Accuracy of training blood volume quantification using a visual estimation tool / 世界急诊医学杂志（英文）

@#BACKGROUND: We investigated whether the use of a specially designed visual estimation tool may improve accuracy in quantifying blood volumes related to surface spreading. METHODS: A prospective, paired-control, single-blinded experimental study was performed at a medical university. Anesthesiologists and emergency medical personnel estimated various blood volumes on surfaces with varying absorptivity (carpet, towel, polyvinyl chloride, wooden flooring) in an experimental setting. We assessed the sensitivity of training blood volume quantification using a self-designed visual estimation tool by comparing the accuracy of visual blood volume estimations before and after practical training with the tool. RESULTS: A total of 352 estimations by 44 participants were evaluated. Accurate estimations improved significantly from pre-training to post-training (P<0.05). The sensitivity of blood volume quantification was 33.0% after training with the visual estimation tool. Estimations did not depend on age, profession, gender or years of the estimator’s professional experience. CONCLUSIONS: Training with a visual estimation tool by professional rescuers can improve the estimation accuracy of blood volumes spread on surfaces with varying absorptivity.

Hemorrhage control of fluid gelatin surgiflo™ versus gelatin sponge in lumbar spine fusion surgery / 中国组织工程研究

BACKGROUND: Hemorrhage control has been an important issue in spine surgery. The widely used gelatin sponge is limited by its long-time bleeding control and poor hemorrhage control. Therefore, new techniques are needed to control bleeding in spine surgery. OBJRCTIVE: To compare the hemostatic effect of fluid gelatin Surgiflo™ with absorbable gelatin sponge in single level posterior lumbar fusion surgery. METHODS: Ninety-eight patients consisting of 52 males and 46 females, aged 54. 32 years who received treatment between September 2017 and December 2017 in Xijing Hospital of The Fourth Military Medical University were included in this study. All patients underwent single-level L4/5 lumbar fusion. Among them, 48 patients received intraoperative hemostasis with fluid gelatin SurgifloTM and 50 patients received intraoperative hemostasis with conventional gelatin sponge. Intraoperative bleeding volume, postoperative drainage volume, success rate of hemostasis in 3 minutes and changes of hemoglobin levels in perioperative period were compared between the two groups. RESULTS AND CONCLUSIONS: The operation time in the Surgiflo™group was significantly shorter than that in the gelatin sponge group [(105±26) vs. (118±32) min, P < 0. 05]. The amount of intraoperative blood loss and total amount of drainage were (156±57) mL and (106±42) mL in the Surgiflo™group which were significantly lower than those in the gelatin sponge group [(204±62) mL, (148±35) mL, P < 0. 05]. The success rate of hemostasis within 3 minutes in the Surgiflo™ group was significantly higher than that in the gelatin sponge group (94% vs. 80%, P < 0. 05). The change in hemoglobin level during the perioperative period relative to pre-surgery level was significantly higher in the Surgiflo™ group was significantly lower than that in the gelatin sponge group [(12. 3±3. 6) vs. (22. 8±4. 3) g/L, P < 0. 05]. No complications such as anaphylaxis, immune rejection, or delayed hematoma occurred in both groups. These results suggest that fluid gelatin Surgiflo™ can significantly reduce intraoperative blood loss and postoperative drainage volume in single-level lumbar fusion surgery and exhibit better hemostatic effects.

Administration of tranexamic acid for victims of severe trauma within pre-hospital care ambulance services (PHCAS) in Malaysia

@#Introduction: Trauma is a Global threat and the 5th highest cause of all-cause mortality in Malaysia caused predominantly due to road traffic accidents. Majority of trauma victims are young adults aged between 21-40 years old. In Malaysia, 24 out of 100,000 population die annually due to trauma, rating us amongst the highest in South East Asia. These alarming figures justify aggressive preventive and mitigation strategies. The aim of this paper is to promote the implementation of evidence-based interventions that will reduce the rate of preventable death because of trauma. Tranexamic acid is one of the few interventions in the early management of severe trauma with level-one evidence. Tranexamic acid has been proven to reduce all causes of mortality and mortality due to bleeding. Evidence proves that it is most effective when administered early, particularly within the 1st hour of trauma. This proposed guideline is formulated based upon quality evidence from multicentre studies, clinical practices in other countries and consideration of the local demographic factors with the intent of enabling an easy and simple pathway to administer tranexamic acid early in the care of the severely injured. Conclusion: The guideline highlights select pre-hospital criteria’s and the methods for drug administration. The authors recognise that some variants may be present amongst certain institutions necessitating minor adaptations, nevertheless the core principles of advocating tranexamic acid early in the course of pre-hospital trauma should be adhered to.

A study on goat models for training combat medics' key first aid skills on battle field / 中国中西医结合急救杂志

Objective To train the combat medics to learn key battle field operative technologies such as tracheotomy, thoracic close drainage, control of massive hemorrhage, etc by practicing the above skills on goats' traumatic models. Methods From 2012 to 2014 for consecutive 3 years, a group army trained the combat medics to learn how to treat war trauma first aid skills every year. 30 combat medics were randomly selected from 136 combat medics who had received goat model training to be tested. Goat model preparation methods: 35 healthy adult goats were anaesthetized with ketamine, then the suffocation models were reproduced by wadding the goat mouths and noses;pneumothorax models were replicated by cutting goat chest cavities; massive hemorrhagic models were produced by cutting goat femoral arteries by scissors. 136 combat medics were trained to perform tracheotomy, tube thoracostomy or thoracic close drainage, and hemorrhagic control by above models. The differences in mastering these skills before training, immediately after training, and one year after training were recorded and compared, and the factors influencing the combat medics training grade were analyzed. Results At the end of the training, the 30 combat medics' successful rates of performing cricothyrotomy or tracheotomy, tube thoracostomy, hemorrhage control were significantly higher than those before the training [respectively was 63.3% (19/30) vs. 10.0% (3/30), 66.7% (20/30) vs. 13.3% (4/30), 86.7% (26/30) vs. 53.3% (16/30), all P < 0.05]. After 1 year of training, the success rates of tracheotomy and thoracic close drainage were 33.3% (9/27) and 37.0% (10/27) respectively, which were significantly lower than those immediately after the end of training; the success rate of hemostasis after femoral artery rupture was 70.4% (19/27), which was lower than that at the end of training, but the difference was not statistically significant (P > 0.05). The education level had effect on the combat medics' performance after training. The success rate of combat medics with higher or above higher education was significantly higher than that of them with high school and below [88.9% (24/27) vs. 65.1% (41/63), P < 0.05]. Cross-sectional survey result showed that in 107 combat medics simultaneously received multimedia teaching, high analogue simulation human model teaching and animal model teaching, 85 combat medics (79.4%) chose the goat models as the first option for training. Conclusion By performing battle field key first aid techniques on goat trauma models, the combat medics' skills can be obviously elevated, they approve this animal model training as the first option, but repetition of the training is necessary to maintain the skills long lasting.

Damage control resuscitation of massive hemorrhage: The key to saving the combat casualties / 解放军医学杂志

Combat casualties can be divided into two types,i.e.,non-survivable (NS) and potentially survivable (PS).According to the data of US army,massive hemorrhage constituted 90.98％ of the potentially survivable casualties,and the most important thing to improve the ability of casualty care is hemorrhage control.In this article,the strategies and techniques of damage control resuscitation like surgical hemorrhage control techniques of non-compressive hemorrhage (NCH) in torso and junctional area,the damage control identification of the injured,field transfusion process and fresh whole blood infusion in tactical level and emergency phase were comprehensively illustrated.

The Efficacy of QuikClot Combat Gauze, Fluid Resuscitation and Movement on Hemorrhage Control in a Porcine Model of Hypothermia.

Aims: The purpose of this study was to compare the effectiveness QuikClot Combat Gauze (QCG) to a control group on hemorrhage control and investigate the effects of intravenous volume resuscitation on rebleeding and movement on hemostasis in a porcine model of hypothermia. Design: This was a prospective, between subjects, experimental design. Twenty-two Yorkshire swine were randomly assigned to two groups: QCG (n = 11) or control (n=11). Methods: The femoral artery and vein were transected. After 1 minute of uncontrolled hemorrhage, the hemostatic agent QCG was placed into the wound followed by standard wound packing. The control group underwent the same procedures without QCG. After 5 minutes of manual pressure, a pressure dressing was applied to the injury site. Initial resuscitation was performed with 500 mL of rapidly administered IV 6% Hetastarch. Following 30 minutes of observation, the dressings were removed and any additional blood loss was collected and total blood loss calculated. Hemostasis was defined as <2% total blood volume or ~ 100 mL in a 70 kg swine. If hemostasis occurred, 5 Liters of IV crystalloid were rapidly administered and the wound was again observed for rebleeding. If no bleeding occurred, the extremity on the side of the injury was systematically moved through flexion, extension, abduction and adduction sequentially 10 times or until rebleeding occurred. Results: There were significant differences in hemorrhage (P=.01), the amount of volume resuscitation (P =.01) and movement (P =.03) between the QCG and control groups. Conclusion: QCG is effective and statistically superior at controlling hemorrhage, allows for greater fluid resuscitation, and tolerates significant movement without rebleeding compared to the standard pressure dressing control in this hypothermic porcine model of uncontrolled hemorrhage.

Emergency bleeding control in a mentally retarded patient with active oral and maxillofacial bleeding injuries: report of a case

Excessive oral and maxillofacial bleeding causes upper airway obstruction, bronchotracheal and gastric aspiration and hypovolemic shock. Therefore, the rapid and correct bleeding control is very important for saving lives in the emergency room. Despite the conventional bleeding control methods of wiring (jaw fracture, wound suture and direct pressure), continuous bleeding can occur due to the presence of various bleeding disorders. There are five main causes for excessive bleeding disorders in the clinical phase; (1) vascular wall alteration (infection, scurvy etc.), (2) disorders of platelet function (3) thrombocytopenic purpura (4) inherited disorders of coagulation, and (5) acquired disorders of coagulation (liver disease, anticoagulant drug etc.). In particular, infections can alter the structure and function of the vascular wall to a point at which the patient may have a clinical bleeding problem due to vessel engorgement and erosion. Wound infection is a frequent cause of postoperative active bleeding. To prevent postoperative bleeding, early infection control using a wound suture with proper drainage establishment is very important, particularly in the active bleeding sites in a contaminated emergency room. This is a case report of a rational bleeding control method by rapid wiring, wound suture with drainage of a rubber strip & iodoform gauze and wet gauze packing, in a 26-year-old male cerebral palsy patient with active oral and maxillofacial bleeding injuries caused by a traffic accident.

Periodontal treatment of a patient with aplastic anemia / 대한치주과학회지

Aplastic anemia is a disease characterized by general lack of bone marrow activity; it may affect not only the red blood cells but also the white blood cells and platelets, resulting in pancytopenia. Spontaneous gingival hemorrhage is present in some cases and it is related to the blood platelet deficiency. This case report presents the periodontal treatment of a patient with aplastic anemia. A 43-year-old female was referred for continuous gingival bleeding after periodontal treatment. Periodontal findings revealed generalized gingival imflammation, oozing of blood from gingival crevice, and it was diagnosed as adult periodontitis. Root planing and extraction of the upper left third molar with poor prognosis were put into operation after elevation of the platelet count with platelet transfusion. The extraction socket was sutured with 3-0 silk. Bleeding continued even after digital compression at the upper right second premolar, second molar, and left canine areas, which presented severe inflammation. Although platelets were transfused repeatedly, platelet count did not stay elevated since survival rate of the transfused platelets were low due to alloimmunization. Thrombin gauze packing was not effective. Bleeding ceased 3 days after treatment with transfusion of donor platelets. 20 days after the treatment, the gingiva was generally healthy except upper right second premolar and lateral incisor areas. The result of periodontal treatment was good, but bleeding control after treatment was troublesome. In the periodontal treatment of patient with aplastic anemia, elevation of the platelet count with platelet transfusion seems to be the best method for hemorrhage control.