Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 12.104
Filtrar
2.
Air Med J ; 39(5): 340-342, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33012469

RESUMO

In late 2019, a novel coronavirus was identified as the cause of a cluster of atypical pneumonia cases in Wuhan, China. It subsequently spread throughout China and around the world, quickly becoming a public health emergency. In March 2020, the World Health Organization declared coronavirus disease 2019 a pandemic. This article explores the preparation and early experiences of a large Canadian critical care transport program during the coronavirus disease 2019 pandemic focused on 6 broad strategic objectives centered around staff welfare, regular and transparent communication, networking, evidenced-based approach to personal protective equipment, agile mission planning, and an expedited approach to clinical practice and policy updates and future state modeling.


Assuntos
Comunicação , Infecções por Coronavirus , Cuidados Críticos/organização & administração , Disseminação de Informação , Liderança , Pandemias , Transferência de Pacientes/organização & administração , Pneumonia Viral , Transporte de Pacientes/organização & administração , Medicina Aeroespacial , Resgate Aéreo , Ambulâncias , Betacoronavirus , Colúmbia Britânica , Prática Clínica Baseada em Evidências , Humanos , Equipamento de Proteção Individual/provisão & distribução , Resiliência Psicológica
3.
PLoS One ; 15(9): e0239194, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32966320

RESUMO

BACKGROUND: Aircrew members are required to attend hypoxia awareness training regularly to strengthen their memory of their personal hypoxia symptoms by undergoing training inside a hypobaric chamber. The aim of this study was to examine the association between hypoxia symptoms experienced during two training sessions that were 4 years apart. METHODS: This was a crossover study to compare hypoxia symptoms and self-reported physiological effects of trapped gas between a previous training session and a current training session in an altitude chamber. The subjects were military crew members who undertook a 25,000-feet refresher training course in 2018. We used a structured questionnaire to obtain the target information before and during hypoxia exposure. Data were analyzed using SPSS software. RESULTS: A total of 341 trainees participated in this survey and completely filled out the questionnaire. Gastrointestinal tract discomfort caused by the expansion of trapped gas was the main physiological reaction during the previous and current training sessions. Frequently reported symptoms were poor concentration (30.5%), impaired cognitive function (20.5%), visual disturbances (16.4%), hot flashes (15.8%), and paresthesia (12.6%) during both exposures. However, the proportions of participants reporting poor concentration (P = 0.378) and visual disturbances (P = 0.594) were not significantly different between the recalled and current training sessions. The five most common symptoms among the subjects with less than 1,000 flight hours were poor concentration (29.8%), visual disturbance (27.3%), impaired cognitive function (14.9%), dizziness/lightheadedness (11.6%), and hot flashes (9.9%), which overlapped substantially with the symptoms reported by other subjects. The occurrence of those five most common symptoms in the group with more than 1,000 flight hours did not significantly differ between the recalled training session and the current training session. CONCLUSIONS: The most common hypoxia symptoms reported were similar between the recalled and current training sessions in an environment with a low oxygen concentration. This finding was also clearly affected by the duration of flight experience. Moreover, GI effects of the expansion of trapped gas were commonly observed at low atmospheric pressure.


Assuntos
Hipóxia , Rememoração Mental , Adulto , Medicina Aeroespacial , Altitude , Pressão Atmosférica , Estudos Cross-Over , Feminino , Humanos , Hipóxia/fisiopatologia , Hipóxia/psicologia , Masculino , Pessoa de Meia-Idade , Militares , Inquéritos e Questionários
5.
Wilderness Environ Med ; 31(1): 110-115, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32734896

RESUMO

We developed an elective course titled Medicine in Extreme Environments (MEE) at the University of Texas Southwestern Medical Center for first- and second-year medical students. This course covered physiology, research, clinical practice, and career guidance regarding the fields of wilderness, space, hyperbaric, combat, and exercise medicine. The primary aim was to generate interest in and awareness of these seldom covered fields of medicine by exposing medical students to these disciplines during their preclinical years. A postcourse questionnaire was implemented to investigate whether the MEE course increased awareness of, interest in, and knowledge in the fields of medicine included in the curriculum. Through 2 iterations of the class, a total of 67 students enrolled in the course, and 38 students completed the questionnaire. After course completion, 95% felt they better understood the work and lifestyle of the fields covered, 100% learned more about concepts of each field, and 74% agreed that the elective influenced the direction of their future careers to include some part of the fields emphasized. Although only a limited number of students enrolled in this course, these initial findings suggest that the MEE curriculum may have some utility in promoting awareness of and interest in these medical disciplines among students who attend the course. With continued student and faculty support, this course will likely be continued annually at our institution. We believe that certain aspects of this course may be useful in helping develop similar courses at other medical schools.


Assuntos
Medicina Aeroespacial/educação , Educação Médica/organização & administração , Terapia por Exercício/educação , Ambientes Extremos , Oxigenação Hiperbárica , Medicina Militar/educação , Medicina Selvagem/educação , Conflitos Armados , Humanos , Meio Selvagem
6.
Air Med J ; 39(4): 251-256, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32690299

RESUMO

Recent coronavirus disease 2019 (COVID-19) events have presented challenges to health care systems worldwide. Air medical movement of individuals with potential infectious disease poses unique challenges and threats to crews and receiving personnel. The US Department of Health and Human Services air medical evacuation teams of the National Disaster Medical System directly supported 39 flights, moving over 2,000 individuals. Infection control precautions focused on source and engineering controls, personal protective equipment, safe work practices to limit contamination, and containment of the area of potential contamination. Source control to limit transmission distance was used by requiring all passengers to wear masks (surgical masks for persons under investigation and N95 for known positives). Engineering controls used plastic sheeting to segregate and treat patients who developed symptoms while airborne. Crews used Tyvek (Dupont Richmond, VA) suits with booties and a hood, a double layer of gloves, and either a powered air-purifying respirator or an N95 mask with a face shield. For those outside the 6-ft range, an N95 mask and gloves were worn. Safe work practices were used, which included mandatory aircraft surface decontamination, airflow exchanges, and designated lavatories. Although most patients transported were stable, to the best of our knowledge, this represents the largest repatriation of potentially contagious patients in history without infection of any transporting US Department of Health and Human Services air medical evacuation crews.


Assuntos
Medicina Aeroespacial , Infecções por Coronavirus/prevenção & controle , Controle de Infecções/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Transporte de Pacientes/métodos , Betacoronavirus , China , Infecções por Coronavirus/terapia , Medicina de Desastres , Desinfecção , Equipamentos e Provisões , Governo Federal , Pessoal de Saúde , Humanos , Eliminação de Resíduos de Serviços de Saúde , Isolamento de Pacientes/métodos , Equipamento de Proteção Individual , Admissão e Escalonamento de Pessoal , Pneumonia Viral/terapia , Quarentena/métodos , Navios , Estados Unidos , United States Dept. of Health and Human Services
10.
J Surg Res ; 254: 390-397, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32540506

RESUMO

BACKGROUND: Noncompressible torso hemorrhage remains a leading cause of death. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) placement may occur before transport; however, its efficacy has not been demonstrated at altitude. We hypothesized that changes in altitude would not result in blood pressure changes proximal to a deployed REBOA. METHODS: A simulation model for 7Fr guidewireless REBOA was used at altitudes up to 22,000 feet. Female pigs then underwent hemorrhagic shock to a mean arterial pressure (MAP) of 40 mm Hg. After hemorrhage, a REBOA catheter was deployed in the REBOA group and positioned but not inflated in the no-REBOA group. Animals underwent simulated aeromedical evacuation at 8000 ft or were left at ground level. After altitude exposure, the balloon was deflated, and the animals were observed. RESULTS: Taking the REBOA catheter to 22,000 ft in the simulation model resulted in a lower systolic blood pressure but a preserved MAP. In the porcine model, REBOA increased both systolic blood pressure and MAP compared with no-REBOA (P < 0.05) and was unaffected by altitude. No differences in postflight blood pressure, acidosis, or systemic inflammatory response were observed between ground and altitude REBOA groups. CONCLUSIONS: REBOA maintained MAP up to 22,000 feet in an inanimate model. In the porcine model, REBOA deployment improved MAP, and the balloon remained effective at altitude.


Assuntos
Medicina Aeroespacial , Altitude , Aorta , Oclusão com Balão , Choque Hemorrágico/terapia , Animais , Pressão Sanguínea , Procedimentos Endovasculares , Feminino , Distribuição Aleatória , Suínos
15.
PLoS One ; 15(6): e0234361, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32525946

RESUMO

Artificial gravity elicited through short-arm human centrifugation combined with physical exercise, such as jumping, is promising in maintaining health and performance during space travel. However, motion sickness symptoms could limit the tolerability of the approach. Therefore, we determined the feasibility and tolerability, particularly occurrence of motion sickness symptoms, during reactive jumping exercises on a short-arm centrifuge. In 15 healthy men, we assessed motion sickness induced by jumping exercises during short-arm centrifugation at constant +1Gz or randomized variable +0.5, +0.75, +1, +1.25 and +1.5 Gz along the body axis referenced to center of mass. Jumping in the upright position served as control intervention. Test sessions were conducted on separate days in a randomized and cross-over fashion. All participants tolerated jumping exercises against terrestrial gravity and on the short-arm centrifuge during 1 Gz or variable Gz at the center of mass without disabling motion sickness symptoms. While head movements markedly differed, motion sickness scores were only modestly increased with jumping on the short-arm centrifuge compared with vertical jumps. Our study demonstrates that repetitive jumping exercises are feasible and tolerable during short-arm centrifugation. Since jumping exercises maintain muscle and bone mass, our study enables further development of exercise countermeasures in artificial gravity.


Assuntos
Centrifugação/efeitos adversos , Gravidade Alterada/efeitos adversos , Enjoo devido ao Movimento/etiologia , Voo Espacial , Adaptação Fisiológica , Adulto , Medicina Aeroespacial , Centrifugação/instrumentação , Exercício Físico/fisiologia , Gravitação , Movimentos da Cabeça/fisiologia , Voluntários Saudáveis , Humanos , Masculino , Enjoo devido ao Movimento/fisiopatologia , Enjoo devido ao Movimento/prevenção & controle , Contramedidas de Ausência de Peso , Adulto Jovem
17.
19.
20.
Urology ; 137: 12, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32115062
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA