Kurz vorgestellt: Tourniquets beim Boston Marathon

3 Tote, 264 Verletzte. Das Fazit des Wahnsinns der Brüder Zarnajew. Wir können daraus lernen, das Erkenntnisse aus der “militärischen Medizin” ihren Weg in den zivilen Bereich noch nicht ausreichend gefunden haben.Boston Marathon Explosions
Tourniquet use at the Boston Marathon bombing: Lost in translation
J Trauma Acute Care Surg; Volume 78, Number 3

The Boston Trauma Collaborative ist ein Netzwerk, das im Nachgang der Ereignisse vom 15. April 2013 eingerichtet wurde. In der Datenbank aller Level 1 Trauma Zentren Bostons wurden alle in diesen Zentren behandelten Verletzten des Anschlages erfasst.

243 der offiziell 264 Verletzen finden sich darin wieder.

Die meisten Verletzten wiesen, der Bauart der mit Kugellager-Kugel, Nägeln und Schwarzpulver gefüllten Druckkochtopf-Sprengsätze entsprechend, Verletzungen insbesondere der unteren Extremität auf.

bost1

bost2

Es wurden bei 15 Patienten traumatische Amputationen der unteren Extremität(en) beobachtet, sowie weitere 10 mit ausgedehnter Weichteilverletzung und Beteiligung der großen Beingefäße.

Lebensbedrohliche Extremitätenverletzungen sollten durch Unterbrechung der arteriellen Blutzufuhr durch Abbinden (Tourniquet) behandelt werden. Eine Methode, die so schon aus der Kriegsmedizin der Antike berichtet wird, und sich durch das gesamte “dunkle Mittelalter” als Therapieform in Europa erhielt.

Meistverbeitet ist das Combat Application Tourniquet (CAT). Die Anwendung eines CAT wird in YouTube Videos erläutert.

Von den insgesamt 66 Patienten mit Extremitätenverletzung wurden 29 (44%) als “aufgrund der Verletzung vom Verbluten bedroht” beurteilt (life-threatening exsanguination). Laut Datenbank sind insgesamt 27 Tourniquets zur Anwendung gebracht worden (teils mehrere bei einem Patienten), alle davon im provisiert.

bost3

94% der traumatisch amputierten Extremitäten waren durch ein solches versorgt, jedoch nur 42% der lebensbedrohlichen Blutungen aufgrund von Gefäßverletzungen. Das Problem der improvisierten Tourniquets ist die häufig unzureichende, rein venös-unterbindende Kompression mit paradoxer (arterieller) Blutung.

bost6

Im beschreibenen Szenario ist es zu keinen Todesfällen dadurch gekommen, jedoch ist das vollständige Fehlen eines lebensrettenden Medizinproduktes beachtenswert. Eine mittlere Transportzeit von 24 +/- 17 Minuten im Zentrum einer Millionen-Metropole mag ebenfalls dazu beigetragen haben.

 

bost4

 

Ein Bericht über die Folgen.

Fazit:

Die Autoren schließen mit der Feststellung, das ein im  militärischen Bereich in Kriesengebieten regelhaft angewandtes System seinen Weg in dern zivilen Bereich (ins “Homeland”) nicht gefunden hat, auf dem Weg der Übersetzung verloren gegangen sein muss…

Das Anlegen eines Tourniquet ist eine einfache und schnelle Maßnahme, die in der strukturierten Traumaversorgung als Erstmaßnahme noch vor dem strukturierten ABCD eine weitergehende Schädigung des Patienten verhindern kann und muss.

Injectable Polymer Helps Stop Severe Bleeding

blood-clot

A 3-D rendering of fibrin forming a blood clot, with PolySTAT (in blue) binding strands together. William Walker/University of Washington

There are new technologies out there that can help stop bleeding from gunshot wounds, a new approach may help deliver hemostasis on a microscopic scale. Researchers at the University of Washington have developed a new polymer that, when injected, rapidly works to help develop a solid clot.

The PolySTAT material works by fusing fibrin strands to each other and creating links between the clumps. This creates a strong web of fibrin capable of withstanding pressure from blood pressing against the clot. Importantly, the material is not influenced by fibrinolytic enzymes that break up fibrin strands to begin the healing process. While the enzymes are important in the long run, they slow down clot formation, a dangerous activity during acute bleeding. Moreover, the material continues to work even when levels of a protein used to make fibrin drop.

In a pre-clinical study using lab rats, the researchers showed a 100% success rate in stopping bleeding to an otherwise lethal injury to the femoral artery. For comparison, rats that were treated with albumin had only a 20% survival.

fibrin-cross-linking

Blood clots treated with PolySTAT (second from right) had denser fibrin networks, which helps reinforce and strengthen the clots. University of Washington

Study in Science Translational Medicine: A synthetic fibrin cross-linking polymer for modulating clot properties and inducing hemostasis…

Source: University of Washington…

The post Injectable Polymer Helps Stop Severe Bleeding appeared first on Medgadget.

Ultrasound and Microbubbles Seemingly Treat Alzheimer’s in Mice

ultrasound-for-alzheimer's

Microbubbles injected into the blood vibrate under ultrasound, temporarily forcing cells lining the blood-brain barrier apart. This may allow amyloid-fighting antibodies to slip into brain tissue (shown) or rouse cells that clean up the protein.

Ultrasound combined with microbubbles has been a promising new way of penetrating the blood-brain barrier (see flashbacks below). Once microbubbles are injected, an ultrasound probe is pointed toward the treatment site. As microbubbles pass through the ultrasound beam, they vibrate and deform in different ways, pushing on cells within the blood-brain barrier. This pushing and shoving seems to open up temporary passages in the barrier, allowing drugs to be pushed through that would otherwise have a next to zero chance of reaching the brain. In a new development, researchers now are finally showing that this technique may work in allowing neurological conditions to be treated with existing and future drugs that are naturally blocked by the blood-brain barrier.

The team from The University of Queensland in Australia have successfully removed amyloid plaque from the brain and restored memory in a mouse model of Alzheimer’s disease. They injected the mice with the microbubbles and swept the ultrasound beam across the entire brain. The treatment was repeated almost daily. After these treatments the mice were put through three memory intensive tasks. Compared to the control group that received microbubbles but no ultrasound, the mice showed “full restoration of memory in all three tasks,” according to the researchers. The next step is to try this out in clinical trials. We hope these results can be replicated and brought to practice as soon as possible.

Some details from the study abstract in Science Translational Medicine:

Spinning disk confocal microscopy and high-resolution three-dimensional reconstruction revealed extensive internalization of Aβ into the lysosomes of activated microglia in mouse brains subjected to SUS, with no concomitant increase observed in the number of microglia. Plaque burden was reduced in SUS-treated AD mice compared to sham-treated animals, and cleared plaques were observed in 75% of SUS-treated mice. Treated AD mice also displayed improved performance on three memory tasks: the Y-maze, the novel object recognition test, and the active place avoidance task.

Flashbacks: Temporarily Opening Up the Blood-Brain Barrier Using Ultrasound Waves…Microbubbles Help Ultrasound See Blood Vasculature Like Never Before…Non-Invasive Brain Acoustic Drug Delivery…Blood-Brain Barrier Opened With Ultrasound Implants to Let Drugs Through…

Study in Science Translational Medicine: Scanning ultrasound removes amyloid-β and restores memory in an Alzheimer’s disease mouse model…

More from Science/AAAS NewsUltrasound therapies target brain cancers and Alzheimer’s disease…

The post Ultrasound and Microbubbles Seemingly Treat Alzheimer’s in Mice appeared first on Medgadget.

Somministrazione di farmaci in sonde gastro-enterali II

Esisto farmaci che possiamo con sicurezza somministrare in sonda? Stante l’introduzione (vedi parte I) no, ma esistono sicuramente forme farmaceutiche che caratterizzate da un basso profilo di rischio, che quindi ci tutelano parzialmente, e farmaci ad alto rischio, che non andrebbero manipolati in nessun caso. farmaci a rischio contenuto Preparati solidi che devono essere dissolti in acqua❋ prima della somministrazione, che deve avvenire immediatamente, e senza miscelare più medicamenti tra loro prima o dopo la manipolazione […]

The post Somministrazione di farmaci in sonde gastro-enterali II appeared first on EM Pills.

New kids on the block. 2015 APLS trauma updates.

St Emlyns - Meducation in Virchester #FOAMed

The Advanced Paediatric Life Support (APLS) is, in my opinion at least, a great course. Covering paediatric life support, serious illness and injury it’s got a good reputation and is led by a team of clinicians who have always tried to the best for children. The course has the ‘right stuff’ for paeds resuscitationists… or […]

The post New kids on the block. 2015 APLS trauma updates. appeared first on St Emlyns.

Better Visualization and Detection of HIV and Other Pathogens

HIV-detectorResearchers at Georgia Tech, Emory University School of Medicine, and Yerkes National Primate Research Center have created a way to visualize the simian immunodeficiency virus (SIV) replication process in real time and in vivo. By using a technique called immunoPET, or antibody-targeted positron emission tomography, in conjunction with the 64Cu-labeled SIV Gp120–specific antibody, the group was able to see where exactly the SIV was inside the monkeys. Surprisingly, the virus was found replicating in parts of the body such as nasal tissue and reproductive organs.

The study demonstrates that this technique is able to see the viral dynamics such as acute infection during antiretroviral therapy and when antiretroviral therapy is not administered. The researchers believe that this technique can be used in the future on human subjects with HIV. Furthermore, this imaging method can also potentially be used to visualize other pathogens and diseases, which will allow doctors and scientists to determine how viruses or other microbes respond to certain therapies and where they congregate in the body. Currently, the researchers are refining the contrast and uptake of this technique.

Study in Nature Methods: Whole-body immunoPET reveals active SIV dynamics in viremic and antiretroviral therapy-treated macaques…

Georgia Institute of Technology: Novel tool captures total body SIV replication…

The post Better Visualization and Detection of HIV and Other Pathogens appeared first on Medgadget.