1
|
Usuda D, Shimozawa S, Takami H, Kako Y, Sakamoto T, Shimazaki J, Inoue J, Nakayama S, Koido Y, Oba J. Crush syndrome: a review for prehospital providers and emergency clinicians. J Transl Med 2023; 21:584. [PMID: 37653520 PMCID: PMC10472640 DOI: 10.1186/s12967-023-04416-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/04/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Disasters and accidents have occurred with increasing frequency in recent years. Primary disasters have the potential to result in mass casualty events involving crush syndrome (CS) and other serious injuries. Prehospital providers and emergency clinicians stand on the front lines of these patients' evaluation and treatment. However, the bulk of our current knowledge, derived from historical data, has remained unchanged for over ten years. In addition, no evidence-based treatment has been established to date. OBJECTIVE This narrative review aims to provide a focused overview of, and update on, CS for both prehospital providers and emergency clinicians. DISCUSSION CS is a severe systemic manifestation of trauma and ischemia involving soft tissue, principally skeletal muscle, due to prolonged crushing of tissues. Among earthquake survivors, the reported incidence of CS is 2-15%, and mortality is reported to be up to 48%. Patients with CS can develop cardiac failure, kidney dysfunction, shock, systemic inflammation, and sepsis. In addition, late presentations include life-threatening systemic effects such as hypovolemic shock, hyperkalemia, metabolic acidosis, and disseminated intravascular coagulation. Immediately beginning treatment is the single most important factor in reducing the mortality of disaster-situation CS. In order to reduce complications from CS, early, aggressive resuscitation is recommended in prehospital settings, ideally even before extrication. However, in large-scale natural disasters, it is difficult to diagnose CS, and to reach and start treatments such as continuous administration of massive amounts of fluid, diuresis, and hemodialysis, on time. This may lead to delayed diagnosis of, and high on-site mortality from, CS. To overcome these challenges, new diagnostic and therapeutic modalities in the CS animal model have recently been advanced. CONCLUSIONS Patient outcomes can be optimized by ensuring that prehospital providers and emergency clinicians maintain a comprehensive understanding of CS. The field is poised to undergo significant advances in coming years, given recent developments in what is considered possible both technologically and surgically; this only serves to further emphasize the importance of the field, and the need for ongoing research.
Collapse
Affiliation(s)
- Daisuke Usuda
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-City, Tokyo, 177-8521, Japan.
| | - Shintaro Shimozawa
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-City, Tokyo, 177-8521, Japan
| | - Hiroki Takami
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-City, Tokyo, 177-8521, Japan
| | - Yoshinobu Kako
- Department of Sport Management, Faculty of Business Informatics, Jobu University, 634-1, Toya-Chou, Isesaki-City, Gunma, 372-8588, Japan
| | - Taigo Sakamoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-City, Tokyo, 113-8602, Japan
| | - Junya Shimazaki
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School, 2-15, Yamadaoka, Suita-City, Osaka, 565-0871, Japan
| | - Junichi Inoue
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, 1-383, Kosugi-Cho, Nakahara-Ku, Kawasaki-City, Kanagawa, 211-8533, Japan
| | - Shinichi Nakayama
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1, Wakinohamakaigandori, Chuo-Ku, Kobe-City, Hyogo, 651-0073, Japan
| | - Yuichi Koido
- National Hospital Organization Headquarters, DMAT Secretariat MHLW Japan, 3256, Midoricho, Tachikawa-City, Tokyo, 190-8579, Japan
| | - Jiro Oba
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-City, Tokyo, 177-8521, Japan
| |
Collapse
|
2
|
Rech FV, Simões RS, Pires JA, Florêncio-Silva R, Fagundes DJ. Effect of hyperbaric oxygenation on random rat skin flaps vascularization. Acta Cir Bras 2021; 36:e360906. [PMID: 34755766 PMCID: PMC8580510 DOI: 10.1590/acb360906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/21/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose: To evaluate the effect of hyperbaric oxygenation (HBO) on angiogenesis in
random rat skin flaps, by immunoexpression of vascular endothelial growth
factor A (VEGF-A). Methods: Forty adult rats were divided into four groups: GE) epilated; GE/HBO)
epilated subjected to HBO; GER) epilated submitted to dorsal skin flap;
GER/HBO) epilated subjected to dorsal skin flap + HBO. HBO was performed
with rats inside a chamber under atmosphere close to 100% oxygen and
pressure of 2.4 absolute atmospheres, 2h per day during seven consecutive
days. GE and GER groups were placed in the hyperbaric chamber without HBO.
Then, under anesthesia, skin flaps were removed and separated into three
portions relative to pedicle fixation. The samples were fixed in formalin
and processed for paraffin embedding. Histological sections were submitted
to immunohistochemistry for VEGF-A detection. The number of
immunostained-blood vessels were counted under light microscopy. Results: GE and GE/HBO groups showed normal and similar skin morphology in the three
flap portions. A fibrin-leukocyte crust, along with denatured collagen and
intense leukocyte infiltrate, was mainly observed in the dermis of the
medial and distal flap portions of GER group. Meanwhile, the GER/HBO group
presented more regions with intact collagen and small areas of leukocyte
infiltrate in the three flap regions. VEGF-A-immunostained blood vessels
were largely seen in all regions of GE and GE/HBO groups, whereas no
significant differences were found between these groups. A decrease in
vascularization was noticed in GER and GER/HBO groups, which was more
evident in the most distal portion of the flaps. However, the number of
VEGF-A-immunostained blood vessels in GER/HBO group was significantly higher
when compared to GER group. Conclusions: Hyperbaric oxygenation was associated with increased angiogenesis and
improved viability of rat skin flaps.
Collapse
|
3
|
Abstract
At the moment of soft tissue injury, an immediate wound healing ballet commences. This coordinated cascade of events works over minutes, hours, weeks, and months to restore tissue integrity and viability in an attempt to rebuild the site to its preinjured state. A thorough understanding of these processes, and options to navigate forks in the road, can help guide patient selection, surgical planning and execution, management of complications, and ultimately the restoration of tissue form and function for optimal outcomes. An exhaustive account of tissue healing mechanics is beyond the scope of this writing. However, a summation of much that is known of these processes and the directions research and therapeutic developments are currently aimed will help the facial plastic surgeon prevent or minimize debilitating functional and cosmetic consequences in the head and neck.
Collapse
Affiliation(s)
- Christian L Stallworth
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, UTHSC at San Antonio, San Antonio, Texas
| |
Collapse
|
4
|
Yoshida T, Ichikawa N, Homma S, Yoshida T, Emoto S, Miyaoka Y, Matsui H, Taketomi A. Ischemic proctitis 6 months after laparoscopic sigmoidectomy: a case report. Surg Case Rep 2021; 7:54. [PMID: 33616775 PMCID: PMC7900365 DOI: 10.1186/s40792-021-01133-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/05/2021] [Indexed: 11/20/2022] Open
Abstract
Background Ischemic colitis is a common disease; however, its pathophysiology remains unclear, especially in ischemic proctitis after sigmoidectomy. We present a rare case of ischemic proctitis 6 months after laparoscopic sigmoidectomy. Case presentation The patient was a 60-year-old man with hypertension, type 2 diabetes, and hyperlipidemia. He was a smoker. He underwent laparoscopic sigmoidectomy for pathological stage I sigmoid colon cancer and was followed up without any adjuvant therapy. Six months after his surgery, he complained of lower abdominal discomfort, bloody stools, and tenesmus. Colonoscopy showed extensive rectal ulcers between the anastomotic site and the anal canal, which was particularly severe on the anal side several centimeters beyond the anastomosis. We provided non-surgical management, including hyperbaric oxygen therapy. The rectal ulcers had healed 48 days after the therapeutic intervention. He has not experienced any recurrence for 3.5 years. Conclusions While performing sigmoidectomy, it is important to consider the blood backflow from the anal side of the bowel carefully, especially for patients with risk factors of ischemic proctitis.
Collapse
Affiliation(s)
- Takuto Yoshida
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, W-7, Kita-ku, Sapporo, N-15060-8638, Japan
| | - Nobuki Ichikawa
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, W-7, Kita-ku, Sapporo, N-15060-8638, Japan.
| | - Shigenori Homma
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, W-7, Kita-ku, Sapporo, N-15060-8638, Japan
| | - Tadashi Yoshida
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, W-7, Kita-ku, Sapporo, N-15060-8638, Japan
| | - Shin Emoto
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, W-7, Kita-ku, Sapporo, N-15060-8638, Japan
| | - Yoichi Miyaoka
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, W-7, Kita-ku, Sapporo, N-15060-8638, Japan
| | - Hiroki Matsui
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, W-7, Kita-ku, Sapporo, N-15060-8638, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, W-7, Kita-ku, Sapporo, N-15060-8638, Japan
| |
Collapse
|