scholarly journals Perspectives of solution to the problem of persistent intra-abdominal hemorrhage at the prehospital stage

2021 ◽  
Vol 23 (1) ◽  
pp. 23-32
Author(s):  
Konstantin P. Golovko ◽  
Igor M. Samokhvalov ◽  
Maxim S. Grishin ◽  
Tatyana Y. Suprun ◽  
Artem M. Nosov ◽  
...  
Keyword(s):  
Surgical Care ◽  
Traumatic Shock ◽  
Terminal State ◽  
High Rate ◽  
Time Of Arrival ◽  
Abdominal Injuries ◽  
Internal Organs ◽  
Lethal Outcome ◽  
Post Hoc ◽  
Abdominal Hemorrhage

A post-hoc analysis of 338 casualties demonstrating persistent intra-abdominal hemorrhage has been carried out, the proportion of this group being 16.5% in overall casualty structure or 64% in the group of casualties with abdominal injuries. Lethal outcome rate in the studied group was 13%, the complication rate was 53.2%. Traumatic shock was found in 86% of casualties, the greatest proportion was accounted for by the first and second degree (59.1%). Lethality rate in the case of the third degree traumatic shock and terminal state was 34.4%. Injured parenchymal organs and abdominal major vessels showed the greatest blood loss 2348 250 ml. The time of arrival of casualties with persistent intra-abdominal hemorrhage to the advanced trauma management stage or definitive surgical care stage was virtually similar amounting to 2.6 0.4 hr. Injuries to hollow organs (34.1%) were most commonly found, injuries to parenchymal organs (24.9%) occurred less frequently, the rate of combination of injuries to abdominal internal organs was approximately the same (24.9%). Major vessels injuries were diagnosed only in one casualty (0.3%), while those combined with internal organs injuries in 37(11%)of casualties. As regards favorable prognosis this group was considered to be the least perspective owing to high rate of hemorrhage and inability to achieve effective hemostasis at the prehospital stage. Thus, persistent hemorrhage was not profuse, and the majority of casualties (88.7%) should be considered as perspective recipients to achieve temporary hemostasis at the prehospital stage. It is this approach based on the principles of early pathogenetic management that could reduce the rate of complications and lethality in casualties with persistent intra-abdominal hemorrhage.

In memory of Georgiy Nicolaevich Tsibulyak

2020 ◽  
Vol 22 (4) ◽  
pp. 249-252
Author(s):  
I. M. Samokhvalov ◽  
V. I. Badalov ◽  
N. A. Tiniankin ◽  
P. P. Liashedko ◽  
K. P. Golovko
Keyword(s):  
Research Laboratory ◽  
Traumatic Shock ◽  
Gold Medal ◽  
Clinical Findings ◽  
Terminal State ◽  
Surgical Trauma ◽  
Senior Lecturer ◽  
War Surgery ◽  
Scientific Papers ◽  
Surgery Department

The biography of colonel of Medical Corps, professor Georgiy Nicolaevich Tsibuliak (19322020) is presented. In 1956 G.N. Tsibuliak graduated from the Kirov Military Academy being awarded with gold medal. When being a cadet, he got actively engaged in research. In 1961 G.N. Tsibuliak defended candidates dissertation on the injury treatment in casualties damaged by ionizing radiation, took part in the study of multiple injuries occurring in atomic tests. After graduating from the medical residency he stayed in War Surgery department of the Academy, was eventually assigned as a senior lecturer, the head of the research laboratory carrying out the study of shock and terminal state. In1966 he defended a doctorate in pathogenesis, clinical findings and treatment of tetanus. G.N. Tsibuliak became one of the leading advocates for the concept of traumatic shock in individuals. This fact that at present emergency physicians and surgeons dealing with traumatic shock consider to be an axiom, is scientifically based, and was gained through hard routine work in treating severely injured casualties. From 1976 to 1982 Georgiy Nicolaevich was Surgeon-in-Chief in Group of Soviet Forces in Germany. In 19901993 he was in charge of research laboratory dealing with combat surgical trauma in the Academy. Since 1993 G.N. Tsibuliak had retired from active duty, holding the position of a professor at the War Surgery department. He is the author of more than 200 scientific papers, including 7 monographs. G.N. Tsibuliak was closest associate of A.N. Berkutov in studying traumatic shock in casualties, took an active part in formation of a new clinical specialty resuscitation.

scholarly journals Fast Timing for High-Rate Environments with Micromegas

2018 ◽  
Vol 174 ◽  
pp. 02002 ◽  
Author(s):  
Thomas Papaevangelou ◽  
Daniel Desforge ◽  
Esther Ferrer-Ribas ◽  
Ioannis Giomataris ◽  
Cyprien Godinot ◽  
...  
Keyword(s):  
Charged Particle ◽  
High Rate ◽  
Time Of Arrival ◽  
Electromagnetic Showers ◽  
Fast Timing ◽  
Timing Resolution ◽  
Current State ◽  
Sustained Performance ◽  
Front Window ◽  
Uv Photons

The current state of the art in fast timing resolution for existing experiments is of the order of 100 ps on the time of arrival of both charged particles and electromagnetic showers. Current R&D on charged particle timing is approaching the level of 10 ps but is not primarily directed at sustained performance at high rates and under high radiation (as would be needed for HL-LHC pileup mitigation). We demonstrate aMicromegas based solution to reach this level of performance. The Micromegas acts as a photomultiplier coupled to a Cerenkovradiator front window, which produces sufficient UV photons to convert the ∼100 ps single-photoelectron jitter into a timing response of the order of 10-20 ps per incident charged particle. A prototype has been built in order to demonstrate this performance. The first laboratory tests with a pico-second laser have shown a time resolution of the order of 27 ps for ∼50 primary photoelectrons, using a bulk Micromegas readout.

Abstract 486: The Effects of Weekend Admission on the Outcomes and Management of Ruptured Aortic Aneurysms

2014 ◽  
Vol 34 (suppl_1) ◽  
Author(s):  
Elliott M Groves ◽  
Mahdi Khoshchehreh ◽  
Christine Le ◽  
Shaista Malik
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Surgical Intervention ◽  
Surgical Care ◽  
Aortic Aneurysms ◽  
High Rate ◽  
Ruptured Aortic Aneurysm ◽  
Primary Endpoints ◽  
Abdominal Aortic ◽  
Thoracic And Abdominal

The Effects of Weekend Admission on the Outcomes and Management of Ruptured Aortic Aneurysms Objective: Ruptured aortic aneurysm is a condition with a high rate of mortality that requires prompt surgical intervention. It has been noted that in some conditions requiting such prompt intervention, in-hospital mortality is increased in patients admitted on the weekends as compared to patients admitted on weekdays. We sought to determine if this was indeed the case for both ruptured thoracic and abdominal aortic aneurysm and elucidate the possible reasons. Methods: Using the Nationwide Inpatient Sample (NIS), a publicly available database of inpatient care, we analyzed the incidence of mortality among patients admitted on the weekends compared to weekdays for ruptured aortic aneurysm. Ultimately the care of over 7,000 patients was analyzed for the primary endpoints. We adjusted for demographics, comorbid conditions, hospital characteristics, rates of surgical intervention, timing of surgical intervention and use of additional therapeutic measures. Results: Patients admitted on the weekend for both ruptured thoracic and abdominal aortic aneurysm had a statistically significant increase in mortality as compared to those admitted on the weekdays (OR 2.55 for Thoracic and 1.32 for Abdominal). By our analysis this is likely due to a delay in surgical care on the weekends. Conclusions: Weekend admission for ruptured aortic aneurysm is associated with an increased mortality when compared to those admitted on the weekend and this is likely due to several factors with the most predominant being a delay in surgical intervention.

Travel for Treatment

2017 ◽  
pp. 20-31
Author(s):  
Bhawna Sharma ◽  
J K Sharma ◽  
Sudir Padroo
Keyword(s):  
Medical Tourism ◽  
Health Care Organizations ◽  
Surgical Care ◽  
High Rate ◽  
Medical Procedure ◽  
Satisfaction Level ◽  
Significant Treatment ◽  
Quality Improvement Process ◽  
Treatment Services ◽  
Study Hospital

Medical tourism is growing and diversifying at a high rate. The medical tourism in India is poised to be next success story after software industry. This term is used to refer to travel activity that involves a medical procedure or activities that promote the wellbeing of the patient. The term medical tourism is the act of travelling to other countries to obtain medical, dental and surgical care. (Connell 2006) All the beneficiaries of this industry are putting their best foot forward by providing quality services at affordable cost in order to lure medical tourists. It goes without saying that only those health care organizations will survive and succeed in gaining competitive advantage over others that incorporates quality improvement process on a continuous basis. The results show that there is significant growth of medical tourism in India, which is growing at the rate 30% in 2015 (Saravana 2015) The standards of medical treatment and hospital facilities provided to patients have significantly improved in India with 21 hospitals in India already accredited by JCI. In this study hospital chosen for the present study is the hospital one amongst the list of JCI accredited hospitals in India. The objective of this study is to identify the medical tourist's satisfaction level & also to identify the grey areas for better services. The results show that they were quite satisfied with the services availed & are recommending it to others due to the significant treatment services.

scholarly journals Dvovremensko krvarenje kod bolesnika sa povredom slezine

2002 ◽  
Vol 49 (3) ◽  
pp. 55-61 ◽  
Author(s):  
B. Stefanovic ◽  
Aleksandar Karamarkovic ◽  
Z. Loncar ◽  
Sladjana Mijatovic ◽  
B. Stefanovic ◽  
...  
Keyword(s):  
Clinical Problem ◽  
Traumatic Shock ◽  
Severe Trauma ◽  
Lethal Outcome ◽  
Number Of Patients ◽  
Delayed Hemorrhage ◽  
Total Proportion ◽  
Immediate Surgery ◽  
Type Of Injury ◽  
Parameter Values

Although the diagnosis of spleen injuries is not a considerable clinical problem today, subsequent ruptures of this organ may occur in a smaller number of patients (2-5% of total proportion of spleen injuries) following the so-called "free interval". Such injuries are most commonly explained by present hematoma localized in the central spleen, which becomes larger in time, and eventually causes its rupture. This form of lesion may be found both in isolated blunt abdominal injuries and in associated injuries. When it is the question of delayed hemorrhage, our results as well as data obtained from foreign literature, suggest three basic rise factors of the etiology of this type of injury. These are as follows: a) spleen injuries in severe trauma or polytrauma, b) older patients (over 65 years of age), and c) in cases when more than a single blood unit had to be administered for the initial hemodynamic stabilization of a patient. Delayed hemorrhage, which is occult in polytraumatized patients since it is frequently "disguised" by severity of clinical picture and traumatic shock, may subsequently cause sudden fall of hemogram and hemodynamic parameter values, and if immediate surgery is not performed, it may lead to heavy bleeding and lethal outcome of the patient.

scholarly journals Characterization of Multiple Refractive Scintillation Events in the Directions of Two Millisecond Pulsars

1996 ◽  
Vol 160 ◽  
pp. 469-470 ◽  
Author(s):  
I. Cognard ◽  
J.-F. Lestrade
Keyword(s):  
Interstellar Medium ◽  
Flux Density ◽  
High Precision ◽  
High Rate ◽  
Time Of Arrival ◽  
Millisecond Pulsars ◽  
Comparable Level ◽  
System Temperature

High-precision timing of the millisecond pulsars PSR B1937+21 and PSR B1821-24 are conducted at 1.4 and 1.7 GHz with the high rate of observations of 10-15 times per month at Nançay. Time Of Arrival (TOA) and pulsar flux density are both measured. The rms of the daily post-fit TOA residuals are at the level of 0.5μs and 3.0μs, respectively. A characterization of refractive scintillation events produced by the Ionized Interstellar Medium (IISM) both in the TOA residuals and flux density variations is discussed.Timing at Nan^ay is conducted with a pre-detection dedispersion system. The analysis of the TOAs was done with our software AnTiOPE solving for the classical pulsar parameters. The flux densities of the pulsars are averaged over ~30 or ~70 minutes. Calibration of the system temperature and efficiency of the telescope is good at the 10% level and diffrative scintillation limits this calibration to a comparable level (~35 scintels for PSR B1937+21 over 30 minutes and 7.5 MHz).

Intubation of Profoundly Agitated Patients Treated with Prehospital Ketamine

2016 ◽  
Vol 31 (6) ◽  
pp. 593-602 ◽  
Author(s):  
Travis D. Olives ◽  
Paul C. Nystrom ◽  
Jon B. Cole ◽  
Kenneth W. Dodd ◽  
Jeffrey D. Ho
Keyword(s):  
Endotracheal Intubation ◽  
Male Gender ◽  
Prehospital Setting ◽  
High Rate ◽  
Publication Type ◽  
Late Night ◽  
Substantial Risk ◽  
Urban Level ◽  
Clinically Significant ◽  
Post Hoc

AbstractBackgroundProfound agitation in the prehospital setting confers substantial risk to patients and providers. Optimal chemical sedation in this setting remains unclear.ObjectiveThe goal of this study was to describe intubation rates among profoundly agitated patients treated with prehospital ketamine and to characterize clinically significant outcomes of a prehospital ketamine protocol.MethodsThis was a retrospective cohort study of all patients who received prehospital ketamine, per a predefined protocol, for control of profound agitation and who subsequently were transported to an urban Level 1 trauma center from May 1, 2010 through August 31, 2013. Identified records were reviewed for basic ambulance run information, subject characteristics, ketamine dosing, and rate of intubation. Emergency Medical Services (EMS) ambulance run data were matched to hospital-based electronic medical records. Clinically significant outcomes are characterized, including unadjusted and adjusted rates of intubation.ResultsOverall, ketamine was administered 227 times in the prehospital setting with 135 cases meeting study criteria of use of ketamine for treatment of agitation. Endotracheal intubation was undertaken for 63% (85/135) of patients, including attempted prehospital intubation in four cases. Male gender and late night arrival were associated with intubation in univariate analyses (χ2=12.02; P=.001 and χ2=5.34; P=.021, respectively). Neither ketamine dose, co-administration of additional sedating medications, nor evidence of ethanol (ETOH) or sympathomimetic ingestion was associated with intubation. The association between intubation and both male gender and late night emergency department (ED) arrival persisted in multivariate analysis. Neither higher dose (>5mg/kg) ketamine nor co-administration of midazolam or haloperidol was associated with intubation in logistic regression modeling of the 120 subjects with weights recorded. Two deaths were observed. Post-hoc analysis of intubation rates suggested a high degree of provider-dependent variability.ConclusionsPrehospital ketamine is associated with a high rate of endotracheal intubation in profoundly agitated patients; however, ketamine dosing is not associated with intubation rate when adjusted for potential confounders. It is likely that factors not included in this analysis, including both provider comfort with post-ketamine patients and anticipated clinical course, play a role in the decision to intubate patients who receive prehospital ketamine.OlivesTD, NystromPC, ColeJB, DoddKW, HoJD. Intubation of profoundly agitated patients treated with prehospital ketamine. Prehosp Disaster Med. 2016;31(6):593–602.

scholarly journals OUR EXPIERENCE OF THE DIAGNOSIS AND TREATMENT OF CONCOMITANT INJURIES IN CHILDREN

2018 ◽  
Vol 22 (3) ◽  
pp. 138-147
Author(s):  
Dzhumberi G. Kiladze ◽  
S. V. Aleksandrov
Keyword(s):  
Diagnosis And Treatment ◽  
Brain Herniation ◽  
Abdominal Injuries ◽  
Concomitant Injuries ◽  
Life Saving ◽  
Hemodynamic State ◽  
Life Threatening ◽  
Post Hoc ◽  
Emergency Measures ◽  
Made In

Background. The severity of patients with concomitant injuries under time constraints determines the need for a rapid adequate assessment of life-threatening syndromes and their sequential alleviation. Most common mistakes are made in the diagnosis of ongoing bleeding and shock. Objective. The improvement results of the treatment of children with concomitant injuries. Material and methods. Post-hoc analysis of the treatment of 239 children with abdominal injuries within concomitant injuries. Results. The development of the algorithm for a surgeon to diagnose and to treat concomitant injuries. Conclusions. The high-priority problem in patients with concomitant injuries is life- saving by revealing and alleviation of life-threatening syndromes (acute respiratory failure, ongoing bleeding and brain herniation with vital disorders). The diagnosis and treatment of injuries should be realized with the elimination of all possible prerequisites for the revealed syndrome, taking into account the degree of the urgency of administration of the emergency measures. Non-life-threatening injuries should be treated only after the stabilization of the hemodynamic state.

scholarly journals Two port laparoscopic retroperitoneal pancreatic necrosectomy: improvement in morbidity and mortality with a less invasive approach

2021 ◽  
Vol 8 (5) ◽  
pp. 1501
Author(s):  
Vinay H. G. ◽  
Ramesh Reddy G. ◽  
Shwetha Chandra R. ◽  
Merin Mary ◽  
Kiran Kumar
Keyword(s):  
Pancreatic Necrosis ◽  
Surgical Care ◽  
Invasive Procedure ◽  
Minimal Invasive ◽  
Infected Pancreatic Necrosis ◽  
Morbidity And Mortality ◽  
High Rate ◽  
Morbidity Rate ◽  
Invasive Approach ◽  
Pancreatic Necrosectomy

Background: Severe pancreatitis is associated with a high rate of mortality even with advanced surgical care and practices worldwide. Morbidity and mortality rates are much higher in the presence of infected pancreatic necrosis. From open necrosectomy, simple percutaneous drainage or one of several minimal access approaches, the question of optimal or best treatment is yet debatable. Step-up approach is currently practised by many physicians. We describe our technique of early drainage by minimal invasive two-port laparoscopic retroperitoneal pancreatic necrosectomy in our centre.Methods: Thirteen consecutive patients with proven infected pancreatic necrosis were treated by 2P-LRPN over a two-year period in the setting of a teaching hospital. The median patient age was 44 years (range: 28-66 years) and 10 of the patients were male.Results: The median time to discharge following the procedure of 14 days (range: 08-21 days). There was no mortality and the morbidity rate was 37%, consisting mainly of pancreatic fistula (37%).Conclusions: Two-port laparoscopic retroperitoneal pancreatic necrosectomy is an effective and minimally invasive procedure which had better outcomes with improved patient morbidity, shorter hospital stay and lesser complication rate. Early intervention with necrosectomy has better patient compliance.

scholarly journals Comparison of Upper Limb Disability in Overhead Women Athletes of Handball, Volleyball, Softball, and Swimming

2021 ◽  
pp. 103-110
Author(s):  
Elmira Arabi ◽  
◽  
Gholam Hossein Nazemzadegan ◽  
Keyword(s):  
Women Athletes ◽  
Upper Limb ◽  
Study Groups ◽  
High Rate ◽  
Joint Disease ◽  
Overhead Athletes ◽  
Study Results ◽  
Significant Difference ◽  
The Difference ◽  
Post Hoc

Purpose: The shoulder joint is one of the most commonly injured joints in sports and may lead to disability, especially in the upper extremities of overhead players (handball, volleyball, softball, and swimming). Methods: This research is a causal-comparative study. After the approval of the Ethics Committee of the Medical University of Tehran, this study was conducted on 120 overhead athletes (Mean±SD height: 1.69±0.07 m, Mean±SD weight: 63.54±7.79 kg, Mean±SD age: 21.96±2.94 years, Mean±SD body mass index: 22.11±2.32 kg/m2). The inclusion criteria were elite female players in overhead sports with at least three years of experience in one of these sports (handball, volleyball, softball, and swimming). Samples with a history of surgery or cervical nerve problems, fractures in the shoulder area, and inflammatory joint disease were excluded from the study. The demographic information was obtained through a researcher-made questionnaire, and the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire was used to measure the degree of upper limb disability in daily activities. Results: In comparison between the study groups, a significant difference was observed between the dependent variable (DASH) and the research groups (F=6.067, df=3, P=0.002, Eta=0.342). Using the Bonferroni post hoc tests, the difference between volleyball and softball (P=0.44), volleyball and swimming (P=0.009), and handball and swimming players (P=0.022) were reported. In the next step, BMI characteristics, weekly training hours, and the number of training sessions per week were entered into the data analysis process as covariate variables (F=8.099, df=0.3, P=0.000, Eta=0.432). The Bonferroni post hoc test indicates the difference between volleyball and swimming athletes (P=0.001) and handball and swimming (P=0.002). Conclusion: The present study results indicate a high rate of upper limb disability in elite women athletes. The present study results showed no difference between volleyball and handball due to the nature of these two disciplines and handball, softball, and swimming.

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