Catastrophic Emergency Research Articles

Emergency airway management in the prone position: an observational mannequin-based simulation study

IntroductionAccidental extubation during prone position can be a life-threatening emergency requiring rapid establishment of the airway. However, there is limited evidence of the best airway rescue method for this potentially catastrophic emergency. The aim of this study was to determine the most effective method to recover the airway in case of accidental extubation during prone positioning by comparing three techniques (supraglottic airway, video laryngoscopy, and fiber-optic bronchoscopy) in a simulated environment.MethodsEleven anesthesiologists and 12 anesthesia fellows performed the simulated airway management using 3 different techniques on a mannequin positioned prone in head pins. Time required for definitive airway management and the success rates were measured.ResultsThe success rates of airway rescue were 100% with the supraglottic airway device (SAD), 69.6% with the video laryngoscope (CMAC), and 91.3% with the FOB. The mean (SD) time to insertion was 18.1 (4.8) s for the supraglottic airway, 78.3 (32.0) s for the CMAC, and 57.3 (24.6) s for the FOB. There were significant differences in the time required for definitive airway management between the SAD and FOB (t = 5.79, p < 0.001, 95% CI = 25.92–52.38), the SAD and CMAC (t = 8.90, p < 0.001, 95% CI = 46.93–73.40), and the FOB and CMAC (t = 3.11, p = 0.003, 95% CI = 7.78–34.25).ConclusionThe results of this simulation-based study suggest that the SAD I-gel is the best technique to manage accidental extubation during prone position by establishing a temporary airway with excellent success rate and shorter procedure time. When comparing techniques for securing a definitive airway, the FOB was more successful than the CMAC.

Endovascular Repair of Ruptured Aortic Aneurysm: A Single-Center Experience.

Aortic rupture is a rare and catastrophic emergency. Prompt diagnosis and treatment are the primary determinants of mortality. During follow-up, the majority of patients who have been effectively treated die from hypovolemic shock and multiorgan failure. This article describes the clinical and procedural details of sixteen patients with ruptured aortic aneurysms treated endovascularly. In addition, it discusses the main factors contributing to the mortality of these patients. Patients who underwent endovascular treatment for acute aortic rupture at our center from October 2016 to March 2023 were included in this retrospective study. A total of 16 patients underwent endovascular aneurysm repair (EVAR) or thoracic endovascular aneurysm repair (TEVAR) for acute aortic rupture. The patients' mean age was 73.06 years (range: 52-92), and 15 of them were male. The ruptures occurred in the abdominal aortic aneurysm in ten patients, in thoracic aortic aneurysm in three patients, in the isolated iliac artery aneurysm in two patients, and there was one case of non-aneurysmal aortic rupture. In our series, patients who presented with an impending, self-limited rupture and stable hemodynamic status had good prognostic outcomes. However, eight patients died due to multiorgan failure, hemorrhagic shock, disseminated intravascular coagulopathy, renal failure, or abdominal compartment syndrome. These patients generally had poor admission vital signs and low hemoglobin values. The most critical determinants for the success of the procedure are promptly stopping the bleeding, avoiding general anesthesia, and opting for blood product replacement instead of fluid replacement. Each patient with ruptured aortic aneurysm should be managed according to the patient's hemodynamics at presentation, the size of the aneurysm, the suitability for percutaneous procedure, logistical factors, and the operator-center's experience.

Manifestations of coronavirus infection disease-19 in anterior eye segment: An up-to-date review.

Coronavirus infection disease-19 (COVID-19) is a worldwide catastrophic emergency that first appeared in late 2019, in Wuhan, China. COVID-19 is a multitropism disease that first affects lung tissue. However, extrapulmonary manifestations have been suspected from the first COVID-19 cases. The ocular signs and symptoms were from the early changes that occur during the course of the disease. Changes in the anterior eye segment have a relatively higher incidence than the posterior eye segment. Of which, conjunctivitis, COVID-19 pharyngioceratoconjuctivitis, iridocyclitis, corneal punctate epitheliopathy, and pathomorphological changes in the physio-anatomy of the anterior eye segment. The potential pathogenesis includes direct penetration of the virus into the eye (conjunctiva, lumbus, and cornea) or due to a systemic pathway through viremia, as well as due to autoimmune antibodies against the ocular structure (immune privilege). The presence of ocular manifestations of the external anterior fibrous layer suggests a mild course of the disease.

INT-767-A Dual Farnesoid-X Receptor (FXR) and Takeda G Protein-Coupled Receptor-5 (TGR5) Agonist Improves Survival in Rats and Attenuates Intestinal Ischemia Reperfusion Injury.

Intestinal ischemia is a potentially catastrophic emergency, with a high rate of morbidity and mortality. Currently, no specific pharmacological treatments are available. Previous work demonstrated that pre-treatment with obeticholic acid (OCA) protected against ischemia reperfusion injury (IRI). Recently, a more potent and water-soluble version has been synthesized: Intercept 767 (INT-767). The aim of this study was to investigate if intravenous treatment with INT-767 can improve outcomes after IRI. In a validated rat model of IRI (60 min ischemia + 60 min reperfusion), three groups were investigated (n = 6/group): (i) sham: surgery without ischemia; (ii) IRI + vehicle; and (iii) IRI + INT-767. The vehicle (0.9% NaCl) or INT-767 (10 mg/kg) were administered intravenously 15 min after start of ischemia. Endpoints were 7-day survival, serum injury markers (L-lactate and I-FABP), histology (Park-Chiu and villus length), permeability (transepithelial electrical resistance and endotoxin translocation), and cytokine expression. Untreated, IRI was uniformly lethal by provoking severe inflammation and structural damage, leading to translocation and sepsis. INT-767 treatment significantly improved survival by reducing inflammation and preserving intestinal structural integrity. This study demonstrates that treatment with INT-767 15 min after onset of intestinal ischemia significantly decreases IRI and improves survival. The ability to administer INT-767 intravenously greatly enhances its clinical potential.

Profile and Outcomes of Women With Amniotic Fluid Embolism in the United States [ID: 1375935

INTRODUCTION: Amniotic fluid embolism (AFE) is one of the most catastrophic pregnancy complications and a significant cause of maternal mortality in the United States. The estimated incidence of AFE is 1:15,200 in North America. However, unanswered questions remain about its etiology, risk factors, perinatal morbidity, mortality, and treatment options. In the present study, we described the profile and outcomes of women who develop AFEs in the United States. METHODS: We collated data from the National Inpatient Sample Database from January 2010 to December 2017 to conduct a retrospective analysis of women who developed AFEs. We conducted a multivariate analysis to determine the risk of the development of AFE and the outcomes after its development. We included covariates such as women’s age, race and ethnicity, preexisting comorbidities, pregnancy-associated risk factors, and region of the country in the multivariate analysis. Samples were weighed to generate nationally representative estimates. RESULTS: There were 1,659 cases of AFE in the NIS during the study period. The median age of these women was 31 years (interquartile range of 26–36 years). 57.8% of the women underwent cesarean section, 48.2% developed disseminated intravascular coagulation, and 37.0% developed acute respiratory distress syndrome. The overall mortality rate was 12.9%. On univariate analysis, women between the ages of 31 and 40 years have a twofold incidence of developing AFE (odds ratio [OR] 2.51, 95% CI 1.45–4.35), while women between 41 and 50 years have a lower risk (OR 0.41, 95% CI 0.19–0.88) compared to the reference (women ≤20 years). Other risk factors include electrolyte abnormalities (OR 5.23, 95% CI 3.72–7.35) and cesarean section (OR 8.2, 95% CI 6.35–10.61). On multivariate analysis, only cesarean section and electrolyte abnormalities have a statistically significant association with the development of AFE. CONCLUSION: Amniotic fluid embolism remains a rare but catastrophic emergency with high morbidity and mortality in the United States.

The Global Impact of COVID-19 on Mental Health of General Population: A Narrative Review

Mental wellness is a crucial component of happiness. A person is happy with better relationships, financial stability, good mental health, and longevity. Disinformation, stigma, ongoing isolation, and disruption of daily activities are all quite prevalent. Any of these elements may impact one's mental health. The Ministry of Health and Family Welfare has taken several steps to address COVID's mental health concerns. In addition to frontline healthcare personnel, who engage in dealing with COVID-19, the general population's mental health was also at stake due to the unprecedented and catastrophic emergency of COVID. Various keywords, including MeSH terms, were used in PubMedand Google Scholar searches. This paper was based on previously available data and article searches on how COVID-19 affected the mental health of the general population and the elements that may influence it. Quarantine and self-isolation have been found to have affected people's daily livelihoods andbehaviors, leading toincreased feelings of loneliness, anxiety, dejection, insomnia, risky alcohol and drug use, self-harm, and suicidal thoughts. Many of the victims of COVID-19 who were critical survivors exhibited lasting psychological harm a year after being discharged, including high anxiety levels, melancholy, and post-traumatic stress disorder. Healthcare employees too experienced significant psychological consequences due to factors such as an excessive workload or the number of hours worked, inadequate personal safety equipment, overly enthusiastic media coverage, and a sense of being under-supported. As a result of this major disaster, mental health concerns have surfaced, perhaps leading to long-term health problems, loneliness, and guilt. To reduce this deportment, global health solutions should be used, particularly while executing the isolation/quarantine and dealing with the people with fearand vulnerability. The mental health ofthe general population should be at the forefront of any worldwide response.

A Cooperative Planning Framework for Enhancing Resilience of Active Distribution Networks With Integrated VPPs Under Catastrophic Emergencies

Extreme incidents can cause diverse and dynamic disruptions to active distribution networks (ADNs). Thus, ADN operators (DNOs) must plan to prepare for and adapt to changes in conditions to withstand and quickly recover from such disruptions. This article proposes a cooperative planning framework to design optimal microgrids (MGs) in smart ADNs integrated with virtual power plants (VPPs) to quickly reconfigure and recover during such events. The proposed framework has two parts: 1) optimal partitioning of ADNs with integrated VPPs into supply-sufficient MGs; and 2) the scheduling of the partitioned MGs. Since the VPPs are autonomous, a smart DNO and VPP interface and operating model for dynamic operating envelopes (DOEs) is proposed to quantify and integrate the supply capacity of VPPs in the operation of MGs. As part of this framework, three optimization models are formulated including VPP optimization, ADN partitioning, and a partitioned ADN scheduling model, where the uncertainty of renewables, loads, and prices is modeled as stochastic scenarios. In part one, the VPP optimization model quantifies the available supply of VPPs. Then, the ADN partitioning model derives the optimal MGs by utilizing the supply of VPPs and network resources. In part two, based on the available supply of VPPs, the partitioned ADN scheduling model derives a day-ahead schedule for the MGs and the DOEs for VPPs. VPPs can then reoptimize to maximize their export within the DOEs. Finally, the proposed framework is validated on IEEE 13 and 123 node test networks, and the results are presented.

Vertigos. Climates of Philosophy

In this essay, I suggest that we are currently witnessing a mutation, which disrupts the mythical imaginary that had confined viruses, climate change, and atmospheric turbulences to an immutable background in the all-too-human narrative of the struggle against nature. I argue that the incapacity of translating this mutation in cultural and social terms, and the repression of this traumatic experience, are the cause of the perturbation that haunts our time. Disorientation pervades philosophy when the entire imaginary to which it had anchored its power to change the world seems to dissolve in the air, when what was silent and distant turns out to be vibrant, more familiar to us than any known proximity. Precisely for this reason, philosophy must rediscover its ability to inhabit times and spaces different from those oriented by the hegemony of capitalist progress, with its correlate of regular catastrophic emergencies and calculated risk. In this essay, I aim to present a perspective in which, instead of coming back straightforwardly ‘down to earth’, philosophy accepts inhabiting the fluctuating disorientation of its own time, itself populated by intermittent and uncertain opportunities of experiencing differently the past and the future—to encounter different relationships with the times that change.

Оценка актуального состояния некоторых компонентов комплекса гидротехнических сооружений хвостохранилища Тырныаузского горно-обогатительного комбината

The paper analyzes the global trend towards increasing the intensity of large-scale accidents of industrial waste accumulators of mining and processing and mining enterprises of various countries. According to the actual (2021, 2022) ground and aerovisual surveys of hydraulic structures (HTS) of the tailings of the Tyrnyauz Mining and Processing Plant (TMPP), an assessment of the risks of catastrophic emergencies is being carried out. Separately, the objects of the HTS complex of the TMPP tailings dam are considered, the condition of which, to date, causes the greatest concern, information is provided on the dynamics of changes in their parameters. The purpose of this study, in addition to determining the current, current situation on individual elements of the tailings hydrotechnical system complex, is to develop the main directions for taking measures to improve the current situation. Based on the analysis of the obtained results, the necessary recommendations are given.

A Connecticut healthcare system's response to the COVID-19 pandemic.

Connecticut was impacted severely and early on by the COVID-19 pandemic due to the state's proximity to New York City. Hartford Healthcare (HHC), one of the largest healthcare systems in New England, became integral in the state's response with a robust emergency management system already in place. In this manuscript, we review HHC's prepandemic emergency operations as well as the response of the system-wide Office of Emergency Management to the initial news of the virus and throughout the evolving pandemic. Additionally, we discuss the unique acquisition of vital critical care resources and personal protective equipment, as well as the hospital personnel distribution in response to the shifting demands of the virus. The public testing and vaccination efforts, with early consideration for at risk populations, are described as well as ethical considerations of scarce resources. To date, the vaccination effort resulted in over 70 percent of the adult population being vaccinated and with 10 percent of the population having been infected, herd immunity is eminent. Finally, the preparation for reestablishing elective procedures while experiencing a second wave of the pandemic is discussed. These descriptions may be useful for other healthcare systems in both preparation and response for future catastrophic emergencies of all types.

Comparing Primary Health-Care Service Delivery Disruptions Across Disasters.

The aim of this study was to compare primary care appointment disruptions around Hurricanes Ike (2008) and Harvey (2017) and identify patterns that indicate differing continuity of primary care or care systems across events. Primary care appointment records covering 5 wk before and after each storm were identified for Veterans Health Affairs (VA) facilities in the greater Houston and surrounding areas and a comparison group of VA facilities located elsewhere. Appointment disposition percentages were compared within and across storm events to assess care disruptions. For Hurricane Harvey, 14% of primary care appointments were completed during the week of landfall (vs 33% for Hurricane Ike and 69% in comparison clinics), and 49% were completed the following week (vs 58% for Hurricane Ike and 71% for comparison clinics). By the second week after Hurricane Ike and third week after Harvey, the scheduled appointment completion percentage returned to prestorm levels of approximately 60%. There were greater and more persistent care disruptions for Hurricane Harvey relative to Hurricane Ike. As catastrophic emergencies including major natural disasters and infectious disease pandemics become a more recognized threat to primary and preventive care delivery, health-care systems should consider implementing strategies to monitor and ensure primary care appointment continuity.

Pioneering Remotely Piloted Aerial Systems (Drone) Delivery of a Remotely Telementored Ultrasound Capability for Self Diagnosis and Assessment of Vulnerable Populations-the Sky Is the Limit.

Remotely Piloted Aerial Systems (RPAS) are poised to revolutionize healthcare in out-of-hospital settings, either from necessity or practicality, especially for remote locations. RPAS have been successfully used for surveillance, search and rescue, delivery, and equipping drones with telemedical capabilities being considered. However, we know of no previous consideration of RPAS-delivered tele-ultrasound capabilities. Of all imaging technologies, ultrasound is the most portable and capable of providing real-time point-of-care information regarding anatomy, physiology, and procedural guidance. Moreover, remotely guided ultrasound including self-performed has been a backbone of medical care on the International Space Station since construction. The TeleMentored Ultrasound Supported Medical Interventions Group of the University of Calgary partnered with the Southern Alberta Institute of Technology to demonstrate RPAS delivery of a smartphone-supported tele-ultrasound system by the SwissDrones SDO50 RPAS. Upon receipt of the sanitized probe, a completely ultrasound-naïve volunteer was guided by a remote expert located 100 km away using online video conferencing (Zoom), to conduct a self-performed lung ultrasound examination. It proved feasible for the volunteer to examine their anterior chest, sides, and lower back bilaterally, correlating with standard recommended examinations in trauma/critical care, including the critical locations of a detailed COVID-19 lung diagnosis/surveillance examination. We contend that drone-delivered telemedicine including a tele-ultrasound capability could be leveraged to enhance point-of-care diagnostic accuracy in catastrophic emergencies, and allow diagnostic capabilities to be delivered to vulnerable populations in remote locations for whom transport is impractical or undesirable, speeding response times, or obviating the risk of disease transmission depending on the circumstances.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10278-021-00475-w.

Numerical study of hemodynamics after stent implantation during the cardiac cycle

The descending aortic aneurysm is one of the most catastrophic cardiovascular emergencies resulting in high mortality worldwide. Clinical observations have pointed out that stent implantation in the sick aorta should probably allow stabilization of the hemodynamic state of the patient's aorta. To better understand the hemodynamic impact of a stent-treated aneurysm, numerical simulations are used to evaluate hemodynamic parameters. These latter including flow profile, velocity distribution, aortic wall pressure and shear stress, which are difficult to measure in vivo. It should be noted that the numerical modeling assists in medical planning by providing patterns of blood circulation, in particular, the distribution of pressures and shear stresses in the wall. In this context, the pulsatile blood flow in the aneurysmal aorta with stent is studied by CFD (Computational Fluid Dynamics) simulations. Realistic boundary conditions time dependent are prescribed at the level of the different arteries of the complete aorta models. The hemodynamic profile of the aneurysmal aorta with stent was analyzed by contour planes of velocity vectors, pressures and shear stresses at different times during the cardiac cycle. The obtained results made it possible to show the effect of the stent on the improvement of the blood flow by solving the problems of hemodynamic disturbances in the aorta. The methodology used in this work has revealed detailed and necessary information for the cases studied and shows the interest of the numerical tool for diagnosis and surgery.

I disastri e la loro relazione con le foreste. Tre casi studio a supporto della gestione degli eventi estremi

This book review is a reworked and translated version of the synthesis from the report “Forest-related disasters - Three case studies and lessons for management of extreme events” by H. van Hensbergen and J. Cedergren, published by the Food And Agriculture Organization (FAO) of the United Nations. The volume describes the complex relationship between disasters and forests, defining the multiple roles that trees play during environmental disasters and how much this affects human activities. After a brief general introduction, the description continues through the analysis of three catastrophic events that occurred since the beginning of this century. The chronicle and the analysis of repercussions on forests and population of the storm Gudrun (Sweden, 2005), the Tohoku tsunami (Japan, 2011) and the firestorm in central Chile (Chile, 2017) are reported. From the synthesis of the three experiences, some lessons of management of extreme events are drawn, reported as a strategic suggestion to face, from a forestry point of view, the planning and reaction to catastrophic emergencies involving forests and trees.

Maternal Death following Induction of Labour: A Case Report with Uncommon Findings of Amniotic Fluid Embolism

Amniotic fluid embolism (AFE) is a rare but potentially catastrophic obstetric emergency characterized by a combination of signs and symptoms that reflect sudden cardiorespiratory collapse and disseminated intravascular coagulation (DIC). The diagnosis of AFE has traditionally been made at autopsy when the amniotic debris is found in the maternal pulmonary vasculature. A 28 years old term mother was admitted to the hospital for confinement. One hour after the induction of labour she complained of difficulty in breathing and excessive sweating and in spite of the intensive resuscitation measures she was pronounced dead. The autopsy examination was unremarkable except for the diffuse extensive retroperitoneal haemorrhage. The histology sections from lungs show amniotic fluid components; mainly cuticulated epithelium, foetal squamous cells and keratinized epithelial cells in small arteries and capillaries. Similar findings were observed in the histology sections obtained from the liver, kidney, brain, myometrium, and myocardium. The value of histopathological confirmation using special stains is emphasized in this case report.

Culture versus Policy: More Global Collaboration to Effectively Combat COVID-19

The outbreak of COVID-19 seriously challenges every government with regard to capacity and management of public health systems facing the catastrophic emergency. Culture and anti-epidemic policy do not necessarily conflict with each other. All countries and governments should be more tolerant to each other in seeking cultural and political consensus to overcome this historically tragic pandemic together.

Ethical guidelines for medical decision-making during COVID-19 pandemic in Chile

The catastrophic emergency experienced by many countries with the COVID-19 pandemic emphasized the importance of bioethics for decision-making, both at the public health (equitable and effective policies) and at the clinical level. At the clinical level, the issues are the fulfillment of medical care demand with adequate health care teams, infrastructure, and supplies, and to cover critical care demands that surpass the available resources. Therefore, ethically correct approaches are required for the allocation of life sustaining resources. There are recommendations for the allocating life support during disasters based on multiple considerations, including ethical ones. However, the ethical criteria of existing guidelines are variable. Ethical principles usually considered are saving the greatest number of lives, saving the greatest number of years of life and the principle of the life cycle or the goal to give each individual equal opportunity to live through the various phases of life. However, the centrality of the human being and the search for the common good should be considered. Knowledge of public perspectives and moral benchmarks on these issues is essential. A successful assignment effort will require everyone's trust and cooperation. Decision making should be planned and discussed in advance, since in-depth deliberation will be extremely complex during the disaster. Our goal is to help the health care teams to wisely allocate resources in shortage periods.

Bioremediation of Unconventional Oil Contaminated Ecosystems under Natural and Assisted Conditions: A Review.

It is a general understanding that unconventional oil is petroleum-extracted and processed into petroleum products using unconventional means. The recent growth in the United States shale oil production and the lack of refineries in Canada built for heavy crude processes have resulted in a significant increase in U.S imports of unconventional oil since 2018. This has increased the risk of incidents and catastrophic emergencies during the transportation of unconventional oils using transmission pipelines and train rails. A great deal of effort has been made to address the remediation of contaminated soil/sediment following the traditional oil spills. However, spill response and cleanup techniques (e.g., oil recuperation, soil-sediment-water treatments) showed slow and inefficient performance when it came to unconventional oil, bringing larger associated environmental impacts in need of investigation. To the best of our knowledge, there is no coherent review available on the biodegradability of unconventional oil, including Dilbit and Bakken oil. Hence, in view of the insufficient information and contrasting results obtained on the remediation of petroleum, this review is an attempt to fill the gap by presenting the collective understanding and critical analysis of the literature on bioremediation of products from the oil sand and shale (e.g., Dilbit and Bakken oil). This can help evaluate the different aspects of hydrocarbon biodegradation and identify the knowledge gaps in the literature.

An Integrated Emergency Call System based on Public Switched Telephone Network for Elevators

Today, most of elevators have an emergency call facility for emergency situations. However, if the network installed in the elevator is also out of power, it cannot be used for the elevator remote monitoring and management. So, we develop an integrated and unified emergency call system, which can transmit not only telephone call but also data signals using PSTN(Public Switched Telephone Network) in order to remote monitoring and management of elevators, even though a power outage occurs. The proposed integrated emergency call system to process multiple data such as voice and operational information is a multi-channel board system which is composed of an emergency phone signal processing module and an operational information processing module in the control box of elevator. In addition, the RMS(remote management server) systems based on the Web consist of a dial-up server and a remote monitoring server where manages the elevator's operating information, status records, and operational faults received via the proposed integrated and unified emergency call system in real time. So even if there's a catastrophic emergency, the proposed RMS systems shall ensure and maintain the safety of passengers inside the elevator. Also, remote control of the elevator by this system should be more efficient and secure. In near future, all elevator emergency call system need to support multifunctional capabilities to transmit operational data as well as phone calls for the safety of passengers. In addition, for safer elevators, it is necessary to improve them more efficiently by combining them with high-tech technologies such as the Internet of Things and artificial intelligence.

Severe Modifications of Biological Markers in Late Neonatal Sepsis in a Very Low Birth Weight Due to Candida lusitaniae

Neonatal sepsis is a major cause of neonatal mortality and morbidity in preterm, very low birth weight infants. Coagulase-negative staphylococcus and Candida spp. are among the most common causes of single infections and coinfections in neonates. Candida lusitaniae is rarely reported as an opportunistic pathogen in very low birth weight neonates. Early diagnosis and appropriate antifungal therapy can prevent morbidity and mortality in preterms especially in coinfections. Necrotizing enterocolitis is one of the most catastrophic gastrointestinal emergencies in premature infants in the intensive care neonatal unit, especially in preterm infants. Currently, the pathogenesis of necrotizing enterocolitis is believed to have multifactorial causes. We present the case of a very low birth weight preterm who developed necrotizing enterocolitis and sepsis caused by a coinfection of Coagulase-negative Staphylococcus and Candida lusitaniae.