Both domestic and foreign terror incidents are an unfortunate outgrowth of our modern times from the Oklahoma City bombings, Sarin gas attacks in Japan, the Madrid train bombing, anthrax spores in the mail, to the Wor...Both domestic and foreign terror incidents are an unfortunate outgrowth of our modern times from the Oklahoma City bombings, Sarin gas attacks in Japan, the Madrid train bombing, anthrax spores in the mail, to the World Trade Center on September 11 th, 2001. The modalities used to perpetrate these terrorist acts range from conventional weapons to high explosives, chemical weapons, and biological weapons all of which have been used in the recent past. While these weapons platforms can cause significant injury requiring critical care the mechanism of injury, pathophysiology and treatment of these injuries are unfamiliar to many critical care providers. Additionally the pediatric population is particularly vulnerable to these types of attacks. In the event of a mass casualty incident both adult and pediatric critical care practitioners will likely be called upon to care for children and adults alike. We will review the presentation, pathophysiology, and treatment of victims of blast injury, chemical weapons, and biological weapons. The focus will be on those injuries not commonly encountered in critical care practice, primary blast injuries, category A pathogens likely to be used in terrorist incidents, and chemical weapons including nerve agents, vesicants, pulmonary agents, cyanide, and riot control agents with special attention paid to pediatric specific considerations.展开更多
Purpose:To establish a severe blast lung injury model of goats and investigate the feasibility of lung ultrasonic score in the evaluation of blast lung injury.Methods:Twenty female healthy goats were randomly divided ...Purpose:To establish a severe blast lung injury model of goats and investigate the feasibility of lung ultrasonic score in the evaluation of blast lung injury.Methods:Twenty female healthy goats were randomly divided into three groups by different driving pressures:4.0 MPa group(n=4),4.5 MPa group(n=12)and 5.0 MPa group(n=4).The severe blast lung injury model of goats was established using a BST-I bio-shock tube.Vital signs(respiration,heart rate and blood pressure),lung ultrasound score(LUS),PO2/FiO2 and extravascular lung water(EVLW)were measured before injury(0 h)and at 0.5 h,3 h,6 h,9 h,12 h after injury.Computed tomography scan was performed before injury(0 h)and at 12 h after injury for dynamic monitoring of blast lung injury and measurement of lung volume.The correlation of LUS with PaO2/FiO2,EVLW,and lung injury ratio(lesion volume/total lung volume*100%)was analyzed.All animals were sacrificed at 12 h after injury for gross observation of lung injury and histopathological examination.Statistical analysis was performed by the SPSS 22.0 software.The measurement data were expressed as mean±standard deviation.The means of two samples were compared using independent-sample t-test.Pearson correlation analysis was conducted.Results:(1)At 12 h after injury,the mortality of goats was 0,41.67% and 100%in the 4.0 Mpa,4.5 MPa and 5.0 MPa groups,respectively;the area of pulmonary hemorrhage was 20.00%±13.14% in the 4.0 Mpa group and 42.14%±15.33% in the 4.5 MPa group.A severe lung shock injury model was established under the driving pressure of 4.5 MPa.(2)The respiratory rate,heart rate,LUS and EVLW were significantly increased,while PaO2/FiO2 was significantly reduced immediately after injury,and then they gradually recovered and became stabilized at 3 h after injury.(3)LUS was positively correlated with EVLW(3 h:r=-0.597,6 h:r=-0.698,9 h:r=-0.729;p<0.05)and lung injury ratio(12 h:r=-0.884,p<0.05),negatively correlated with PaO2/FiO2(3 h:r=-0.871,6 h:r=-0.637,9 h:r=-0.658;p<0.05).Conclusion:We established a sever展开更多
文摘Both domestic and foreign terror incidents are an unfortunate outgrowth of our modern times from the Oklahoma City bombings, Sarin gas attacks in Japan, the Madrid train bombing, anthrax spores in the mail, to the World Trade Center on September 11 th, 2001. The modalities used to perpetrate these terrorist acts range from conventional weapons to high explosives, chemical weapons, and biological weapons all of which have been used in the recent past. While these weapons platforms can cause significant injury requiring critical care the mechanism of injury, pathophysiology and treatment of these injuries are unfamiliar to many critical care providers. Additionally the pediatric population is particularly vulnerable to these types of attacks. In the event of a mass casualty incident both adult and pediatric critical care practitioners will likely be called upon to care for children and adults alike. We will review the presentation, pathophysiology, and treatment of victims of blast injury, chemical weapons, and biological weapons. The focus will be on those injuries not commonly encountered in critical care practice, primary blast injuries, category A pathogens likely to be used in terrorist incidents, and chemical weapons including nerve agents, vesicants, pulmonary agents, cyanide, and riot control agents with special attention paid to pediatric specific considerations.
基金supported by State Key Laboratory of Trauma,Burns and Combined Injury Project(No.SKLYQ201901,No.SKLKF201801).
文摘Purpose:To establish a severe blast lung injury model of goats and investigate the feasibility of lung ultrasonic score in the evaluation of blast lung injury.Methods:Twenty female healthy goats were randomly divided into three groups by different driving pressures:4.0 MPa group(n=4),4.5 MPa group(n=12)and 5.0 MPa group(n=4).The severe blast lung injury model of goats was established using a BST-I bio-shock tube.Vital signs(respiration,heart rate and blood pressure),lung ultrasound score(LUS),PO2/FiO2 and extravascular lung water(EVLW)were measured before injury(0 h)and at 0.5 h,3 h,6 h,9 h,12 h after injury.Computed tomography scan was performed before injury(0 h)and at 12 h after injury for dynamic monitoring of blast lung injury and measurement of lung volume.The correlation of LUS with PaO2/FiO2,EVLW,and lung injury ratio(lesion volume/total lung volume*100%)was analyzed.All animals were sacrificed at 12 h after injury for gross observation of lung injury and histopathological examination.Statistical analysis was performed by the SPSS 22.0 software.The measurement data were expressed as mean±standard deviation.The means of two samples were compared using independent-sample t-test.Pearson correlation analysis was conducted.Results:(1)At 12 h after injury,the mortality of goats was 0,41.67% and 100%in the 4.0 Mpa,4.5 MPa and 5.0 MPa groups,respectively;the area of pulmonary hemorrhage was 20.00%±13.14% in the 4.0 Mpa group and 42.14%±15.33% in the 4.5 MPa group.A severe lung shock injury model was established under the driving pressure of 4.5 MPa.(2)The respiratory rate,heart rate,LUS and EVLW were significantly increased,while PaO2/FiO2 was significantly reduced immediately after injury,and then they gradually recovered and became stabilized at 3 h after injury.(3)LUS was positively correlated with EVLW(3 h:r=-0.597,6 h:r=-0.698,9 h:r=-0.729;p<0.05)and lung injury ratio(12 h:r=-0.884,p<0.05),negatively correlated with PaO2/FiO2(3 h:r=-0.871,6 h:r=-0.637,9 h:r=-0.658;p<0.05).Conclusion:We established a sever
