasing activity, there is no political drive in Norway to acknowledge the importance of maintaining the research facilities that support this industry. If the door does close on the NTNU facility, it will take many years and substantial funding to re-establish a modern research centre. Most importantly, it will be impossible to bring new students into the field of barophysiology in the foreseeable future. Whilst the off-shore oil industry has a finite future, aquaculture and other in-shore activities requiring diving support continue to expand. Good barophysiological research in established centres will be essential to support these industries into the future. Alf Brubakk often quoted an old Chinese proverb: "When planning for a month, sow rice, when planning for a year, plant trees, when planning for a decade, train and educate men". In Norway, we are only planting trees.
Topics: Decompression Sickness; Diving; Female; Humans; Male; Norway; Research
PubMed: 29888377
DOI: 10.28920/dhm48.2.72 -
Expert Review of Respiratory Medicine 2023Although very uncommon, severe injury and death can occur during scuba diving. One of the main causes of scuba diving fatalities is pulmonary barotrauma due to... (Review)
Review
INTRODUCTION
Although very uncommon, severe injury and death can occur during scuba diving. One of the main causes of scuba diving fatalities is pulmonary barotrauma due to significant changes in ambient pressure. Pathology of the lung parenchyma, such as cystic lesions, might increase the risk of pulmonary barotrauma.
AREAS COVERED
Birt-Hogg-Dubé syndrome (BHD), caused by pathogenic variants in the FLCN gene, is characterized by skin fibrofolliculomas, an increased risk of renal cell carcinoma, multiple lung cysts and spontaneous pneumothorax. Given the pulmonary involvement, in some countries patients with BHD are generally recommended to avoid scuba diving, although evidence-based guidelines are lacking. We aim to provide recommendations on scuba diving for patients with BHD, based on a survey of literature on pulmonary cysts and pulmonary barotrauma in scuba diving.
EXPERT OPINION
In our opinion, although the absolute risks are likely to be low, caution is warranted. Given the relative paucity of literature and the potential fatal outcome, patients with BHD with a strong desire for scuba diving should be informed of the potential risks in a personal assessment. If available a diving physician should be consulted, and a low radiation dose chest computed tomography (CT)-scan to assess pulmonary lesions could be considered.
Topics: Humans; Birt-Hogg-Dube Syndrome; Diving; Tumor Suppressor Proteins; Pneumothorax; Lung Diseases; Lung Injury; Cysts; Barotrauma
PubMed: 37991821
DOI: 10.1080/17476348.2023.2284375