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1.
Aviat Space Environ Med ; 84(2): 89-96, 2013 Feb.
Article in English | MEDLINE | ID: mdl-23447845

ABSTRACT

INTRODUCTION: Ebullism is the spontaneous evolution of liquid water in tissues to water vapor at body temperature when the ambient pressure is 47 mmHg or less. While injuries secondary to ebullism are generally considered fatal, some reports have described recovery after exposure to near vacuum for several minutes. The objectives of this article are to review the current literature on ebullism and to present prevention and treatment recommendations that can be used to enhance the safety of high altitude activities and space operations. METHODS: A systematic review was conducted on currently available information and published literature of human and animal studies involving rapid decompression to vacuum and ebullism, with subsequent development of an applicable treatment protocol. RESULTS: Available research on ebullism in human and animal subjects is extremely limited. Literature available identified key pathophysiologic processes and mitigation strategies that were used for treatment protocol design and outlining appropriate interventions using current best medical practices and technologies. DISCUSSION: Available literature suggests that the pathophysiology of ebullism leads to predictable and often treatable injuries, and that many exposures may be survivable. With the growing number of high altitude and space-related activities, more individuals will be at risk for ebullism. An integrated medical protocol can provide guidance for the prevention and treatment of ebullism and help to mitigate this risk in the future.


Subject(s)
Altitude , Decompression Sickness/physiopathology , Decompression Sickness/therapy , Vacuum , Algorithms , Animals , Decompression Sickness/pathology , Decompression Sickness/prevention & control , Gravity Suits , Humans , Lung/pathology , Lung/physiopathology , Space Flight , Steam , Vapor Pressure
2.
Clin Geriatr Med ; 25(1): 93-107, vii, 2009 Feb.
Article in English | MEDLINE | ID: mdl-19217495

ABSTRACT

Medicare reimbursement for home visits average around $100 without ancillaries, so making 10 home visits to prevent even a single $1,000 ambulance ride is cost-neutral for Medicare. Home medical care is only an added cost if it fails to offset acute care use. The government's demographic and financial pressure suggests a need to press ahead with the enhanced mobile care model, so the explosion in point-of-care devices should continue. The main challenge is to decide which ones provide dispositive value to patients.


Subject(s)
Home Care Services , Mobile Health Units , Point-of-Care Systems , Diagnostic Tests, Routine , Emergency Service, Hospital/statistics & numerical data , House Calls , Humans , Medical Records Systems, Computerized , Telemedicine
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