Hemopneumothorax detection through the process of artificial evolution - a feasibility study.

BACKGROUND: Tension pneumothorax is one of the leading causes of preventable death on the battlefield. Current prehospital diagnosis relies on a subjective clinical impression complemented by a manual thoracic and respiratory examination. These techniques are not fully applicable in field conditions and on the battlefield, where situational and environmental factors may impair clinical capabilities. We aimed to assemble a device able to sample, analyze, and classify the unique acoustic signatures of pneumothorax and hemothorax. METHODS: Acoustic data was obtained with simultaneous use of two sensitive digital stethoscopes from the chest wall of an ex-vivo porcine model. Twelve second samples of acoustic data were obtained from the in-house assembled digital stethoscope system during mechanical ventilation. The thoracic cavity was injected with increasing volumes of 200, 400, 600, 800, and 1000 ml of air or saline to simulate pneumothorax and hemothorax, respectively. The data was analyzed using a multi-objective genetic algorithm that was used to develop an optimal mathematical detector through the process of artificial evolution, a cutting-edge approach in the artificial intelligence discipline. RESULTS: The in-house assembled dual digital stethoscope system and developed genetic algorithm achieved an accuracy, sensitivity and specificity ranging from 64 to 100%, 63 to 100%, and 63 to 100%, respectively, in classifying acoustic signal as associated with pneumothorax or hemothorax at fluid injection levels of 400 ml or more, and regardless of background noise. CONCLUSIONS: We present a novel, objective device for rapid diagnosis of potentially lethal thoracic injuries. With further optimization, such a device could provide real-time detection and monitoring of pneumothorax and hemothorax in battlefield conditions.

Comparison of the Effects of Motion and Environment Conditions on Accuracy of Handheld and Finger-Based Pulse Oximeters.

INTRODUCTION: The most common cause of preventable death on the battlefield is significant blood loss, eventually causing decrease in tissue oxygen delivery. Pulse oximeters (POs) are widely used by the Israeli Defense Forces to obtain fast and noninvasive information about peripheral oxygen saturation (SpO2). However, POs are produced by different manufacturers and therefore include different sensors and are based on distinctive algorithms. This makes them susceptible to different errors caused by factors varying from environmental conditions to the severity of injury. The objectives of this study were to compare the reliability of different devices and their accuracy under various conditions. MATERIAL AND METHODS: Six POs underwent performance analysis. The finger-based category included: MightySat by Masimo, Onyx II by Nonin, and CMS50D by Contec. The handheld category comprised: RAD5 by Masimo, 9847 model by Nonin, and 3301 model by BCI. Several environmental and physiological parameters were altered using the ProSim8 simulator by Fluke biomedical, forming unique test cases under which the devices were tested in stationary and motion conditions. RESULTS: All finger-based POs showed higher error rates of PO SpO2 and heart rate measurements in motion conditions, regardless of the manufacturer. However, newer devices in the handheld category were not affected. Results presented in Phase II showed that the SpO2 measurement error in all the devices was affected by pigmentation. However, the CMS50D, considered a low-cost device, had a significantly higher error size than other devices. In the devices that were influenced both by pigmentation and the finger cleanliness factors, the combined detected error size was clinically significant. The pigmentation, ambient light, and finger cleanliness also had a significant effect on the heart rate measurement in the CMS50D model, unlike the handheld devices, which were not affected. During Phase II, neither the Nonin nor the Masimo devices were deemed to have a significant advantage. CONCLUSION: Considering measurement limitations of POs used is extremely important. Use of handheld devices should be favored for use in motion conditions. Technologically advanced and/or recently developed devices should be preferred because of evolving algorithms, which decrease or eliminate the error factors. The "dirty finger" effect on the measurement error cannot be neglected and therefore the action of finger cleaning should be considered part of the treatment protocol.

Assessment of the Efficacy and Safety of a Novel, Low-Cost, Junctional Tourniquet in a Porcine Model of Hemorrhagic Shock.

INTRODUCTION: Commercially available junctional tourniquets (JTQs) have several drawbacks. We developed a low-cost, compact, easy to apply JTQ. The aim of this study was to assess the tourniquets' safety and efficacy in a swine model of controlled hemorrhage. MATERIALS AND METHODS: Five pigs were subjected to controlled bleeding of 35% of their blood volume. Subsequently, the JTQ was applied to the inguinal area for 180 minutes. Afterwards, the tourniquet was removed for additional 60 minutes of follow up. During the study, blood flow to both hind limbs and blood samples for tissue damage markers were repeatedly assessed. Following sacrifice, injury to both inguinal areas was evaluated microscopically and macroscopically. RESULTS: Angiography demonstrated complete occlusion of femoral artery flow, which was restored following removal of the tourniquet. No gross signs of tissue damage were noticed. Histological analysis revealed mild necrosis and infiltration of inflammatory cells. Blood tests showed a mild increase in potassium and lactic acid levels throughout the protocol. CONCLUSIONS: The tourniquet achieved effective arterial occlusion with minimal tissue damage, similar to reports of other JTQs. Subjected to further human trials, the tourniquet might be a suitable candidate for widespread frontline deployment because of its versatility, compactness, and affordable design.