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Trousers against shock.

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Emergency Medical Services↗

Controversial issues in prehospital care.

Despite the maturing of prehospital emergency care over the last 25 years, many controversies still persist. Although EMS personnel now widely recognize that medical cardiac arrest patients and traumatic cardiac arrest patients require different amounts of field stabilization and treatment, there is still no clear answer as to how much stabilization using what treatments is necessary. Similarly, although it is widely accepted that out-of-hospital cardiac arrest with ventricular fibrillation should be rapidly defibrillated, there is no consensus as to who should deliver the countershock and with the use of what equipment. These and many other controversies of prehospital care arise because this field is new and rapidly growing.

Emergency Medical Services↗

Massage in hypertrophic scars.

Various attempts have been made to intervene with the formation of hypertrophic scarring (HTS) or to ameliorate it once it has developed, but none have yet proved effective. Massage therapy is routinely used by therapists for the treatment of various conditions, and there have been reports of increased scar pliability and decreased scar banding with the use of massage. This study examines the use of friction massage over a 3-month period in a group of 30 pediatric patients with HTS. The patients were randomly assigned to receive either therapeutic massage sessions of 10 minutes per day in combination with treatment with pressure garments or they were treated with pressure garments alone. A modified Vancouver Burn Scar Assessment Scale was used to measure the characteristics of the identified scars (10 cm by 10 cm) before and after the implementation of massage therapy. The study failed to demonstrate any appreciable effects of massage therapy on the vascularity, pliability, and height of the HTS studied, although there were reports of a decrease in pruritus in some patients. Further studies, with prolonged treatment intervals, are necessary to conclusively demonstrate the ineffectiveness of this therapy for HTS.

Burns↗

Echocardiographic evaluation of female centrifuge subjects for chronic changes in cardiac function.

BACKGROUND: High sustained G exposure as experienced in flying high performance aircraft can affect cardiac function. Numerous studies, mostly on male pilots, have evaluated the chronic effects of exposure to high G. To date, none of these studies has revealed significant positive findings in cardiac function as a result of long-term high G exposure. METHODS: A longitudinal study was conducted on six female centrifuge panel members who did not have a history of significant high +Gz exposure. Baseline echocardiographic studies were conducted prior to any +Gz exposure on the Dynamic Environment Simulator (DES) centrifuge. The echocardiograms were repeated after each panel member completed approximately 100 3-min high G (up to 9 G) exposures over the period of 7 mo. These follow-up echos were performed after all six subjects had been exposed to at least 6 h (cumulative) of sustained acceleration > 3 G. The women were protected with the COMBAT EDGE positive pressure breathing G protection ensemble. Each subject served as her own control. All studies were evaluated independently by a cardiologist who was blinded to the order in which the echos were performed. Although complete echocardiographic studies were performed, only the parameters identified as significant in prior studies were evaluated. RESULTS: No significant differences were found between the initial and follow-up echo parameters. CONCLUSIONS: We found no significant differences in cardiac function after at least 6 and up to 17 h (cumulative) of exposure to G > 3 in women. These subjects will be monitored during a longitudinal study throughout their centrifuge subject career.

Aerospace Medicine↗

Positive pressure generation by pneumatic and electronic O2 regulators: a bench experimental evaluation.

BACKGROUND: The introduction of advanced anti-G protection into agile fast fighter aircraft may result in the regular use of positive pressure breathing (PPB) for G protection by aircrew. Since PPB results in an external additional work of breathing (WoB), we compared the mechanical performance of the pneumatic and electronic O2 regulators designed for "Mirage 2000" and "Rafale" aircraft. HYPOTHESIS: Since mask pressure is regulated by the electronic device in relation to flow, mask pressure will remain constant throughout the respiratory cycle, so that PPB-related additional WoB will be less with the electronic regulator. METHODS: In a bench dynamic study performed with a sinusoidal pump, we measured variations in mask pressure (deltaP) and calculated WoB at 0, 3 and 6 kPa of PPB (0, 30 and 60 cm H2O, respectively), for 0.5, 1 and 2 L of volume and for 10, 15 and 20 cycles per minute of respiratory rate. RESULTS: We found that, compared with the pneumatic device, inspiratory and expiratory WoB with the electronic device were respectively lower by approximately 25% (p < 0.05) and by approximately 10% (NS) at 3 and 6 kPa of PPB, for all respiratory conditions. Nevertheless, we also observed remaining variations in mask pressure with the electronic regulator, due to complex impedance of the inspiratory circuit, since the device uses the pressure measured into the regulator. CONCLUSIONS: We concluded that the electronic control of mask pressure is relatively efficient but that the device would be improved by placing the site of the pressure measurement into the mask.

Aerospace Medicine↗

[Critical appraisal of treatments in emergency settings].

A critical appraisal was carried out of treatment with high-dose epinephrine (HDE) in cardiopulmonary resuscitation (CPR), active compression and decompression CPR (ACD-CPR), military antishock trousers (MAST), and Continuous renal replacement therapy (CRRT) in the emergency setting, based on evidence-based medicine. Although the pathophysiological rationale encourage the clinical application of these treatments to improve the long-term outcome (mortality), no clinical trial could confirm their benefit. Additionally, Japanese investigators have reported no clinical epidemiological study related to this issue. Thus a clinicoepidemiological study associated with treatments in critical settings is required in this country.

Emergencies↗

[Out-of-hospital cardiac arrest and the Utstein style: utilization of an international standardized format to evaluate surgical outcome].

The Utstein style is the recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest. The Utstein style was, originally developed to analyze out-of-hospital cardiopulmonary arrest due to cardiac etiology. However trauma remains a major cause of out-of-hospital cardiac arrest and it is recommended that it also be reported accurately by the Utstein style. There exist some controversy regarding treatment methods such as military antishock trousers (MAST) or emergency room resuscitative thoracotomy for cardiac arrest due to trauma. MAST is has been shown to be beneficial experimentally in traumatic shock and cardiac arrest, but this has not been confirmed clinically and Mast is used rarely. Emergency room resuscitative thoracotomy is a common treatment for cardiac arrest due to trauma. There have been no survivors among those who experienced trauma-related cardiac arrest and showed no signs of life before transport to a hospital, although the survival rate of cardiac arrest due to penetrating chest injury is relatively high, clinical date should be accumulated following the Utstein style to determine the indications for these treatments.

Cardiopulmonary Resuscitation↗