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Bicakcioglu M, Gok A, Cicek IB, Dogan Z, Ozer AB. Mortality predictors in earthquake victims admitted to intensive care unit in Kahramanmaraş earthquakes. Injury 2024; 55:111632. [PMID: 38852033 DOI: 10.1016/j.injury.2024.111632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 05/03/2024] [Accepted: 05/25/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND The purpose of this study is to report the data for patients followed-up in our intensive care unit due to the 6th February 2023, earthquake in Kahramanmaraş, Türkiye, and to investigate parameters affecting mortality. METHODS The demographic characteristics of patients followed-up in intensive care due to trauma following the earthquake, the treatments administered, developing complications, lengths of stay in the hospital and intensive care, and laboratory data were scanned retrospectively and recorded. These data were then compared between the surviving and non-surviving patients. RESULTS Twenty-six patients, 13 (50 %) male, were followed-up in our intensive care, 24 (92 %) due to being buried under earthquake debris, and 2 (8 %) due to falling from heights. Increased Sequential Organ Failure Assessment (SOFA) (p = 0.027), higher initial serum potassium (p = 0.043), higher initial serum phosphorus (p = 0.035), higher initial and peak serum magnesium (p = 0.004 and p = 0.001), lower initial and peak bicarbonate (p = 0.021 and p = 0.012) and higher initial and peak serum base deficit values (p = 0.012 and p = 0.009) were associated with mortality. In the subgroup with crush injuries, higher initial and peak serum potassium (p = 0.001 and p = 0.025), higher initial and peak serum magnesium (p = 0.005 and p = 0.004), lower initial and peak bicarbonate (p = 0.019 and p = 0.021) and higher initial and peak serum base deficit values (p = 0.017 and p = 0.025) were associated with mortality. Multiorgan dysfunction failure developed in nine patients, sepsis in seven, dissemine intravascular coagulation in four, and acute respiratory distress syndrome in two. Fasciotomy was performed on 2 (8 %) patients and amputation on 8 (31 %). Extremity injuries were most frequently observed. 10 (38.5 %) of the 12 (46 %) patients developing acute kidney injury required renal replacement therapy. 7 (27 %) patients died during follow-up. In logistic regression analysis, higher SOFA scores, lower initial bicarbonate and BE levels, higher serum initial potassium and magnesium levels were a risk factor for mortality. Higher SOFA scores, lower initial bicarbonate and base deficit and higher initial phosphorus values affected mortality in patients with crush syndrome. CONCLUSION Not only increased SOFA, serum potassium, serum phosphorus, and serum magnesium, but also decreased bicarbonate, and base deficit were associated with mortality in earthquake victims with crush syndrome in ICU.
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Affiliation(s)
- Murat Bicakcioglu
- İnönü University Medical Faculty Anesthesiology Department, Intensive Care Unit, Turkey
| | - Abdullah Gok
- İnönü University Medical Faculty Anesthesiology Department, Intensive Care Unit, Turkey
| | - Ipek Balikci Cicek
- İnönü University Medical Faculty Biostatistics and Medical Informatics Department, Turkey
| | - Zafer Dogan
- İnönü University Medical Faculty Anesthesiology Department, Intensive Care Unit, Turkey
| | - Ayse B Ozer
- İnönü University Medical Faculty Anesthesiology Department, Intensive Care Unit, Turkey.
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Zhang Y, Jian F, Wang L, Chen H, Wu Z, Zhong S. Navigating the 'Triangle of Death': A Multidisciplinary Approach in Severe Multi-Trauma Management. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2024; 17:11795476241271544. [PMID: 39148708 PMCID: PMC11325324 DOI: 10.1177/11795476241271544] [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: 02/12/2024] [Accepted: 06/26/2024] [Indexed: 08/17/2024]
Abstract
This case report details the challenging management of a 45-year-old male construction worker who suffered severe multiple injuries after a fall and subsequent collision with cement mixers. The patient presented with extensive injuries, including amputation, fractures and internal bleeding, leading to a state known as the 'triangle of death'. Despite the initial grim prognosis, evidenced by an ISS score of 28 and a mortality risk coefficient of 89.56%, the patient was successfully resuscitated and managed through a multidisciplinary approach. This included damage control resuscitation, emergency vascular interventions and targeted temperature management for brain protection. The patient's recovery highlights the effectiveness of comprehensive trauma management and the critical role of coordinated care in severe multi-trauma cases.
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Affiliation(s)
- Yushan Zhang
- Department of Intensive Care Medicine, Army Medical Center of PLA, Yuzhong District, Chongqing, China
| | - Fuxia Jian
- Department of Intensive Care Medicine, Army Medical Center of PLA, Yuzhong District, Chongqing, China
| | - Liang Wang
- Dermatology, Army Medical Center of PLA, Yuzhong District, Chongqing, China
| | - Hao Chen
- Department of Intensive Care Medicine, Army Medical Center of PLA, Yuzhong District, Chongqing, China
| | - Zhengbin Wu
- Department of Intensive Care Medicine, Army Medical Center of PLA, Yuzhong District, Chongqing, China
| | - Shili Zhong
- Department of Intensive Care Medicine, Army Medical Center of PLA, Yuzhong District, Chongqing, China
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Barça F, Atilla HA, Demir EB, Çevik K, Ilgın BU, Atlı OY, Yüksel S, Şibar K, Ünlü S, Duman E, Fırat A, Akdoğan M. Comparison of single and double incision leg fasciotomy in disaster settings-Experience from 2023 Türkiye earthquakes. Injury 2024; 55:111582. [PMID: 38640595 DOI: 10.1016/j.injury.2024.111582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/26/2024] [Accepted: 04/16/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION Although there are studies comparing methods for leg fasciotomy in compartment syndrome after fractures, choice of single or double fasciotomies in disasters was not investigated. The aim of this study was to compare the efficacy of single and double incision leg fasciotomy in the setting of disaster. METHODS Patients that have undergone fasciotomy after 2023 Kahramanmaraş earthquakes were retrospectively analyzed. The cases were separated into two groups as single incision and double incision according to the method of the first fasciotomy. The number of debridements after each fasciotomy, muscle group excisions, completion time of treatment, presence of amputation, the method of closure (primary closure or graft/flap) and positive results of wound cultures were analyzed and compared between two groups. RESULTS 62 legs of 52 patients (22 females, 30 males, age 36.9 ± 11.2 years) with compartment syndrome that have undergone fasciotomy after 2023 Kahramanmaraş earthquakes were included in the study. Single-incision group included 27 legs and double incision group included 35 legs. Amputation was needed in 15 patients (%24.2), six in single incision group and nine in double incision group. (p = 0.75). Compartment excision (eight patients in single incision, nine patients in double incision groups, p = 0.81), number of debridements (median 4 in both groups, p = 0.55), wound closure time (median 17 days in single incision, 22 days in double incision groups, p = 0.52), graft or flap requirement (11 patients in single incision, 16 patients in double incision groups, p = 0.53), positive culture results (15 patients in single incision, 16 patients in double incision groups, p = 0.44) were not different statistically between two groups. CONCLUSION Single and double incision fasciotomy methods are equally effective and safe in treatment of compartment syndrome of the leg in disaster situations. To our knowledge, this is the first study comparing outcomes of single and double incision fasciotomy in disaster settings.
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Affiliation(s)
- Fatih Barça
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye.
| | - Halis Atıl Atilla
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
| | - Ekin Barış Demir
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
| | - Kadir Çevik
- Başakşehir Çam and Sakura City Hospital, Department of Hand Surgery, Istanbul, Türkiye
| | - Bünyamin Uğur Ilgın
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
| | - Osman Yağız Atlı
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
| | - Sinan Yüksel
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
| | - Kemal Şibar
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
| | - Serhan Ünlü
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
| | - Evrim Duman
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
| | - Ahmet Fırat
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
| | - Mutlu Akdoğan
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
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Ceferino L, Merino Y, Pizarro S, Moya L, Ozturk B. Placing engineering in the earthquake response and the survival chain. Nat Commun 2024; 15:4298. [PMID: 38769363 PMCID: PMC11106327 DOI: 10.1038/s41467-024-48624-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 05/06/2024] [Indexed: 05/22/2024] Open
Abstract
Earthquakes injure millions and simultaneously disrupt the infrastructure to protect them. This perspective argues that the current post-disaster investigation paradigm is insufficient to protect communities' health effectively. We propose the Earthquake Survival Chain as a framework to change the current engineering focus on infrastructure to health. This framework highlights four converging research opportunities to advance understanding of earthquake injuries, search and rescue, patient mobilizations, and medical treatment. We offer an interdisciplinary research agenda in engineering and health sciences, including artificial intelligence and virtual reality, to protect health and life from earthquakes.
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Affiliation(s)
- Luis Ceferino
- University of California, Berkeley, Berkeley, California, USA.
- New York University, Brooklyn, New York, USA.
| | - Yvonne Merino
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastián Pizarro
- Servicio de Atención Médica de Urgencia, Santiago, Chile
- Universidad Finis Terrae, Santiago, Chile
| | - Luis Moya
- Pontificia Universidad Católica del Perú, Lima, Perú
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Zhang Y, Lyu Q, Han X, Wang X, Liu R, Hao J, Zhang L, Chen XM. Proteomic analysis of multiple organ dysfunction induced by rhabdomyolysis. J Proteomics 2024; 298:105138. [PMID: 38403185 DOI: 10.1016/j.jprot.2024.105138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/12/2024] [Accepted: 02/22/2024] [Indexed: 02/27/2024]
Abstract
Rhabdomyolysis (RM) leads to dysfunction in the core organs of kidney, lung and heart, which is an important reason for the high mortality and disability rate of this disease. However, there is a lack of systematic research on the characteristics of rhabdomyolysis-induced injury in various organs and the underlying pathogenetic mechanisms, and especially the interaction between organs. We established a rhabdomyolysis model, observed the structural and functional changes in kidney, heart, and lung. It is observed that rhabdomyolysis results in significant damage in kidney, lung and heart of rats, among which the pathological damage of kidney and lung was significant, and of heart was relatively light. Meanwhile, we analyzed the differentially expressed proteins (DEPs) in the kidney, heart and lung between the RM group and the sham group based on liquid chromatography-tandem mass spectrometry (LC-MS/MS). In our study, Serpina3n was significantly up-regulated in the kidney, heart and lung. Serpina3n is a secreted protein and specifically inhibits a variety of proteases and participates in multiple physiological processes such as complement activation, inflammatory responses, apoptosis pathways, and extracellular matrix metabolism. It is inferred that Serpina3n may play an important role in multiple organ damage caused by rhabdomyolysis and could be used as a potential biomarker. This study comprehensively describes the functional and structural changes of kidney, heart and lung in rats after rhabdomyolysis, analyzes the DEPs of kidney, heart and lung, and determines the key role of Serpina3n in multiple organ injury caused by rhabdomyolysis. SIGNIFICANCE: This study comprehensively describes the functional and structural changes of kidney, heart and lung in rats after rhabdomyolysis, analyzes the DEPs of kidney, heart and lung, and determines the key role of Serpina3n in multiple organ injury caused by rhabdomyolysis.
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Affiliation(s)
- Yan Zhang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China; Graduate School of Chinese PLA General Hospital, Beijing 100853, China
| | - Qiang Lyu
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
| | - Xiao Han
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China; Graduate School of Chinese PLA General Hospital, Beijing 100853, China
| | - Xu Wang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
| | - Ran Liu
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
| | - Jing Hao
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
| | - Li Zhang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China.
| | - Xiang-Mei Chen
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China.
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Safari S, Aghili SH, Shahlaee MA, Jamshidi Kerachi A, Farhang Ranjbar M. Incidence of Electrolyte Imbalances Following Traumatic Rhabdomyolysis: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e59333. [PMID: 38817473 PMCID: PMC11137607 DOI: 10.7759/cureus.59333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
Rhabdomyolysis, a medical condition caused by the destruction of striated muscle fibers, can have many etiologies, with the most common one being traumatic etiologies, that is, crushing injuries, heavy exertion, and being trapped under rubbles, and so forth. Rhabdomyolysis causes many complications, including acute kidney injury and different electrolyte imbalances, which later can cause cardiac dysrhythmia and even death as a result. This systematic review and meta-analysis investigate the incidence of imbalances of four important electrolytes among patients diagnosed with traumatic rhabdomyolysis. PubMed, Scopus, Web of Science, and Embase databases were searched for any article related to traumatic rhabdomyolysis using keywords related to the topic of our study, excluding case studies and case series. Relevant data were extracted from the included articles, and finally, a meta-analysis was performed on them to calculate the pooled incidence of each electrolyte imbalance. Collectively, 32 articles were included in our study (through the database and citation checking). The following were the pooled incidence of each electrolyte imbalance: hyperkalemia, 31% (95%CI 22%-41%); hypokalemia, 10% (95%CI 4%-17%); hypernatremia, 3% (95%CI 0%-8%); hyponatremia, 23% (95%CI 7%-44%); hypercalcemia, 0% (95%CI 0%-1%); hypocalcemia, 57% (95%CI: 22%-88%); hyperphosphatemia, 33% (95%CI 11%-59%); hypophosphatemia, 4% (95%CI 0%-16%). According to the meta-analyses, the rate of hyperkalemia, hyponatremia, hypocalcemia, and hyperphosphatemia is higher than their counterpart in patients diagnosed with traumatic rhabdomyolysis.
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Affiliation(s)
- Saeed Safari
- Emergency Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IRN
- Research Center for Trauma in Police Operations, Directorate of Health, Rescue & Treatment, Police Headquarter, Tehran, IRN
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IRN
| | - Seyed Hadi Aghili
- Research Center for Trauma in Police Operations, Directorate of Health, Rescue & Treatment, Police Headquarter, Tehran, IRN
- Neurosurgery, Imam Khomeini Hospital Complex, Tehran, IRN
- Neurosurgery, Valiasr Hospital, Tehran, IRN
| | - Mohammad A Shahlaee
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IRN
| | | | - Mehri Farhang Ranjbar
- Research Center for Trauma in Police Operations, Directorate of Health, Rescue & Treatment, Police Headquarter, Tehran, IRN
- Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, IRN
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Abu-Zidan FM, Jawas A, Idris K, Cevik AA. Surgical and critical care management of earthquake musculoskeletal injuries and crush syndrome: A collective review. Turk J Emerg Med 2024; 24:67-79. [PMID: 38766416 PMCID: PMC11100580 DOI: 10.4103/tjem.tjem_11_24] [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: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 05/22/2024] Open
Abstract
Earthquakes are unpredictable natural disasters causing massive injuries. We aim to review the surgical management of earthquake musculoskeletal injuries and the critical care of crush syndrome. We searched the English literature in PubMed without time restriction to select relevant papers. Retrieved articles were critically appraised and summarized. Open wounds should be cleaned, debrided, receive antibiotics, receive tetanus toxoid unless vaccinated in the last 5 years, and re-debrided as needed. The lower limb affected 48.5% (21.9%-81.4%) of body regions/patients. Fractures occurred in 31.1% (11.3%-78%) of body regions/patients. The most common surgery was open reduction and internal fixation done in 21% (0%-76.6%), followed by plaster of Paris in 18.2% (2.3%-48.8%), and external fixation in 6.6% (1%-13%) of operations/patients. Open fractures should be treated with external fixation. Internal fixation should not be done until the wound becomes clean and the fractured bones are properly covered with skin, skin graft, or flap. Fasciotomies were done in 15% (2.8%-27.2%), while amputations were done in 3.7% (0.4%-11.5%) of body regions/patients. Principles of treating crush syndrome include: (1) administering proper intravenous fluids to maintain adequate urine output, (2) monitoring and managing hyperkalemia, and (3) considering renal replacement therapy in case of volume overload, severe hyperkalemia, severe acidemia, or severe uremia. Low-quality studies addressed indications for fasciotomy, amputation, and hyperbaric oxygen therapy. Prospective data collection on future medical management of earthquake injuries should be part of future disaster preparedness. We hope that this review will carry the essential knowledge needed for properly managing earthquake musculoskeletal injuries and crush syndrome in hospitalized patients.
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Affiliation(s)
- Fikri M. Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Ali Jawas
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Kamal Idris
- Department of Critical Care and the Intensive Care Unit, Burjeel Royal Hospital, Al-Ain, United Arab Emirates
| | - Arif Alper Cevik
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
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Bilir EE, Borman P, Merve Ata A, Alemdaroğlu E, Bodur H, Yanık B, Yurdakul F, Kesikburun B, Güler T, Başkan B, Akkuş S, Uzun O, Yaşar E. Clinical properties and rehabilitation needs of earthquake survivors in a subacute rehabilitation setting. ULUS TRAVMA ACIL CER 2024; 30:297-304. [PMID: 38634844 PMCID: PMC11065973 DOI: 10.14744/tjtes.2024.27553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND This descriptive analysis examines the victims of the February 6, 2023, earthquakes in Kahramanmaraş and Elbistan, Türkiye. It aims to detail the injury profiles related to neuro-musculoskeletal trauma, assess the rehabilitation needs of patients, and propose a comprehensive rehabilitation approach. METHODS The study included patients injured in the Kahramanmaraş-centered earthquake on February 6, 2023, who were transported to our hospital based on their rehabilitation needs. Data from patients treated at our hospital were recorded retrospectively. This included demographic information, accompanying pathologies, laboratory findings, rehabilitation programs, and treatments received during their hospital stay. Statistical analyses were conducted to examine the data. RESULTS A total of 141 patients with musculoskeletal injuries were admitted due to injuries sustained from the earthquake. The mean age of the participants was 39.76 years, with a slight female predominance (56.7%). The majority of patients sustained injuries while trapped under debris (90.1%), with an average duration of 10 hours under rubble. Fractures were the most common form of injury (53.2%), predominantly affecting the lower extremities. Peripheral nerve injuries were present in 41.1% of patients, and amputations were observed in 30.5%. Complications included compartment syndrome (46.1%), crush syndrome (36.2%), and various infections. Pain was prevalent among patients, with somatic pain being the most reported type. Individualized rehabilitation programs were implemented, incorporating physical therapy, wound care, pain management, and psychosocial support. CONCLUSION This study highlights the critical rehabilitation needs of earthquake survivors and emphasizes the importance of early and comprehensive rehabilitation interventions. Multidisciplinary rehabilitation programs were crucial in addressing medical issues, functional limitations, and psychological challenges faced by the survivors. The findings contribute to a deeper understanding of earthquake-related injuries and underscore the significance of well-coordinated rehabilitation strategies in disaster responses.
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Affiliation(s)
- Emine Esra Bilir
- Departmant of Physical Medicine and Rehabilitation, Ankara Bilkent City Hospital, Ankara-Türkiye
| | - Pinar Borman
- Department of Physical Medicine and Rehabilitation, Univercity of Health Sciences Gulhane Faculty of Medicine, Ankara City Hospital, Ankara-Türkiye
| | - Ayşe Merve Ata
- Departmant of Physical Medicine and Rehabilitation, Ankara Bilkent City Hospital, Ankara-Türkiye
| | - Ebru Alemdaroğlu
- Department of Physical Medicine and Rehabilitation, Univercity of Health Sciences Gulhane Faculty of Medicine, Ankara City Hospital, Ankara-Türkiye
| | - Hatice Bodur
- Departmant of Physical Medicine and Rehabilitation, Yıldırım Beyazıt Univercity, Ankara Bilkent City Hospital, Ankara-Türkiye
| | - Burcu Yanık
- Departmant of Physical Medicine and Rehabilitation, Ankara Bilkent City Hospital, Ankara-Türkiye
| | - Fatma Yurdakul
- Department of Physical Medicine and Rehabilitation, Univercity of Health Sciences Gulhane Faculty of Medicine, Ankara City Hospital, Ankara-Türkiye
| | - Bilge Kesikburun
- Department of Physical Medicine and Rehabilitation, Univercity of Health Sciences Gulhane Faculty of Medicine, Ankara City Hospital, Ankara-Türkiye
| | - Tuba Güler
- Department of Physical Medicine and Rehabilitation, Univercity of Health Sciences Gulhane Faculty of Medicine, Ankara City Hospital, Ankara-Türkiye
| | - Bedriye Başkan
- Departmant of Physical Medicine and Rehabilitation, Ankara Bilkent City Hospital, Ankara-Türkiye
| | - Selami Akkuş
- Departmant of Physical Medicine and Rehabilitation, Yıldırım Beyazıt Univercity, Ankara Bilkent City Hospital, Ankara-Türkiye
| | - Oznur Uzun
- Departmant of Physical Medicine and Rehabilitation, Sincan Doctor Nafiz Körfez State Hospital, Ankara-Türkiye
| | - Evren Yaşar
- Department of Physical Medicine and Rehabilitation, Univercity of Health Sciences Gulhane Faculty of Medicine, Ankara City Hospital, Ankara-Türkiye
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Aydin K, Ozel Yesilyurt A, Cetinkaya F, Gok MG, Dogan O, Ozcengiz D. Earthquake victims in focus: a cross-sectional examination of trauma and management in intensive care unit. BMC Emerg Med 2024; 24:30. [PMID: 38378483 PMCID: PMC10880224 DOI: 10.1186/s12873-024-00949-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 02/06/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND After the Kahramanmaras earthquake of February 6, 2023, the disaster of the century, a significant number of victims were admitted to intensive care units (ICUs). In this study, we aimed to share the characteristics and management of critical earthquake victims and shed light on our experiences as intensivists in future earthquakes. METHODS The study included 62 earthquake victims in two tertiary ICUs. Demographic characteristics, laboratory findings, clinical characteristics, trauma and disease severity scores, treatments administered to patients, and the clinical course of the patients were recorded retrospectively. The patients were divided into two groups, survivors and nonsurvivors, according to 7-day mortality and into two groups according to the duration of their stay under the rubble: those who remained under the rubble for 72 hours or less and those who remained under the rubble for more than 72 hours. A receiver operating characteristic (ROC) curve analysis was used to determine the best cutoff value for the 'Circulation, Respiration, Abdomen, Motor, and Speech' (CRAMS) score. RESULTS The median age of the 62 patients included in the study was 35.5 (23-53) years. The median length of stay under the rubble for the patients was 30.5 (12-64.5) hours. The patient was transferred to the ward with a maximum duration of 222 hours under the rubble. The limb (75.8%) was the most common location of trauma in patients admitted to the ICU. Crush syndrome developed in 96.8% of the patients. There was a positive correlation between the development of acute kidney injury (AKI) and myoglobin, serum lactate, and uric acid levels (r = 0.372, p = 0.003; r = 0.307, p = 0.016; r = 0.428, p = 0.001, respectively). The best cutoff of the CRAMS score to predict in-7-day mortality was < 4.5 with 0.94 area under the curve (AUC); application of this threshold resulted in 75% sensitivity and 96.3% specificity. CONCLUSION Search and rescue operations should continue for at least ten days after an earthquake. The CRAMS score can be used to assess trauma severity and predict mortality in critically ill earthquake victims.
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Affiliation(s)
- Kaniye Aydin
- Division of Medical Intensive Care Unit, Department of Internal Medicine, School of Medicine, Cukurova University, Adana, Türkiye.
| | - Aysun Ozel Yesilyurt
- Department of Anesthesiology and Reanimation, School of Medicine, Cukurova University, Adana, Türkiye
| | - Ferhat Cetinkaya
- Department of Anesthesiology and Reanimation, School of Medicine, Cukurova University, Adana, Türkiye
| | - Mehmet Gokhan Gok
- Department of Anesthesiology and Reanimation, School of Medicine, Cukurova University, Adana, Türkiye
| | - Omer Dogan
- Department of Anesthesiology and Reanimation, School of Medicine, Cukurova University, Adana, Türkiye
| | - Dilek Ozcengiz
- Department of Anesthesiology and Reanimation, School of Medicine, Cukurova University, Adana, Türkiye
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Yılmaz S, Cetinkaya R, Ozel M, Tatliparmak AC, Ak R. Enhancing Triage and Management in Earthquake-Related Injuries: The SAFE-QUAKE Scoring System for Predicting Dialysis Requirements. Prehosp Disaster Med 2023; 38:716-724. [PMID: 37789711 DOI: 10.1017/s1049023x23006453] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVES Identifying early predictors of dialysis requirements in earthquake-related injuries is crucial for optimal resource allocation and timely intervention. This study aimed to develop a predictive scoring system, named SAFE-QUAKE (Seismic Assessment of Kidney Function to Rule Out Dialysis Requirement), to identify patients at high risk of developing acute kidney injury (AKI) and requiring dialysis. METHODS A retrospective analysis was conducted on a cohort of 205 patients presenting with earthquake-related injuries. Patients were divided into two groups based on their need for dialysis: the no dialysis group (n = 170) and the dialysis group (n = 35). Demographic, clinical, and laboratory data were collected and compared between the two groups to identify significant predictors of dialysis requirements. The parameters that would form the score were determined by conducting an importance analysis using artificial neural networks (ANNs) to identify parameters that exhibited statistically significant differences in univariate analysis. RESULTS The dialysis group had a significantly longer median duration of being trapped under debris (48 hours) compared to the no dialysis group (eight hours). Blood gas and laboratory analyses revealed significant differences in pH levels, lactate values, creatinine levels, lactate dehydrogenase (LDH) levels, and aspartate transaminase (AST)-to-alanine transaminase (ALT) ratio between the two groups. Based on these findings, the SAFE-QUAKE rule-out scoring system was developed, incorporating entrapment duration (<45 hours), pH levels (>7.31), creatinine levels (<2mg/dL), LDH levels (<1600mg/dL), and the AST-to-ALT ratio (<2.4) as key predictors of dialysis requirements. This score included 139 patients, and among them, only one patient required dialysis, resulting in a negative predictive value of 99.29%. CONCLUSIONS The SAFE-QUAKE scoring system demonstrated a high negative predictive value of 99.29% in ruling out the need for dialysis among earthquake-related injury cases. This scoring system offers a practical approach for health care providers to identify patients at high risk of developing AKI and requiring dialysis in earthquake-affected regions.
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Affiliation(s)
- Sarper Yılmaz
- University of Health Sciences, Dept. of Emergency Medicine, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey; Secretary of the Disaster Commission of the Turkish Emergency Medicine Association, Ankara, Turkey
| | - Remzi Cetinkaya
- University of Health Sciences, Dept. of Emergency Medicine, Diyarbakır Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Mehmet Ozel
- University of Health Sciences, Dept. of Emergency Medicine, Diyarbakır Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | | | - Rohat Ak
- University of Health Sciences, Dept. of Emergency Medicine, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
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Uluöz M, Gökmen MY. The 2023 Turkey Earthquake: Management of 627 Pediatric Musculoskeletal Injuries in the First Month. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1733. [PMID: 38002824 PMCID: PMC10670203 DOI: 10.3390/children10111733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023]
Abstract
(1) Background: On 6February 2023, two consecutive earthquakes hit Kahramanmaraş and surrounding ten cities, killing over 50,000 people. We aimed to reveal the treatment process of pediatric patients admitted to Adana City Hospital (ACH) in the first month after the earthquake. (2) Methods: Demographic data of the patients, time of presentation to the emergency department, injury locations, treatment procedures, and patient file information were recorded retrospectively and evaluated statistically. (3) Results: There were 1246 patients under the age of 18. A total of 560 patients were hospitalized in the orthopedic clinic; 42% were admitted in the first 24 h and 58% in the first three days. Of these children, 69 (12%) were referred, 52 (10%) were transferred to other departments within the hospital, and 421 (75.2%) were discharged in stable condition. The number of patients with large bone fractures was 77 (34 open fractures). Fasciotomy surgery was performed on 131 patients, 78 of whom had bilateral procedures. Of the 31 patients who underwent amputation, 17 (55%) were performed within the first 24 h and 28 (90%) within the first week. (4) Conclusions: Almost all injured children are admitted to the hospital during the first few days after an earthquake. The management of earthquake injuries in pediatric patients requires specialized care and immediate attention during the treatment process.
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Affiliation(s)
- Mesut Uluöz
- Orthopedics and Traumatology Clinic, Adana City Training and Research Hospital, Health Sciences University, Adana 01230, Turkey;
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Cuthbertson J, Weinstein E, Franc JM, Jones P, Lamine H, Magalini S, Gui D, Lennquist K, Marzi F, Borrello A, Fransvea P, Fidanzio A, Benítez CY, Achaz G, Dobson B, Malik N, Neeki M, Pirrallo R, Castro Delgado R, Strapazzon G, Farah Dell’Aringa M, Brugger H, Rafalowsky C, Marzoli M, Fresu G, Kolstadbraaten KM, Lennquist S, Tilsed J, Claudius I, Cheeranont P, Callcut R, Bala M, Kerbage A, Vale L, Hecker NP, Faccincani R, Ragazzoni L, Caviglia M. Sudden-Onset Disaster Mass-Casualty Incident Response: A Modified Delphi Study on Triage, Prehospital Life Support, and Processes. Prehosp Disaster Med 2023; 38:570-580. [PMID: 37675480 PMCID: PMC10548019 DOI: 10.1017/s1049023x23006337] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/26/2023] [Accepted: 08/03/2023] [Indexed: 09/08/2023]
Abstract
The application and provision of prehospital care in disasters and mass-casualty incident response in Europe is currently being explored for opportunities to improve practice. The objective of this translational science study was to align common principles of approach and action and to identify how technology can assist and enhance response. To achieve this objective, the application of a modified Delphi methodology study based on statements derived from key findings of a scoping review was undertaken. This resulted in 18 triage, eight life support and damage control interventions, and 23 process consensus statements. These findings will be utilized in the development of evidence-based prehospital mass-casualty incident response tools and guidelines.
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Affiliation(s)
- Joe Cuthbertson
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Monash University Disaster Resilience Initiative, Monash University, ClaytonVICAustralia
| | - Eric Weinstein
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
| | - Jeffrey Michael Franc
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Peter Jones
- Assistance Publique – Hópitaux de Paris (APHP), SAMU de Paris Hôpital Necker, Paris, France
| | - Hamdi Lamine
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
| | - Sabina Magalini
- Department of Surgery, Catholic University of the Sacred Heart, Policlinico Gemelli, Rome, Italy
| | - Daniele Gui
- Department of Neurosciences, Catholic University of the Sacred Heart, Policlinico Gemelli, Rome, Italy
| | - Kristina Lennquist
- Department of Neurosciences, Catholic University of the Sacred Heart, Policlinico Gemelli, Rome, Italy
| | - Federica Marzi
- Department of Neurosciences, Catholic University of the Sacred Heart, Policlinico Gemelli, Rome, Italy
| | - Alessandro Borrello
- Department of Neurosciences, Catholic University of the Sacred Heart, Policlinico Gemelli, Rome, Italy
| | - Pietro Fransvea
- Department of Neurosciences, Catholic University of the Sacred Heart, Policlinico Gemelli, Rome, Italy
| | - Andrea Fidanzio
- Department of Neurosciences, Catholic University of the Sacred Heart, Policlinico Gemelli, Rome, Italy
| | | | - Gerhard Achaz
- London Ambulance Service NHS Trust, London, London, United Kingdom
| | - Bob Dobson
- London Ambulance Service NHS Trust, London, London, United Kingdom
| | - Nabeela Malik
- University Hospitals Birmingham NHS Trust, Edgbaston, Birmingham, United Kingdom
| | - Michael Neeki
- Clinical Professor of Emergency Medicine, Arrowhead Regional Medical Center, Colton, CaliforniaUSA; Professor of Medical Education, California University of Science and Medicine, Colton, California USA
| | - Ronald Pirrallo
- Department of Emergency Medicine, Prisma Health University of South Carolina School of Medicine Greenville, Greenville, South CarolinaUSA
| | - Rafael Castro Delgado
- Health Service of the Principality of Asturias (SAMU-Asturias), Health Research Institute of the Principality of Asturias (Team Leader of the Research Group on Prehospital Care and Disasters, GIAPREDE), Oviedo, Spain
- Department of Medicine, Oviedo University, Oviedo, Spain
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy; University of Padova, Padova, Italy; International Commission for Mountain Emergency Medicine, Zurich, Switzerland
| | - Marcelo Farah Dell’Aringa
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy; Medical University Innsbruck, Innsbruck, Austria; International Commission of Mountain Emergency Medicine-ICAR MedCom, Zurich, Switzerland
| | - Chaim Rafalowsky
- Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Marcello Marzoli
- Department of Fire Service, Public Rescue and Civil Defence, Ministero dell’Interno, Rome, Italy
| | - Giovanni Fresu
- Department of Surgery, Catholic University of the Sacred Heart, Policlinico Gemelli, Rome, Italy
| | | | - Stenn Lennquist
- Department of Neurosciences, Catholic University of the Sacred Heart, Policlinico Gemelli, Rome, Italy
| | - Jonathan Tilsed
- London Ambulance Service NHS Trust, London, London, United Kingdom
| | - Ilene Claudius
- Department of Emergency Medicine, Harbor-UCLA, Torrence, CaliforniaUSA
| | - Piyapan Cheeranont
- Faculty of Medicine, Praboromarajchanok Institute, Ministry of Public Health, Nonthaburi, Thailand
| | - Rachel Callcut
- University of California Davis Department of Surgery, Sacramento, CaliforniaUSA
| | - Miklosh Bala
- Department of Fire Service, Public Rescue and Civil Defence, Ministero dell’Interno, Rome, Italy
| | - Anthony Kerbage
- Department of Internal Medicine, Hôtel-Dieu de France hospital, Beirut, Lebanon
| | - Luis Vale
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
| | - Norman Philipp Hecker
- ESTES—European Society for Trauma and Emergency Surgery, Disaster and Military Surgery Section, Milan, Italy
| | - Roberto Faccincani
- ESTES—European Society for Trauma and Emergency Surgery, Disaster and Military Surgery Section, Milan, Italy
| | - Luca Ragazzoni
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
| | - Marta Caviglia
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
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Abu-Zidan FM, Idris K, Cevik AA. Prehospital management of earthquake crush injuries: A collective review. Turk J Emerg Med 2023; 23:199-210. [PMID: 38024191 PMCID: PMC10664202 DOI: 10.4103/tjem.tjem_201_23] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/13/2023] [Indexed: 12/01/2023] Open
Abstract
Earthquakes are natural disasters which can destroy the rural and urban infrastructure causing a high toll of injuries and death without advanced notice. We aim to review the prehospital medical management of earthquake crush injuries in the field. PubMed was searched using general terms including rhabdomyolysis, crush injury, and earthquake in English language without time restriction. Selected articles were critically evaluated by three experts in disaster medicine, emergency medicine, and critical care. The medical response to earthquakes includes: (1) search and rescue; (2) triage and initial stabilization; (3) definitive care; and (4) evacuation. Long-term, continuous pressure on muscles causes crush injury. Ischemia-reperfusion injury following the relieving of muscle compression may cause metabolic changes and rhabdomyolysis depending on the time of extrication. Sodium and water enter the cell causing cell swelling and hypovolemia, while potassium and myoglobin are released into the circulation. This may cause sudden cardiac arrest, acute extremity compartment syndrome, and acute kidney injury. Recognizing these conditions and treating them timely and properly in the field will save many patients. Majority of emergency physicians who have worked in the field of the recent Kahramanmaraş 2023, Turkey, earthquakes, have acknowledged their lack of knowledge and experience in managing earthquake crush injuries. We hope that this collective review will cover the essential knowledge needed for properly managing seriously crushed injured patients in the earthquake field.
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Affiliation(s)
- Fikri M. Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, United Arab Emirates
| | - Kamal Idris
- Department of Critical Care and the Intensive Care Unit, Burjeel Royal Hospital, Al-Ain, United Arab Emirates
| | - Arif Alper Cevik
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, United Arab Emirates
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Nola IA, Dvorski M, Žižak M, Kuliš T. CRUSH SYNDROME IN EARTHQUAKES - STAY AND PLAY OR LOAD AND GO? Acta Clin Croat 2023; 62:158-165. [PMID: 38966034 PMCID: PMC11221230 DOI: 10.20471/acc.2023.62.s2.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024] Open
Abstract
Earthquakes are unpredictable natural disasters accompanied by material damage and many victims. In the case of a person remaining trapped under the collapsed material, the development of crush syndrome can occur. Crush syndrome is the result of traumatic rhabdomyolysis and is present in 2%-15% of all injured persons in an earthquake. It is not easy to recognize, and proper treatment is challenging. Persons who have a clear crush injury and/or have been immobilized for more than four hours should be considered potential victims of crush syndrome. Therefore, knowledge about crush syndrome must be comprehensive and accessible to all parties involved. In this paper, the management of crush syndrome victims, which includes the principles of triage, and medical and logistic principles as well, is presented. Triage principles are presented at the level of triage priorities, places, and diagnoses. Medical principles, crucial for crush syndrome, are presented regarding the duration of compression and time before or after extraction of the patient. Logistic principles provide an overview of the priorities and modes of transport in relation to distance of health institutions, and the importance of management and education associated with crush syndrome. Each country with recognized disasters (natural or man-made) in which crush-related victims are expected, will benefit if the knowledge about triage, medical and logistic principles for crush syndrome is incorporated in their educational programs and regularly updated.
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Affiliation(s)
- Iskra Alexandra Nola
- Department of Environmental and Occupational Health and Sports Medicine, Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Matija Dvorski
- Department of Environmental and Occupational Health and Sports Medicine, Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Mirza Žižak
- Department of Physiology and Immunology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Tomislav Kuliš
- Department of Urology, Zagreb University Hospital Center, School of Medicine, University of Zagreb, Zagreb, Croatia
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15
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Mousavi SH, Khankeh H, Atighechian G, Yarmohammadian MH, Memarzadeh M. Analysis of the intellectual and social structure of health system response plan to earthquake studies adopting word co-occurrence and narrative approaches. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:362. [PMID: 36618473 PMCID: PMC9818769 DOI: 10.4103/jehp.jehp_1632_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/21/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND AIM Earthquake is a natural disaster severely affecting the societies' health, hygiene, and welfare as such the most effective method to respond to its damages is to develop a readiness plan. This study aimed to discover thematic patterns and co-author relationships extracted from relevant publications to plan an earthquake response. MATERIALS AND METHODS This descriptive-analytical study adopted the scientometric approach and used word co-occurrence and social network analysis. The published articles indexed in PubMed were retrieved from 1970 to 2021 using a combination of keywords "earthquake and response." The data were analyzed in VOSviewer, UCINET, and NetDraw software. RESULTS The following six thematic clusters with a social map were extracted: Initial response of the healthcare system, response to probabilistic risks after the hazard, response to mental health and community resilience, response to public health, response to post-traumatic stress disorders, and staff's response to the needs assessment and continuity of diagnostic treatment services. Moreover, social network analysis revealed the great impact of Japanese and Chinese authors and institutes. CONCLUSION The present study detected many gaps in the literature on earthquake response, which can contribute to developing a general framework to prepare integrated healthcare earthquake response plans to promote the performance of this system.
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Affiliation(s)
- Seyed Hossein Mousavi
- Department of Health in Disaster and Emergencies, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Khankeh
- Research Center for Emergency and Disaster Health, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Golrokh Atighechian
- Department of Health in Emergencies and Disasters, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mehrdad Memarzadeh
- Department of Surgery, School of Medicine Craniofacial and Cleft Research Center, Imam Hossein Children Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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Murata I, Sugai T, Murakawa Y, Miyamoto Y, Kobayashi J, Inoue Y, Kanamoto I. Salvianolic acid B improves the survival rate, acute kidney dysfunction, inflammation and NETosis‑mediated antibacterial action in a crush syndrome rat model. Exp Ther Med 2022; 23:320. [DOI: 10.3892/etm.2022.11249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/21/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Isamu Murata
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Sakado, Saitama 350‑0295, Japan
| | - Tsugumi Sugai
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Sakado, Saitama 350‑0295, Japan
| | - Yumiko Murakawa
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Sakado, Saitama 350‑0295, Japan
| | - Yoshiaki Miyamoto
- Laboratory of Pharmacotherapeutics and Neuropsychopharmacology, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Sakado, Saitama 350‑0295, Japan
| | - Jun Kobayashi
- Laboratory of Pathophysiology, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Sakado, Saitama 350‑0295, Japan
| | - Yutaka Inoue
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Sakado, Saitama 350‑0295, Japan
| | - Ikuo Kanamoto
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Sakado, Saitama 350‑0295, Japan
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Banerjee S, Gupta A, Jeshwanth N. Acute Kidney Injury Secondary to Rhabdomyolysis: A Rare Complication of Low-Energy Trauma. J Orthop Case Rep 2021; 11:16-19. [PMID: 34141635 PMCID: PMC8046484 DOI: 10.13107/jocr.2021.v11.i01.1946] [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] [Indexed: 11/30/2022] Open
Abstract
Introduction Crush syndrome refers to the systemic manifestation of muscle cell injury following release of myocyte contents into the blood circulation. It is seen most commonly in patients sustaining high-energy trauma. Acute kidney injury is one of the most serious complications of crush syndrome and is an important cause of mortality in these patients. In contrast, the occurrence of rhabdomyolysis in patients sustaining low-energy trauma is sparsely reported in the literature. The authors report one such rare case. Case Report The patient was a 77-year-old hypertensive male who presented to the emergency following an episode of slip and fall at home. After prompt resuscitation, he was sent for radiological evaluation which revealed fractures of the left inter-trochanteric femur and left proximal humerus. Meanwhile, laboratory investigations showed grossly deranged renal parameters, along with elevated serum creatinine phosphokinase levels (more than 5 times the baseline). A diagnosis of acute kidney injury secondary to traumatic rhabdomyolysis was made. Medical management included adequate intravenous fluid administration combined with strict input-output monitoring. Subsequently, the patient underwent closed reduction and internal fixation of the inter-trochanteric femur fracture with a proximal femoral nail. However, fracture of the proximal humerus was managed non-operatively with sling immobilization as patient refused to give consent for a second surgery. Conclusion Although rare, acute kidney injury secondary to rhabdomyolysis can occur in patients with low-energy trauma. It is important not to confuse it with chronic renal insufficiency, especially in geriatrics many of whom are long-standing hypertensives.
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Affiliation(s)
- Sumit Banerjee
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Akshat Gupta
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - N Jeshwanth
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Ceferino L, Mitrani-Reiser J, Kiremidjian A, Deierlein G, Bambarén C. Effective plans for hospital system response to earthquake emergencies. Nat Commun 2020; 11:4325. [PMID: 32859917 PMCID: PMC7455727 DOI: 10.1038/s41467-020-18072-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 07/27/2020] [Indexed: 11/09/2022] Open
Abstract
Hospital systems play a critical role in treating injuries during disaster emergency responses. Simultaneously, natural disasters hinder their ability to operate at full capacity. Thus, cities must develop strategies that enable hospitals' effective disaster operations. Here, we present a methodology to evaluate emergency response based on a model that assesses the loss of hospital functions and quantifies multiseverity injuries as a result of earthquake damage. The proposed methodology can design effective plans for patient transfers and allocation of ambulances and mobile operating rooms. This methodology is applied to Lima, Peru, subjected to a disaster scenario following a magnitude 8.0 earthquake. Our results show that the spatial distribution of healthcare demands mismatches the post-earthquake capacities of hospitals, leaving large zones on the periphery significantly underserved. This study demonstrates how plans that leverage hospital-system coordination can address this demand-capacity mismatch, reducing waiting times of critically injured patients by factors larger than two.
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Affiliation(s)
- Luis Ceferino
- Department of Civil and Environmental Engineering, Stanford University, Stanford, CA, USA. .,The Andlinger Center for Energy and the Environment, Princeton University, Princeton, NJ, USA.
| | - Judith Mitrani-Reiser
- Materials and Structural Systems Division, Engineering Laboratory, National Institute of Standards and Technology, Gaithersburg, MD, USA
| | - Anne Kiremidjian
- Department of Civil and Environmental Engineering, Stanford University, Stanford, CA, USA
| | - Gregory Deierlein
- Department of Civil and Environmental Engineering, Stanford University, Stanford, CA, USA
| | - Celso Bambarén
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
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Systemic Inflammatory Response and Multiple Organ Dysfunctions Following Crush Injury: a New Experimental Model in Rabbits. Inflammation 2018; 41:240-248. [PMID: 29071515 DOI: 10.1007/s10753-017-0683-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In this study, we aim to develop a new, reproducible crush injury (CI) model in rabbits. Anesthetized rabbits were compressed on both hind limbs using a special instrument for 6 h followed by 3 h of reperfusion. Blood samples and injured muscles were collected for biochemical analysis and morphological evaluation. Survival observation lasted for 72 h. Bilateral compressions with 10 kg/kg body weight (BW), but not with 5 kg/kg BW, reduced serious systemic impairment. Bilateral compressions with 10 kg/kg BW resulted in severe lactic acidosis; increased serum K+, creatine phosphokinase, aspartate transaminase, alanine transaminase, blood urea nitrogen, and creatinine levels; and a sharply decreased mean arterial blood pressure after compression release. Serious tissue edema and inflammation were observed in the damaged muscles. The mortality rates in compression groups were 20% (5 kg/kg BW) and 60% (10 kg/kg BW). There was a significant increase in plasma concentrations of TNF-α and IL-1β after compression. Plasma IL-1β levels returned to control levels at 6 h after compression release, whereas TNF-α peaked at 12 h following reperfusion. Furthermore, antiinflammatory cytokines, including IL-4 and IL-10, were also increased after compression, and these two cytokines peaked at 12 h after compression release. Our data suggested that bilateral compression with 10 kg/kg BW on rabbits' hind limbs is a reproducible CI model, and we also reported the CI-induced systemic inflammatory responses and changes of cytokines over time.
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Peng J, Ren X, Lan T, Chen Y, Shao Z, Yang C. Renoprotective effects of ursolic acid on ischemia/reperfusion‑induced acute kidney injury through oxidative stress, inflammation and the inhibition of STAT3 and NF‑κB activities. Mol Med Rep 2016; 14:3397-402. [PMID: 27573738 DOI: 10.3892/mmr.2016.5654] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 06/22/2016] [Indexed: 11/05/2022] Open
Abstract
Ursolic acid, a pentacyclic triterpene compound with low toxicity and easy availability, has a variety of biological activities, including antitumor, antioxidant, antihepatitis, anti‑inflammatory and antibacterial effects. The present study aimed to investigate the renoprotective effects of ursolic acid on ischemia/reperfusion‑induced acute kidney injury (I/R‑IAKI) in rats associated with its antioxidant and anti‑inflammatory effects, as well as interference with the signal transducer and activator of transcription (STAT)3/nuclear factor (NF)‑κB signaling pathway. The present study demonstrated that pre‑treatment with ursolic acid significantly increased renal functioning and attenuated increases of serum angiotensin II levels in rats subjected to I/R‑IAKI. In addition, I/R‑IAKI‑induced inflammation and oxidative stress were significantly reduced by pre‑treatment with ursolic acid. Furthermore, ursolic acid significantly suppressed the upregulation of STAT3, NF‑κB and caspase‑3 activities in rats following I/R‑IAKI. These results indicated that ursolic acid may be a potential drug for reducing I/R‑IAKI through suppression of inflammation and oxidative stress damage, as well as modulation of STAT3 and NF‑κB activities.
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Affiliation(s)
- Jun Peng
- Department of Nephrology, Wuhan General Hospital of Guangzhou Military Area, Wuhan, Hubei 430030, P.R. China
| | - Xingfeng Ren
- Department of Nephrology, Wuhan General Hospital of Guangzhou Military Area, Wuhan, Hubei 430030, P.R. China
| | - Tianbiao Lan
- Department of Nephrology, Wuhan General Hospital of Guangzhou Military Area, Wuhan, Hubei 430030, P.R. China
| | - Yan Chen
- Department of Nephrology, Wuhan General Hospital of Guangzhou Military Area, Wuhan, Hubei 430030, P.R. China
| | - Ziyun Shao
- Department of Nephrology, Wuhan General Hospital of Guangzhou Military Area, Wuhan, Hubei 430030, P.R. China
| | - Cheng Yang
- Department of Nephrology, Wuhan General Hospital of Guangzhou Military Area, Wuhan, Hubei 430030, P.R. China
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Zengin Y, Icer M, Gunduz E, Dursun R, Durgun HM, Gullu MN, Orak M, Guloglu C. How was Felt Van Earthquake by a Neighbor University Hospital? Turk J Emerg Med 2015; 15:33-8. [PMID: 27437521 PMCID: PMC4909966 DOI: 10.5505/1304.7361.2015.03274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 12/09/2014] [Indexed: 12/05/2022] Open
Abstract
Objectives Natural disasters, which are defined as events causing great damage or loss of life, are events of natural origin unpreventable by human beings that occur in a short period of time and lead to loss of life and property. The aim of the study is to analyze which patient groups and problems at a university hospital after the earthquakes in Van. Methods For the purposes of this study, 169 patients who presented to our emergency room following the earthquakes that occurred on the 23rd of October, 2011 and the 9th of November, 2011 in Van and were treated as an outpatient or inpatient were enrolled. Patients were divided into two groups. Patient data including the clinical and demographic characteristics were analyzed. Results Among the 169 patients included in our study, 97 (57.4%) were male and 72 (42.6%) were female. The mean age was 26.95±16.44 years in Group 1 and 39.80±23.08 years in Group 2. In our study, the majority of the patients in Group 1 had orthopedic injuries, while internal problems were more common in Group 2. The need for intensive care was greater among the patients in Group 1 compared to Group 2 (p<0.05). The leading cause of death in Group 1 was multi-systemic trauma in 7 out of the 10 patients (70%) and internal problems in Group 2 with 5 out of 12 patients (41.5%). Conclusions Our country is in a geographical location where earthquakes are responsible for great losses of life and property. An efficient disaster relief plan may help to minimize the possible damage of earthquakes.
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Affiliation(s)
- Yilmaz Zengin
- Department of Emergency Medicine, Dicle University, Diyarbakır, Turkey
| | - Mustafa Icer
- Department of Emergency Medicine, Dicle University, Diyarbakır, Turkey
| | - Ercan Gunduz
- Department of Emergency Medicine, Dicle University, Diyarbakır, Turkey
| | - Recep Dursun
- Department of Emergency Medicine, Dicle University, Diyarbakır, Turkey
| | | | | | - Murat Orak
- Department of Emergency Medicine, Dicle University, Diyarbakır, Turkey
| | - Cahfer Guloglu
- Department of Emergency Medicine, Dicle University, Diyarbakır, Turkey
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Einav S, Hick JL, Hanfling D, Erstad BL, Toner ES, Branson RD, Kanter RK, Kissoon N, Dichter JR, Devereaux AV, Christian MD. Surge capacity logistics: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest 2015; 146:e17S-43S. [PMID: 25144407 DOI: 10.1378/chest.14-0734] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Successful management of a pandemic or disaster requires implementation of preexisting plans to minimize loss of life and maintain control. Managing the expected surges in intensive care capacity requires strategic planning from a systems perspective and includes focused intensive care abilities and requirements as well as all individuals and organizations involved in hospital and regional planning. The suggestions in this article are important for all involved in a large-scale disaster or pandemic, including front-line clinicians, hospital administrators, and public health or government officials. Specifically, this article focuses on surge logistics-those elements that provide the capability to deliver mass critical care. METHODS The Surge Capacity topic panel developed 23 key questions focused on the following domains: systems issues; equipment, supplies, and pharmaceuticals; staffing; and informatics. Literature searches were conducted to identify studies upon which evidence-based recommendations could be made. The results were reviewed for relevance to the topic, and the articles were screened by two topic editors for placement within one of the surge domains noted previously. Most reports were small scale, were observational, or used flawed modeling; hence, the level of evidence on which to base recommendations was poor and did not permit the development of evidence-based recommendations. The Surge Capacity topic panel subsequently followed the American College of Chest Physicians (CHEST) Guidelines Oversight Committee's methodology to develop suggestion based on expert opinion using a modified Delphi process. RESULTS This article presents 22 suggestions pertaining to surge capacity mass critical care, including requirements for equipment, supplies, and pharmaceuticals; staff preparation and organization; methods of mitigating overwhelming patient loads; the role of deployable critical care services; and the use of transportation assets to support the surge response. CONCLUSIONS Critical care response to a disaster relies on careful planning for staff and resource augmentation and involves many agencies. Maximizing the use of regional resources, including staff, equipment, and supplies, extends critical care capabilities. Regional coalitions should be established to facilitate agreements, outline operational plans, and coordinate hospital efforts to achieve predetermined goals. Specialized physician oversight is necessary and if not available on site, may be provided through remote consultation. Triage by experienced providers, reverse triage, and service deescalation may be used to minimize ICU resource consumption. During a temporary loss of infrastructure or overwhelmed hospital resources, deployable critical care services should be considered.
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Lu M, Wang Y, Yue L, Chiu J, He F, Wu X, Zang B, Lu B, Yao X, Jiang Z. Follow-up evaluation with ultrasonography of peripheral nerve injuries after an earthquake. Neural Regen Res 2014; 9:582-8. [PMID: 25206859 PMCID: PMC4146238 DOI: 10.4103/1673-5374.130095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2014] [Indexed: 01/02/2023] Open
Abstract
Published data on earthquake-associated peripheral nerve injury is very limited. Ultrasonography has been proven to be efficient in the clinic to diagnose peripheral nerve injury. The aim of this study was to assess the role of ultrasound in the evaluation of persistent peripheral nerve injuries 1 year after the Wenchuan earthquake. Thirty-four patients with persistent clinical symptoms and neurologic signs of impaired nerve function were evaluated with sonography prior to surgical repair. Among 34 patients, ultrasonography showed that 48 peripheral nerves were entrapped, and 11 peripheral nerves were disrupted. There was one case of misdiagnosis on ultrasonography. The concordance rate of ultrasonographic findings with those of surgical findings was 98%. A total of 48 involved nerves underwent neurolysis and the symptoms resolved. Only five nerves had scar tissue entrapment. Preoperative and postoperative clinical and ultrasonographic results were concordant, which verified that ultrasonography is useful for preoperative diagnosis and postoperative evaluation of injured peripheral nerves.
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Affiliation(s)
- Man Lu
- Department of Ultrasound, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Yue Wang
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Linxian Yue
- Department of Ultrasound, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Jack Chiu
- Department of Radiology, University Hospital, University of Western Ontario, Ontario, Canada
| | - Fanding He
- Department of Ultrasound, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Xiaojing Wu
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Bin Zang
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Bin Lu
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Xiaoke Yao
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Zirui Jiang
- Chengdu Jiaxiang Foreign Languages School, Chengdu, Sichuan Province, China
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Confined space medicine and the medical management of complex rescues: a case series. Disaster Med Public Health Prep 2014; 8:20-9. [PMID: 24528883 DOI: 10.1017/dmp.2014.1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE A variety of hazards can precipitate the full or partial collapse of occupied structures. The rescue of entrapped survivors in these situations can be complex, require a multidisciplinary approach, and last for many hours. METHODS The modern discipline of Urban Search and Rescue, which includes an active medical component, has evolved to address such situations. This case series spans several decades of experience and highlights the medical principles in the response to collapsed structure incidents. RESULTS Recurring concepts of confined space medicine include rescuer safety, inter-disciplinary coordination, patient protection, medical resuscitation in austere environments, and technical extrications. CONCLUSION Strategies have been developed to address the varied challenges in the medical response to collapsed structure incidents.
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Liu X, Liu YY, Liu SH, Zhang XR, Du L, Huang WX. Classification tree analysis of the factors influencing injury-related disability caused by the Wenchuan earthquake. J Int Med Res 2014; 42:487-93. [PMID: 24501163 DOI: 10.1177/0300060513487629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To identify the factors that influenced the risk of injury-related disability caused by the Wenchuan earthquake. METHODS A chi-squared automatic interaction detection (CHAID) classification tree analysis was used to retrospectively analyse clinical data from patients who underwent surgical treatment for earthquake-related injuries in the first 5 days after the earthquake. The CHAID classification tree explored the relationships between the development of disability and potential influencing factors including sex, age, time interval between injury and treatment, wound type, preoperative and postoperative haemoglobin levels, and operation time. RESULTS A total of 334 patients underwent surgery; of these, 113 (33.8%) were discharged with varying degrees of permanent disability. The CHAID classification tree showed that children (≤ 17 years old), a long time interval between injury and treatment, an open wound and a low preoperative haemoglobin level were significant risk factors for disability. CONCLUSION The results of this study can help to stratify patients according to their medical needs and to help allocate the available resources efficiently to ensure the best outcomes for injured patients during future earthquakes.
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Affiliation(s)
- Xiang Liu
- Department of Social Medicine, School of Public Health, Sichuan University, Chengdu, Sichuan Province, China
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Abstract
AIM OF THE STUDY The aim of the study was to evaluate the effects of bolus infusion of hypertonic hydroxyethyl starches (HHESs) and continuous infusion of hypertonic saline (HTS) in the early resuscitation in crush syndrome. METHODS A rat model of crush injury was established. Rats were randomly divided into five groups: (1) HHES group, (2) HTS group, (3) volume resuscitation group, (4) normal resuscitation (NR) group, and (5) sham group. Blood samples were collected 6 h after the crush period for biochemical evaluation. Blood pressure was monitored throughout this experiment. Muscles and kidneys were evaluated morphologically 24 h after reperfusion. Twenty rats in each group were taken for survival observation for 72 h. RESULTS Compared with the NR and HTS groups, the HHES group had significantly increased the survival rate 72 h after release (P < 0.05). In the first 2 h after release, mean arterial blood pressure in the HHES group was significantly higher than in HTS, volume resuscitation, and NR groups (respectively, P < 0.05). Animals that received HHES infusion showed a better acid-base balance and renal function. However, there was no significant difference in survival rate between the HTS and NR groups. Furthermore, animals in the HTS group showed a bad acid-base balance and a higher serum sodium level. CONCLUSIONS Bolus infusion of HHES combined with normal saline could be an effective therapy for crush syndrome in the early resuscitation period. However, continuous HTS injection was not seemed to be a suitable choice particularly in the absence of monitoring equipment for serum irons or blood gases (institutional protocol no. ZN5R20110016).
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Guner SI, Oncu MR. Evaluation of crush syndrome patients with extremity injuries in the 2011 Van Earthquake in Turkey. J Clin Nurs 2013; 23:243-9. [DOI: 10.1111/jocn.12398] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2013] [Indexed: 11/27/2022]
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Macintyre AG, Barbera JA, Petinaux BP. Survival Interval in Earthquake Entrapments: Research Findings Reinforced During the 2010 Haiti Earthquake Response. Disaster Med Public Health Prep 2013; 5:13-22. [PMID: 21357474 DOI: 10.1001/dmp.2011.5] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
ABSTRACTEarthquakes can result in collapsed structures with the potential to entrap individuals. In some cases, people can survive entrapment for lengthy periods. The search for and rescue of entrapped people is resource intensive and competes with other postdisaster priorities. The decision to end search and rescue activities is often difficult and in some cases protracted. Medical providers participating in response may be consulted about the probability of continued survival in undiscovered trapped individuals. Historically, many espouse a rigid time frame for viability of entrapped living people (eg, 2 days, 4 days, 14 days). The available medical and engineering data and media reports demonstrate a wide variety in survival “time to rescue,” arguing against the acceptance of a single time interval applicable to all incidents. This article presents historical evidence and reports from the 2010 Haiti earthquake. Factors that may contribute to survival after entombment are listed. Finally, a decision process for projecting viability that considers the critical factors in each incident rather than adhering to a single time frame for ceasing search and rescue activities is proposed. (Disaster Med Public Health Preparedness. 2011;5:13–22)
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Affiliation(s)
- Anthony G Macintyre
- The George Washington University, 2150 Pennsylvania Ave, NW, Suite 2B, Washington, DC 20037, USA.
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Smith RM, Dyer GSM, Antonangeli K, Arredondo N, Bedlion H, Dalal A, Deveny GM, Joseph G, Lauria D, Lockhart SH, Lucien S, Marsh S, Rogers SO, Salzarulo H, Shah S, Toussaint RJ, Wagoner J. Disaster triage after the Haitian earthquake. Injury 2012; 43:1811-5. [PMID: 21868011 DOI: 10.1016/j.injury.2011.07.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 06/15/2011] [Accepted: 07/18/2011] [Indexed: 02/02/2023]
Abstract
In the aftermath of the devastating Haitian earthquake, we became the primary relief service for a large group of severely injured earthquake victims. Finding ourselves virtually isolated with extremely limited facilities and a group of critically injured patients whose needs vastly outstripped the available resources we employed a disaster triage system to organize their clinical care. This report describes the specific injury profile of this group of patients, their clinical course, and the management philosophy that we employed. It provides useful lessons for similar situations in the future.
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Affiliation(s)
- R M Smith
- Massachusetts General Hospital, Boston, MA, United States.
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Gao R, Yang L, Yuan W, Li T, Fu Q. Overview of polytrauma patients in the first 10 days after the Sichuan earthquake: a report from the No. 903 Military Hospital, Jiangyou. Eur J Trauma Emerg Surg 2012; 38:85-8. [PMID: 26815823 DOI: 10.1007/s00068-012-0182-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Accepted: 02/14/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to investigate the profile of traumas, the severity, and mortality of polytrauma patients in a front-line hospital after the 2008 Sichuan earthquake. METHODS Patients who had two or more injuries to physical regions or organ systems, where at least one injury or the combination of injuries carried a certain risk of fatal outcome, with Injury Severity Score (ISS) ≥16, were considered as polytrauma patients and included in this study. Medical records consisting of demographic data, distribution and type of injuries, Abbreviated Injury Scale (AIS) score of each injury, ISS, surgical procedures, mortality rate, and features of the deaths were collected and analyzed. RESULTS A total of 70 earthquake-related polytrauma patients were treated in our hospital during the first 10 days after the earthquake. The mean ISS of these patients was 26.9, and 77.1% of these patients were critically injured (ISS ≥ 25). Among the 224 injuries, the most common injury site was the extremities (30.8%), 81.2% of which were fractures. A total of 152 surgical procedures were performed on these patients, of which orthopedic procedures accounted for 85.5%. During the first 10 days, 21 patients with significantly higher ISS than the survivors died in the hospital. CONCLUSIONS The mortality rate of the polytrauma patients in this rescue operation was high. The ISS was a feasible tool to estimate the severity of polytrauma patients. Specialists in orthopedics, critical care, and respiratory disorders were in great demand during the management of these patients in such conditions.
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Affiliation(s)
- R Gao
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - L Yang
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - W Yuan
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - T Li
- Department of Emergency, The No. 903 Military Hospital, Jiangyou, Sichuan, China
| | - Q Fu
- Department of Orthopedics, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China.
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Reinhardt JD, Li J, Gosney J, Rathore FA, Haig AJ, Marx M, DeLisa JA. Disability and health-related rehabilitation in international disaster relief. Glob Health Action 2011; 4:7191. [PMID: 21866223 PMCID: PMC3160807 DOI: 10.3402/gha.v4i0.7191] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 06/22/2011] [Accepted: 06/23/2011] [Indexed: 11/22/2022] Open
Abstract
Background Natural disasters result in significant numbers of disabling impairments. Paradoxically, however, the traditional health system response to natural disasters largely neglects health-related rehabilitation as a strategic intervention. Objectives To examine the role of health-related rehabilitation in natural disaster relief along three lines of inquiry: (1) epidemiology of injury and disability, (2) impact on health and rehabilitation systems, and (3) the assessment and measurement of disability. Design Qualitative literature review and secondary data analysis. Results Absolute numbers of injuries as well as injury to death ratios in natural disasters have increased significantly over the last 40 years. Major impairments requiring health-related rehabilitation include amputations, traumatic brain injuries, spinal cord injuries (SCI), and long bone fractures. Studies show that persons with pre-existing disabilities are more likely to die in a natural disaster. Lack of health-related rehabilitation in natural disaster relief may result in additional burdening of the health system capacity, exacerbating baseline weak rehabilitation and health system infrastructure. Little scientific evidence on the effectiveness of health-related rehabilitation interventions following natural disaster exists, however. Although systematic assessment and measurement of disability after a natural disaster is currently lacking, new approaches have been suggested. Conclusion Health-related rehabilitation potentially results in decreased morbidity due to disabling injuries sustained during a natural disaster and is, therefore, an essential component of the medical response by the host and international communities. Significant systematic challenges to effective delivery of rehabilitation interventions during disaster include a lack of trained responders as well as a lack of medical recordkeeping, data collection, and established outcome measures. Additional development of health-related rehabilitation following natural disaster is urgently required.
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Affiliation(s)
- Jan D Reinhardt
- International Society of Physical and Rehabilitation Medicine-ISPRM, Rehabilitation Disaster Relief Committee, Assenede, Ghent, Belgium.
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Speck K, Schneider BSP, Deashinta N. A Rodent Model to Advance the Field Treatment of Crush Muscle Injury During Earthquakes and Other Natural Disasters. Biol Res Nurs 2011; 15:17-25. [DOI: 10.1177/1099800411414698] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Approximately 170 earthquakes of 6.0 or higher magnitude occur annually worldwide. Victims often suffer crush muscle injuries involving impaired blood flow to the affected muscle and damage to the muscle fiber membrane. Current rescue efforts are directed toward preventing acute kidney injury (AKI), which develops upon extrication and muscle reperfusion. But field-usable, muscle-specific interventions may promote muscle regeneration and prevent or minimize the pathologic changes of reperfusion. Although current rodent crush injury models involve reperfusion upon removal of the crush stimulus, an analysis of their methodological aspects is needed to ensure adequate simulation of the earthquake-related crush injury. The objectives of this systematic review are to (a) describe rodent crush muscle injury models, (b) discuss the benefits and limitations of these models, and (c) offer a recommendation for animal models that would increase our understanding of muscle recovery processes after an earthquake-induced crush muscle injury. The most commonly used rodent model uses a clamping or pressing crush stimulus directly applied to murine hindlimb muscle. This model has increased our understanding of muscle regeneration but its open approach does not adequately represent the earthquake-related crush injury. The model we recommend for developing field-usable, muscle-specific interventions is a closed approach that involves a nonclamping crush stimulus. Findings from studies employing this recommended model may have greater relevance for developing interventions that lessen the earthquake’s devastating impact on individual and community health and quality of life, especially in developing countries.
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Affiliation(s)
- Kirsten Speck
- School of Nursing, University of Nevada, Las Vegas, NV, USA
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Bibliography. Current world literature. Thoracic anesthesia. Curr Opin Anaesthesiol 2011; 24:111-3. [PMID: 21321525 DOI: 10.1097/aco.0b013e3283433a20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Metzger JC, Eastman AL, Pepe PE. Year in review 2009: Critical Care--cardiac arrest, trauma and disasters. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2010; 14:242. [PMID: 21122166 PMCID: PMC3220035 DOI: 10.1186/cc9302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
During 2009, Critical Care published nine papers on various aspects of resuscitation, prehospital medicine, trauma care and disaster response. One article demonstrated that children as young as 9 years of age can learn cardiopulmonary resuscitation (CPR) effectively, although, depending on their size, some may have difficulty performing it. Another paper showed that while there was a trend toward mild therapeutic hypothermia reducing S-100 levels, there was no statistically significant change. Another predictor study also showed a strong link between acute kidney injury and neurologic outcome while another article described a program in which kidneys were harvested from cardiac arrest patients and showed an 89% graft survival rate. One experimental investigation indicated that when a pump-less interventional lung assist device is present, leaving the device open (unclamped) while performing CPR has no harmful effects on mean arterial pressures and it may have positive effects on blood oxygenation and CO2 clearance. One other study, conducted in the prehospital environment, found that end-tidal CO2 could be useful in diagnosing pulmonary embolism. Three articles addressed disaster medicine, the first of which described a triage system for use during pandemic influenza that demonstrated high reliability in delineating patients with a good chance of survival from those likely to die. The other two studies, both drawn from the 2008 Sichuan earthquake experience, showed success in treating crush injured patients in an on-site tent ICU and, in the second case, how the epidemiology of earthquake injuries and related factors predicted mortality.
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Affiliation(s)
- Jeffery C Metzger
- Department of Surgery/Emergency Medicine, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Mail Code 8579, Dallas, TX 75390-8579, USA.
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Kam CW, Lai CH, Lam SK, So FL, Lau CL, Cheung KH. What are the ten new commandments in severe polytrauma management? World J Emerg Med 2010; 1:85-92. [PMID: 25214947 PMCID: PMC4129756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Accepted: 08/03/2010] [Indexed: 06/03/2023] Open
Abstract
This review aims to provide a concise overview of the trauma management evolution in the past decade. 1) Trauma care priorities have incorporated staff protection against infection and early decision making in addition to the conventional ABCDE. 2) Five stratified levels for DAM have replaced the non-specific conventional Plans A & B. 3) CT scanning can be the tunnel to death for the hemodynamically unstable patient. 4) DPL has virtually been replaced by the FAST USG. 5) Direct whole-body MDCT provides rapid imaging diagnosis & expedites the definitive treatment but carries high radiation hazards. 6) The dynamic shock assessment by fluid resuscitation response provides more outcome-specific evaluation than the static blood volume loss model. 7) DCR comprising of permissive hypotension, hemostatic resuscitation & DCS aims to overcome the lethal triad of trauma. Early transfusion of blood components of FFP & platelet concentrates improves the outcome in massive blood transfusion. 8) DCS aims to rectify the deranged physiology and not to fully restore the damaged anatomy. 9) A pre-defined protocol for major pelvic fracture can be life-saving and the novel Pre-PPP (pre-peritoneal pelvic packing) may further reduce mortality coupled with the necessary TCAE. 10) Injury prevention is equally important if not more than the trauma resuscitation & operation.
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Affiliation(s)
- CW Kam
- Accident & Emergency Department, Tuen Mun Hospital, Hong Kong, China
| | - CH Lai
- Accident & Emergency Department, Tuen Mun Hospital, Hong Kong, China
| | - SK Lam
- Accident & Emergency Department, Tuen Mun Hospital, Hong Kong, China
| | - FL So
- Accident & Emergency Department, Tuen Mun Hospital, Hong Kong, China
| | - CL Lau
- Accident & Emergency Department, Tuen Mun Hospital, Hong Kong, China
| | - KH Cheung
- Accident & Emergency Department, Tuen Mun Hospital, Hong Kong, China
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