Aspiration Of Water Research Articles

The revisit of 2004 tsunami in Thailand: characteristics of wounds

The name, tsunami that was unknown to most Thai people, had hit west southern coast of Thailand on 26 December 2004. Following the disaster, prices have been paid and many lessons have been learnt. The current report provides a historical background of the incident, which was reviewed by documents, brief discussion and observation. Data of the patients from three hospitals involved in the management were collected and reviewed. Some of the illustrations were from the operating rooms of Takuapa, Surat Thani and Songklanagarind hospitals. There were totally 2311 patients. Of these, 45% were males and 40% were multinationals. Nearly 40% suffered from salted water aspiration, while 2% developed complication associated with near drowning. The most common orthopaedic-related injury were minor [559 patients (24%)] and major wounds [586 (25%)]. Around 7% sustained fracture dislocation. Lower extremity fractures were more common. The characteristics of wounds associated with the tsunami were severe contamination, multiple sites and organ involvement. Another characteristic was the early development and spreading of infection. The lessons proposed by the study are that minor wound should be left open, small penetrating wound should be thoroughly explored and observed and lacerated wounds need emergency dressing, debridement and subsequent cleansing procedures. Re-evaluation and closed surveillance of the seriously injured patients are mandatory to eliminate the complicated infection and life-threatening conditions. Medical record of any disastrous event should be completed by health care professionals. The model and reporting system should be internationalised.

Breath-Hold Time During Cold Water Immersion: Effects of Habituation with Psychological Training

The loss of the conscious control of respiration on whole body cold water immersion (CWI) can result in the aspiration of water and drowning. Repeated CWI reduces the respiratory drive evoked by CWI and should prolong breath-hold time on CWI (BHmax(CWI)). Psychological skills training (PST) can also increase BHmax(CWI) by improving the ability of individuals to consciously suppress the drive to breathe. This study tested the hypothesis that combining PST and repeated CWI would extend BHmax(CWI) beyond that seen following only repeated CWI. There were 20 male subjects who completed two 2.5-min, head-out breath-hold CWI (BH1 and BH2) in water at 12 degrees C. Following BH1, subjects were matched on BHmax(CWI) and allocated to a habituation (HAB) group or a habituation plus PST group (H+PST). Between BH1 and BH2 both experimental groups undertook five 2.5-min CWI on separate days, during which they breathed freely. The H+PST also received psychological training to help tolerate cold and suppress the drive to breathe on immersion to extend BHmax(CWI). During BH1, mean BHmax(CWI) (+/- SD) in the HAB group was 22.00 (10.33) s and 22.38 (10.65) s in the H+PST. After the five free-breathing CWI, both groups had a longer BHmax(CWI) in BH2. The HAB group improved by 14.13 (20.21) s, an increase of 73%. H+PST improved by 26.86 (24.70) s, a 120% increase. No significant differences were identified between the groups. Habituation significantly increases BHmax on CWI, the addition of PST did not result in statistically significant improvements in BHmax(CWI), but may have practical significance.

Differences in postmortem urea nitrogen, creatinine and uric acid levels between blood and pericardial fluid in acute death

Previous studies showed significant differences in postmortem urea nitrogen (UN), creatinine (Cr) and uric acid (UA) levels in heart blood depending on the causes of death, including acute death. In addition, the levels in pericardial fluid approximated the clinical serum reference ranges, and their elevations may be assessed based on clinical criteria. The present study investigated difference between blood and pericardial levels of these markers. Medicolegal autopsy cases ( n = 556, within 48 h postmortem) of the following causes of death were examined: injury ( n = 136), asphyxiation ( n = 50), drowning ( n = 39), fire fatalities ( n = 99), hyperthermia ( n = 11), hypothermia ( n = 8), poisoning ( n = 26), delayed traumatic death ( n = 44) and natural diseases ( n = 143). When serum UN, Cr and UA levels were compared with the pericardial levels, there was an equivalency for delayed traumatic death and chronic renal failure, although each level was markedly elevated. Parallel increases in serum and pericardial UA and/or Cr levels were also observed for hypothermia and gastrointestinal bleeding. However, in drowning cases, the left cardiac and pericardial UN levels were lower than the right cardiac and peripheral levels, suggesting the influence of water aspiration. Significant elevations in serum and pericardial Cr and UA levels with a higher serum/pericardial UA ratio for fatal methamphetamine intoxication suggest progressive skeletal muscle damage due to advanced hypoxia/acidosis. Similar findings were often observed for other acute and subacute deaths. These findings suggest that a comparison between blood and pericardial nitrogenous compounds would be useful for investigating the cause and process of death.

Shortboard Performance Surfing: A Qualitative Assessment of Maneuvers and a Sample Periodized Strength and Conditioning Program In and Out of the Water

Surfing can be defined as a risk sport due to several variables including but not limited to currents, wave force, water aspiration, and collisions with equipment, rocks, coral reefs, and other surfers. It is essential for surfers, both novice and elite, to have a significant base of paddling strength, balance, and general physical fitness in order to meet the demands of an unpredictable oceanic environment and to prevent repetitive motion injuries. The purpose of this paper is to describe the physiological demands of surfing and to introduce a periodized strength and general fitness model.

A microbiological test for the diagnosis of death by drowning

The present study was aimed at demonstrating the diffusion of sea water or freshwater into the bloodstream as a consequence of water aspiration due to drowning. The study was carried out on 42 study group subjects who died by drowning in salt water (20 cases) and freshwater (22 cases) and 30 control group subjects who died from causes other than drowning. For 25 cases we obtained water samples from the aquatic locations where the victims were found. The blood samples of study and control groups were analyzed to search for faecal coliforms (FC) and faecal streptococci (FS) bacteria. The presence of FC and FS was showed by the development of blue and red colonies, respectively. From left ventricular (LV) and right ventricular (RV) blood cultures of the 20 sea drowning victims we always isolated FS and FC, whereas 19 (95%) femoral arterial (FA) and 18 (90%) femoral venous (FV) blood cultures were positive for both faecal bacteria. Related to freshwater victims, LV blood cultures showed FS presence for all the 22 cases studied (100%) and FC presence for 20 cases (90.91%). Blood cultures from RV, FV, and FA showed various patterns of faecal bacteria presence. The analysis of 25 water samples from the aquatic locations where the victims were found showed the presence of FC and FS bacteria. Blood cultures from the 30 control subjects uniformly proved the absence of faecal bacteria.

Clinical Cases Seen in Tsunami Hit Banda Aceh – From a Primary Health Care Perspective

The 2004 Indian Ocean earthquake and tsunami caused catastrophic damage to many cities on the rim of the Indian Ocean. Banda Aceh in Sumatra, Indonesia was particularly badly hit due to its close proximity to the epicenter. The Singapore Armed Forces Medical Team was one of the earliest medical teams to arrive in Banda Aceh, providing primary health care to the survivors. In the first 17 days of its operation, more than 2000 injured and sick were seen by the Medical Team at 2 locations within Banda Aceh. Approximately one-third of the patients suffered from infected superficial wounds on their limbs and faces. Many developed deep-seated necrosis of the skin tissue, requiring repeated wound dressing and debridement. Another one-third suffered from respiratory tract infection, some due to aspiration of sea water. There were relatively few major trauma and fracture cases seen, and there were a few cases of compression barotrauma of the tympanic membranes resulting from underwater immersion in the sea water. The casualty patterns seem consistent with those reported in other tsunami disasters, which differ distinctly from those seen in a pure earthquake disaster.

Evaluation des Aspirationsschutzes blockbarer Trachealkanülen

The aim of the study was to evaluate leakage of liquids in terms of water and artificially produced saliva past low-pressure cuffs of tracheal tubes. Three different types of tracheal tubes, TRACOE vario, Rüsch Ultra-Tracheoflex, and Portex Blue Line Ultra, were tested in isolated pig tracheas by infusing 6 ml of water or artificially produced saliva over the cuff and measuring the volume of fluid leaking past the cuff after 5, 10, and 15 min. The leakage in the saliva experiments was significantly lower than in the water experiments (p < 0.05). The amount of leakage between the three different types of tubes showed statistically significant (p < 0.05) results. There was no statistically significant difference between tracheal tubes of 7 and 8 mm internal diameter. The present laboratory findings suggest that the three tracheal tubes studied will not guard against aspiration of water but they will prevent the leakage of artificial saliva to a great extent.

Point-of-care controls for nosocomial legionellosis combined with chlorine dioxide potable water decontamination: a two-year survey at a Welsh teaching hospital

This study reports a two-year programme of attempted eradication of Legionella colonization in the potable water supply of a 1000-bed tertiary care teaching hospital in Wales. There was a simultaneous, point-of-care, sterile-water-only policy for all intensive care units (ICU) and bone marrow and renal transplant units in order to prevent acquisition of nosocomial Legionnaires' disease. The programme was initiated following a case of nosocomial pneumonia caused by Legionella pneumophila serogroup 1-Bellingham-like genotype A on the cardiac ICU. The case occurred 14 days after mitral and aortic valve replacement surgery. Clinical and epidemiological investigations implicated aspiration of hospital potable water as the mechanism of infection. Despite interventions with chlorine dioxide costing over 25000 UK pounds per annum, Legionella has remained persistently present in significant numbers (up to 20000 colony forming units/L) and with little reduction in the number of positive sites. Two further cases of nosocomial disease occurred over the following two-year period; in one case, aspiration of tap water was implicated again, and in the other case, instillation of contaminated water into the right main bronchus via a misplaced nasogastric tube was implicated. These cases arose because of inadvertent non-compliance with the sterile-water-only policy in high-risk locations. Enhanced clinical surveillance over the same two-year period detected no other cases of nosocomial disease. This study suggests that attempts at eradication of Legionella spp. from complex water systems may not be a cost-effective measure for prevention of nosocomial infections, and to the best of our knowledge is the first study from the UK to suggest that the introduction of a sterile-water-only policy for ICUs and other high-risk units may be a more cost-effective approach.

The adverse effects of water aspiration in birthing pools

The adverse effects of water aspiration in birthing pools

Archipelago strait exchange processes?an overview

Archipelagos consist of a set of islands forming a collection of basins interconnected by straits, and are typically characterized by widely varying spatial and temporal scales regarding geometry and forcing conditions. Focusing on the strait exchange parameterization, we describe an archipelago water exchange model in which the archipelago is subdivided into a network of discrete basins and interconnecting straits and where the time integration assumes a series of quasi-steady states. We propose an algorithm that should be sufficiently flexible to provide reasonable strait exchange estimates under the variety of forcing conditions encountered in the Stockholm archipelago. We start from the functional formulation of two-layer hydraulic theory, which allows numerical schemes to be designed that, given the forcing conditions at the ends of a given strait, distinguish between maximal and sub-maximal flow cases and solve the flow accordingly. We relax the assumption of two homogeneous layers when necessary, using an approximate method based on a self-similarity assumption and with the sea-level difference over the strait as an explicit part of the problem. This method allows exchange flows with two groups of layers to be solved for the same set of geometries that the pure two-layer theory can handle, including sill–contraction combinations and non-rectangular cross-sections. We further show how aspiration of dense water from below the sill crest can be quantified with hydraulic theory, and be included in the method for stratified strait exchange. Rotational control in wide straits and in parallel straits connecting the same two basins is treated with a simple but robust scheme. We evaluate the calculations with data from the Oxdjupet strait in the Stockholm archipelago. Simulations with a three-dimensional, non-hydrostatic numerical model are performed to compensate for sparsity in data.

Archipelago strait exchange processes—an overview

Archipelagos consist of a set of islands forming a collection of basins interconnected by straits, and are typically characterized by widely varying spatial and temporal scales regarding geometry and forcing conditions. Focusing on the strait exchange parameterization, we describe an archipelago water exchange model in which the archipelago is subdivided into a network of discrete basins and interconnecting straits and where the time integration assumes a series of quasi-steady states. We propose an algorithm that should be sufficiently flexible to provide reasonable strait exchange estimates under the variety of forcing conditions encountered in the Stockholm archipelago. We start from the functional formulation of two-layer hydraulic theory, which allows numerical schemes to be designed that, given the forcing conditions at the ends of a given strait, distinguish between maximal and sub-maximal flow cases and solve the flow accordingly. We relax the assumption of two homogeneous layers when necessary, using an approximate method based on a self-similarity assumption and with the sea-level difference over the strait as an explicit part of the problem. This method allows exchange flows with two groups of layers to be solved for the same set of geometries that the pure two-layer theory can handle, including sill-contraction combinations and non-rectangular cross-sections. We further show how aspiration of dense water from below the sill crest can be quantified with hydraulic theory, and be included in the method for stratified strait exchange. Rotational control in wide straits and in parallel straits connecting the same two basins is treated with a simple but robust scheme. We evaluate the calculations with data from the Oxdjupet strait in the Stockholm archipelago. Simulations with a three-dimensional, non-hydrostatic numerical model are performed to compensate for sparsity in data.

Organ weight effects of drowning and asphyxiation on the lungs, liver, brain, heart, kidneys, and spleen

An examination of the organ weights associated with victims of drowning, asphyxiation and trauma was undertaken to determine (a) the effects of asphyxiation compared to a trauma group, and in turn, (b) the effects of drowning compared to an asphyxiation group. Included in the study were 217 drowning deaths, 166 pure asphyxiation deaths and 381 trauma deaths. The effects of asphyxiation (compared to trauma) resulted in elevated mean organ weights for the lungs, liver, kidneys and spleen (with mean increases of 17.8, 10.5, 10.3 and 23.4%, respectively). Effects of drowning (compared to asphyxiation) resulted in elevated mean organ weights only with the lungs and kidneys (with mean increases of 30.0 and 4.4%, respectively). Only the mean heart and brain weight remained constant across all experimental groups. A picture of drowning is suggested in which elevated lung and kidney weights are the result of both asphyxiation and the aspiration of water that occurs with drowning, whereas elevated spleen and liver weights in drowning victims are associated with only the effects of asphyxiation. In addition, the common autopsy finding of a small, anemic spleen in drowning, rather than caused by some pathophysiological mechanism of death, is hypothesized to be a postmortem phenomenon.

Waterborne Nosocomial Infections.

Waterborne pathogens cause infections in health-care facilities. Despite guidelines addressing these pathogens, outbreaks and pseudo-outbreaks continue to occur. We reviewed recent reports of infections caused by Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Chryseobacterium species, nontuberculous mycobacteria, and Legionella species. Mycobacterium avium complex (MAC) infection in HIV patients has been linked to hospital water distribution systems; molecular subtyping showed that MAC isolates in patients and hospital water were identical. In immunosuppressed patients, Fusarium infection has been linked to the hospital water distribution system; again molecular subtyping showed that isolates from patients and the water supply were identical. Parasites, especially Cryptosporidium, and viruses have also been implicated in nosocomial infection. Transmission occurs via contact, ingestion, aspiration, or aerosolization of potable water, or via the hands of health-care workers. Interventions designed to interrupt transmission of waterborne pathogens have included the use of antimicrobial handwashes, targeted disinfection of the water supply, and, in high-risk populations, restricting the use of tap water.

Waterbirths: A Comparative Study

Background: Waterbirths were introduced in 1991 as part of a new birth concept which consisted of careful monitoring and birth management, restrictive use of invasive methods and free choice of different birth methods. Methods: After the introduction of this new birth concept a prospective observational study was initiated. All parturients of the region give birth in our clinic without preselection, ours being the only birth clinic of the region. 2% of the parturients will be referred to a larger birth clinic (university clinic) mainly because of preterm births before the end of the 33rd week of pregnancy. Every one of the 7,508 births between November 1991, and May 21, 1997, was analyzed. In this article the birth parameters of mother and child in the most often chosen spontaneous birth methods will be compared to assess the safety of alternative birth methods in general and of waterbirths in particular. 2,014 of these 5,953 spontaneous births were waterbirths, 1,108 were Maia-birthing stool births and 2,362 bedbirths (vacuum extractions not included). Results: The parity and age of the mother as well as the newborn’s birth weight are comparable in all 3 groups: waterbirth, Maia-birthing stool, and bedbirths. An episiotomy was performed in only 12.8% of the births in water, in 27.7% of the births on the Maia-birthing stool and in 35.4% of the bedbirths. These differences are statistically significant. In spite of the highest episiotomy rates, the bedbirths also show the highest 3rd- and 4th-degree laceration rates (4.1%), thus the difference between the rates for bedbirths and alternative births methods for severe lacerations is significant. The mothers’ blood loss is the lowest in waterbirths. Fewer painkillers are used in waterbirths and the experience of birth itself is more satisfying after a birth in water. The average arterial blood pH of the umbilical cord as well as the Apgar scoring at 5 and 10 min are significantly higher after waterbirths. Infections of the neonate do not occur more often after waterbirths. No case of water aspiration or any other perinatal complication of the mother or child which might be water-related was reported. Conclusion: Waterbirths and other alternative forms of birthing such as Maia-birthing stool do not demonstrate higher birth risks for the mother or the child than bedbirths if the same medical criteria are used in the monitoring as well as in the management of birth.

Aspiration diseases: findings, pitfalls, and differential diagnosis.

The aspiration of different substances into the airways and lungs may cause a variety of pulmonary complications. These disease entities most commonly involve the posterior segment of the upper lobes and the superior segment of the lower lobes. Esophagography and computed tomography (CT) are especially useful in the evaluation of aspiration disease related to tracheoesophageal or tracheopulmonary fistula. Foreign body aspiration typically occurs in children and manifests as obstructive lobar or segmental overinflation or atelectasis. An extensive, patchy bronchopneumonic pattern may be observed in patients following massive aspiration of gastric acid or water. CT is the modality of choice in establishing the diagnosis of exogenous lipoid pneumonia, which can result from aspiration of hydrocarbons or of mineral oil or a related substance. Aspiration of infectious material manifests as necrotizing consolidation and abscess formation. The relatively low diagnostic accuracy of chest radiography in aspiration diseases can be improved with CT and by being familiar with the clinical settings in which specific complications are likely to occur. Recognition of the varied clinical and radiologic manifestations of these disease entities is imperative for prompt, accurate diagnosis, resulting in decreased morbidity and mortality rates.

Sudden infant death syndrome: can gastroesophageal reflux cause sudden infant death?

Although gastric contents in the airways and lungs of sudden infant death syndrome (SIDS) victims is commonly found during postmortem examination, its significance as a sole or contributory cause of death has long been controversial. Currently, most authorities view such aspiration as resulting from “agonal” processes and, therefore, irrelevant to cause of death. Recent clinical and experimental evidence indicates that infants who are near death because of a variety of conditions, frequently “autoresuscitate,” which produces rapid and complete recovery. In animal models, aspiration of water or saline into the airways has been shown to prevent autoresuscitation. In light of these findings, aspiration of gastric contents should be reconsidered as a contributory cause of many SIDS deaths.

Isolated pulmonary oedema associated with SCUBA diving

AbstractPulmonary oedema may be a presenting feature of the classical diving illnesses decompression illness and barotrauma, but it may also present as an isolated phenomenon. Possible causes include: salt water aspiration syndrome or near drowning (sometimes associated with faulty apparatus); and cold, immersion and exercise‐induced pulmonary oedema. The pathophysiology may involve peripheral vasoconstriction; changes in preload, afterload and circulating fluid volume; and pulmonary capillary fragility. A case that presented to Auckland Hospital is discussed, together with a review of the literature. In this case, treatment with continuous positive airway pressure ventilation proved highly effective. Guidelines for the use of continuous positive airway pressure ventilation in diving‐related accidents are presented.

Hydraulic analysis of the functional properties of saline-jet aspiration thrombectomy catheters

The purpose of this paper is to clarify the functional properties of a saline-jet aspiration thrombectomy catheter based on hydraulics. This catheter, developed by the authors, aspirates intravascular thrombi by means of the effect of a high-speed jet. We have derived the relationships between Qs, Qa and pn, where Qs is the water supply rate, Qa is the water aspiration rate and pn is the negative pressure created in the distal lumen of the catheter. The relationships are represented by simple equations using c1 and c2, where c1 and c2 are coefficients proper to the catheter. We have obtained c1 and c2 experimentally for three types of catheter with different distal shapes. Two practical conclusions are derived from this study. First, making a short taper at the distal end increases the negative pressure created and is advantageous for thrombus aspiration. Second, making the diameter of the inner tube and nozzle smaller is essential for improving the aspiration ability of the catheter.

Perinatal mortality and morbidity among babies delivered in water: surveillance study and postal survey

Aim: To compare perinatal morbidity and mortality for babies delivered in water with rates for babies delivered conventionally (not in water).Design: Surveillance study (of all consultant paediatricians) and postal survey...

Near-drowning.

Near-drowning.