Noninvasive Bi-Level Positive Airway Pressure Ventilation in Blunt Chest Trauma

Background: Chest injury was found to cause death in 20%–25% of multiple trauma patients. Thoracic trauma is, therefore, important in the overall management of multiple injury patients and may require a longer stay in the Intensive Care Unit (ICU) and use of mechanical ventilation. Methods: This prospective randomized clinical study was in Emergency Intensive Care, Tanta University Hospitals. For, 88 adult patients with blunt chest injury. Patients were enrolled in this study aged ≥18 years old classified into two equal groups: Group I (Non-Invasive Mechanical Ventilation group) = 44 patient: Patients in this group received BIPAP. Group II (Control group=44 patient: Patients in this group have received high flow O2 by mask O2 without use of non-invasive mechanical ventilation. Data of collection were: the demographic data, Frequent arterial blood gas analysis of all patients every 6 hrs. Respiratory rate, Arterial blood pressure, Heart rate were recorded: every 6 h. All Patients receive analgesia. Evaluate outcome: a-Primary outcome. Tracheal intubation, duration of ventilation. b-Secondary outcome. Mortality, ICU length stay. And Chest Trauma Scoring System. Results: Ten patients (22%) were intubated and mechanically ventilated in group I (BiPAP). with mean value of duration of ventilation 34.4 hrs. But at group II 16 patients (36%) were intubated and mechanically ventilated with mean value of duration of ventilation 34.12 hrs. ICU stay at group I (BiPAP) was statistically decrease of number of days when compared to group II (control). 6 days at group I and 12 days at group II. In this study no case of mortality was recorded with non-invasive ventilation, although three mortality cases were recorded with the control group. Conclusion: This study recommends the pre-emptive use of Non-Invasive Ventilation in the treatment for blunt chest injury in patients at risk for respiratory failure. Success of Non-Invasive Ventilation depends on improvement of hypercarbia and hypoxemia in patients impending respiratory failure due to reversible cause as blunt chest trauma with the expectation of a good outcome and avoidance of intubation.

Effects of sedan wheelbase size on left rear-seat occupant injury risk in small offset crashes

The objective of this study was to investigate the effect of sedan wheelbase size on the kinematics and injury severity of left rear-seat occupants by using the finite element (FE) modeling method. A total of 270 cases with detailed accidental information records were analyzed to define the influence laws of wheelbase size and impact speed on the injury of left rear-seat occupants. First, the THUMS (Ver. 4.0.2) FE model was used to reconstruct two small offset collisions with different wheelbases size and unbelted left rear-seat occupants, and the effectiveness of the accident model was verified. Then, seatbelts were added to the left rear-seat occupant models. Finally, LS-DYNA software was used to study the correlation among head and chest injury and five sedan wheelbases sizes (2300, 2450, 2600, 2750, and 2905 mm) at three impact velocities (54, 64, and 74 km/h). The results showed that the occupants’ chest injuries showed an upward trend at the impact velocity of 64 and 74 km/h when the wheelbases sizes was reduced to 2300 mm. This research illustrated that at higher impact velocities, excessively small wheelbases might increase the chest injury severity of left rear-seat occupants.

Impact of a care bundle for patients with blunt chest injury (ChIP): A multicentre controlled implementation evaluation

Background Blunt chest injury leads to significant morbidity and mortality. The aim of this study was to evaluate the effect of a multidisciplinary chest injury care bundle (ChIP) on patient and health service outcomes. ChIP provides guidance in three key pillars of care for blunt chest injury—respiratory support, analgesia and complication prevention. ChIP was implemented using a multi-faceted implementation plan developed using the Behaviour Change Wheel. Methods This controlled pre-and post-test study (two intervention and two non-intervention sites) was conducted from July 2015 to June 2019. The primary outcome measures were unplanned Intensive Care Unit (ICU) admissions, non-invasive ventilation use and mortality. Results There were 1790 patients included. The intervention sites had a 58% decrease in non-invasive ventilation use in the post- period compared to the pre-period (95% CI 0.18–0.96). ChIP was associated with 90% decreased odds of unplanned ICU admissions (95% CI 0.04–0.29) at the intervention sites compared to the control groups in the post- period. There was no significant change in mortality. There were higher odds of health service team reviews (surgical OR 6.6 (95% CI 4.61–9.45), physiotherapy OR 2.17 (95% CI 1.52–3.11), ICU doctor OR 6.13 (95% CI 3.94–9.55), ICU liaison OR 55.75 (95% CI 17.48–177.75), pain team OR 8.15 (95% CI 5.52 –-12.03), analgesia (e.g. patient controlled analgesia OR 2.6 (95% CI 1.64–3.94) and regional analgesia OR 8.8 (95% CI 3.39–22.79), incentive spirometry OR 8.3 (95% CI 4.49–15.37) and, high flow nasal oxygen OR 22.1 (95% CI 12.43–39.2) in the intervention group compared to the control group in the post- period. Conclusion The implementation of a chest injury care bundle using behaviour change theory was associated with a sustained improvement in evidence-based practice resulting in reduced unplanned ICU admissions and non-invasive ventilation requirement. Trial registration ANZCTR: ACTRN12618001548224, approved 17/09/2018

New method of epidural anesthesia in closed blunt chest injury

The thoracic epidural anesthesia is the most suitable method for the treatment of the closed blunt chest injury but there is probability of the spinal cord injuiry. The original method combining the efficiency of classic thoracic epidural anesthesia with safety and simplicity of lumbar epidural anesthesia is suggested. This method is based on the postulates of the molecular hydrokinetic theory. Two catheters ends are disposed in lumbar epidural space in distance about two inches between them. Through one catheters end the anesthetic solution and through others end the 0,9% saline are injected synchronously in equal volumes. Hydroplunger phenomenon provides the upward anesthetic solution spreading

Research on characteristics of occupant’s chest responses in oblique impact

The oblique impact is the second most common frontal impact, in which both the forward and lateral accelerations are applied to the occupant. It is noticed that the oblique impact is a primary source of serious injuries, in which the chest injuries are mostly fatal through the statistics of traffic accidents. This study aims to investigate the characteristics of the occupant’s chest injury in the frontal oblique impact. First, a model with a sled and a Test Human Occupant Restraint (THOR) dummy is established. Second, an acceleration curve with a peak of 9.0 g is applied to the sled. Then 11 sets of simulations with different impact angles and belt peak loads are conducted to evaluate the occupant’s chest responses. Results indicate that there is a negative correlation between belt peak force and injury outcomes, while there is a weak correlation between chest injury and impact angle. With the increase of the belt force limit, the chest deflection at Lower Left (LL) would increase by 37.9%, and the acceleration at LL would increase by 23.1%. Meanwhile, the Viscous Criterion (VC) at LL would increase by 61.4%. However, the relationship between the impact angle and injury drawn by VC and acceleration is inconsistent. Additionally, in all simulations, the maximum deflections are captured at the LL, while the maximum VCs happens at Upper Right (UR) or LL. It is demonstrated that a seatbelt with a lower peak force is friendly to the occupant’s chest under all the impact angles. This study can provide a reference to the study of chest injury in the oblique impact.

Traditional uses, phytochemistry and pharmacology of genus Fritillaria—a review

Background Genus Fritillaria is one among the biggest genera of family Liliaceae comprising of around 130–165 species. Fritillaria is viewed as a significant genus and a source of significant pharmaceutically active compounds utilized in conventional drugs by folklore. Fritillaria is utilized worldwide as medication and food. Different chemically dynamic components separated from genus Fritillaria, their phytochemistry with structure and pharmacology of these compounds have been extensively reviewed. Main body Fritillaria is utilized for treatment of dyspepsia, chest injury, tuberculosis, cough, asthma, gout, bronchitis, dysuria, sinus, boils, stomatitis, malaria, insanity, anaemia, immunity promoter, remedy for child emaciation, fever, burning sensation, phthisis and broncho-asthma, heart diseases, dysfunction of breathing and nervous system, etc. Different chemical components isolated from genus Fritillaria include around 120 alkaloids, 15 terpenoids as well as saponins, glycosides, volatile components, nucleosides, amino acids, nucleobases, flavonoids, fatty acids and so forth. Conclusions Many Fritillaria species have been utilized in traditional Chinese medication on account of their effects of clearing heat, moistening the lung, alleviating cough, asthma, tumours, scrofula and so on. Fritillaria is utilized for treatment of dyspepsia, chest injury, tuberculosis, cough, asthma, gout, bronchitis, dysuria, sinus, boils, stomatitis, malaria, insanity, anaemia, immunity promoter, remedy for child emaciation, also for fever, burning sensation, phthisis and broncho-asthma, heart diseases, dysfunction of breathing and nervous system, etc.