1/11. Systolic pressure variation in hemodynamic monitoring after severe blast injury.Fluid management in patients following blast injury is a major challenge. Fluid overload can exacerbate pulmonary dysfunction, whereas suboptimal resuscitation may exacerbate tissue damage. In three patients, we compared three methods of assessing volume status: central venous (CVP) and pulmonary artery occlusion (PAOP) pressures, left ventricular end-diastolic area (LVEDA) as measured by transesophageal echocardiography, and systolic pressure variation (SPV) of arterial blood pressure. All three patients were mechanically ventilated with high airway pressures (positive end-expiratory pressure 13 to 15 cm H2O, pressure control ventilation of 25 to 34 cm H2O, and I:E 2:1). central venous pressure and PAOP were elevated in two of the patients (CVP 14 and 18 mmHg, PAOP 25 and 17 mmHg), and were within normal limits in the third (CVP 5 mmHg, PAOP 6 mmHg). Transesophageal echocardiography was performed in two patients and suggested a diagnosis of hypovolemia (LVEDA 2.3 and 2.7 cm2, shortening fraction 52% and 40%). Systolic pressure variation was elevated in all three patients (15 mmHg, 15 mmHg, and 20 mmHg), with very prominent dDown (23, 40, and 30 mmHg) and negative dUp components, thus corroborating the diagnosis of hypovolemia. Thus, in patients who are mechanically ventilated with high airway pressures, SPV may be a helpful tool in the diagnosis of hypovolemia.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/11. Extensive facial damage caused by a blast injury arising from a 6 volt lead accumulator.Low-voltage electrical injuries are relatively uncommon. Injury caused by flow of heavy current due to short-circuiting a low-voltage battery has not been described in the English literature. A 9-year-old boy connected two thin household electrical wires to the two terminals of a 6 volt (lead accumulator) battery and pressed the other two ends between his teeth. This resulted in a blast causing a compound comminuted fracture of the mandible and extensive tissue damage in the oral cavity. The low internal resistance of a lead accumulator (approximately 0.03 ohms) permits the flow of a heavy current (approximately 200 amps) when short-circuited. This instantaneously vaporises a minuscule portion of wire at approximately 2000 K resulting in a sudden rise of intraoral pressure to 30 kg cm-2 leading to tissue damage.- - - - - - - - - - ranking = 0.076923076923077keywords = pressure (Clic here for more details about this article) |
3/11. High-pressure water injection injury: emergency presentation and management.Presentations of high-pressure water blaster injuries to the emergency department are varied. Though these injuries are sometimes described as a 'benign variant' of high-pressure injection injuries, external appearances can be deceptive. These injuries can produce an unexpected pattern of severe internal injury and infectious complications. Such injuries are surgical emergencies and must be evaluated quickly and thoroughly in the emergency department. We review the current literature of these injuries and present the first reported case involving a forearm injury.- - - - - - - - - - ranking = 0.46153846153846keywords = pressure (Clic here for more details about this article) |
4/11. Homemade chemical bomb events and resulting injuries--selected states, January 1996-March 2003.Homemade chemical bombs (HCBs), also known as acid bombs, bottle bombs, and MacGyver bombs, are explosive devices that can be made easily from volatile household chemicals (e.g., toilet bowl, drain, and driveway cleaners) purchased at a local hardware or grocery store. When these and other ingredients are combined and shaken in a capped container, the internal gas pressure generated from the chemical reaction causes the container to expand and explode. The subsequent explosion can cause injuries or death to persons in the immediate vicinity of the detonation. Since 1996, some of the states participating in the Agency for Toxic Substances and disease Registry (ATSDR)'s hazardous substances Emergency Events Surveillance (HSEES) system have been documenting HCB events. This report describes examples of HCB events, summarizes all reported HCB events, discusses associated injuries, and suggests injury-prevention methods.- - - - - - - - - - ranking = 0.076923076923077keywords = pressure (Clic here for more details about this article) |
5/11. Unusual blast colonic injury due to a fall.Civilian colonic injuries are usually due to penetrating injuries like gun shots, stab wounds and blunt trauma especially following road traffic accidents. blast injuries are caused by bomb blasts, intracolonic explosion of gases after diathermy, over-enthusiastic bowel insufflation at sigmoidoscopy or by pressure hose applied to the anus. We report the case of a 28-year old man with an unusual blast injury of the colon following a fall from a colanut tree. The transverse colon was sheared off at its two ends while the descending colon was split open along its entire length. There was a delay of 14 hours before the man was discovered in the remote bush and brought to hospital. The mode of injury, its severity and the ultimate favourable outcome are quite unique considering the gross faecal soilage of the peritoneal cavity and the inevitable time lapse before the institution of medical care.- - - - - - - - - - ranking = 0.076923076923077keywords = pressure (Clic here for more details about this article) |
6/11. The use of continuous positive airway pressure in blast injury of the chest.A 15-year-old boy suffered blast injury of the lungs and developed acute respiratory distress with severe hypoxemia. The patient required mechanical ventilation with high-level PEEP, in the early postblast injury period. In order to reduce the risk of air embolization and barotrauma, we reverted to spontaneous breathing using intermittent mechanical ventilation (IMV) and continuous positive airway pressure (CPAP) as early as possible. The patient recovered after successful treatment. Treatment with IMV and CPAP is discussed and recommended in such cases.- - - - - - - - - - ranking = 0.38461538461538keywords = pressure (Clic here for more details about this article) |
7/11. blast injuries to the lungs: clinical presentation, management and course.Five patients with blast injuries to the lungs after bomb explosions are reported. In each patient radiological changes were apparent on the initial chest film taken within 4 hours of the explosions. Arterial hypoxaemia was also present. Four patients were actively treated with continuous positive-pressure ventilation, which was adjudged effective therapy. Two patients died, one owing to bilateral pneumothorax which occurred during anaesthesia, and the other owing to overwhelming infection. Hypoxaemia persisted for 4 months in one of the survivors. lung function tests which were performed on the same patient 10 monhts after the blast injuries, however, were normal.- - - - - - - - - - ranking = 0.076923076923077keywords = pressure (Clic here for more details about this article) |
8/11. The reconstruction of major femoral vessels in a four-year-old girl wounded with shrapnel.A four-year-old girl who sustained an explosive injury to the femoral artery and vein underwent vascular reconstruction. An allograft was used as a substitute conduit for both the artery and the vein. Eight months after reconstruction there was no pulse deficit and decrease in systolic blood pressure, nor were there any signs of venous obstruction.- - - - - - - - - - ranking = 0.076923076923077keywords = pressure (Clic here for more details about this article) |
9/11. Effects of blast overpressure on the ear: case reports.The case histories of five patients who experienced blast overpressure in excess of 200-dB peak pressure level are presented. Despite the significance of the sound pressure levels received in a military training accident and the severe injuries that resulted from the blast, these individuals experienced substantial improvement of hearing 1 year later. Undoubtedly, successful surgical intervention and medical management were the primary contributors to the restoration of hearing. Audiometric data are presented documenting hearing status within 2 to 3 weeks postinjury and following final surgical remediation of the resulting middle ear damage. A review of these cases offers insight into the possible prognosis of patients with similar injuries.- - - - - - - - - - ranking = 0.53846153846154keywords = pressure (Clic here for more details about this article) |
10/11. Round window fistula.Round window fistula as a cause of sudden hearing loss was diagnosed in five people. It was associated with a sudden change in middle ear pressure in three, with heavy lifing in one, and was probably caused by a significant blast exposure in the other. The clinical features of the condition are varied, with hearing loss and tinnitus being the only constant findings in our patients. One case demonstrates, perhaps for the first time, the association of an abnormally mobile portion of the round window membrane with vertigo and nystagmus. Suggestions on identification and management of round window fistula are made.- - - - - - - - - - ranking = 0.076923076923077keywords = pressure (Clic here for more details about this article) |
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