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BMC Emergency Medicine Mar 2024Frontline hospitals near active hostilities face unique challenges in delivering emergency care amid threats to infrastructure and personnel safety. Existing literature...
BACKGROUND
Frontline hospitals near active hostilities face unique challenges in delivering emergency care amid threats to infrastructure and personnel safety. Existing literature focuses on individual aspects like mass casualty protocols or medical neutrality, with limited analysis of operating acute services directly under fire.
OBJECTIVES
To describe the experience of a hospital situated meters from hostilities and analyze strategies implemented for triage, expanding surge capacity, and maintaining continuity of care during attacks with limited medical staff availability due to hazardous conditions. A focus will be placed on assessing how the hospital functioned and adapted care delivery models in the event of staffing limitations preventing all teams from arriving on site.
METHODS
A retrospective case study was conducted of patient records from Barzilai University Medical Center at Ashkelon (BUMCA) Medical Center in Israel within the first 24 h after escalated conflict began on October 7, 2023. Data on 232 admissions were analyzed regarding demographics, treatment protocols, time to disposition, and mortality. Missile alert data correlated patient surges to attacks. Statistical and geospatial analyses were performed.
RESULTS
Patients predominantly male soldiers exhibited blast/multisystem trauma. Patient surges at the hospital were found to be correlated with the detection of incoming missile attacks from Gaza within 60 min of launch. While 131 (56%) patients were discharged and 55 (24%) transferred within 24 h, probabilities of survival declined over time reflecting injury severity limitations. 31 deaths occurred from severe presentation.
CONCLUSION
Insights gleaned provide a compelling case study on managing mass casualties at the true frontlines. By disseminating BUMCA's trauma response experience, strategies can strengthen frontline hospital protocols optimizing emergency care delivery during hazardous armed conflicts through dynamic surge capacity expansion, early intervention prioritization, and infrastructure/personnel protection measures informed by risks.
Topics: Humans; Male; Female; Retrospective Studies; Emergency Medical Services; Triage; Mass Casualty Incidents; Hospitals; Blast Injuries; Disaster Planning; Emergency Service, Hospital
PubMed: 38515061
DOI: 10.1186/s12873-024-00964-5 -
Diving and Hyperbaric Medicine Mar 2024This is a review of commercial heliox saturation decompression procedures. The scope does not include compression, storage depth or bell excursion dive procedures. The... (Review)
Review
INTRODUCTION
This is a review of commercial heliox saturation decompression procedures. The scope does not include compression, storage depth or bell excursion dive procedures. The objectives are to: identify the sources of the procedures; trace their evolution; describe the current practice; and detect relevant trends.
METHODS
Eleven international commercial diving companies provided their diving manuals for review under a confidentiality agreement.
RESULTS
Modern commercial diving saturation procedures are derived from a small number of original procedures (United States Navy, Comex, and NORSOK). In the absence of relevant scientific studies since the late 80's, the companies have empirically adapted these procedures according to their needs and experience. Such adaptation has caused differences in decompression rates shallower than 60 msw, decompression rest stops and the decision to decompress linearly or stepwise. Nevertheless, the decompression procedures present a remarkable homogeneity in chamber PO and daily decompression rates when deeper than 60 msw. The companies have also developed common rules of good practice; no final decompression should start with an initial ascending excursion; a minimum hold is required before starting a final decompression after an excursion dive. Recommendation is made for the divers to exercise during decompression.
CONCLUSIONS
We observed a trend towards harmonisation within the companies that enforce international procedures, and, between companies through cooperation inside the committees of the industry associations.
Topics: Humans; Diving; Decompression; Oxygen; Helium; Decompression Sickness
PubMed: 38507907
DOI: 10.28920/dhm54.1.23-38 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Mar 2024Despite the widespread use of pressure cookers for quick and efficient cooking, literature has insufficiently highlighted the potential dangers resulting from...
BACKGROUND
Despite the widespread use of pressure cookers for quick and efficient cooking, literature has insufficiently highlighted the potential dangers resulting from inappropriate handling. This study aims to provide a comprehensive overview of 32 patients who presented with pressure cooker burns, emphasizing the serious risks associated with their misuse.
METHODS
Retrospective data were collected from patients admitted to Bağcılar Training and Research Hospital Burn Center between 2017 and 2020 with pressure cooker burns in Türkiye. Data encompassed patient characteristics, burn causes, locations, severities, treatments, and clinical outcomes.
RESULTS
The study included 32 patients (29 female/3 male) with a mean age of 42.3 (8-83). Patients were categorized based on burn areas, revealing associated injuries such as ocular (34.3%) and ear injuries (6.25%). The average hospital stay was 10.5 days [2-37]. While five pressure cookers exploded due to product-related issues, 26 explosions resulted from user errors (15.6%/81.2%). Importantly, no mortality was observed among the patients.
CONCLUSION
While pressure cookers facilitate rapid food preparation, this study underscores the severe risks arising from product or usage errors. This study emphasizes the need for more effective usage instructions and increased awareness about pressure cookers to prevent burn risks. We anticipate that educational programs focused on safe pressure cooker use could significantly reduce the incidence of serious injuries.
Topics: Adult; Female; Humans; Male; Burn Units; Explosions; Hospitalization; Incidence; Length of Stay; Retrospective Studies; Child; Adolescent; Young Adult; Middle Aged; Aged; Aged, 80 and over; Blast Injuries; Burns
PubMed: 38506385
DOI: 10.14744/tjtes.2024.38131 -
Journal of the Belgian Society of... 2024This is a case of barotrauma imaging (Macklin effect) after invasive mechanical ventilation in a 14-week-old newborn with complicated bronchiolitis. Imaging could help...
This is a case of barotrauma imaging (Macklin effect) after invasive mechanical ventilation in a 14-week-old newborn with complicated bronchiolitis. Imaging could help us improve defining the anatomical boundaries of the Macklin effect, an incompletely known anatomo-physiological entity.
PubMed: 38504856
DOI: 10.5334/jbsr.3410 -
Ear, Nose, & Throat Journal Mar 2024
PubMed: 38477503
DOI: 10.1177/01455613241237082 -
BioRxiv : the Preprint Server For... Mar 2024Patients with compromised respiratory function frequently require mechanical ventilation to survive. Unfortunately, non-uniform ventilation of injured lungs generates...
Patients with compromised respiratory function frequently require mechanical ventilation to survive. Unfortunately, non-uniform ventilation of injured lungs generates complex mechanical forces that lead to ventilator induced lung injury (VILI). Although investigators have developed lung-on-a-chip systems to simulate normal respiration, modeling the complex mechanics of VILI as well as the subsequent recovery phase is a challenge. Here we present a novel humanized in vitro ventilator-on-a-chip (VOC) model of the lung microenvironment that simulates the different types of injurious forces generated in the lung during mechanical ventilation. We used transepithelial/endothelial electrical resistance (TEER) measurements to investigate how individual and simultaneous application of the different mechanical forces alters real-time changes in barrier integrity during and after injury. We find that compressive stress (i.e. barotrauma) does not significantly alter barrier integrity while over-distention (20% cyclic radial strain, volutrauma) results in decreased barrier integrity that quickly recovers upon removal of mechanical stress. Conversely, surface tension forces generated during airway reopening (atelectrauma), result in a rapid loss of barrier integrity with a delayed recovery relative to volutrauma. Simultaneous application of cyclic stretching (volutrauma) and airway reopening (atelectrauma), indicate that the surface tension forces associated with reopening fluid-occluded lung regions is the primary driver of barrier disruption. Thus, our novel VOC system can monitor the effects of different types of injurious forces on barrier disruption and recovery in real-time and can be used to identify the biomechanical mechanisms of VILI.
PubMed: 38464068
DOI: 10.1101/2024.02.26.582200 -
European Journal of Case Reports in... 2024Until now, only a few cases of Valsalva-induced barotraumas (pneumothorax, pneumomediastinum and subcutaneous emphysema) have been described, and none of them among...
BACKGROUND
Until now, only a few cases of Valsalva-induced barotraumas (pneumothorax, pneumomediastinum and subcutaneous emphysema) have been described, and none of them among COVID-19 patients.
CASE DESCRIPTION
A man in his 50s was admitted for SARS-CoV-2-related acute respiratory distress syndrome (ARDS). Initial evolution was favourable with non-invasive ventilatory support, high-flow oxygen nasal cannula and the best supportive drugs available at the time. During the Valsalva manoeuvre while defecating, the patient reported sudden chest pain and showed a new acute hypoxemic respiratory failure due to a pneumothorax. It led to multiple complications (pulmonary embolism, haemoptysis, and cardiac arrest), and despite the best supportive care, led to the patient's death.
DISCUSSION
The Valsalva manoeuvre can be an overlooked cause of pneumothorax in patients with COVID-19. Predisposition to barotrauma in COVID-19 patients could be explained by several factors, including the extensive use of non-invasive and invasive ventilation during the pandemic, and the histological changes observed in the lungs of those infected with COVID-19.
CONCLUSION
We report the first description of a Valsalva-induced barotrauma in a COVID-19 infection. We emphasise the importance of treating constipation particularly in severe COVID-19 cases, to prevent complications such as barotrauma.
LEARNING POINTS
Pneumothorax is a common complication of severe COVID-19 infection, but Valsalva manoeuvre-induced pneumothorax in COVID-19 patients has never been reported previously.Particular care should be taken to prevent and treat constipation in hospitalised patients as it may cause a wide range of complications, including barotraumatism.The extensive use of non-invasive and invasive ventilation may play a role in barotrauma, but causal association has not been proven.
PubMed: 38455690
DOI: 10.12890/2024_004217 -
Radiology Case Reports May 2024Crack is the most potent form of cocaine. It directly affects lungs if inhaled and the damage may include barotrauma, acute pulmonary edema, alveolar hemorrhage,...
Crack is the most potent form of cocaine. It directly affects lungs if inhaled and the damage may include barotrauma, acute pulmonary edema, alveolar hemorrhage, bronchiolitis obliterans with organizing pneumonia, or vasculitis. The diagnosis of cocaine-related lung damage is based on clinical symptoms and radiological findings. When young individuals develop respiratory symptoms, investigation into cocaine use is necessary. We report the case of a young man with a history of cocaine use who presented for respiratory and neurological symptoms revealing crack lung and toxic cerebral vasculitis.
PubMed: 38444596
DOI: 10.1016/j.radcr.2024.02.015 -
Herzschrittmachertherapie &... Mar 2024In 1930, Wolff, Parkinson and White described the syndrome that bears their names. The mechanisms of supraventricular tachycardias were analyzed by brilliant... (Review)
Review
In 1930, Wolff, Parkinson and White described the syndrome that bears their names. The mechanisms of supraventricular tachycardias were analyzed by brilliant electrocardiography interpretation by Pick and Langendorf. Wellens and Durrer using electrophysiologic studies analyzed the tachycardia mechanism invasively. In Germany the group by Seipel and Breithardt as well as Neuss and Schlepper studied the tachycardia mechanisms and response to antiarrhythmic drugs invasively by electrophysiological studies. Following the first successful interruption of an accessory pathway by Sealy in 1967, surgeons and electrophysiologists cooperated in Germany. Two centers, Hannover and Düsseldorf were established. Direct current (DC) ablation of accessory pathways was introduced by Morady and Scheinman. Because of side effects induced by barotrauma of DC, alternative strategies were studied. In 1987, radiofrequency ablation was introduced and thereafter established as curative therapy of accessory pathways in all locations.
Topics: Humans; Wolff-Parkinson-White Syndrome; Pre-Excitation Syndromes; Tachycardia, Supraventricular; Tachycardia; Accessory Atrioventricular Bundle; Catheter Ablation; Electrocardiography
PubMed: 38427036
DOI: 10.1007/s00399-024-01000-6 -
Journal of Applied Physiology... Apr 2024Decompression sickness (DCS) is caused by gaseous nitrogen dissolved in tissues forming bubbles during decompression. To date, no method exists to identify nitrogen...
Decompression sickness (DCS) is caused by gaseous nitrogen dissolved in tissues forming bubbles during decompression. To date, no method exists to identify nitrogen within tissues, but with advances in positron-emission tomography (PET) technology, it may be possible to track gaseous radionuclides into tissues. We aimed to develop a method to track nitrogen movement in vivo and under hyperbaric pressure that could then be used to further our understanding of DCS using nitrogen-13 (N). A single anesthetized female Sprague-Dawley rat was exposed to 625 kPa, composed of air, isoflurane, and N for 10 min. The PET scanner recorded N during the hyperbaric exposure with energy windows of 250-750 keV. The PET showed an increase in N concentration in the lung, heart, and abdominal regions, which all reached a plateau after ∼4 min. This showed that it is possible to gain noninvasive in vivo measurements of nitrogen kinetics through the body while at hyperbaric pressures. Tissue samples showed radioactivity above background levels in the blood, brain, liver, femur, and thigh muscle when assessed using a γ counter. The method can be used to evaluate an array of challenges to our understanding of decompression physiology by quantifying nitrogen load through γ counts of N, and signal intensity of the PET. Further development of the method will improve the specificity of the measured outcomes, and enable it to be used with larger mammals, including humans. This article describes a method for the in vivo quantification and tracking of nitrogen through the mammalian body whilst exposed to hyperbaric pressure. The method has the potential to further our understanding of decompression sickness, and quantitatively evaluate the effectiveness of both the treatment and prevention of decompression sickness.
Topics: Humans; Rats; Animals; Female; Nitrogen; Decompression Sickness; Diving; Rats, Sprague-Dawley; Decompression; Gases; Hyperbaric Oxygenation; Positron-Emission Tomography; Mammals; Nitrogen Radioisotopes
PubMed: 38420678
DOI: 10.1152/japplphysiol.00859.2023