Dosage of Lipid Emulsions as an Antidote to Lipid-Soluble Substances

Introduction: Lipid emulsions are increasingly used as an antidote to lipophilic drug intoxications. The dose recommended by the American Society of Regional Anesthesia is used primarily for the treatment of local anesthetic systemic toxicity. There is insufficient information about what the dose of lipid emulsions (LE) should be in other intoxications depending on their severity. Aim: To determine the LE dose in a shock or haemodynamic instability in patients with acute exogenous intoxications treated with LE. Materials and methods: Forty-nine patients with acute lipophilic drug intoxications were treated with LE in the Clinic of Toxicology at the Naval Hospital in Varna. Statistical analysis was performed using the statistical functions of Excel 2016 and the Statistica 7.0 software package. Results: The percentage of patients receiving a low dose of LE of 0.3 ml/kg (93.87%) was significantly higher than the percentage of patients treated with a medium (2.04%) and a high dose (4.08%) of LF. The high dose of LE of 1.5 ml/kg recommended by the American Society of Regional Anesthesia was administered to two patients (4.08%). In severe intoxications with exotoxic shock, the rate of LE administration varies from 20 ml/h to 40 ml/h. Conclusions: In severe intoxications with cardiotoxic syndrome and haemodynamic instability, LE should be used in the dose as suggested by the American Society of Regional Anesthesia. It is possible to use lower doses of LE in the range of 0.3–0.6 ml/kg in all moderate poisonings administered by continuous intravenous infusion for 12-24-48 hours. No side effects were observed at these doses.

Architects of the Medical and Surgical Аcademy. Сonstruction of the landforces and naval hospital complex according to Dominiko Trezini's project

The article represents data on the initial development of the territory of the Vyborg side and the construction of Land-forces and Naval hospitals according to the plans of Domenico Trezzini, M.G. Zemtsov, P.A. Trezzini, I.K. Korobov. Information about main creations of these famous architects in St. Petersburg is given.

А case of heparin-induced thrombocytopenia in a patient with a novel coronaviral infection, features of diagnosis and treatment in a naval hospital conditions

The heparin-induced thrombocytopenia is a severe, potentially life-threatening complication of heparinotherpapia associated with thrombosis, develops as a result of antibody-mediated platelet activation. In the context of the SARS CoV-2 pandemic, the frequency of use of heparin in clinical practice has significantly increased, as a result of which the doctors have become more likely to face this complication. The article presents a review of the literature, describes the pathogenesis, modern algorithms for diagnosis and treatment, demonstrates a clinical case of heparin-induced thrombocytopenia in a patient with the SARS CoV-2, and discusses the features of diagnosis and treatment of this complication in a naval hospital.

FAMILY KNOWLEDGE ON PREHOSPITAL STROKE DETECTION CORRELATES WITH HOSPITAL ARRIVAL TIME IN STROKE PATIENTS AT THE NAVAL HOSPITAL DR. RAMELAN, SURABAYA

Background: Successful stroke management depends on the speed, accuracy, and timeliness of the initial treatment. Stroke patients with immediate medical help can minimize permanent disability and even mortality. Objective: This study analyzes the correlation between family knowledge on prehospital stroke detection with hospital arrival time. Method: The research design was correlational analytic with a cross-sectional approach. This paper was conducted at the Naval Hospital Dr.Ramelan, Surabaya, from January to February 2019, with ethical clearance from the hospital. The independent variable was family knowledge on prehospital stroke detection, and the dependent variable was hospital arrival time. There were 115 population and 111 samples by consecutive sampling technique. The instrument to measure family knowledge was a questionnaire about prehospital stroke detection consisted of 30 items, while to evaluate hospital arrival time was data from the medical record. The data analysis used the Mann-Whitney statistical test with a significance of 0.05. Result: Most respondents had adequate knowledge regarding prehospital stroke detection (54.1%) and early hospital arrival time (59.5%). There was a correlation between family knowledge on prehospital stroke detection and hospital arrival time in stroke patients (p=0.000). Conclusion: The better family knowledge on prehospital stroke detection, the faster hospital time arrival. Health workers should give health education on prehospital stroke detection to prevent delayed hospital arrival. Further research could involve electronic and social media to improve knowledge on prehospital stroke detection.

Neonatal Aeromedical Evacuation During COVID-19: An Interview With Captain Danielle James

ABSTRACT During the coronavirus-19 pandemic, limited information existed about the risks and consequences of severe acute respiratory syndrome coronavirus 2 infection associated with maternal transmission to neonates. With rapidly evolving evidence, Air Force Neonatal Intensive Care Unit nurses at U.S. Naval Hospital Okinawa, Japan, adapted their standard operating procedures to safeguard their at-risk neonatal patients. This interview describes an Air Force NICU nurse’s view of neonatal transport and nursing care during the coronavirus-19 pandemic.

Leadership Root Cause Analysis: Using a Formal Analysis Tool to Dissect and Promote Intrusive Leadership in a U.S. Naval Hospital

ABSTRACT Intrusive leadership is a method that looks for signs that might indicate a problem within or outside of the workplace that can affect a member’s performance and, subsequently, the mission. Our scenario demonstrates how intrusive leadership can identify potential problems which, when coupled with accountability, can prevent more significant complications.

The analysis of personnel workload on navy hospital ships using the NASA-TLX method

Navy Ships A is a Republic of Indonesia Ship type LPD (Landing Platform Dock) which has the main task and additional duties as a Naval Hospital Auxiliary Ship. In their daily life, Navy Ships A carries out maritime security operations to maintain the sovereignty of the Republic of Indonesia, as well as carry out humanitarian social activities. This makes the workload of Navy Ships A personnel in the high category. And it causes a decrease in productivity and morale of personnel which will result in work accidents and not achieving the main tasks assigned to Navy Ships A. This study aims to calculate the workload of Navy Ships A personnel using the NASA TLX (Task Load Index) method under conditions the current number of personnel. This research is expected to be able to calculate the workload of Navy Ships A personnel with the condition that the proper Personnel Composition List (DSP) has not been fulfilled. As well as being able to provide workload calculations according to the number of existing DSPs, so that they can provide recommendations for the right solution to the problem of high workload experienced by Navy Ships A personnel.

The Challenging but Imperative Path to Monoclonal Antibody Use Against COVID-19 for a Small Overseas Military Hospital

ABSTRACT Upon the U.S. FDA approval in early November for a monoclonal antibody proven to potentially mitigate adverse outcomes from coronavirus disease 2019 (COVID-19) infections, our small overseas community hospital U.S. Naval Hospital Rota, Spain (USNH Rota) requested and received a limited number of doses. Concurrently, our host nation, which previously had reported the highest number of daily deaths from COVID-19, was deep within a second wave of infections, increasing hospital admissions, near intensive care unit capacity, and deaths. As USNH Rota was not normally equipped for the complex infusion center required to effectively deliver the monoclonal antibody, we coordinated a multi-directorate and multidisciplinary effort in order to set up an infusion room that could be dedicated to help with our fight against COVID. Identifying a physician team lead, with subject matter experts from nursing, pharmacy, facilities, and enlisted corpsmen, our team carefully ensured that all requisite steps were set up in advance in order to be able to identify the appropriate patients proactively and treat them safely with the infusion that has been clinically proven to decrease hospital admissions and mortality. Additional benefits included the establishment of an additional negative pressure room near our emergency room for both COVID-19 patients and, when needed, the monoclonal antibody infusion. In mid-January, a COVID-19-positive patient meeting the clinical criteria for monoclonal antibody infusion was safely administered this potentially life-saving medication, a first for small overseas hospitals. Here, we describe the preparation, challenges, obstacles, lessons learned, and successful outcomes toward effectively using the monoclonal antibody overseas.

Current standard protocols of RT-PCR of nasopharyngeal swab in neonatal patient is not sensitive enough for determination of vertical transmission

The pandemic experienced in recent months has raised questions that should be investigate in the clinical practice. Transplacental transmission of SARS-CoV-2 and the consequences to the fetus and newborn have called attention due to the increasing number of infections, contradicting previous evidences that there was no possibility of coronavirus transmission from the mother to the fetus. We presented three cases of pregnant women with positive SARS-CoV-2 antibodies serology on admission in Naval Hospital Marcílio Dias (HNMD), Rio de Janeiro, Brazil. Samples of umbilical cord blood was double positive (IgM and IgG) for one patient, double negative for one patient and positive for IgG and negative for IgM for third patient. Maternal and neonatal nasopharyngeal swab samples analyzed by PCR for SARS-CoV-2 was positive for two maternal patients and negative for all newborns tested. It was possible to detect the SARS-CoV-2 in amniotic fluid and umbilical cord blood using the nested-PCR technics, thus being successfully evidenced transplacental transmission. We suggested that nasopharyngeal swab PCR test of neonates does not have a correlation with vertical transmission and thus, this molecular test is not useful for investigation of transplacental infection.

Current standart protocols of RT-PCR of nasopharyngeal swab in neonatal patient is not sensitive enough for determination of vertical transmission

The pandemic experienced in recent months has raised questions that should be investigate in the clinical practice. Transplacental transmission of SARS-CoV-2 and the consequences to the fetus and newborn have called attention due to the increasing number of infections, contradicting previous evidences that there was no possibility of coronavirus transmission from the mother to the fetus. In this work we showed three cases of pregnant women with positive SARS-CoV-2 antibodies serology on admission in Naval Hospital Marcílio Dias (HNMD), Rio de Janeiro, Brazil. Samples of umbilical cord blood was double positive (IgM and IgG) for one patient, double negative for one patient and positive for IgG and negative for IgM for third patient. Maternal and neonatal nasopharyngeal swab samples analyzed by PCR for SARS-CoV-2 was positive for two maternal patients and negative for all newborns tested. It was possible to detect the SARS-CoV-2 in amniotic fluid and umbilical cord blood using the nested-PCR technics, thus being successfully evidenced transplacental transmission. We suggested that nasopharyngeal swab PCR test of neonates does not have a correlation with vertical transmission and thus, this molecular test is not useful for investigation of transplacental infection.