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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 -
Cirugia Y Cirujanos 2016Extreme violence events are consequence of current world-wide economic, political and social conditions. Injury patterns found among victims of extreme violence events... (Review)
Review
Extreme violence events are consequence of current world-wide economic, political and social conditions. Injury patterns found among victims of extreme violence events are very complex, obeying several high-energy injury mechanisms. In this article, we present the basic concepts of trauma kinematics that regulate the clinical approach to victims of extreme violence events, in the hope that clinicians increase their theoretical armamentarium, and reflecting on obtaining better outcomes.
Topics: Biomechanical Phenomena; Blast Injuries; Burns; Contusions; Deceleration; Electric Injuries; Fractures, Bone; Humans; Models, Biological; Pressure; Stress, Mechanical; Torsion, Mechanical; Violence; Wounds and Injuries; Wounds, Penetrating
PubMed: 27036670
DOI: 10.1016/j.circir.2015.12.008 -
AJNR. American Journal of Neuroradiology 2014Diving-related decompression illness is classified into 2 main categories: arterial gas embolism and decompression sickness. The latter is further divided into types 1... (Review)
Review
Diving-related decompression illness is classified into 2 main categories: arterial gas embolism and decompression sickness. The latter is further divided into types 1 and 2, depending on the clinical presentation. MR imaging is currently the most accurate neuroimaging technique available for the detection of brain and spinal cord lesions in neurologic type 2 decompression sickness. Rapid bubble formation in tissues and the bloodstream during ascent is the basic pathophysiologic mechanism in decompression illness. These bubbles can damage the central nervous system through different mechanisms, namely arterial occlusion, venous obstruction, or in situ toxicity. Neuroimaging studies of decompression sickness have reported findings associated with each of these mechanisms: some typical results are summarized and illustrated in this article. We also review the limitations of previous work and make practical methodologic suggestions for future neuroimaging studies.
Topics: Brain Diseases; Decompression Sickness; Diving; Embolism, Air; Humans; Neuroimaging; Spinal Cord Diseases
PubMed: 24924550
DOI: 10.3174/ajnr.A4005 -
Anaesthesiology Intensive Therapy 2022There is increased incidence of barotrauma in COVID-19 patients, probably due to disease pathology, oxygen therapy and coughing. We aimed to retrospectively compare the...
BACKGROUND
There is increased incidence of barotrauma in COVID-19 patients, probably due to disease pathology, oxygen therapy and coughing. We aimed to retrospectively compare the characteristics, associations and outcomes of COVID-19 patients with and without barotrauma in the intensive care unit (ICU).
METHODS
All adults admitted between October 1st and December 31st 2020 in the ICUs of a COVID-19 hospital were retrospectively analysed for presence of a 'barotrauma event' (presence of at least one of pneumothorax, pneumomediastinum, subcutaneous emphysema or bronchopleural fistula). A control group was formed by matching each case to a patient belonging to the same gender and age range from the remaining patients in the cohort, i.e., those without barotrauma. Demographic details, ICU stay details, details of oxygen therapy and ventilation, and outcomes were noted and compared.
RESULTS
Of 827 patients, 30 patients (3.6%) developed barotrauma events. The typical patient was middle aged (median age 55.5 years) and male (73.3%). The mortality rate was significantly higher in the barotrauma group (83.3% vs. 43.3%, P < 0.001), and odds of survival decreased by 85% if barotrauma occurred (OR 0.15; 95% CI: 0.46-0.51). Patients who developed barotrauma spent a longer time on a high-flow nasal cannula (median 6.7 vs. 1.73 days, P = 0.04), and mechanical ventilation (median 9.54 vs. 0.867 days, P < 0.001), and had a longer ICU stay (median 15.5 vs. 9 days, P = 0.014). The most common event was pneumothorax (26/30).
CONCLUSIONS
Barotrauma in the COVID-19 ICU is associated with prolonged ICU stay, higher odds of mortality and longer duration spent on mechanical ventilation and a high-flow nasal cannula. Key words: barotrauma, ICU, COVID-19, mortality, pneumothorax.
Topics: Adult; Barotrauma; COVID-19; Case-Control Studies; Critical Illness; Humans; Male; Middle Aged; Retrospective Studies
PubMed: 35359137
DOI: 10.5114/ait.2022.114034 -
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 -
Molecules (Basel, Switzerland) Jan 2018Traumatic brain injury (TBI) is one of the most frequent causes of combat casualties in Operations Iraqi Freedom (OIF), Enduring Freedom (OEF), and New Dawn (OND).... (Review)
Review
Traumatic brain injury (TBI) is one of the most frequent causes of combat casualties in Operations Iraqi Freedom (OIF), Enduring Freedom (OEF), and New Dawn (OND). Although less common than combat-related blast exposure, there have been significant numbers of blast injuries in civilian populations in the United States. Current United States Department of Defense (DoD) ICD-9 derived diagnoses of TBI in the DoD Health Care System show that, for 2016, severe and moderate TBIs accounted for just 0.7% and 12.9%, respectively, of the total of 13,634 brain injuries, while mild TBIs (mTBIs) accounted for 86% of the total. Although there is a report that there are differences in the frequency of long-term complications in mTBI between blast and non-blast TBIs, clinical presentation is classified by severity score rather than mechanism because severity scoring is associated with prognosis in clinical practice. Blast TBI (bTBI) is unique in its pathology and mechanism, but there is no treatment specific for bTBIs-these patients are treated similarly to TBIs in general and therapy is tailored on an individual basis. Currently there is no neuroprotective drug recommended by the clinical guidelines based on evidence.
Topics: Adult; Blast Injuries; Brain Injuries, Traumatic; Disease Management; Female; Humans; Iraq War, 2003-2011; Male; Practice Guidelines as Topic; Precision Medicine; Prognosis; Trauma Severity Indices; United States
PubMed: 29373501
DOI: 10.3390/molecules23020245 -
Computer Methods and Programs in... Nov 2021Bomb blast injuries exerts a shearing force on the air-tissue interfaces, causing devastating ocular injury from the blast wave. Improvised explosive devices (IEDs) are...
BACKGROUND AND OBJECTIVE
Bomb blast injuries exerts a shearing force on the air-tissue interfaces, causing devastating ocular injury from the blast wave. Improvised explosive devices (IEDs) are usually placed at different heights from the ground to induce more severe injury through ground blast reinforcement (GBR). However, there is still a lack of knowledge of the role of GBR and IED height from the ground on ocular biomechanics, and how they can affect the intraocular pressure (IOP) in the eye. This study aimed to estimate the IOP due to frontal IED explosion at different heights from the ground using a fluid-structure interaction model with and without GBR effects.
METHODS
A 2 kg IED was placed within 5 m of the victim at 5 different heights from the ground, including 0, 0.42, 0.85, 1.27, and 1.70 m. Two different blast formulations were used to simulate the IED explosion: (a) spherical airburst, with no amplification of the initial shock wave due to interaction with the ground-surface, and (b) hemispherical surface-burst, where the initial blast wave is immediately reflected and reinforced by the ground (GBR).
RESULTS
Results revealed that the blast wave due to GBR reaches to the skull prior to the IED blast itself. The GBR also reached to the skull ∼ 0.6 ms earlier when the IED was on the ground compared to the height of 1.70 m. The highest and lowest IOPs of ∼ 17,000 and ∼ 15,000 mmHg were observed at the IED heights of 1.70 and 0 m from the ground considering GBR. However, when the role of the GBR is ignored, IOP of ∼ 9,000 mmHg was observed regardless of the IED height from the ground. The deformation in the apex of the cornea was higher when considering the GBR (∼ 0.75 cm) versus no GBR (∼ 0.65 cm). Considering GBR led to higher stresses and strains in the sclera.
CONCLUSIONS
When the role of GBR was ignored, the results showed similar patterns and magnitudes of stresses and deformations in the skull and eye regardless of the height of the IED from the ground, which was not the case when GBR was considered. The findings of this study suggest the critical role of GBR in ocular blast simulations.
Topics: Biomechanical Phenomena; Biophysics; Blast Injuries; Explosions; Eye; Humans
PubMed: 34598082
DOI: 10.1016/j.cmpb.2021.106425 -
Diving and Hyperbaric Medicine Sep 2020This paper summarises the history and capabilities of monoplace chambers in treatment of decompression illness (DCI); both in support of diving operations and in the... (Review)
Review
This paper summarises the history and capabilities of monoplace chambers in treatment of decompression illness (DCI); both in support of diving operations and in the hospital setting. In the field, monoplace hyperbaric chambers provide victims of DCI immediate access to recompression in settings where traditional multiplace chambers are not available. Alternatively, they may facilitate pressurised transport to a multiplace chamber for continued management. Recently, collapsible lightweight versions have improved suitability for field deployment aboard small vessels in remote settings, and for use by less technically capable military, occupational and civilian operators. The resulting elimination of treatment delays may prove lifesaving and central nervous system sparing, and avoid subsequent diving fitness disqualification. Monoplace chambers thus facilitate diving operations that would otherwise be difficult to condone on health and safety grounds. The 1960s saw the introduction of multiplace hyperbaric chambers into the hospital setting, as a number of non-diving conditions appeared to benefit from hyperbaric oxygen. This coincided with interest in hyperbaric oxygen as a solid tumour radiation sensitiser. Development of a novel acrylic-hulled single occupancy chamber enabled patients to undergo radiotherapy while pressurised within its oxygen atmosphere. Increasing numbers of health care facilities adopted this chamber type as a more economical, less complex alternative to the multiplace chamber. Incorporation of relevant biomedical technologies have allowed monoplace chambers to support increasingly complex patients in a safe, effective manner. Despite these advances, criticism of medical centre-based monoplace chamber treatment of DCI exists. This paper evaluates this controversy and presents relevant counter-arguments.
Topics: Decompression Sickness; Diving; Humans; Hyperbaric Oxygenation; Military Personnel
PubMed: 32957129
DOI: 10.28920/dhm50.3.264-272 -
The Journal of the Acoustical Society... Feb 2022Blast trauma from explosions affects hearing and communication in a significant proportion of soldiers. Many veterans report difficulty communicating, especially in...
Blast trauma from explosions affects hearing and communication in a significant proportion of soldiers. Many veterans report difficulty communicating, especially in noisy and reverberant environments, which contributes to complex mental health problems including anxiety and depression. However, the relationship between communication and perceptual problems after a blast has received little scientific attention. In the current studies, the effects of blast trauma on the production and perception of ultrasonic vocalizations (USVs) by CBA/CaJ mice, a common animal model for hearing and communication disorders, was explored. Overall, mice change the total number of vocalizations, the proportion produced of each syllable category, and the peak frequency, bandwidth, and duration of their vocalizations after blast exposure. Further, the perception of USVs is affected after blast trauma, with an immediate worsening of detection for most USV categories in the first 1-5 days after blasts, which later recovers. This study is the first to examine changes in the production and perception of communication signals after blast traumas in mice and is an important step towards developing treatments for blast-induced hearing and communication disorders.
Topics: Animals; Blast Injuries; Mice; Mice, Inbred CBA; Perception; Ultrasonics; Vocalization, Animal
PubMed: 35232087
DOI: 10.1121/10.0009359 -
Forensic Science, Medicine, and... Sep 2021Explosion-related deaths are uncommon events which require expertise and confidence so that an appropriate death investigation can be performed. The present study aims... (Review)
Review
PURPOSE
Explosion-related deaths are uncommon events which require expertise and confidence so that an appropriate death investigation can be performed. The present study aims to provide a detailed forensic analysis of the issues and implications arising in the event of an explosion.
METHODS
A retrospective review of casualty data was conducted on electronic literature databases. Cases concerning deadly explosions registered at the Milan Institute of Legal Medicine were examined and analyzed altogether.
RESULTS
Explosions may involve closed or open systems. A security assessment of the site is always necessary. Alterations of the site due to rescue procedures can occur; thus, on-site forensic investigation should be adapted to the environment. Then, a study protocol based on autopsy procedures is presented. Application of the postmortem radiology enforces forensic procedures both for the analysis of blast injuries and skeleton fractures, and for identification purposes. Blast injuries typically cause lacerations of the lungs, intestine and major vessels; moreover, hyoid fractures can be documented. Histopathology may help to define blast injuries effectively. Forensic chemistry, toxicology and ballistics provide useful investigative evidence as well as anthropology and genetics. Different forensic topics regarding explosions are discussed through five possible scenarios that forensic pathologists may come across. Scenarios include self-inflicted explosion deaths, domestic explosions, work-related explosions, terrorist events, and explosions caused by accidents involving heavy vehicles.
CONCLUSION
The scenarios presented offer a useful instrument to avoid misinterpretations and evaluation errors. Procedural notes and technical aspects are provided to the readers, with an insight on collaboration with other forensic experts.
Topics: Accidents; Blast Injuries; Explosions; Forensic Medicine; Humans; Retrospective Studies
PubMed: 34196925
DOI: 10.1007/s12024-021-00383-z