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1.
J R Army Med Corps ; 164(5): 370-379, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29626137

RESUMO

Snakebite envenoming is rare among military patients, with few cases reported in recent years. Increasingly, however, military operations are taking place in remote parts of Africa, which are inhabited by numerous species of venomous snake, and in Europe, where dangerous species exist but are less common. Bites from a venomous snake may prove fatal, and therefore military medics must be adequately prepared to manage them. This paper reviews the most medically significant species of venomous snake present in Africa and Europe, before suggesting an evidence-based approach to snakebite prevention and management, including possible changes to the UK's Clinical Guidelines for Operations.


Assuntos
Mordeduras de Serpentes/terapia , Serpentes , África , Animais , Antivenenos/uso terapêutico , Serviços Médicos de Emergência , Europa (Continente) , Humanos , Medicina Militar , Militares
2.
Intensive Care Med ; 41(5): 735-43, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25761540

RESUMO

PURPOSE: Early central venous catheter (CVC) insertion in Ebola virus disease (EVD) is a novel approach and has not previously been described. This report delineates the safety, feasibility and clinical implications of early CVC insertion as the optimum means of vascular access in patients with EVD, in the setting of a deployed military Ebola virus disease treatment unit in Sierra Leone. METHODS: In the gastrointestinal phase of EVD, a 7-French 20-cm triple-lumen CVC was inserted using aseptic technique. Data were collected prospectively on all cases to include baseline and subsequent blood test variables, insertion site and technique, and complications associated with CVC placement. RESULTS: Twenty-three patients underwent CVC insertion as follows: subclavian, 21 (88 %); internal jugular, 2 (8 %); axillary, 1 (4 %). The mean duration of CVC placement was 5 days. There were no significant procedure-related adverse events. Despite coagulopathy being present in 75 % of cases, CVC insertion was safe, and there was only 1 case of significant catheter site bleeding. A total of 152 needle venepunctures were avoided owing to the presence of a CVC, a mean of 7 (±3.8) per case over the average stay. CONCLUSION: The early use of CVCs in Ebola virus disease is safe, effective and facilitates patient care. It should be considered a feasible additional route of venous access, where physician expertise and resources allow.


Assuntos
Antivirais/uso terapêutico , Cateterismo Venoso Central/métodos , Doença pelo Vírus Ebola/tratamento farmacológico , Medicina Militar/métodos , Adulto , Cateteres Venosos Centrais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Militares , Segurança do Paciente , Serra Leoa , Fatores de Tempo , Reino Unido , Adulto Jovem
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