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The Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) has developed a good clinical practice to address the challenges of treating critically ill patients in resource-limited austere environments, exacerbated by recent pandemics, natural disasters, and conflicts. The methodological approach was based on a literature review and a modified Delphi method, which involved blind voting and consensus evaluation using a Likert scale. This process was conducted over two rounds of online voting. The document covers six critical topics: the overall impact of austere conditions on critical care, airway management, analgesia, bleeding control, vascular access, and medical devices and equipment. In these settings, it is vital to apply basic care techniques flexibly, focusing on immediate bleeding control, airway management, and hypothermia treatment to reduce mortality. For airway management, rapid sequence intubation with ketamine for sedation and muscle relaxation is suggested. Effective pain management involves a multimodal approach, including patient-controlled analgesia by quickly acting safe drugs, with an emphasis on ethical palliative care when other options are unavailable. Regarding hemorrhage, military-derived protocols like Tactical Combat Casualty Care significantly reduced mortality and influenced the development of civilian bleeding control devices. Establishing venous access is crucial, with intraosseous access as a swift option and central venous access for complex cases, ensuring aseptic conditions. Lastly, selecting medical equipment that matches the specific logistical and medical needs is essential, maintaining monitoring standards and considering advanced diagnostic tools like point-of-care ultrasounds. Finally, effective communication tools for coordination and telemedicine are also vital. [ABSTRACT FROM AUTHOR]

Worldwide, burns are the fourth most frequent type of injury. The treatment of burn wounds requires a lot of experience and an interdisciplinary approach including both surgical treatment and pharmacological wound care. The most common management of burn wounds is debridement and wound closure through the use of skin grafts. The purpose of the study was to evaluate the hemostatic and antibacterial effects of the commercially available Tromboguard® foam dressing with an active layer containing alginates and chitosan. The site of application of the product was the donor fields for skin grafts. Findings proved that a polyurethane foam dressing with an active chitosan-alginate layer is a useful option for achieving rapid hemostasis, antimicrobial protection and effective healing at split-thickness skin graft donor sites. Substances present in the active layer promote clot formation and the wound healing process.

Background: Road traffic accidents (RTA) account for 4.7% of all deaths in the Kingdom of Saudi Arabia (KSA), with rates ranging from 17.4 to 24 per 100,000 people over the past decade. This study aims to enhance community engagement and understanding of bleeding control methods to empower effective responses to bleeding in accident scenarios. Method: This observational cross-sectional study evaluated the knowledge and willingness of the community to engage in bleeding control in the setting of medical emergencies. The study population was comprised of adults in Saudi Arabia who were over the age of 17 at the time of the research. Results: A total of 392 participants took part in the research. Of these, 66.3% (n = 260) were willing to assist a stranger bleeding as a result of a motor vehicle accident. There was no significant gender difference among those with past experiences of assisting someone after an accident. Only 15.5% (n = 61) had certified training, while the majority (77%, n = 47) held bachelor's degrees. Interest in educational workshops on bleeding control was shown by 55.1% (n = 216), with 32% (n = 126) undecided. Regarding tourniquet use, 20.1% (n = 38) believed this to be safe. Conclusion: This study highlighted the community's awareness of bleeding control and readiness to respond to bleeding situations after accidents. While more than half were likely to act, concerns about aggravating injuries, legal issues, and discomfort with blood were significant barriers, underscoring the need for public education and legal protection. Educational status, and particularly a bachelor's degree, was a stronger predictor of the likelihood to intervene than certified training. Significant knowledge gaps were noted with regard to tourniquet use, with few trusting their safety and many incorrectly applying them directly to the wound.

Introduction: The incidence of penetrating neck injuries is experiencing an upward trend. Given that hemorrhaging stands as one of the most preventable causes of fatality in traumatic situations, the prospect of employing a foley catheter (FC) to manage bleeding following penetrating neck injuries has led to contemplation on its integration into standardized protocols for bleeding control (BC), both in prehospital and in-hospital settings. Furthermore, inquiries into establishing standardized schedules for its application have arisen. Material and Methods: A meticulous search strategy was conducted utilizing the NCBI Medical Subject Heading (MeSH) term "foley*" and various combinations such as "foley" AND "trauma"; "foley" AND "neck"; "foley" AND "penetrating"; "catheter" AND "balloon" AND "trauma"; "gunshot" AND "neck"; "hemorrhage*" AND "neck" across multiple databases. These databases include MEDLINE, PubMed, PubMed Central, Scopus, Ovid, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL). Additionally, comprehensive searches using these terms were performed on Google, Google Scholar, and ResearchGate. The references cited in documents retrieved from these searches, covering 1833 to 2023, were thoroughly scrutinized. Results: 15 relevant articles were identified, and pertinent data were extracted from these studies. Historically, the use of FC was confined to immediate bleeding control; however, it has now extended its application into prehospital, emergency room (ER), and intraoperative settings. The primary success rate of FC stands at n=229 out of 274 cases (84%). FC serves as a valuable tool to bridge the gap in time before reaching the ER or operating room (OR), facilitating necessary radiological studies or interventions, especially when more severe injuries necessitate prioritization. Typically, FC was retained for 24-48 hours, but instances of prolonged applications up to 240 hours have been documented. Notably, it includes the definitive management of venous neck bleeding injuries, contingent upon excluding significant arterial defects through CTA. Late rebleeding stands at a low rate of 6% (14 out of 229 cases). Conclusion: Using FC is a pertinent strategy in managing neck injuries resulting from bleeding from penetrating wounds. Its substantial primary success rate in prehospital and ER phases surpasses the success rates achieved solely through pressure or chitosan dressing. Post-primary bleeding control, the presence of FC facilitates examinations and radiological interventions. Determining the optimal duration for FC placement remains a subject for consideration, leaning toward 2-3 days, if not longer. FC is progressively solidifying its role in Selective Non-Operative Management (SNOM) for hemorrhagic penetrating neck injuries. Consequently, a Foley catheter should be an essential tool in the possession of every prehospital and ER physician. Further delineation of criteria establishing the suitability of FC placement as definitive SNOM therapy for hemorrhagic penetrating neck injuries warrants consolidation.

Background/Aim: Vasopressin injected during myomectomy is known to effectively reduce bleeding but is sometimes associated with intraoperative vasoconstriction and hypertension due to systemic absorption. Although there is a growing preference for the use of diluted vasopressin, evidence of its effect and safety is still lacking. Patients and Methods: We performed a randomized controlled pilot trial to evaluate the effect and safety of vasopressin diluted in a constant volume during robot-assisted laparoscopic myomectomy (RALM), where a total of 39 women with uterine fibroids were randomly assigned into the following three groups (group 1, 0.2 IU/ml; group 2, 0.1 IU/ml; group 3, 0.05 IU/ml with a total of 100 ml of normal saline). The primary endpoint was to compare estimated blood loss (EBL), and the secondary endpoints were to compare postoperative value and drop ratio of hemoglobin, operation time, transfusion, hospitalization, and complications among the three groups. Results: There were no differences in the number and largest size of uterine fibroids, total weight of uterine fibroids, console time, and volumes of intravenous fluid administered during RALM among the three groups, whereas combined operation was performed more commonly in group 2 than in groups 1 and 3 (53.9% vs. 0 to 7.7%; p=0.01). The primary and secondary endpoints were also not different among the three groups. However, two patients in group 1 (15.4%) showed vasopressin-related hypertension. Conclusion: Vasopressin diluted in a volume of 100 ml showed an effective hemostatic effect and safety during RALM (Trial No. NCT04874246 in ClinicalTrial.gov). [ABSTRACT FROM AUTHOR]

Introduction: Unintentional bleeding is the leading cause of death in people 1-44 years of age in the United States. The Stop the Bleed (STB) campaign is a nationwide course that teaches the public to ensure their own safety, call 911, find the bleeding injury, and achieve temporary hemorrhage control by several techniques. Although the national campaign for the training course was inspired by active shooter events, the training can be applied to motor vehicle accidents and small-scale penetrating and gunshot wounds. Extending the audience to inner-city high school students in a violence-prone neighborhood has the potential to save lives if they are first on the scene.Objectives: We hypothesized that students would have a greater degree of comfort, willingness, and preparedness to intervene in acute bleeding after taking the course.Methods: This was a prospective, interventional pilot study in one inner-city high school in Brooklyn, New York. Students were given the option to participate in the STB course with pre- and postsurveys. We recruited 286 students from physical education or health education class to take a 50-minute bleeding control training course. Mean age was 15.7 years old. Students were divided into groups of 20-25 and taught by 2-3 emergency medicine, pediatric, or trauma surgery STB instructors. Each course included 2-3 skills stations for placing a tourniquet, wound packing, and pressure control.Results: Prior to the course, only 43.8% of the students reported being somewhat likely or very likely to help an injured person who was bleeding. After the course, this increased to 80.8% of students even if no bleeding control kit was available. Additionally, there were significant improvements in self-rated comfort level from pre- to post-course 45.4% to 76.5%, and in self-rated preparedness from 25.1% to 83.8%. All three measures showed statistically significant improvement, P

The rupture of hepatocellular carcinoma (rHCC) is uncommon but causes sudden life-threatening bleeding. Selective transarterial embolization (STAE) is an effective bleeding-control option. The optimal embolic agent is unknown, and data on the use of cyanoacrylate glue are lacking. The objective of this study was to report the outcomes of cyanoacrylate-lipiodol embolization for rHCC. We retrospectively reviewed the files of the 16 patients (14 males; mean age, 72 years) who underwent emergency cyanoacrylate-lipiodol STAE at a single center in 2012–2023 for spontaneous rHCC. All 16 patients had subcapsular HCC and abundant hemoperitoneum. The technical success rate was 94% (15/16). Day 30 mortality was 19%; the three patients who died had severe hemodynamic instability at admission; one death was due to rebleeding. Liver enzyme levels returned to baseline by day 30. No rebleeding was recorded during the median follow-up of 454 days in the 10 patients who were alive with available data after day 30. Larger prospective studies with the collection of longer-term outcomes are needed to assess our results supporting the safety and effectiveness of cyanoacrylate-lipiodol STAE for rHCC. Randomized trials comparing this mixture to other embolic agents should be performed. [ABSTRACT FROM AUTHOR]

Objective: A kaolin-based nonresorbable hemostatic gauze, QuikClot Control+, has demonstrated effective hemostasis and safety when used for severe/life-threatening (grade 3/4) internal organ space bleeding. We evaluated the efficacy and safety of this gauze for mild to moderate (grade 1-2) bleeding in cardiac surgery compared with control gauze. Methods: This was a randomized, controlled, single-blinded study of patients who underwent cardiac surgery between June 2020 and September 2021 across 7 sites with 231 subjects randomized 2:1 to QuikClot Control+ or control. The primary efficacy end point was hemostasis rate (ie, subjects achieving grade 0 bleed) through up to 10 minutes of bleeding site application, assessed using a semiquantitative validated bleeding severity scale tool. The secondary efficacy end point was the proportion of subjects achieving hemostasis at 5 and 10 minutes. Adverse events, assessed up to 30 days postsurgery, were compared between arms. Results: The predominant procedure was coronary artery bypass grafting, and 69.7% and 29.4% were sternal edge and surgical site (suture line)/other bleeds, respectively. Of the QuikClot Control+ subjects, 121 of 153 (79.1%) achieved hemostasis within 5 minutes, compared with 45 of 78 (58.4%) controls (P

Biopsies and excisions of mucosal surfaces can be challenging due to poor visualization and bleeding control. Surgeons have utilized chalazion clamps to overcome these challenges. However, its original design incorporates a locking mechanism which restricts its use to more proximal mucosal surfaces, does not allow for flexible exertional pressure control by the operator, and it is only available in one size. We designed a modified chalazion clamp without a locking mechanism and in two different sizes and ring diameters to overcome these challenges. In this report, we demonstrate the enhanced utility and effectiveness of the modified chalazion clamp in dermatological procedures through different cases. [ABSTRACT FROM AUTHOR]

BACKGROUND: We developed a culturally-adapted program (WE Stop the Bleed) to increase bleeding control knowledge and self-efficacy among Somali individuals, and to build trust between Somali individuals and first responders. METHODS: WE Stop the Bleed was piloted in the Seattle Somali community with first responders as skills coaches. The program included: 1) adapted ACS Stop the Bleed program; 2) cultural exchange. We evaluated knowledge, self-efficacy, and trust between Somali participants and first responders using a pre/post survey. RESULTS: Attendance exceeded a priori goals (27 community participants, 13 first responders). 96% of participants would recommend the training. Knowledge and self-efficacy improved pre/post (62%-72%, 65%-93% respectively). First responders indicated increased comfort with Somali individuals, and participants reported positive changes in perceptions of first responders. CONCLUSIONS: WE Stop the Bleed is a feasible and acceptable program to increase bleeding control knowledge and self-efficacy among participants and build trust between participants and first responders.

Introduction: Blood loss management in craniotomy is essential for a patient's haemodynamic stability and a significantly better view of the surgical site. The study aimed to address the comparative efficacy of labetalol (LAB), remifentanil (REM) and dexmedetomidine (DXM) on the bleeding control during the craniotomy procedure. Materials and Methods: In a double-blind trial, ninety patients eligible for undergoing craniotomy were recruited and assigned to DXM, LAB and REM groups by the block-randomised method. The vital signs, including heart rate (HR), mean arterial pressure, and oxygen saturation (SaO2) after induction and during the hypotension phase every 15 min until the end of surgery and at recovery and certain time points (2, 4 and 6 h post-operative), were recorded. The amount of bleeding, surgeon satisfaction and dose of propofol used, side effects and haemoglobin level before and 12 h after surgery were registered. Data analysis was conducted using the SPSS software by one-way analysis of variance, repeated measurement test and Chi-square test at a significance level of 0.05. Results: No significant difference was found in vital signs, including SaO2, blood pressure, HR, duration of surgery, extubation time and the amount of propofol consumed, side effects and haemoglobin level (P > 0.05). Nevertheless, the DXM group showed a prolonged recovery time (P = 0.018), less bleeding (P = 0.001) and the highest surgeon satisfaction (P = 0.001) when compared with other groups. Conclusion: Our results showed that DXM helps increase surgeon satisfaction and reduce bleeding while increasing the recovery time. Overall, it does, however, have improved performance without any side effects, based on which DXM can hence be recommended to be used to control bleeding during craniotomy.

Abstract Background The paucity of literature on surgical outcomes of Jehovah’s Witness (JW) patients undergoing lung resection suggests some patients with operable lung cancers may be denied resection. The aim of this study is to better understand perioperative outcomes and long-term cancer survival of JW patients undergoing lung resection. Methods All pulmonary resections in JW patients at one institution from 2000 through 2020 were examined. Demographics, comorbidities, operative parameters, and perioperative outcomes were reviewed. Among operations performed for primary non-small cell lung cancer (NSCLC), details regarding staging, extent of resection, additional therapies, recurrence, and survival were abstracted. Results Seventeen lung resections were performed in fourteen patients. There were nine anatomic resections and eight wedge resections. Fourteen resections (82%) were approached thoracoscopically, of which 3 of 6 anatomic resections were converted to thoracotomy as compared to 1 of 8 wedge resections. There was one (6%) perioperative death. Ten resections in 8 patients were performed for primary pulmonary malignancies, and two patients underwent procedures for recurrent disease. Median survival for resected NSCLCs (N = 7) was 65 months. Three of 6 patients who survived the immediate perioperative period underwent additional procedures: 2 pulmonary wedge resections for diagnosis and one pleural biopsy. Conclusions This series of JW patients undergoing lung resections demonstrates that resections for cancer and inflammatory etiologies can be performed safely in the setting of both primary and re-operative procedures.

Sterile silicone ring tourniquets (SSRTs) reduce intraoperative bleeding and provide a wide surgical view. Moreover, they reduce the risk of contamination and are cheaper than conventional pneumatic tourniquets. Our study describes the perioperative outcomes of sterile silicone ring tourniquet placement in pediatric patients undergoing orthopedic surgery. We prospectively recruited 27 pediatric patients aged < 18 years who underwent 30 orthopedic surgeries between March and September 2021. Following complete surgical draping, all operations were initiated by placing SSRTs. We investigated the demographic and clinical characteristics of these patients, details of the tourniquet used, and intra- and postoperative outcomes of tourniquet placement. Owing to the narrowness of tourniquet bands and tourniquet placement at the proximal ends of the extremities, wide surgical fields were achieved, without limiting joint range of motion. Bleeding control was effective. Tourniquets were applied and removed rapidly and safely, regardless of limb circumference. None of the patients experienced postoperative pain, paresthesia, skin problems at the application site, surgical site infections, ischemic problems, or deep vein thrombosis. SSRTs effectively reduced intraoperative blood loss and facilitated wide operative fields in pediatric patients with various limb sizes. These tourniquets allow quick, safe, and effective orthopedic surgery for pediatric patients. [ABSTRACT FROM AUTHOR]

Introduction: Blood loss management in craniotomy is essential for a patient's haemodynamic stability and a significantly better view of the surgical site. The study aimed to address the comparative efficacy of labetalol (LAB), remifentanil (REM) and dexmedetomidine (DXM) on the bleeding control during the craniotomy procedure. Materials and Methods: In a double-blind trial, ninety patients eligible for undergoing craniotomy were recruited and assigned to DXM, LAB and REM groups by the block-randomised method. The vital signs, including heart rate (HR), mean arterial pressure, and oxygen saturation (SaO2) after induction and during the hypotension phase every 15 min until the end of surgery and at recovery and certain time points (2, 4 and 6 h post-operative), were recorded. The amount of bleeding, surgeon satisfaction and dose of propofol used, side effects and haemoglobin level before and 12 h after surgery were registered. Data analysis was conducted using the SPSS software by one-way analysis of variance, repeated measurement test and Chi-square test at a significance level of 0.05. Results: No significant difference was found in vital signs, including SaO2, blood pressure, HR, duration of surgery, extubation time and the amount of propofol consumed, side effects and haemoglobin level (P > 0.05). Nevertheless, the DXM group showed a prolonged recovery time (P = 0.018), less bleeding (P = 0.001) and the highest surgeon satisfaction (P = 0.001) when compared with other groups. Conclusion: Our results showed that DXM helps increase surgeon satisfaction and reduce bleeding while increasing the recovery time. Overall, it does, however, have improved performance without any side effects, based on which DXM can hence be recommended to be used to control bleeding during craniotomy. [ABSTRACT FROM AUTHOR]

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Background: In Germany, current school-based first aid training recommendations do not include children under 13 years. Our aim was therefore to evaluate a primary school-based first aid course for children aged 6–13 years. Methods: Our 2-day course (4 hours per day) for primary schools in the German rural state Brandenburg included basic elements of scene safety, compression bandages, recovery position, and resuscitation. The evaluation of specific knowledge and skills took place 1-day post-course. Results: Among the 1,268 included children (median age 9y, 49% girls) from six primary schools, 25% had previously attended first aid courses. Most children knew emergency phone number(s) pre-course. Afterward, this knowledge improved by 15% in the 6–7-year age group (reaching 80%) whereas it remained at 90% in children aged 8–13 years. After the course, about 80% of the 8–13-year-old children (40% in 6–7-year age group) answered at least one resuscitation question correctly. In the practical skill assessments, about 80% of the 8–13-year-old children (60% in the 6–7-year age group) chose a correct or almost-correct chest compression rate during resuscitation. The correct depth of compression was achieved by about 80% (10–13 years), 60% (8–9 years), and 40% (6–7 years). Three-quarters successfully put another child in the recovery position; more than two-thirds applied a compression bandage appropriately. Conclusions: A 2-day course in a primary school setting showed considerable improvement in first aid and resuscitation skills of children aged 6–13 years. Future studies should examine these effects’ sustainability and the appropriate timing for refresher courses. Zusammenfassung Hintergrund: In Deutschland umfassen die aktuellen schulbasierten Erste-Hilfe-Schulungsempfehlungen keine Kinder unter 13 Jahren. Unser Ziel war es daher, einen Erste-Hilfe-Kurs für Grundschulen zu evaluieren. Material und Methode: Unser zweitägiger Kurs (4 Stunden pro Tag) für Grundschulen im Bundesland Brandenburg umfasste Basiselemente der eigenen Sicherheit am Unfallort, Kompressionsverbände, stabile Seitenlage und Wiederbelebung. Nach der Basiserhebung kurz vor Schulungsbeginn fand die Evaluation spezifischer Kenntnisse (mit Fragebogen) und Fertigkeiten einen Tag nach dem Kurs statt. Ergebnisse Unter den 1.268 eingeschlossenen Kindern (Altersmedian 9 Jahre, 49% Mädchen) von sechs Grundschulen hatten 25% bereits früher an einem Erste-Hilfe-Kurs teilgenommen. Die meisten Kinder kannten vor dem Kurs bereits die Notrufnummer(n). Danach verbesserte sich dieses Wissen um 15% und erreichte 80% in der Altersgruppe der 6-7-Jährigen, während es bei älteren Kindern (8-13 Jahre) bei 90% blieb. Nach dem Kurs beantworteten 40% der 6-7-Jährigen und etwa 80% der 8-13-jährigen Kinder mindestens eine Frage zur Reanimation richtig. Bei den Bewertungen der praktischen Fertigkeiten wählten 60% der 6-7-Jährigen und etwa 80% der 8-13-jährigen Kinder während der Wiederbelebung die korrekte oder nahezu korrekte Rate der Kompression des Brustkorbs aus. Die richtige Kompressionstiefe wurde von 40% (6-7 Jahre), 60% (8-9 Jahre) und etwa 80% (10-13 Jahre) erreicht. Drei Viertel der Teilnehmenden setzten erfolgreich ein anderes Kind in die Stabile Seitenlage; mehr als zwei Drittel legten einen Kompressionsverband angemessen an. Schlussfolgerungen Ein zweitägiger Kurs in der Grundschule führte in allen Altersgruppen von 6-13 Jahren zu einer deutlichen Verbesserung ihrer Kenntnisse in Erster-Hilfe und Fähigkeiten bei der Wiederbelebung. Zukünftige Studien sollten die Nachhaltigkeit dieser Effekte und den geeigneten Zeitpunkt für Auffrischungskurse untersuchen. Streszczenie Tło Obecne zalecenia dotyczące szkolenia z pierwszej pomocy w niemieckich szkołach nie obejmują dzieci poniżej 13 roku życia. Naszym celem było zatem ocenienie kursu pierwszej pomocy dla dzieci w wieku od 6 do 13 lat prowadzonego w szkole podstawowej. Metody Nasz dwudniowy kurs (4 godziny dziennie) dla szkół podstawowych na obszarach wiejskich w niemieckim kraju związkowym Brandenburgia obejmował podstawowe elementy bezpieczeństwa w miejscu zdarzenia, bandażowanie uciskowe, pozycję bezpieczną i resuscytację. Ocena konkretnych umiejętności i wiedzy odbyła się dzień po zakończeniu kursu. Wyniki Wśród 1268 uwzględnionych dzieci (średni wiek 9 lat, 49% dziewczyn) z sześciu szkół podstawowych, 25% uczestniczyło wcześniej w kursach pierwszej pomocy. Większość dzieci przed kursem znała już numer(y) alarmowy. Po kursie wiedza ta poprawiła się o 15% w grupie wiekowej 6-7 lat (osiągając 80%), podczas gdy w grupie wiekowej 8-13 lat pozostała na poziomie 90%. Po kursie około 80% dzieci w wieku od 8 do 13 lat (40% w grupie wiekowej 6-7 lat) poprawnie odpowiedziało na co najmniej jedno pytanie dotyczące resuscytacji. W ocenach praktycznych umiejętności, około 80% dzieci w wieku od 8 do 13 lat (60% w grupie wiekowej 6-7 lat) wybrało właściwe lub prawie właściwe tempo ucisków klatki piersiowej podczas resuscytacji. Prawidłowa głębokość ucisków była osiągana przez około 80% (w wieku od 10 do 13 lat), 60% (w wieku od 8 do 9 lat) i 40% (w wieku od 6 do 7 lat). Trzy czwarte dzieci skutecznie ułożyło inne dziecko w pozycji bezpiecznej, a ponad dwie trzecie odpowiednio zastosowało bandaż uciskowy. Wnioski Dwudniowy kurs przeprowadzony w szkole podstawowej wykazał znaczną poprawę umiejętności pierwszej pomocy i resuscytacji u dzieci w wieku od 6 do 13 lat. W przyszłych badaniach należy zbadać trwałość tych efektów oraz odpowiedni czas na odświeżenie wiedzy pozyskanej na kursach. Schlüsselwörter: Grundschule, Erste Hilfe, Wiederbelebung, Laienschulung, Schulkinder, Schüler, Basisreanimation, Klassenzimmer, Blutungsstillung, Kompressionsverband, Stabile Seitenlage, Wiederbelebung, Laien-Wiederbelebung Słowa kluczowe: szkoła podstawowa, pierwsza pomoc, resuscytacja, szkolenie dla laików, dzieci szkolne, uczniowie

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a tool used in the management of hemorrhagic shock in trauma patients. REBOA has also been proposed as an option for non-traumatic hemorrhage, such as gastrointestinal (GI) hemorrhage. In this case report, the use of a partial REBOA (p-REBOA) for a patient with an acute upper GI hemorrhage is presented as a management strategy to temporize bleeding. Methods: Case information was obtained from the electronic medical record at the University Medical Center in New Orleans. Results: A 46-year-old woman presented to the Emergency Department with concern for an upper GI bleed. The patient was tachycardic on presentation and then quickly became unresponsive. Massive transfusion protocol was initiated and a p-REBOA catheter was placed in Zone 1. After the REBOA was inflated 20 mL in 2 mL increments, the patient’s blood pressure improved, while maintaining distal perfusion. An exploratory laparotomy, with an angiogram once the patient had been stabilized, was planned. Despite resuscitative efforts for more than 2 hours, the patient progressed to cardiac arrest and did not have return of spontaneous circulation. Conclusions: This case report describes the use of p-REBOA in Zone 1 to control hemorrhage in a patient with a suspected upper GI bleed. This strategy could be utilized in patients with suspected non-traumatic hemorrhage in order to control bleeding temporarily and allow for ongoing resuscitation and stabilization of a patient prior to definitive treatment.

Background: The paucity of literature on surgical outcomes of Jehovah's Witness (JW) patients undergoing lung resection suggests some patients with operable lung cancers may be denied resection. The aim of this study is to better understand perioperative outcomes and long-term cancer survival of JW patients undergoing lung resection.Methods: All pulmonary resections in JW patients at one institution from 2000 through 2020 were examined. Demographics, comorbidities, operative parameters, and perioperative outcomes were reviewed. Among operations performed for primary non-small cell lung cancer (NSCLC), details regarding staging, extent of resection, additional therapies, recurrence, and survival were abstracted.Results: Seventeen lung resections were performed in fourteen patients. There were nine anatomic resections and eight wedge resections. Fourteen resections (82%) were approached thoracoscopically, of which 3 of 6 anatomic resections were converted to thoracotomy as compared to 1 of 8 wedge resections. There was one (6%) perioperative death. Ten resections in 8 patients were performed for primary pulmonary malignancies, and two patients underwent procedures for recurrent disease. Median survival for resected NSCLCs (N = 7) was 65 months. Three of 6 patients who survived the immediate perioperative period underwent additional procedures: 2 pulmonary wedge resections for diagnosis and one pleural biopsy.Conclusions: This series of JW patients undergoing lung resections demonstrates that resections for cancer and inflammatory etiologies can be performed safely in the setting of both primary and re-operative procedures. [ABSTRACT FROM AUTHOR]

Introduction: Hemorrhagic shock requires immediate treatment to prevent mortality and organ dysfunction. This study evaluates the efficacy of methylene blue (MB) with blood transfusion (BT) as a potential rescue therapy in acute severe bleeding in pigs., Methods: Thirty animals were randomly assigned to one of six groups following the induction of fixed-pressure hemorrhagic shock, after reaching a mean arterial pressure (MAP) of 55 mmHg - Group 1 (60 BT: BT after 60 minutes), Group 2 (60 MB: MB infusion after 60 minutes), Group 3 (60 MB + BT: MB and BT after 60 minutes), Group 4 (15 MB + BT: MB and BT after 15 minutes), Group 5 (15 BT + 60 MB: BT after 15 minutes and MB infusion after 60 minutes), and Group 6 (15 MB + 60 BT: MB infusion after 15 minutes and BT after 60 minutes). Hemodynamic and blood gas parameters were meticulously recorded, reversal of the shock was considered when MAP reached 90% of the baseline MAP., Results: Except for Group 2, all groups reverted from the shock. However, groups that received MB in combination with BT, specifically Groups 3 and 4, exhibited statistically significant higher ratios of maximum MAP to baseline MAP., Conclusion: Using MB concomitant with BT allowed the reversal of hemorrhagic shock with higher median arterial pressure levels compared to BT alone or applying MB separately from BT. This suggests that simultaneous application of MB and BT could be a more effective strategy for reversing the effects of severe acute bleeding.

Abstract Introduction First aid performed by immediate responders can be the difference between life and death in the case of trauma with massive bleeding. To develop effective training programs to teach bleeding control to laypersons, it is important to be aware of beliefs and misconceptions people hold on bleeding and severity of bleeding situations. Method A controlled study was conducted in which 175 American college students viewed 78 video clips of simulated bleeding injuries. The volume of blood present (between 0 and 1900 ml), rate of blood flow, and victim gender were systematically varied within participants. Participants were asked to rate injury severity, indicate the appropriate first aid action, and estimate the amount of time until death for the victim. Results Though the Stop the Bleed® campaign recommends training laypeople to treat 165 ml of blood loss as life threatening, participants largely rated this volume of blood loss as minimal, mild, or moderate and estimated that the victim had just under one hour to live. Increased blood loss was associated with increased recommendations to use a tourniquet. However, in the 1900 ml conditions, participants still estimated that victims had around 22 minutes to live and approximately 15% recommended direct pressure as the intervention. Severity ratings and recommendations to use a tourniquet were also higher for the male victim than the female victim. Conclusions Injury classification, intervention selection, and time to death-estimations revealed that training interventions should connect classifications of blood loss to appropriate action and focus on perceptions of how much time one has to respond to a bleeding. The study also revealed a gender related bias in terms of injury classification and first aid recommendations. Bleeding control training programs can be designed to address identified biases and misconceptions while building on existing knowledge and commonly used terminology.

Desmopressin is a synthetic analogue of vasopressin and a selective vasopressin receptor 2 agonist. It was first synthesised in 1967 and utilised for its antidiuretic properties. It is also used in bleeding disorders to enhance clotting. Other potential uses of the drug have been reported. The present review aims to provide a broad overview of the literature on potential further uses of oral forms of desmopressin. Key therapeutic areas of interest were identified based on known physiological activities/targets of desmopressin or reports of an effect of desmopressin in the literature. The feasibility of adequate dosing with oral forms of the drug was also considered. Systematic literature searches were carried out using the silvi.ai software for the identified areas, and summaries of available papers were included in tables and discussed. The results of the searches showed that desmopressin has been investigated for its efficacy in a number of areas, including bleeding control, renal colic, the central nervous system and oncology. Evidence suggests that oral desmopressin may have the potential to be of clinical benefit for renal colic and bleeding control in particular. However, further research is needed to clarify its effect in these areas, including randomised controlled studies and studies specifically of oral formulations (and doses). Further research may also yield findings for cancer, cognition and overactive bladder. [ABSTRACT FROM AUTHOR]

The continuous advances in surgical procedures require continuous research regarding materials with surgical applications. Biopolymers are widely studied since they usually provide a biocompatible, biodegradable, and non-toxic material. Among them, chitosan is a promising material for the development of formulations and devices with surgical applications due to its intrinsic bacteriostatic, fungistatic, hemostatic, and analgesic properties. A wide range of products has been manufactured with this polymer, including scaffolds, sponges, hydrogels, meshes, membranes, sutures, fibers, and nanoparticles. The growing interest of researchers in the use of chitosan-based materials for tissue regeneration is obvious due to extensive research in the application of chitosan for the regeneration of bone, nervous tissue, cartilage, and soft tissues. Chitosan can serve as a substance for the administration of cell-growth promoters, as well as a support for cellular growth. Another interesting application of chitosan is hemostasis control, with remarkable results in studies comparing the use of chitosan-based dressings with traditional cotton gauzes. In addition, chitosan-based or chitosan-coated surgical materials provide the formulation with antimicrobial activity that has been highly appreciated not only in dressings but also for surgical sutures or meshes. [ABSTRACT FROM AUTHOR]

Objective: To compare tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA) in patients undergoing cardiac surgery with cardiopulmonary bypass. Methods: Over a consecutive 2-year period, 824 adult cardiac surgery patients who received TXA during an EACA shortage were compared with 778 patients who received EACA postshortage. Patient characteristics and process and outcome variables were collected through chart review and database queries. This retrospective analysis used inverse probability of treatment weighting to control for confounding by indication, and propensity scores were calculated using a logistic regression model. Results: In adjusted models, overall transfusion rates for the TXA cohort (odds ratio [OR], 0.94; 95% confidence interval [95% CI], 0.81-1.10) and administration of platelets (OR, 1.04; 95% CI, 0.85-1.27), red blood cells (OR, 0.93; 95% CI, 0.80-1.09), fresh frozen plasma (OR, 1.00; 95% CI, 0.79-1.25), and cryoprecipitate (OR, 1.08; 95% CI, 0.71-1.64) were equivalent to the EACA cohort. In addition, there was no statistical difference with respect to stroke, seizure, mortality, reoperation for bleeding, chest tube drainage, and acute kidney injury. Patients who received TXA had shorter ventilator times (difference in medians −1.33 hours [95% CI, −1.86 to −0.80]) and lower postsurgical charges (difference of medians −$2913 [95% CI, −5147 to −679]). Conclusions: Substituting TXA for EACA during cardiac surgery with cardiopulmonary bypass did not change transfusion rate or amount, nor was there a significant difference in chest tube drainage. Patients who received TXA had a statistically significant but not clinically significant lower postoperative ventilator times and charges without an increase in mortality, stroke, reoperation for bleeding, acute kidney injury, or seizures.

Amaç: Total diz artroplastisi(TDA) sonrası kan kaybını, hemoglobin düşüklüğünü, kan transfüzyon ihtiyacını ve hastanede kalış süresini azaltmak için traneksamik asit (TXA)’ in topikal uygulamasındaki etkinliğini değerlendirmektir.Yöntem: Total diz artroplastisi yapılan 40 hasta, 59-83 yaşları arasından seçilmiştir. VAS 7’ nin üzerinde, Ahlback evre 4-5 ve ASA 1. ve 2. grup olan hastalar çalışmaya dahil edilmiştir. Ameliyatlar aynı cerrah ve standart medial parapatellar artrotomi ile aynı marka implantlar kullanılarak yapılmıştır. Ameliyat boyunca turnike sadece sementleme aşamasında kullanılmıştır. Koagülopati, pulmoner emboli, akut myokard enferktüsü, beyin felci, kronik arter hastalığı hikayesi olanlar ve hemoglobin seviyesi 10 g/dl nin altında olan hastalar çalışmaya alınmamıştır. Hastalar 2 gruba ayrıldı. Grup A’ daki hastalara artrotomi kapatıldıktan sonra 4 ampül 250 mg %10 TXA salin ile seyreltilerek diz eklemine enjekte edildi. 2 saat boyunca dren kapalı tutuldu. Grup B’ deki hastalarda TXA kullanılmadı. Drenler 48. Saat sonunda çekildi. Kan hemoglobin değerleri 8 g/dl’ nin altına düşmedikçe kan transfüzyonu yapılmadı. Hastalar ko-morbiditeleri açısından da değerlendirmeye alındı.Bulgular: 40 hastanın 8 (%20)’ ine kan transfüzyonu yapıldı. Bunların 6 (%75)’ sı TXA kullanılmayan Grup B’ deki hastalar idi. Grup A’ da sadece hastaların 2 (%10)’ sine kan trasfüzyonu yapıldı. Grup B’ deki kan trasfüzyonu yapılan hastaların 1 tanesine 2 ünite kan replase edilmiştir. Ameliyat sonrası ilk 24 saatteki kan drenaj miktarlarına bakıldığında Grup A’ da 232,5 cc, Grup B’ de 407,75 cc idi. 48. saat sonundaki toplam drenaj miktarına bakıldığında Grup A’ da 370,5 cc, Grup B’ de 552,2 cc olarak görüldü. Ameliyat sırasında ortalama kanama miktarı Grup A’ da 247,5 cc, Grup B’ de 235 cc idi. Ameliyat öncesi ortalama hemoglobin değeri Grup A’ da 13 g/dl iken Grup B’ de 12,75 g/dl idi. Ameliyattan sonraki 6. Saatte alınan hemoglobin değeri Grup A’ da 11,7, Grup B’ de 11 g/dl olarak gözlendi. Ameliyat sonrası ilk 24. saatteki hemoglobin değerleri Grup A’ da 11,07 iken Grup B’ de 10,6 idi. 48. saatteki hemoglobin değerleri Grup A’ da 10,3 iken Grup B’ de 9,5 olarak gözlendi. Postop dönemdeki hemoglobin değişim seviyelerine ve drenaj miktarlarına bakıldığında TXA kullanılan grupta özellikle ilk 24. saatteki drenaj miktarında diğer gruba oranla önemli bir azalma olduğu gözlemlenmiştir.Çıkarımlar: Total diz artroplastisinde traneksamik asit kullanımı postoperatif kanama miktarını anlamlı şekilde azaltır. TXA' nın intravenöz yerine eklem içi olarak uygulanmasıyla sistemik absorpsiyon azaltılabilir ve istenmeyen yan etkiler hafifletilebilir. Bu çalışmanın bulguları toplam kan kaybında ve hemoglobin seviyelerindeki azalmada bir düşüş olduğunu ve dolayısıyla kan transfüzyonu ihtiyacını azalttığını göstermiştir.

The use of oral gauze is a quick, cheap, and effective method of preventing bleeding into the patient's mouth during dermatologic surgery. We recommend this technique combined with appropriate positioning for lesions in the perioral and perinasal regions. Similar approaches may be applied for the prevention of bleeding into the ear canal during facial/periauricular surgery.

Introduction Intraoperative and postoperative bleeding in total knee arthroplasty (TKA) affects postoperative outcomes. Although the hemostatic effect of a flowable gelatin hemostatic matrix (FGHM) is known across several surgical fields, its effectiveness on TKA remains controversial. This study aimed to compare the amount of bleeding across three groups treated with different doses of FGHM in TKA. Methods Overall, 122 knee joints of patients who underwent unilateral primary TKA were included and divided into three groups according to FGHM dose: absence of FGHM (control group, N=48), administration of 5 mL of FGHM (5 mL group, N=46), and administration of 8 mL of FGHM (8 mL group, N=38). Total hemoglobin (Hb) loss, drain output, hidden blood loss (HBL), calculated total blood loss (TBL) on the first postoperative day (POD1) and one week postoperatively (POD7), postoperative flexion angle at one week and discharge, and incidence of postoperative deep venous thrombosis (DVT) were assessed. Results At POD1, the mean total Hb losses were 6.3±3.1g (control group), 5.5±3.3g (5 mL group), and 5.3±2.5g (8 mL group), with no significant differences. At POD7, the mean Hb losses were 9.1±4.6g (control), 8.7±3.6g (5 mL), and 8.3±4.0g (8 mL), also with no significant differences. Mean drain outputs and HBLs showed no significant differences among groups. While there was a decreasing trend in TBL with higher FGHM doses, it was not statistically significant at either POD1 or POD7. There were no statistically significant differences in the mean postoperative flexion angle at POD7 or discharge among the groups (99.7±12.6°, 95.7±12.5°, 98.3±13.8° at POD7; 115.9±9.7°, 113.8±9.6°, 116.6±9.2° at discharge). Of these, only one patient in the 8 mL group developed proximal DVT. Conclusion Despite a trend towards decreased bleeding with FGHM, no significant differences were found among the three groups. However, the clinical utility of this hemostatic agent for reducing blood loss after primary TKA remains still unclear., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The Institutional Review Board of Oita University Hospital issued approval No. 1850. Informed consent was obtained in the form of an opt-out. The need for informed consent from individual patients was waived by the ethics committee of our institution. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Matsuda et al.)

Introduction: Road Traffic Injuries (RTI) are one of the toughest public health challenges confronting India. An estimated 40% of RTI deaths are due to uncontrolled bleeding. Stopping the bleeding in the first few minutes is crucial for meaningful survival considering the delays between the RTI and definitive trauma care. Our objective was to develop and implement a lay first responder Active Bleeding Control (ABC) program to help RTI victims along two high risk corridors using simulation methodology. Methods: ABC is a multi-partner collaboration pilot program with government and non-governmental agencies. Therefore, using EMS and Police geolocation data, two corridors of 50 kms of highway with high risk of RTI were identified in Medchal district (population 2.5 million) near Hyderabad city, India. In depth interviews with 22 potential lay first responders were conducted in 2019 to understand the barriers for helping RTI victims. Simulation training modules were developed using a step-by-step scenario script and a 90-min curriculum including a video. A low cost ‘stop the bleed kit’ was developed and distributed among volunteers. Data collection to capture use cases, barriers and facilitators to program success is ongoing. Results: All 22 respondents reported having witnessed many life-threatening RTI in the area, and had no previous knowledge, training or skills in bleeding control. 1005 ABC volunteers have now been simulation trained to stop the bleed. Of these, 162 have self-reported helping RTI victims on the selected highway corridors. The ABC pilot program shows that by training lay first responders to assess and arrest bleeding, passive RTI “by-standers” can be converted into active “try-standers”. Conclusion: The ABC program has the potential to create a much-needed community of trained citizens to help save lives from RTI in India.

Introduction: First aid performed by immediate responders can be the difference between life and death in the case of trauma with massive bleeding. To develop effective training programs to teach bleeding control to laypersons, it is important to be aware of beliefs and misconceptions people hold on bleeding and severity of bleeding situations.Method: A controlled study was conducted in which 175 American college students viewed 78 video clips of simulated bleeding injuries. The volume of blood present (between 0 and 1900 ml), rate of blood flow, and victim gender were systematically varied within participants. Participants were asked to rate injury severity, indicate the appropriate first aid action, and estimate the amount of time until death for the victim.Results: Though the Stop the Bleed® campaign recommends training laypeople to treat 165 ml of blood loss as life threatening, participants largely rated this volume of blood loss as minimal, mild, or moderate and estimated that the victim had just under one hour to live. Increased blood loss was associated with increased recommendations to use a tourniquet. However, in the 1900 ml conditions, participants still estimated that victims had around 22 minutes to live and approximately 15% recommended direct pressure as the intervention. Severity ratings and recommendations to use a tourniquet were also higher for the male victim than the female victim.Conclusions: Injury classification, intervention selection, and time to death-estimations revealed that training interventions should connect classifications of blood loss to appropriate action and focus on perceptions of how much time one has to respond to a bleeding. The study also revealed a gender related bias in terms of injury classification and first aid recommendations. Bleeding control training programs can be designed to address identified biases and misconceptions while building on existing knowledge and commonly used terminology. [ABSTRACT FROM AUTHOR]

The continuous advances in surgical procedures require continuous research regarding materials with surgical applications. Biopolymers are widely studied since they usually provide a biocompatible, biodegradable, and non-toxic material. Among them, chitosan is a promising material for the development of formulations and devices with surgical applications due to its intrinsic bacteriostatic, fungistatic, hemostatic, and analgesic properties. A wide range of products has been manufactured with this polymer, including scaffolds, sponges, hydrogels, meshes, membranes, sutures, fibers, and nanoparticles. The growing interest of researchers in the use of chitosan-based materials for tissue regeneration is obvious due to extensive research in the application of chitosan for the regeneration of bone, nervous tissue, cartilage, and soft tissues. Chitosan can serve as a substance for the administration of cell-growth promoters, as well as a support for cellular growth. Another interesting application of chitosan is hemostasis control, with remarkable results in studies comparing the use of chitosan-based dressings with traditional cotton gauzes. In addition, chitosan-based or chitosan-coated surgical materials provide the formulation with antimicrobial activity that has been highly appreciated not only in dressings but also for surgical sutures or meshes.

OBJECTIVE: Tranexamic acid (TXA) and the hemostatic agent Floseal® have already been used to minimize bleeding during total knee arthroplasty (TKA). METHODS: We conducted a prospective, randomized study of 90 patients with indications for TKA. Following inclusion, the participants were randomly allocated in blocks to the following 3 groups: control, Floseal® and TXA. Bleeding parameters, including decreases in hemoglobin (Hb), drain output, number of blood transfusions and complications, were assessed. ClinicalTrials.gov: NCT02152917. RESULTS: The mean decrease in Hb was highest in the control group (4.81±1.09 g/dL), followed by the Floseal® (3.5±1.03 g/dL) and TXA (3.03±1.2 g/dL) groups. The Floseal® and TXA groups did not differ, and both performed better than the control group. The mean total drain output was 901.3±695.7 mL in the control group, 546.5±543.5 mL in the TXA group and 331.2±278.7 mL in the Floseal® group. Both TXA and Floseal® had significantly less output than the control group, and Floseal® had significantly less output than TXA. The number of blood transfusions was very small in all 3 groups. CONCLUSION: The use of TXA or Floseal® was associated with less blood loss than that of the control group among patients undergoing primary TKA, as measured both directly (intraoperative bleeding + drainage) and on the basis of a decrease in Hb, without differences in the rate of complications. TXA and Floseal® showed similar decreases in Hb and total measured blood loss, but the drain output was smaller in the Floseal® group.

Background/aim: Vasopressin injected during myomectomy is known to effectively reduce bleeding but is sometimes associated with intraoperative vasoconstriction and hypertension due to systemic absorption. Although there is a growing preference for the use of diluted vasopressin, evidence of its effect and safety is still lacking., Patients and Methods: We performed a randomized controlled pilot trial to evaluate the effect and safety of vasopressin diluted in a constant volume during robot-assisted laparoscopic myomectomy (RALM), where a total of 39 women with uterine fibroids were randomly assigned into the following three groups (group 1, 0.2 IU/ml; group 2, 0.1 IU/ml; group 3, 0.05 IU/ml with a total of 100 ml of normal saline). The primary endpoint was to compare estimated blood loss (EBL), and the secondary endpoints were to compare postoperative value and drop ratio of hemoglobin, operation time, transfusion, hospitalization, and complications among the three groups., Results: There were no differences in the number and largest size of uterine fibroids, total weight of uterine fibroids, console time, and volumes of intravenous fluid administered during RALM among the three groups, whereas combined operation was performed more commonly in group 2 than in groups 1 and 3 (53.9% vs. 0 to 7.7%; p=0.01). The primary and secondary endpoints were also not different among the three groups. However, two patients in group 1 (15.4%) showed vasopressin-related hypertension., Conclusion: Vasopressin diluted in a volume of 100 ml showed an effective hemostatic effect and safety during RALM (Trial No. NCT04874246 in ClinicalTrial.gov)., (Copyright © 2024, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Objective: The use of epinephrine for controlling the blood loss has gained out in many dermatological surgeries; however, its use in liposuction has not been studied. In this regard, we aimed to figure out the effectiveness of using epinephrine in tumescent solution during liposuctions surgery. Methods: In this study, we present a prospective, double-blind, non-randomized study evaluating the effects of adding epinephrine to tumescent solution intraoperative in patients undergoing liposuction. Thirty-six patients including 6 males and 29 females undergoing liposuction were divided into two groups. In case group, we use 1-1.4 mg/L epinephrine (based on the location of surgery) in tumescent solution; and control group did not receive epinephrine. Lab data such as hemoglobin and hematocrit as well as clinical data including blood pressure and heart rate were recorded before, after 1 h, and 6 h of liposuction. Results: In this study, we observed that both case and control group faced a significant drop in their hemoglobin and hematocrit levels; however, the decrement was significantly lower in case group. In addition, both groups had a stable hemostasis after 1 h and 6 h of surgery. In this regard, we did not observe any significant difference between heart rate and blood pressure of two groups. Conclusion: The results of this study suggest that using epinephrine as vasoconstriction agent in tumescent solution might decrease the rate of bleeding and increase the chance of stable hemostasis both during and after abdominal liposuction. [ABSTRACT FROM AUTHOR]

Study Question: Does pre-treatment with a low dose of mifepristone improve irregular vaginal bleeding patterns during the initial 3 months after LNG-IUS placement?Summary Answer: Mifepristone treatment prior to LNG-IUS insertion results in significantly lower bleeding and spotting rates but no significant reduction post insertion.What Is Known Already: One of the leading causes of premature discontinuation of the LNG-IUS is unscheduled bleeding in the first months following its insertion. Up to now, there has been no effective treatment to prevent this side effect which reduces continuation rates for one of the most effective contraceptives.Study Design, Size, Duration: This randomized, double blinded, controlled trial was conducted between 2009 and 2015. In total, 68 women opting for a LNG-IUS were screened for eligibility, of whom 58 were randomized at a ratio of 1:1 in blocks of 10 to pre-treatment with mifepristone or a comparator. The main outcome was the rate of bleeding and spotting days reported during the first 3 months post LNG-IUS 52 mg placement.Participants/materials, Setting, Methods: Healthy women with regular and normal menstrual cycles aged 18-43 years were enrolled at a single center in a university hospital; 29 were allocated to 2 months pre-treatment with a low dose mifepristone and 29 to the comparator prior to insertion of the LNG-IUS. Women were advised to use barrier methods during the pre-treatment period. Bleeding diaries were collected for the pre-treatment period and for the first 6 months after the LNG-IUS placement.Main Results and the Role Of Chance: There were no differences in demographics or baseline characteristics between the study groups. Data for analysis of the main outcome were contributed by a per protocol population of 19 women per group. There was a significant lower bleeding and spotting rate in the mifepristone group (-17.8% points, P < 0.001) after 2 months of pretreatment but after the LNG-IUS insertion no significant difference could be seen. While no pregnancies occurred prior to LNG-IUS insertion in the mifepristone group, there were three unintended pregnancies in the comparator group which emphasizes the need for a reliable contraceptive potential in any pre-treatment regiment used in clinical practice.Limitations, Reasons For Caution: The use of mifepristone prior to the LNG-IUS insertion in this trial was used as prophylaxis against unscheduled bleeding after the placement of the device. Although this side effect constitutes a major concern in a clinical setting, only a subset of women are at risk. This is the first study using pre-treatment to attempt improved bleeding control. The differences were small and the effect was short lasting but the reduced rate of bleeding and spotting observed during the first month following LNG-IUS insertion, even though not statistically significant, indicates that this approach may be further explored. The fact that there were three pregnancies in the comparator group stresses the need for any pre-treatment to also protect against unplanned pregnancy.Wider Implications Of the Findings: Modified treatment protocols of mifepristone could be used prior to the LNG-IUS insertion to investigate possible further improvement of the outcome. The effect size of the current dose used might have been more prominent in women with LNG-IUS if the treatment also continued some weeks after the placement of the device. Although the low dose of mifepristone used in this trial is not available in Europe, other progesterone receptor modulators currently available could be investigated in larger clinical trials. To avoid unintended pregnancy in the pretreatment period, the dosage used should, ideally, also be effective for contraception and the pretreatment period should be kept as short as possible.Study Funding/competing Interest(s): This study was funded by the Swedish Research Council (2012-2844, 2017-00932), Stockholm County Council and Karolinska Institutet (ALF). Conflicts of interests for K.G.D. and H.K.K. are listed at the end of the paper. The other authors have no conflicts of interest.Trial Registration Number: EudraCT number 2009-009014-40. Regional ethical review board at Karolinska Institutet permit 2009/144-31/4.Trial Registration Date: 20 July 2009.Date Of First Patient’s Enrolment: 24 November 2009. [ABSTRACT FROM AUTHOR]

Abstract The bleeding control method and analysis of advantages, challenges on wavecatcher (inward turning) intakes are investigated in this paper. Firstly, a quantitative analysis on the substantial advantages of wavecatcher intakes for ramjet is presented comparing to two-dimensional planar symmetry compression. According to the results, with the same parameters in the entrance and exit section, the total pressure recovery of Internal Conical Flow of C increases by 28.0%; the compression surface length decreases by 5%; the wetted area decreases by 15.7% and the pressure drag decreases by 12.1%. However, due to high compressive efficiency of wavecatcher intake, the boundary layer experiences a higher adverse pressure gradient, contributing to enhance shock wave/boundary layer interaction (SBLI). Secondly, the effects of bleeding control on wavecatcher intake are elucidated by numerical simulations. The bleeding control improves the flow structures by decreasing the boundary layer thickness to weaken the SBLI and bleeding the spanwise vortex out. Furthermore, due to the weak interaction, the terminal shock wave is stable closely behind the throat section, increasing the resistance against the back pressure, decreasing the Mach number before the terminal shock wave and improving the total pressure recovery of the exit section by 3.73% relatively. Highlights • The qualitative and quantitative advantages of wavecatcher intake has been obtained. • The large numbers of challengeable APG zones have been found in inward-turning flowpath. • A bleeding control method on section-controllable wavecatcher intake has been designed. • The positive results by bleeding control to weaken SBLI in the wavecatcher intake has been obtained. [ABSTRACT FROM AUTHOR]

Surgicel® is bioabsorbable hemostatic mesh, frequently packed around oozing surgical bed. We report two morbidities due to it. Following transannular patch repair for Fallot′s tetralogy, Surgicel® was packed around distal main pulmonary artery. Echocardiography in the intensive care unit (ICU) showed right ventricular dysfunction due to extrinsic obstruction and complete occlusion of left pulmonary artery (LPA) flows. Another patient with arterial switch operation had postoperative fibrillatory cardiac arrest, needing resuscitation with internal cardiac massage. The arrest was triggered by coronary ischemia due to periaortic compression. Both instances were caused by hygroscopic nature of Surgicel®, which absorbed blood, swelled, and compressed the luminal tissues.

Background Arthroscopic anterior cruciate ligament (ACL) reconstruction is a common orthopedic surgery, and rehabilitation is very important to achieve successful postoperative results. Postoperative hemarthrosis causes pain and limitation of movement, which prolongs the rehabilitation period. For these reasons, various strategies are used to reduce hemarthrosis in patients undergoing ACL reconstruction. This study aimed to evaluate the effect of bleeding control after releasing the tourniquet in ACL reconstruction surgery on the amount of hemarthrosis and pain in the postoperative period. Methodology A total of 60 patients who underwent arthroscopic single-bundle ACL reconstruction were enrolled in this prospective randomized control study. Bleeding control with the radiofrequency (RF) probe after releasing the tourniquet was done at the end of the arthroscopic ACL reconstruction in 30 patients (coagulation group) while bleeding control was not done for the other 30 patients (control group). Both groups were compared in terms of the degree of hemarthrosis using the Coupens and Yates classification in the early postoperative period and the degree of pain using the Visual Analog Scale (VAS) score and postoperative complications. Results In both groups, isolated ACL reconstruction was performed in 10 patients, additional partial meniscectomy in three patients, and additional arthroscopic meniscus repair in 17 patients. There was no statistically significant difference between the coagulation and control groups in terms of VAS (p > 0.05) and the degree of hemarthrosis (p > 0.05). Although the duration of tourniquet application was similar in both groups (p = 0.78), the duration of anesthesia was significantly longer in the coagulation group (p = 0.001). There was no significant difference between the groups in terms of postoperative complications. Conclusions Bleeding control with the RF probe after tourniquet release does not yield superior outcomes. More research with larger populations is needed to confirm these findings., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Çimen et al.)

Background: Tourniquet efficacy for extremity hemorrhage is well established, although literature demonstrates variable first responder application efficacy. Several newer models, including the Smart Tactical Application Tourniquet (STAT, STAT Medical Devices, LLC, Freehold, New Jersey), offer alternatives to well-established devices like the Combat Application Tourniquet (CAT, C-A-T Resources, LLC, Rock Hill, South Carolina). Newer models are commercially sold without significant literature regarding efficacy or user feedback. We developed a pilot study to compare CAT and STAT applications for layperson hemorrhage control efficacy after a brief, standardized instructional video., Study Design and Methods: This is a prospective randomized observational study that utilized layperson volunteers for the application of STAT or CAT. After a demographic survey, volunteers were randomized and watched the respective tourniquet instructional video, then applied the tourniquet to a HapMed hemorrhage simulator. The application was assessed for trial time, time to hemorrhage control, occlusion pressure, and total blood loss. Investigators also evaluated volunteers for proper application and received user feedback., Results: Eighty-four total volunteers (42 CAT, 42 STAT) completed testing. Volunteers applied the CAT (50.0%, n = 21) with significantly greater rates of success than the STAT (0%, n = 0, p < 0.001). The CAT demonstrated significantly greater average occlusion pressure compared to the STAT (409.9 mm Hg vs. 116.5 mm Hg, p < 0.001). Similarly, CAT application resulted in significantly less average blood loss compared to the STAT (577.8 mL vs. 974.6 mL, p < 0.001). On the 5-point Likert scale, volunteers reported significantly higher benefits from video instruction and comfort with tourniquet application with the CAT over the STAT (4.7 vs. 4.0, p < 0.001, 4.0 vs. 2.4, p < 0.001)., Conclusions: When performed by laypersons with minimal video instruction, the CAT was applied with significantly higher rates of success, higher mean occlusion pressures, reduced blood loss, and higher end-user ratings than the STAT., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Gabbitas et al.)