Traumatic rupture of the thoracic aorta during pregnancy. Surgical considerations.

This is a report of successful management of a traumatic rupture of the thoracic aorta in pregnancy. Both mother and daughter are alive and well 24 months after the injury. The various aspects of the surgical and supportive treatment are discussed.

The safety of air transportation of patients with advanced lung disease. Experience with 21 patients requiring lung transplantation or pulmonary thromboendarterectomy.

Air travel can cause severe respiratory decompensation in a patient with advanced lung disease due to high altitude hypoxemia. We report our experience in flying 21 patients with advanced lung disease to a medical center remote from Israel for lung transplantation or pulmonary thromboendarterectomy (PTE). All patients had severe lung disease with marked hypoxemia (PaO2, 40 to 59) and 16 had significant pulmonary hypertension. Nine patients (with emphysema and pulmonary fibrosis) required single lung transplant, four (with cystic fibrosis and emphysema) required double-lung transplant, six (with primary or secondary pulmonary hypertension) required heart-lung transplant, and two (with major vessel pulmonary thrombosis) required PTE. All patients were flown by commercial aircraft to centers located 2,634 to 13,181 km away from Israel. Length of flight was between 4 and 21 h. Patients were given oxygen supplementation during the flight and were monitored by portable oximeters. All but three patients were hemodynamically stable and 19 of them were escorted by physicians. All but one hemodynamically unstable patient who died on board arrived safely at their destinations. We conclude that with careful preparation, sufficient oxygen supply, oximetric monitoring, and medical escort, almost any patient with severe lung disease can travel by air to any necessary destination.

Pulmonary barotrauma including orbital emphysema following inhalation of toxic gas.

Severe pulmonary barotrauma occurred following smoke and toxic gas inhalation in a 20-year-old male. He developed pneumothorax, pneumomediastinum, and extensive facial subcutaneous emphysema which intensified during treatment with positive pressure ventilation. Following the appearance of diplopia and exotropia, orbital emphysema was demonstrated radiologically. The diplopia and exotropia were manifestations of mechanical interference in extra-ocular muscle function by the intra-orbital air, an unusual expression of pulmonary barotrauma.

Successful resuscitation using aminophylline in refractory cardiac arrest with asystole.

Adenosine antagonists may have therapeutic potential in cardiopulmonary resuscitation. Aminophylline, a widely available adenosine antagonist, is not included in the Guidelines for Advanced Life Support by the European Resuscitation Council or the American Heart Association. This report addresses a case of out-of-hospital cardiac arrest caused by inferior wall myocardial infarction in which effective circulation was restored subsequent to aminophylline administration, after prolonged conventional resuscitation had resulted in asystole.

Metkephamid-induced Flehmen in lambs.

When metkephamid, a systemically active analog of methionine enkephalin, was administered intracisternally to male or female prepubescent lambs as early as the first week of life, we observed a behavioral pattern akin to Flehmen, which is a well-characterized grimace displayed by mature ungulates during mating. This metkephamid-induced Flehmen was preceded by transient bradycardia and apnea followed by somnolence for approximately 1 hour, during which Flehmen was observed intermittently. Pretreatment with the specific opiate antagonist, naloxone, blocked this behavioral response. These observations indicate that endogenous opioid peptides may be involved in Flehmen.

Military medicine: trauma anesthesia and critical care on the battlefield.

This article presents a few of the basic guidelines that must be considered once a decision is made to provide anesthesia and advanced surgical care in the battlefield--or in civilian catastrophes (for example, terrorist incidents, and man-made or natural disasters) that resemble the battlefield. However, it must be stressed that the most central consideration in battlefield anesthesia is the selection, training, and experience of the battlefield anesthesiologist. There are strict guidelines for providing safe anesthesia under the dire circumstances of war or similar civilian circumstances; the properly trained and experienced TA/CCS, however, will be best able to deliver battlefield anesthesia and to improvise equipment and agents for its safest delivery in those circumstances.

Trauma anesthesia for disasters. Anything, anytime, anywhere.

Field anesthesia can be practiced safely and effectively but requires special training to acquire familiarity with the techniques. Because field anesthesia may be required even in sophisticated countries for entrapment situations, skill should be maintained by practicing the appropriate techniques on a regular basis. Field anesthetic techniques are not second rate methods; they are just different. Although improvisation in the disaster situation has merit, it is not the place for experimenting with new and untried techniques.

Detection of firearm imprints on the hands of suspects: effectiveness of PDT reaction.

Pyridyldiphenyl triazine (PDT) and three of its analogues were compared as practical reagents for visualizing unseen impressions left on the hands of a person who has held a firearm. The parent compound, PDT, gave the best results using intensity and clarity as measuring criteria. The effectiveness of the PDT reaction was then studied on 147 volunteers who had held firearms in their hands. Identifiable impressions of the metallic parts of the weapons were developed on the hands of 103 volunteers (70%). Results with females were slightly higher than with males, however, the difference was possibly statistically insignificant, and needs further study. Ferroprint and Ferrotrace, 5 commercial preparations that are based on the PDT reaction, have become a part of the professional equipment of every crime scene technician in Israel.

Pregraduate training in emergency medicine.

A panel session on undergraduate education in Emergency Medicine from a worldwide perspective was conducted at the Seventh World Congress of Emergency and Disaster Medicine in Montreal, in May, 1991. Desmond Colohan MD, of the University of Toronto (Canada) was the panel moderator. Panel speakers were: Louis Binder MD, Texas Tech University Health Services Center (USA); Wolfgang Dick MD, University of Mainz (Germany); Bernard Nemitz MD, Faculty de Medicine d'Ameins (France); Yoel Donchin MD, Hadassa Medical Organization (Israel); and Noriyoshi Ohashi MD, Tsukuba Medical Center (Japan).

[Assessment of IDF physicians in in-field trauma].

The system of care delivery of in-field trauma was assessed, leading to suggestions for improving the system and military medical training. This study reports the feasibility and validity of various methods of assessing the performance of Israel Defense Force physicians in administering trauma care. The methods included a standardized medical debriefing with filling in of a report form by a senior traumatologist, his review of the physician's performance, self-assessment by the physician, and a written test. 5 senior traumatologists with extensive experience in military trauma care were trained to assess the physicians' performance within 24-48 hours of incidents involving moderate to severe trauma injuries. 75 physicians who had been involved in the care of the in-field trauma patients during a 1-year period, November 1988 to October 1989, were assessed. Analysis of the results clearly indicated 2 areas for assessment: a) knowledge, mainly levels of comprehension and application in relevant areas of trauma and b) performance, including immediate diagnosis, treatment skills, and triage. The best method for evaluating knowledge was the written test, not peer review nor self-evaluation. However, the traumatologist's evaluation of care performance was highly correlated with the physician's self-assessment. For comprehensive assessment of in-field care it is advisable to integrate the 2 methods: performance review by a traumatologist and a comprehensive written test. Information gained from such assessment could improve the planning of in-service trauma training and the posting of physicians within the military framework.