Severe neurologic impairment and uncommon magnetic resonance imaging findings after carbon monoxide poisoning.

Carbon monoxide poisoning is the most common cause of fatal poisoning worldwide and can lead to severe brain damages. We report a delayed encephalopathy after a severe carbon monoxide poisoning with uncommon magnetic resonance imaging findings.

In-flight auscultation during medical air evacuation: comparison between traditional and amplified stethoscopes.

OBJECTIVES: The aim of this study was to evaluate the capacity of a traditional stethoscope versus an electronically amplified one (expected to reduce background and ambient noise) to assess heart and respiratory sounds during medical transport. MATERIALS AND METHODS: It was a prospective, double-blinded, randomized performed study. One traditional stethoscope (Littmann Cardiology III; 3M, St Paul, MN) and 1 electronically amplified stethoscope (Littmann 3200, 3M) were used for our tests. Heart and lung auscultation during real medical evacuations aboard a medically configured Falcon 50 aircrafts were studied. The quality of auscultation was ranged using a numeric rating scale from 0 to 10 (0 corresponding to "I hear nothing" and 10 to "I hear perfectly"). Data collected were compared using a t-test for paired values. RESULTS: A total of 40 comparative evaluations were performed. For cardiac auscultation, the value of the rating scale was 4.53 ± 1.91 and 7.18 ± 1.88 for the traditional and amplified stethoscope, respectively (paired t-test: P < .0001). For respiratory sounds, quality of auscultation was estimated at 3.1 ± 1.95 for a traditional stethoscope and 5.10 ± 2.13 for the amplified one (paired t-test: P < .0001). CONCLUSIONS: This study showed that practitioners would be better helped in hearing cardiac and respiratory sounds with an electronically amplified stethoscope than with a traditional one during air medical transport in a medically configured Falcon 50 aircraft.

Evaluation of the altitude impact on a point-of-care thromboelastography analyzer measurement: prerequisites for use in airborne medical evacuation courses.

PURPOSE: Hemorrhagic shock is the first cause of preventable death in combat. Evacuations of wounded by aircraft are increasingly used and severely injured patients can spend consequent time in the air, mostly during strategic evacuation. In these situations, monitoring of blood coagulation may be pivotal in the management of blood product transfusion. Viscoelastic-guided transfusion is relevant in these situations. However, evaluation of these devices used in aircraft is lacking, especially the impact of decreased atmospheric pressure. The aim of this study is to evaluate the performance of an easy-to-carry viscoelastic system (TEG® 6s, Haemonetics). METHODS: First, TEG® 6s repeatability, reproducibility, and correlation with chronometric methods and TEG-5000 were assessed on quality controls, healthy volunteers, and patients. Secondly, we tested the influence of vibrations and altitude on TEG® 6s parameters (0ft vs. 8000 ft = 2428 m) and on quality control samples (normal and hypocoagulable). RESULTS: TEG® 6s exhibited good correlation with the reference method and TEG® 5000. Repeatability and reproducibility CVs were satisfactory. The tests performed in the hypobaric chamber revealed that performance at 0 ft and 8000 ft (2428 m) for 9 out of 13 parameters was not significantly different. However, we showed a significant increasing of CRT.Alpha (p = 0.049), CK.Alpha, CK.MA (p < 0.001 and p < 0.01, respectively) and CFF.MA increased (p < 0.05). CONCLUSION: Our study provides proof of concept to validate testing in an actual aeromedical situation. Indeed, TEG® 6s appears to ease of use, resistance to high altitude conditions, and reliability on healthy humans. It is necessary to carry out a study on hemorrhagic injured patients in an aircraft.

Strategic air medical evacuation of critically ill patients involving an intensive care physician: A retrospective analysis of 16 years of mission data.

BACKGROUND: Strategic medical evacuation (MEDEVAC) allows airborne repatriation of soldiers injured or sick on missions to their national territory. The aim of this study was to describe the epidemiology of strategic MEDEVAC performed by intensive care physicians (ICP) and to analyze the role of the ICP in the management of critical care situations in flight. METHODS: All soldiers who had high or medium dependency conditions and who benefited from a strategic MEDEVAC with an ICP on board between 1 January 2001 and 30 November 2017 were included in this epidemiological retrospective study. RESULTS: A total of 452 soldiers were repatriated; the causes of repatriation were either trauma (n = 245; 54%) or medical pathologies (n = 207; 46%). Two hundred and seventy-six (61%) evacuations were performed within 48 h. The median annual number of strategic MEDEVAC with an ICP was 26 [20-32]. One hundred and fifty-five (34%) patients were mechanically ventilated and 103 (23%) received catecholamines. The median SAPS II score was 13 [8-24]. One hundred and seventy-eight adverse events were identified, of which 123 (69%) related to a worsening of the patient's clinical condition and 30 (20%) related to a technical problem. Forty-seven (20%) patients who initially appeared stable worsened during the flight. No deaths occurred on board, however, and no flights had to be diverted due to an uncontrolled care situation. CONCLUSION: The results suggested that the presence of an ICP ensured a continued high-level care for patients with serious trauma and medical injuries, due to the medical and aeronautical expertise that resulted from the theoretical and practical training of the personnel on board. Based on these results, lessons regarding future MEDEVAC flights could be learned in order to continue to improve patient outcome.