Google Analytics Alternative

Ok

En poursuivant votre navigation sur ce site, vous acceptez l'utilisation de cookies. Ces derniers assurent le bon fonctionnement de nos services. En savoir plus.

14/03/2021

Hydrazine: Qu'est ce que c'est ?

The Toxicity, Pathophysiology, and Treatment of Acute Hydrazine Propellant Exposure: A Systematic Review

Nguyen HN et Al. Mil Med. 2021 Feb 26;186(3-4):e319-e326. 

-----------------------------------

L'hydrazine est employé comme combustible dans les fusées et dans les F16 américains en tant que combustible alimentant une unité de puissance de secours. Et cela n'est pas sans conséquence lors d'une intervention auprès d'un tel type d'aéronef.

-----------------------------------

Introduction:

Hydrazines are highly toxic inorganic liquids that are used as propellants in military and aviation industries, such as the U.S. Air Force F-16 Emergency Power Unit and SpaceX SuperDraco Rockets. The most commonly used derivatives include hydrazine, monomethylhydrazine, and 1,1-dimethylhydrazine (unsymmetrical dimethylhydrazine). Industrial workers in close contact with hydrazines during routine maintenance tasks can be exposed to levels well above the National Institute for Occupational Safety and Health relative exposure limits.

Materials and methods: A systematic review was performed using PubMed, Web of Science, Google Scholar, National Aeronautics and Space Administration Technical Server, and Defense Technical Information Center, and data related to hydrazine exposures were searched from inception to April 2020. Publications or reports addressing hydrazine toxicity, pathophysiology, and treatment of hydrazine fuel exposure were selected.

Results: Acute toxic exposures to hydrazine and its derivatives are rare. There are few case reports of acute toxic exposure in humans, and data are largely based on animal studies. The initial search identified 741 articles, manuscripts, and government reports. After screening for eligibility, 51 were included in this review. Eight articles reported acute exposures to hydrazine propellant in humans, and an additional 14 articles reported relevant animal data.

Conclusions: Exposure to small amounts of hydrazine and its derivatives can cause significant soft tissue injury, pulmonary injury, seizures, coma, and death. Neurologic presentations can vary based on exposure compound and dose. Decontamination is critical as treatment is mainly supportive. High-dose intravenous pyridoxine has been suggested as treatment for hydrazine-related neurologic toxicity, but this recommendation is based on limited human data. Despite recent research efforts to generate less toxic alternatives to hydrazine fuel, it will likely continue to have a role in military and aviation industries. Aerospace and military physicians should be aware of the toxicity associated with hydrazine exposure and be prepared to treat hydrazine toxicity in at-risk populations.

10/01/2020

Plaie du coeur: Un retex brestois

Un cas clinique peu fréquent mais classique de plaie du coeur par balle où tous les grands principes du sauvetage au combat se retrouvent.

Plaie Coeur actusanté.jpg

Clic sur l'image pour agrandir

03/01/2020

Les brûlures

Les-brulures.jpg

Le blessé de guerre

9782718413457-blesse-guerre_g.jpg

Secours en milieu périilleux

9782257206039-secours-milieu-perilleux_g.jpg

Le blessé par attentat terroriste

9782718414812-blesse-attentat-terroriste_g.jpg

 

13/09/2019

Médecine et parachutisme dans les armées

1re-couv-2-2019_article_demi_colonne.jpg

Clic sur l'image pour accéder au sommaire

12/09/2019

Ophtalmologie de guerre

https://media.springernature.com/w306/springer-static/cover-hires/book/978-3-030-14437-1

Clic sur l'image pour accéder à la table des matières

16/04/2019

FST, chirurgie et USAparticulièrement innovant

Où comment faire évoluer la chirurgie de guerre par la mise en place d'un écosystème spécifique

 

Borden_FST.jpg

Clic sur l'image pour accéder au document

TCCC: Un écosystème spécifique

Un regard sur l'émergence des nouvelles modalités de prise en charge des blessés de guerre avec pour point d'orgue l'innovation conduite et la construction d'un écosystème complet autour de la prise en charge du blessé de guerre. Une démarche à comprendre et à bien méditer.

Borden_Crudible.jpg

Clic sur l'image pour accéder au document

19/03/2019

ATLS 9ème Edition

ATLS.jpg

Clic sur l'image pour accéder au document

13/12/2018

Rétrospective sur les missions du SSA

A lire pour avoir une image actualisée du SSA. Certes peine à la peine mais, fidèle à ses traditions,  n'a manifestement pas chômé ses dernières années 

Missions SSA.jpeg

Clic sur l'image pour accéder à la publication

09/12/2018

Tuerie massive: Les 30 premières min.

3 Echo: concept of operations for early care and evacuation of victims of mass violence

 

This report describes the successful use of a simple 3-phase approach that guides the initial 30 minutes of a response to blast and active shooter events with casualties: Enter, Evaluate, and Evacuate (3 Echo) in a mass-shooting event occurring in Minneapolis, Minnesota USA, on September 27, 2012. Early coordination between law enforcement (LE) and rescue was emphasized, including establishment of unified command, a common operating picture, determination of evacuation corridors, swift victim evaluation, basic treatment, and rapid evacuation utilizing an approach developed collaboratively over the four years prior to the event. Field implementation of 3 Echo requires multi-disciplinary (Emergency Medical Services (EMS), fire and LE) training to optimize performance.

Active shooter.jpeg

Blast.jpeg

 

This report details the mass-shooting event, the framework created to support the response, and also describes important aspects of the concepts of operation and curriculum evolved through years of collaboration between multiple disciplines to arrive at unprecedented EMS transport times in response to the event.

07/12/2018

K comme Killer ?

Hyperkalemia in Combat CasualtiesImplications for Delayed Evacuation.
 

-----------------------------

K comme Killer ? Peut être pas, mais en tous cas plus fréquent que l'on croit.

-----------------------------

OBJECTIVE:

Fixed facilities and rapid global evacuation ensured that delayed complications of trauma, such as hyperkalemia, occurred late in the evacuation chain where renal replacement therapies were available. However, future conflicts or humanitarian disasters may involve prolonged evacuation times. We sought to quantify one potential risk of delayed evacuation by assessing hyperkalemia in combat casualties.

METHODS:

Retrospective study of military members admitted to intensive care units in Iraq and Afghanistan from February 1, 2002, to February 1, 2011. This study was approved by the U.S. Army Medical Research and Materiel Command Institutional Review Board. Demographics, injury severity score, burn injury, mechanism of injury, vital signs, creatinine, and potassium were collected. Logistic regression models were used to identify incidence and risk factors for hyperkalemia.

RESULTS:

Of 6,011 patient records, 1,472 had sufficient data to be included for analysis. Hyperkalemia occurred in 5.8% of patients. Those with hyperkalemia had higher injury severity scores, higher shock index, were more likely to have acute kidney injury, and were more likely to die. On multivariate analysis, acute kidney injury and shock index were significantly associated with the development of hyperkalemia. In a subgroup of patients with data on creatine kinase, rhabdomyolysis was associated with hyperkalemia in the univariate model, but was not significant after adjustment.

CONCLUSION:

Hyperkalemia occurred in 5.8% of patients in our cohort of critically injured combat casualties. The development of hyperkalemia was independently associated with acute kidney injury and shock index. In future conflicts, with prolonged evacuation times, mitigation strategies should be developed to treat hyperkalemia in casualties before arrival at definitive care.

01/11/2018

Combat urbain: Problématique

Combat urbain.jpeg

Clic sur l'image pour accéder au document

08/10/2018

Military Medicine: Numéro spécial 2018

m_milmed_183_suppl_2_cover.png?Expires=2147483647&Signature=AUJrUG27lr1c~FO2KaGM0PVzllcU4Eq6AnyOKm3iChyM~lB7p59~EOyLNta84AvLhC8cqmumuZgMeHEElD9xYXeMcJFZLoOacEVbb2nDEwtN-B8sqaEBL03sRoKqnQMQBbGaPdRwuo5PFqwrJJYhkx2mhrdBqPxIOP7yB1DOIcUQ8YpaxpiSzEg5Vox-rgj7FAlNQXmbe51Heol--uGxAdfJDQj4H2kW24T16XDH3VxPh3ocZOvHvN0vXrnxx3rNFA0GtdKIFvFBWeqQLzf2OEZoQg3n2OZBiAj5chRQMwpoIV5fc-NCWAMlsyrn0-FvHygCNwGdsNoBwpRPK6Jajw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA

Clic sur l'image pour accéder à la revue

25/09/2018

Intervenir sur une tuerie massive: Un savoir faire à acquérir

3 Echo: concept of operations for early care and evacuation of victims of mass violence.
 

This report describes the successful use of a simple 3-phase approach that guides the initial 30 minutes of a response to blast and active shooter events with casualties: Enter, Evaluate, and Evacuate (3 Echo) in a mass-shooting event occurring in Minneapolis, Minnesota USA, on September 27, 2012. Early coordination between law enforcement (LE) and rescue was emphasized, including establishment of unified command, a common operating picture, determination of evacuation corridors, swift victim evaluation, basic treatment, and rapid evacuation utilizing an approach developed collaboratively over the four years prior to the event. Field implementation of 3 Echo requires multi-disciplinary (Emergency Medical Services (EMS), fire and LE) training to optimize performance.

3Echo Concept.png

This report details the mass-shooting event, the framework created to support the response, and also describes important aspects of the concepts of operation and curriculum evolved through years of collaboration between multiple disciplines to arrive at unprecedented EMS transport times in response to the event.

15/09/2018

Aggressions collectives par arme de guerre

Aggressions collectives.jpg

Clic sur l'image pour accéder au document

10/09/2018

Settings standard for CCC

m_milmed_183_suppl_2_cover.png?Expires=2147483647&Signature=AUJrUG27lr1c~FO2KaGM0PVzllcU4Eq6AnyOKm3iChyM~lB7p59~EOyLNta84AvLhC8cqmumuZgMeHEElD9xYXeMcJFZLoOacEVbb2nDEwtN-B8sqaEBL03sRoKqnQMQBbGaPdRwuo5PFqwrJJYhkx2mhrdBqPxIOP7yB1DOIcUQ8YpaxpiSzEg5Vox-rgj7FAlNQXmbe51Heol--uGxAdfJDQj4H2kW24T16XDH3VxPh3ocZOvHvN0vXrnxx3rNFA0GtdKIFvFBWeqQLzf2OEZoQg3n2OZBiAj5chRQMwpoIV5fc-NCWAMlsyrn0-FvHygCNwGdsNoBwpRPK6Jajw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA

08/09/2018

Le TCCC dans la vraie vie

Survey of Casualty Evacuation Missions Conducted by the 160th Special Operations Aviation Regiment During the Afghanistan Conflict.

 
------------------------
Une vision des techniques mises en oeuvre en préhospitalier par des équipes américaines en afghanistan. Les pratiques gestuelles mies en oeuvre sur le terrain et en cours d'évacuation sont décrites. Ces dernières doivent être maîtrisées, ce qui est un vrai challenge en terme de formation et d'implication des équipes
------------------------
 

BACKGROUND:

Historically, documentation of prehospital combat casualty care has been relatively nonexistent. Without documentation, performance improvement of prehospital care and evacuation through data collection, consolidation, and scientific analyses cannot be adequately accomplished. During recent conflicts, prehospital documentation has received increased attention for point-of-injury care as well as for care provided en route on medical evacuation platforms. However, documentation on casualty evacuation (CASEVAC) platforms is still lacking. Thus, a CASEVAC dataset was developed and maintained by the 160th Special Operations Aviation Regiment (SOAR), a nonmedical, rotary-wing aviation unit, to evaluate and review CASEVAC missions conducted by their organization.

METHODS:

A retrospective review and descriptive analysis were performed on data from all documented CASEVAC missions conducted in Afghanistan by the 160th SOAR from January 2008 to May 2015. Documentation of care was originally performed in a narrative after-action review (AAR) format. Unclassified, nonpersonally identifiable data were extracted and transferred from these AARs into a database for detailed analysis. Data points included demographics, flight time, provider number and type, injury and outcome details, and medical interventions provided by ground forces and CASEVAC personnel.

RESULTS:

There were 227 patients transported during 129 CASEVAC missions conducted by the 160th SOAR. Three patients had unavailable data, four had unknown injuries or illnesses, and eight were military working dogs. Remaining were 207 trauma casualties (96%) and five medical patients (2%). The mean and median times of flight from the injury scene to hospital arrival were less than 20 minutes. Of trauma casualties, most were male US and coalition forces (n = 178; 86%). From this population, injuries to the extremities (n = 139; 67%) were seen most commonly. The primary mechanisms of injury were gunshot wound (n = 89; 43%) and blast injury (n = 82; 40%). The survival rate was 85% (n = 176) for those who incurred trauma. Of those who did not survive, most died before reaching surgical care (26 of 31; 84%).

CONCLUSION:

Performance improvement efforts directed toward prehospital combat casualty care can ameliorate survival on the battlefield. Because documentation of care is essential for conducting performance improvement, medical and nonmedical units must dedicate time and efforts accordingly. Capturing and analyzing data from combat missions can help refine tactics, techniques, and procedures and more accurately define wartime personnel, training, and equipment requirements. This study is an example of how performance improvement can be initiated by a nonmedical unit conducting CASEVAC missions.