External Bleeding Research Articles

Prognosis and Evolution of Lassa Virus Infected Persons during the 2017 Epidemic in Togo

Introduction: Lassa viral hemorrhagic fever is common in West Africa. Almost 300,000 persons are affected each year with 5000 deaths. The mice of the genus mastomys is the wild tank. Objective: The aim of our study is to describe clinic, therapeutic and evolution of the affected patients during February-March 2017 epidemic that occurred in the north of Togo. Methodology: Our study is a record review study from patients’ record, who were hospitalized from February, 1st to March, 31st 2017 at Mango hospital. Lassa diagnosis was performed by PCR. They patients have received Ribavirin and blood transfusion when necessary. Results: We have reported 5 clinical observations of Lassa viral hemorrhagic fever. Patients came from Benin (03 cases), from Burkina-Faso (1 case), from Togo (1 case) and were 25, 34, 60, 52 years old and a premature baby of 13 days. External hemorrhage and abdominal pains were the main symptoms. Fever was observed for all the cases. Complications were marked by hemorrhages and shocks. Only 3 patients had benefitted of Antiviral therapy with Ribavirin. The other 2 patients did not benefit from the treatment because the diagnosis of Lassa fever was done the day they dead before the treatment started. Lethality was 80% (4 cases) with a highly secured burial. Effective management of contacts was done. Conclusion: Diagnostic and therapeutic delays of patients are responsible of the bad prognosis of the disease.

Oral intake of polyphenols of Chromolaena odorata: A perspective in peptic ulcer, thrombocytopenia, and heparin-induced bleeding diathesis in rodent model

Objective: Bleeding disorder is of two types: external bleeding due to trauma, surgery, and internal bleeding which happens mainly due to ulcers and thrombocytopenia or use of excessive anticoagulants. Proven hemostatic activity of Chromolaena odorata (L) in bleeding and wound healing had encouraged to evaluate the efficacy of aqueous extract and spray-dried powder (SDP) on ulcers, thrombocytopenia, and heparin-induced bleeding diathesis. Materials and Methods: Internal bleeding in the form of lesions in empty stomach was induced by absolute ethanol. Busulfan is administered through intraperitoneal injection to produce thrombocytopenia in Wistar rats and heparin at 1000 IU/ml was injected intravenous to mice, and after 30 min, tail was truncated to qualitatively and quantitatively differentiate the bleeding diathesis in treated versus nontreated controls. Results: A significant reduction in the lesions was observed in treated rats as compared to disease control rats which was evident from ulcer index and histopathology data. Considerable protection and production of platelets were observed in the thrombocytopenia model which was drastically reduced in the Busulfan administered disease control. Both aqueous extract and SDP were successful in preventing blood loss in heparin-induced tail-bleeding model. Conclusion: The presence of polyphenols attributes to the crucial role of C. odorata in arresting internal bleeding from stomach ulcer, protecting the thrombocytes from destroying, and minimizing the bleeding diathesis in mice. Abbreviations Used: SDP: Spray-dried powder, μL: Microliter, ml: Milliliter, nm: Nanometer, μg: Microgram, NAD: No abnormality detected, SD: Standard deviation.

2 Major incident triage and the implementation of a new triage tool, the MPTT-24

IntroductionOver the last decade, a number of European cities including London, have witnessed high profile terrorist attacks resulting in major incidents with large numbers of casualties. Triage, the process of...

End-of-life care in children with hematologic malignancies.

IntroductionHematologic malignancies (HM) represent the most common neoplasms in childhood. Despite improved overall survival rates, they are still a major contributor to cancer death in children.AimsTo determine the proportion of children with HM in pediatric palliative care (PPC) and to identify the clinical characteristics and symptoms in comparison to children with extracranial solid tumors (non HM patients).Patients and MethodsThis study was conducted as a single-center retrospective cohort study of patients in the care of a large specialized PPC team.ResultsFifteen HM and 50 non HM patients were included. Symptoms in which HM patients scored significantly higher than non HM patients were mucositis, difficulty moving, somnolence, fatigue, petechiae and paleness. Blood transfusions were more frequently administered to HM patients, but large external hemorrhage was not observed in any child. A large variety of drugs and appliances were needed by the patients, with morphine being the most frequently prescribed drug. During the study period, a much larger and over the years even increasing number of HM patients (not in the care of the PPC team) died in hospital with an (assumed) curative intent, with two thirds dying in the ICU.ConclusionsChildren with HM were referred to outpatient PPC with almost the full clinical picture of advanced leukemia. Noteworthy, the number of children with HM dying at home is decreasing in our center, instead a substantial proportion received high-intensity medical hospital care including novel anticancer therapies. These patients thus seem to be at an increased risk of dying in hospital as the right time to transfer them to palliative care is oftentimes missed.

Presentation and Management of Hepatic Injury due to Blunt Trauma in Patients Attending in Casualty Block of dmch- a Study of 50 cases

Objective: To diagnose the cases of hepatic injury due to blunt abdominal trauma in a shortest possible time and find out the way of efficient and planned management of hepatic injury in our present setting.Materials and methods: This study was done in the casualty department of Dhaka Medical College Hospital and 50 patients of hepatic injury following blunt abdominal trauma were selected over a period of January 2010 to December 2010. All 50 patients were admitted within 24 hours of incidence. The patients were diagnosed clinically by history and physical examination and relevant investigations. Immediately after admission patients were resuscitated by clearance of airway, maintenance of respiration, arrest of external bleeding and maintenance of normal circulation (ATLS Protocol). After resuscitation further management was planned depending upon the condition of the patient. Clinical presentation, overall management and outcome were evaluated by the available resources of casualty ward of DMCH.Results: Most patients were male (88%) and 68% of patients were belonged to age group of 21 to 40 years. Most of the patients (90%) were injured as a result of road traffic accidents. All patients had a history of trauma and most of them presented with abdominal pain, tenderness muscular rigidity of abdomen and shock (38%). Only 13 (26%) patients had isolated hepatic injury. Rest of the patients had associated other organ injuries. Majority patients (46%) had Grade-I hepatic injury. Out of 50 patients, 46 were operated and most of them had other intra abdominal organ injuries and 4 patients were given non-operative management. Suture hepatorrhaphy was done in 38 (76%) cases. Most common post operative complications were pulmonary in origin (24%) and three patients were died in this series.Conclusion: Simple technique of hemostasis such as suture hepatorrhaphy is sufficient in most cases with adequate drainage and non operative management can be tried based on haemodynamic stability.J Dhaka Medical College, Vol. 25, No.2, October, 2016, Page 133-137

Intramedullary Venous Drainage System for Distal Fingertip Replantations.

The number of venous anastomoses performed during fingertip replantation is one of the most important factors affecting the success of replantation. However, because vessel diameters decrease in the zone 1 level, vessel anastomoses, especially vein anastomoses, are technically difficult and, thus, cannot be performed in most cases. Alternative venous drainage methods are crucial when any reliable vein repair is not possible. In the literature, so many artery-only replantation techniques have been defined, such as arteriovenous anastomoses, forming an arteriovenous or venocutaneous fistula, manual milking and massage, puncturing, and external bleeding via a fishmouth incision and using a medical leech. It has been shown that, in distal fingertip replantations, the medullary cavity may also be a good way for venous return. In this study, we introduce an alternative intramedullary venous drainage system we developed to facilitate venous drainage in artery-only fingertip replantations. The results of 24 fingertip replantations distal to the nail fold by using this system are presented with a literature review.

Hemorrhage Rate After External Ventricular Drain Placement in Subarachnoid Hemorrhage: Time to Heparin Administration.

The use of antiplatelet or anticoagulants has previously been shown to increase hemorrhagic complications of ventricular catheterization. Although heparin use 24h after ventriculostomy appears safe, the safety of heparin immediately (within 4h) after ventriculostomy is unknown. The objective of this study was to assess the safety of heparin immediately (within 4h) after ventriculostomy in subarachnoid hemorrhage (SAH) patients undergoing endovascular treatment. This is a retrospective cohort study of 46 patients with aneurysmal SAH secondary to aneurysm rupture who required ventriculostomy. Post-ventriculostomy imaging was carefully reviewed for tract hemorrhaging. Timing of heparinization was noted. Early heparinization was within 4h after ventriculostomy, and intermediate heparinization was between 4 and 24h after ventriculostomy. Overall, the tract hemorrhage rate was 26.1% for the study cohort-mostly grade I tract hemorrhages-consistent with the existing literature. The tract hemorrhage rate in the early (<4h) heparin group was a remarkable 58.8%. The hemorrhages were also notably larger in the early (<4h) heparin group. Although heparin appears to be safe after 4h, immediate heparinization (within 4h) after ventriculostomy significantly increases the odds of tract hemorrhage. Additional time should be afforded between ventriculostomy and heparinization to avoid potentially devastating external ventricular drain tract hemorrhage. It is advisable to wait a sufficient time (at least 4h) after ventriculostomy before embarking on endovascular treatment of ruptured aneurysms.

Improvement of non-key traits in radiata pine breeding programme when long-term economic importance is uncertain.

Diameter at breast height (DBH), wood density (DEN) and predicted modulus of elasticity (PME) are considered as ‘key traits’ (KT) in the improvement in radiata pine breeding programmes in New Zealand. Any other traits which are also of interest to radiata pine breeders and forest growers are called ‘non-key traits’ (NKTs). External resin bleeding (ERB), internal checking (IC), number of heartwood rings (NHR) are three such non-key traits which affect wood quality of radiata pine timber. Economic importance of the KTs and NKTs is hard to define in radiata pine breeding programmes due to long rotation period. Desired-gain index (DGIs) and robust selection were proposed to incorporate NKTs into radiata pine breeding programme in order to deal with the uncertainty of economic importance. Four desired-gain indices A-D were proposed in this study. The desired-gain index A (DGI-A) emphasized growth and led to small decrease in ERB and small increase in IC and NHR. The expected genetic gains of all traits in the desired-gain index B (DGI-B) were in the favourable directions (positive genetic gains in the key traits and negative genetic gains in the non-key traits). The desired-gain index C (DGI-C) placed emphasis on wood density, leading to favourable genetic gain in the NKTs but reduced genetic gains for DBH and PME. The desired-gain index D (DGI-D) exerted a bit more emphasis on the non-key traits, leading large favourable reduction in the non-key traits and lower increase in the key traits compared with the other DGIs. When selecting both the key traits and the non-key traits, the average EBVs of six traits were all in the same directions as the expected genetic gains except for DBH in the DGI-D. When the key traits were measured and selected, internal checking always had a negative (favourable) genetic gain but ERB and NHR had unfavourable genetic gain in the most of time. After removing some individuals with high sensitivity to the change of economic weights, robust desired-gain selection made genetic gains of all the key and non-key traits to move a little bit toward unfavourable directions in the four indices. It is concluded that desired-gain index combined with robust selection concept is an efficient way for selecting the key and non-key traits in radiata pine breeding programmes.

Medical training for police officers in specialist role (D13): A retrospective review of patient report forms from 2010–2015

Introduction D13 is a nationally agreed bespoke medical training package for specialist firearms police officers introduced in 2010. Patient report forms are completed after every episode of care provision. Methods A review of patient report forms submitted by police firearms officers in five regions of England over the five years since the introduction of D13. Results Officers attended a large range of incidents, both traumatic and medical, minor and life critical. The majority (69.5%) were responded to as part of a normal police response, while 30.5% of cases were due to primary firearm deployments. Catastrophic haemorrhage was dealt with in 8.1% of cases including the use of haemostatic dressings and tourniquet application. Airway interventions were required in 36.1% of patients and 50.4% required interventions for external bleeding. Discussion From a background of a minimum of 18 h for Standard and 24 h for Enhanced courses and with regular simulation refreshers, specialist police officers, who are part of a robust clinical governance process, play an important role in providing immediate medical care in non-permissive or dangerous environments where ambulance personnel will not be present and when the officers are frequently first on scene.

Coaching in the United States: High School Coaches’ Knowledge and Confidence Regarding Athlete Safety and Injury Management

The purpose of this original research was to survey high school coaches in four states in the Midwest region of the United States regarding their knowledge of first aid, cardiopulmonary resuscitation (CPR), and use of an Automated External Defibrillator (AED) as well as confidence in managing/treating emergency situations. Responses to general knowledge inquiries revealed that coaches were able to accurately answer questions related to return to play, level of consciousness, external bleeding, and cardiac arrest. However, coaches were unable to correctly answer questions specific to rest, ice, compression, and elevation (RICE) and also misidentified information related to pediatric AED use. Because sudden cardiac death is the leading cause of death and has been linked to lack of bystander intervention, the results of this project should be considered by coaches and administrators to implement certification and continuing education for high school coaches. Finally, coaches who were certified in first aid, CPR, and AED were more confident in treating an individual who required care compared with coaches not certified. Therefore, individuals who coach at all levels of sport and recreational activities should consider formal training and certification.

Recognition and management of platelet-refractory bleeding in patients with Glanzmann's thrombasthenia and other severe platelet function disorders.

Patients with rare qualitative platelet disorders or platelet function disorders (PFDs) may present to the hospital physician with severe bleeding episodes or excessive surgical bleeding. Although standard treatment consists of platelet transfusions, repeated transfusions may result in the development of antiplatelet antibodies (APA) or clinical refractoriness, rendering further platelet therapy ineffective. In such settings, an approved treatment option for patients with Glanzmann’s thrombasthenia (GT), one of the well-known rare PFDs, is recombinant activated coagulation factor VII (rFVIIa). Data regarding the efficacy of rFVIIa in patients with GT and platelet refractoriness are available from a large patient registry, an international survey, and multiple case reports and demonstrate efficacy in patients with and without refractoriness or APA. This article reviews the rFVIIa clinical data in patients with GT and platelet refractoriness and discusses clinical implications relevant to the hospital-based physician. Because uncontrolled bleeding can be life-threatening, hospital physicians should be alert to the signs of platelet refractoriness, be able to recognize continued internal or external bleeding, and know how to adapt treatment regimens for the effective management of bleeding. The management of patients who receive rFVIIa should occur in consultation with a hematologist with experience in PFDs, and patients with suspected platelet refractoriness should be referred to such a hematologist as early as possible. A critical unmet need is the development of a definition of an adequate response to platelet transfusion, which would facilitate early recognition of platelet refractoriness in patients with PFDs who exhibit a normal platelet count.

Cardiopulmonary resuscitation of out-of-hospital traumatic cardiac arrest in Qatar: A nationwide population-based study

BackgroundTraumatic cardiac arrest studies have reported improved survival rates recently, ranging from 1.7–7.5%. This population-based nationwide study aims to describe the epidemiology, interventions and outcomes, and determine predictors of survival from out-of-hospital traumatic cardiac arrest (OHTCA) in Qatar. MethodsAn observational retrospective population-based study was conducted on OHTCA patients in Qatar, from January 2010 to December 2015. Traumatic cardiac arrest was redefined to include out-of-hospital traumatic cardiac arrest (OHTCA) and in-hospital traumatic cardiac arrest (IHTCA). ResultsA total of 410 OHTCA patients were included in the 6-year study period. The mean annual crude incidence rate of OHTCA was 4.0 per 100,000 population, in Qatar. OHTCA mostly occurred in males with a median age of 33. There was a preponderance of blunt injuries (94.3%) and head injuries (66.3%). Overall, the survival rate was 2.4%. Shockable rhythm, prehospital external hemorrhage control, in-hospital blood transfusion, and surgery were associated with higher odds of survival. Adrenaline (Epinephrine) lowered the odds of survival. ConclusionThe incidence of OHTCA was less than expected, with a low rate of survival. Thoracotomy was not associated with improved survival while Adrenaline administration lowered survival in OHTCA patients with majority blunt injuries. Interventions to enable early prehospital control of hemorrhage, blood transfusion, thoracostomy and surgery improved survival.

Two Decades of Saving Lives on the Battlefield: Tactical Combat Casualty Care Turns 20.

Twenty years ago, the original Tactical Combat Casualty Care (TCCC) article was published in this journal. Since TCCC is essentially a set of best-practice prehospital trauma care guidelines customized for use on the battlefield, the presence of a journal with a specific focus on military medicine was a profound benefit to the initial presentation of TCCC to the U.S. Military. In the two ensuing decades, which included the longest continuous period of armed conflict in our nation's history, TCCC steadily evolved as the prehospital trauma care evidence base was augmented and as feedback from user medics, corpsmen, and pararescuemen was obtained. TCCC has taken a leadership role in advocating for battlefield trauma care advances such as the aggressive use of tourniquets and hemostatic dressings to control life-threatening external hemorrhage; improved fluid resuscitation techniques for casualties in hemorrhagic shock; increased emphasis on airway positioning and surgical airways to manage the traumatized airway; faster, safer, and more effective battlefield analgesia; the increased use of intraosseous vascular access when needed; battlefield antibiotics; and combining good medicine with good small-unit tactics. With the continuing assistance of Military Medicine, these advances and the evidence base that supports them have been presented to TCCC stakeholders. Now-20 years later-TCCC has been documented to produce unprecedented decreases in preventable combat death in military units that have trained all of their members in TCCC. As a result of this proven success, TCCC has become the standard for battlefield trauma care in the U.S. military and for the militaries of many of our allied nations. Committee on TCCC members and the Joint Trauma System also work closely with civilian trauma colleagues through initiatives such as the Hartford Consensus, the White House Stop the Bleed campaign, and the development of National Association of Emergency Medical Technicians TCCC-based courses to ensure that advances in prehospital trauma care pioneered by the military on the battlefield are translated into civilian practice on the streets of America. Active shooter incidents, terrorist bombings, and the day-to-day trauma that results from motor vehicle accidents and criminal violence create the potential for many additional lives to be saved in the civilian sector. Along with the other components of the Department of Defense's Joint Trauma System, the Committee on TCCC, and the TCCC Working Group have been recognized as a national resource and will continue to advocate for advances in best-practice battlefield trauma care as opportunities to improve are identified.

Evaluation of the Effect of the Blood Stopper; Ankaferd in Management of Post Laparoscopic Cholecystectomy Liver Bed Bleeding

Introduction: The incidence of bleeding complications during laparoscopic cholecystectomy remains a frequent reason for conversion. Ankaferd Blood Stopper is a unique medicinal plant extract that has historically been used as a hemostatic agent and has been approved for the management of external hemorrhage and dental surgery bleeding. The aim of this study was to evaluate the effect of Ankaferd as a blooding stopper; in the management of liver bed bleeding in post laparoscopic cholecystectomy. Patients and Methods: A total of 120 patients; 60 for each group; group A (laparoscopic cholecystectomy with cauterization of gallbladder bed of the liver) and group B (laparoscopic cholecystectomy with application of Ankaferd drops by laparoscopic injector into gallbladder bed). End points: The primary end point of the study was measurement of the intraoperative bleeding as a result of application of both techniques; ankaferd instillation and cauterization of gallbladder bed of the liver. The secondary end points were estimation of the amount and characteristics of postoperative discharge till removal of drains, length of hospital stay and postoperative wound infection. Results: The operative time in group A was 85±34.5 minutes while in group B, it was 56±20.5 minutes. The mean amount of intraoperative bleeding was 58.1±29.97 ml and 37±14.47 ml in group A&B respectively. The mean amount of postoperative fluid drainage was 41.75±12.9 ml in group A while in group B was 30±6.75 ml and the hospital stay, It was 51.6±15.35 hours for patients of group A versus 31.8 ±8.5 hours for patients of group B respectively with significant distribution {P ≤ 0.001}. Conclusion: Ankaferd rapidly achieves hemostasis allowing surgeon to control bleeding properly and therefore the amount of operative bleeding, the operative time and the amount of postoperative fluid discharge on using ankaferd is statistically reduced.

Monitoring and complications during neonatal/pediatric ECMO run

Extracorporeal membrane oxygenation (ECMO) is a commonly used form of mechanical circulatory support in children with congenital or acquired heart disease, and cardiac failure refractory to conventional medical treatments.1 The cardiac output is partially or completely provided by the ECMO machine. To assess how much support is needed at any given time, a constant balance of oxygen delivery and oxygen consumption is required. Permanent monitoring of flow, hemoglobin, arterial, and mixed venous saturations are key elements to provide the needed understanding and continuous guidance of body requirements, aiming at controlling and maintaining optimal management of the ECMO patient. Although ECMO is lifesaving in many circumstances, it bares challenges and certain risks of complications. Despite bioline-coated circuits, anticoagulation is required. Measurement of activated clotting time (ACT) and activated partial thromboplastin time (APTT) are both used to guide anticoagulation, but it is unclear which method is the best, and constant monitoring of the hemoglobin level allows the early detection of internal and external bleeding.2 For children, sedation and analgesia, most often in combination with paralysis, is unavoidable for a smooth ECMO run. On the other hand, with such treatment on board, it is almost impossible to assess the neurological status of the patient on ECMO. Different monitoring tools, such as cerebral near infrared spectroscopy (NIRS) and serial brain ultrasound studies, are used to estimate brain integrity and function, but further research is needed to show which methods are the most practical and useful to achieve a favorable outcome.3 Nutrition in critically ill children is known to be crucial but debated how to achieve as the gut perfusion can be impaired and therefore the risk of necrotizing enterocolitis (NEC) is increased. It is discussed if somatic perfusion by NIRS monitoring can help to avoid NEC.4 The kidney function is often impaired in these critically ill children and careful monitoring of kidney function and urine output leads the decision when to start which type of renal replacement therapy for renal clearance and/or fluid removal. Techniques available include peritoneal dialysis or continuous renal replacement therapy (CRRT) incorporated with the ECMO circuit. Medication dosing is under discussion in many centers as the circulatory volume is higher than normal. Adjustment of medication dosing could consequently be of great importance. Close monitoring of medications where toxic levels can be reached is crucial to avoid further damage to the patient's organ functions.

Et si c’était des enfants ? Adaptation de la prise en charge médicale en cas d’attentats terroristes avec de nombreux enfants victimes

In light of the recent terrorist attacks in Europe, we need to reconsider the organization of rescue and medical management and plan for an attack involving multiple pediatric victims. To ensure quick surgical management, but also to minimize risk for on-site teams (direct threats from secondary terrorist attacks targeting deployed emergency services), it is crucial to evacuate patients in a swift but orderly fashion. Children are vulnerable targets in terrorist attacks. Their anatomical and physiological characteristics make it likely that pediatric victims will suffer more brain injuries and require more, often advanced, airway management. Care of multiple pediatric victims would also prove to be a difficult emotional challenge. Civilian medical teams have adapted the military-medicine principles of damage control in their medical practice using the MARCHE algorithm (Massive hemorrhage, Airway, Respiration [breathing], Circulation, Head/Hypothermia, Evacuation). They have also learned to adapt the level of care to the level of safety at the scene. Prehospital damage control principles should now be tailored to the treatment of pediatric patients in extraordinary circumstances. Priorities are given to hemorrhage control and preventing the lethal triad (coagulopathy, hypothermia, and acidosis). Managing hemorrhagic shock involves quickly controlling external bleeding (tourniquets, hemostatic dressing), using small volumes for fluid resuscitation (10-20ml/kg of normal saline), quickly introducing a vasopressor (noradrenaline 0.1μg/kg/min then titrate) after one or two fluid boluses, and using tranexamic acid (15mg/kg over 10min for loading dose, maximum 1g over 10min). Prehospital resources specifically dedicated to children are limited, and it is therefore important that everyone be trained and prepared for a scene with multiple pediatric patients.

The Lassa Virus Epidemic in Mango, Togo: Therapeutic Route of the First 4 Cases

Introduction: Lassa viral hemorrhagic fever is caused by the Lassa virus. The aim of our study is to describe the therapeutic itinerary of the 4 cases of Lassa virus hemorrhagic of February-March 2017 epidemic that occurred in Mango. Methodology: Our study is a transverse retro-prospective and descriptive study from February, 1st to March, 31st 2017 that dealt with 4 confirmed Lassa fever cases declared positive on the PCR basis; hospitalized or deceased at the hospital “Esperance” of Mango; support center of Lassa viral hemorrhagic fever. Results: we reported 4 clinical observations of Lassa viral hemorrhagic fever diagnosed on the PCR basis during the Lassa fever epidemic. Patients came from Benin (2 cases) or from Burkina-Faso (1 case) and were 25, 60, 52 years old and a premature baby of 13 days. The reasons for admission were external hemorrhage, a pultated tonsillitis and abdominal pains. Fever was observed for all the cases. Complications were marked by hemorrhages and shocks. Only two patients benefitted from Antiviral therapy with Ribavirin and were declared healed. The other two patients did not benefit from the treatment due to diagnostic and therapeutic delays. Lethality was 75% (3 cases) with a highly secured burial. Effective management of contacts was established. Conclusion: Diagnostic and therapeutic delays of patients are responsible of the Dark Prognosis of Lassa fever during the epidemic.

THE EXPERIENCE OF CHITOSAN-BASED HEMOSTATIC AGENTS APPLICATION IN PREHOSPITAL TRAUMA CARE FOR TEMPORARY BLEED STOP

The article presents the results of the local hemostatic agent Hemoflex Combat (Inmed LLC,Russia) application during the first and emergency medical care for casualty in terms of external traumatic bleeding stop.

The iatrogenic complications of tracheostomy

The objective of the present study was to analyze the complications of tracheostomy associated with bleeding from the brachiocephalic trunk. A total of 13 protocols of the autopsy study of the patients who had died in the intensive care unit were available for the analysis. These patients had experienced heavy external bleeding from the tracheostomy defect shortly before death. The study has demonstrated that all the victims had the tracheostomy hole localized below the level of the standard dissection of the tracheal rings. Nine patients presented with a damage to the brachiocephalic trunk while four others had a pressure injury to the blood vessels. The study included the elucidation of the possible relationship between the anthropometric characteristics of the patients and the variability of the passage of the brachiocephalic trunk in front of the trachea. The length of the neck was found to usually correlate with the length of the body and the brachiocephalic trunk to run in front of the trachea at the level of its 8th-11th rings. The results of the present study may be instrumental in reducing the risk of complications after tracheostomy.

Therapeutic Potential and Cellular Mechanisms of Panax Notoginseng on Prevention of Aging and Cell Senescence-Associated Diseases.

Owing to a dramatic increase in average life expectancy, most countries in the world are rapidly entering an aging society. Therefore, extending health span with pharmacological agents targeting aging-related pathological changes, are now in the spotlight of gerosciences. Panax notoginseng (Burk.) F. H. Chen, a species of the genus Panax, has been called the "Miracle Root for the Preservation of Life," and has long been used as a Chinese herb with magical medicinal value. Panax notoginseng has been extensively employed in China to treat microcirculatory disturbances, inflammation, trauma, internal and external bleeding due to injury, and as a tonic. In recent years, with the deepening of the research pharmacologically, many new functions have been discovered. This review will introduce its pharmacological function on lifespan extension, anti-vascular aging, anti-brain aging, and anti-cancer properties, aiming to lay the ground for fully elucidating the potential mechanisms of Panax notoginseng’s anti-aging effect to promote its clinical application.