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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 -
World Neurosurgery Nov 2022Blast-related traumatic brain injury (bTBI) is a significant cause of wartime morbidity and mortality. In recent decades, thermobaric explosives have emerged as... (Review)
Review
Blast-related traumatic brain injury (bTBI) is a significant cause of wartime morbidity and mortality. In recent decades, thermobaric explosives have emerged as particularly devastating weapons associated with bTBI. With recent documentation of the use of these weapons in the war in Ukraine, clinicians and laypersons alike could benefit from an improved understanding behind the dynamic interplay between explosive weaponry, its potential for bTBI, and the subsequent long-term consequences of these injuries. Therefore, we provide a general overview of the history and mechanism of action of thermobaric weapons and their potential to cause bTBI. In addition, we highlight the long-term cognitive and neuropsychiatric sequelae following bTBI and discuss diagnostic, therapeutic, and rehabilitation strategies, with the aim of helping to guide mitigation strategies and humanitarian relief in Ukraine. Thermobaric weapons produce a powerful blast wave capable of causing bTBIs, which can be further classified from primary to quaternary injuries. When modeling the hypothetical use of thermobaric weapons in Odessa, Ukraine, we estimate that the detonation of a salvo of thermobaric rockets has the potential to affect approximately 272 persons with bTBIs. In addition to the short-term damage, patients with bTBIs can present with long-term symptoms (e.g., post-traumatic stress disorder), which incur substantial financial costs and social consequences. Although these results are jarring, history has seen radical advancements in the understanding, diagnosis, and management of bTBI. Moving forward, a better understanding of the mechanism and long-term sequelae of bTBIs could help guide humanitarian relief to those affected by the war in Ukraine.
Topics: Humans; Brain Injuries; Explosive Agents; Ukraine; Blast Injuries; Brain Injuries, Traumatic
PubMed: 36028113
DOI: 10.1016/j.wneu.2022.08.073 -
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 -
Acta Neuropathologica Communications May 2023In the course of military operations in modern war theaters, blast exposures are associated with the development of a variety of mental health disorders associated with...
Late chronic local inflammation, synaptic alterations, vascular remodeling and arteriovenous malformations in the brains of male rats exposed to repetitive low-level blast overpressures.
In the course of military operations in modern war theaters, blast exposures are associated with the development of a variety of mental health disorders associated with a post-traumatic stress disorder-related features, including anxiety, impulsivity, insomnia, suicidality, depression, and cognitive decline. Several lines of evidence indicate that acute and chronic cerebral vascular alterations are involved in the development of these blast-induced neuropsychiatric changes. In the present study, we investigated late occurring neuropathological events associated with cerebrovascular alterations in a rat model of repetitive low-level blast-exposures (3 × 74.5 kPa). The observed events included hippocampal hypoperfusion associated with late-onset inflammation, vascular extracellular matrix degeneration, synaptic structural changes and neuronal loss. We also demonstrate that arteriovenous malformations in exposed animals are a direct consequence of blast-induced tissue tears. Overall, our results further identify the cerebral vasculature as a main target for blast-induced damage and support the urgent need to develop early therapeutic approaches for the prevention of blast-induced late-onset neurovascular degenerative processes.
Topics: Rats; Male; Animals; Vascular Remodeling; Blast Injuries; Brain; Inflammation; Arteriovenous Malformations; Disease Models, Animal
PubMed: 37173747
DOI: 10.1186/s40478-023-01553-6 -
The Journal of Trauma and Acute Care... Aug 2022During the last 20 years of conflict in the Middle East, improvements in body armor and the use of improvised explosive devices have resulted in an increased incidence...
BACKGROUND
During the last 20 years of conflict in the Middle East, improvements in body armor and the use of improvised explosive devices have resulted in an increased incidence of complex craniofacial trauma (CFT). Currently, CFT comprises up to 40% of all casualties. We present new data from the recent conflict in Iraq and Syria during Operation Inherent Resolve.
METHODS
Data were collected for patients treated at role 1, role 2, and role 3 facilities in Iraq and Syria over a 1-year period. During this time, a specialized head & neck surgical augmentation team was deployed and colocated with the central role 3 facility. Data included for this cross-sectional study are as follows: injury type and mechanism, triage category, initial managing facility and subsequent levels of care, and procedures performed.
RESULTS
Ninety-six patients sustained CFT over the study period. The most common injuries were soft tissue (57%), followed by cranial (44%) and orbital/facial (31%). Associated truncal and/or extremity injuries were seen in 46 patients (48%). There were marked differences in incidence and pattern of injuries between mechanisms (all p < 0.05). While improvised explosive devices had the highest rate of cranial and truncal injuries, gunshot wounds and blunt mechanisms had higher incidences of orbital/facial and neck injuries. Overall, 45% required operative interventions including complex facial reconstruction, craniotomy, and open globe repair. Mortality was 6% with 83% due to associated severe brain injury. Most patients were local nationals (70%) who required discharge or transfer to the local health care system.
CONCLUSION
Complex craniofacial trauma is increasingly seen by deployed surgeons, regardless of subspecialty training or location. Deployment of a centrally located head and neck team greatly enhances the capabilities for forward deployed management of CFT, with excellent outcomes for both US and local national patients.
LEVEL OF EVIDENCE
Therapeutic/care management; Level V.
Topics: Afghan Campaign 2001-; Blast Injuries; Cross-Sectional Studies; Fractures, Bone; Humans; Iraq War, 2003-2011; Neck Injuries; Wounds, Gunshot
PubMed: 35583970
DOI: 10.1097/TA.0000000000003700 -
Journal of the Mechanical Behavior of... May 2023Injury due to the penetration of fragments into parts of the body has been the major cause of morbidity and mortality after an explosion. Penetrating injuries into the...
Injury due to the penetration of fragments into parts of the body has been the major cause of morbidity and mortality after an explosion. Penetrating injuries into the heart present very high mortality, yet the risk associated with such injuries has not been quantified. Quantifying this risk is key in the design of personal protection and the design of infrastructure. This study is the first quantitative assessment of cardiac penetrating injuries from energised fragments. Typical fragments (5-mm sphere, 0.78-g right-circular cylinder and 1.1-g chisel-nosed cylinder) were accelerated to a range of target striking velocities using a bespoke gas-gun system and impacted ventricular and atrial walls of lamb hearts. The severity of injury was shown to not depend on location (ventricular or atrial wall). The striking velocity with 50% probability of critical injury (Abbreviated Injury Scale (AIS) 5 score) ranged between 31 and 36 m/s across all 3 fragments used. These findings can help directly in reducing morbidity and mortality from explosive events as they can be implemented readily into models that aim to predict casualties in an explosive event, inform protocols for first responders, and improve design of infrastructure and personal protective equipment.
Topics: Animals; Sheep; Blast Injuries; Atrial Fibrillation; Wounds, Penetrating
PubMed: 36989869
DOI: 10.1016/j.jmbbm.2023.105776 -
BMC Anesthesiology Jul 2022Postoperative atelectasis occurs in 90% of patients receiving general anesthesia. Recruitment maneuvers (RMs) are not always effective and frequently associated with... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Postoperative atelectasis occurs in 90% of patients receiving general anesthesia. Recruitment maneuvers (RMs) are not always effective and frequently associated with barotrauma and hemodynamic instability. It is reported that many natural physiological behaviors interrupted under general anesthesia could prevent atelectasis and restore lung aeration. This study aimed to find out whether a combined physiological recruitment maneuver (CPRM), sigh in lateral position, could reduce postoperative atelectasis using lung ultrasound (LUS).
METHODS
We conducted a prospective, randomized, controlled trial in adults with open abdominal surgery under general anesthesia lasting for 2 h or longer. Subjects were randomly allocated to either control group (C-group) or CPRM-group and received volume-controlled ventilation with the same ventilator settings. Patients in CPRM group was ventilated in sequential lateral position, with the addition of periodic sighs to recruit the lung. LUS scores, dynamic compliance (Cdyn), the partial pressure of arterial oxygen (PaO) and fraction of inspired oxygen (FiO) ratio (PaO/FiO), and other explanatory variables were acquired from each patient before and after recruitment.
RESULTS
Seventy patients were included in the analysis. Before recruitment, there was no significant difference in LUS scores, Cdyn and PaO/FiO between CPRM-group and C-group. After recruitment, LUS scores in CPRM-group decreased significantly compared with C-group (6.00 [5.00, 7.00] vs. 8.00 [7.00, 9.00], p = 4.463e-11 < 0.05), while PaO/FiO and Cdyn in CPRM-group increased significantly compared with C-group respectively (377.92 (93.73) vs. 309.19 (92.98), p = 0.008 < 0.05, and 52.00 [47.00, 60.00] vs. 47.70 [41.00, 59.50], p = 6.325e-07 < 0.05). No hemodynamic instability, detectable barotrauma or position-related complications were encountered.
CONCLUSIONS
Sigh in lateral position can effectively reduce postoperative atelectasis even without causing severe side effects. Further large-scale studies are necessary to evaluate it's long-term effects on pulmonary complications and hospital length of stay.
TRIAL REGISTRATION
ChiCTR1900024379 . Registered 8 July 2019,.
Topics: Adult; Barotrauma; Humans; Lung; Oxygen; Postoperative Complications; Prospective Studies; Pulmonary Atelectasis
PubMed: 35820814
DOI: 10.1186/s12871-022-01748-9 -
The Annals of Otology, Rhinology, and... Jan 2023To perform a systematic review to investigate the common presenting symptoms of barosinusitis, the incidence of those findings, the methods for diagnosis, as well as the...
OBJECTIVE
To perform a systematic review to investigate the common presenting symptoms of barosinusitis, the incidence of those findings, the methods for diagnosis, as well as the medical and surgical treatment options.
METHODS
A review of PubMed/MEDLINE, EMBASE, and Cochrane Library for articles published between 1967 and 2020 was conducted with the following search term: aerosinusitis OR "sinus squeeze" OR barosinusitis OR (barotrauma AND sinusitis) OR (barotrauma AND rhinosinusitis). Twenty-seven articles encompassing 232 patients met inclusion criteria and were queried for demographics, etiology, presentation, and medical and surgical treatments.
RESULTS
Mean age of patients was 33.3 years, where 21.7% were females and 78.3% were males. Causes of barotrauma include diving (57.3%), airplane descent (26.7%), and general anesthesia (0.4%). The most common presentations were frontal pain (44.0%), epistaxis (25.4%), and maxillary pain (10.3%). Most patients received topical steroids (44.0%), oral steroids (28.4%), decongestants (20.7%), and antibiotics (15.5%). For surgical treatment, most patients received functional endoscopic sinus surgery (FESS) (49.6%). Adjunctive surgeries include middle meatal or maxillary antrostomy (20.7%), septoplasty (15.5%), and turbinate surgery (9.1%). The most efficacious medical treatments are as follows: 63.6% success rate with oral steroids (66 treated), 50.0% success rate with topical steroids (102 treated), and 50.0% success rate analgesics (10 treated). For surgical treatments received by greater than 10% of the sample, the most efficacious was FESS (91.5% success rate, 108 treated).
CONCLUSION
Oral and topical steroids should be first line therapies. If refractory, then functional endoscopic sinus surgery is an effective treatment.
Topics: Male; Female; Humans; Adult; Endoscopy; Sinusitis; Barotrauma; Steroids; Chronic Disease; Craniocerebral Trauma; Pain
PubMed: 35130739
DOI: 10.1177/00034894211072353 -
Arquivos Brasileiros de Oftalmologia 2024
Topics: Humans; Eye Injuries; Blast Injuries
PubMed: 38655939
DOI: 10.5935/0004-2749.2023-0322