Bringing Packed Red Blood Cells to the Point of Combat Injury: Are We There Yet?

INTRODUCTION: Hemorrhage is the leading cause of injury related pre-hospital mortality. We investigated worst case scenarios and possible requirements of Turkish Military. As we plan to use blood resources during casualty transport, the impact of transport related mechanical stress on PRBC (packed red blood cell) were analyzed. MATERIAL AND METHODS: The in vitro experiment was performed in the environmental test laboratories of ASELSAN(R). Operational vibrations of potential casualty transport mediums such as Sikorsky Helicopters, Kirpi(R) Armoured Vehicle and NATO vibration standardsoftware MIL-STD-810G were recorded. The most powerful mechanical stress, which was created by the NATO standard, was applied to 15 units of fresh (7 day) PRBC in a blood cooler box. The vibrations were simulated by TDS v895 Medium-Force Shaker Device. On site blood samples were analyzed at 0, 6th and 24th hours for biochemical and biomechanical analyses. RESULTS: The mean age of fresh and old PRBCs was 4.9 (SD +/- 2.2) and 32.8 (SD +/- 11.8) days, respectively. Six-hour mechanical damage of fresh PRBC was demonstrated by increased erythrocyte fragmentation rates (p=0.015), hemolysis rates (p=0.003), supernatant potassium levels (p=0.003) and decreased hematocrit levels (p=0.015). Old PRBC hemolysis rates (p=0.015), supernatant potassium levels (p=0.015), supernatant Hb (p=0.015) were increased and Htc levels were decreased (p=0.015) within 6 hours. Two (%13) units of fresh and none of the old PRBC were eligible for transfusion after 6 hours of mechanical stress. CONCLUSION: When the austere combat environment was simulated for 24 hours, fresh and old PRBC hemolysis rates were above the quality criteria. Currently, a technology to overcome this mechanical damage does not seem to exist. In the light of the above data, a new national project is being performed

Intelligent Tourniquet System for Emergency Aid

In case of traffic accidents, firearm injuries and explosions, it is necessary to apply a tourniquet in order to survive the injuries of serious extremity injuries and blood loss. There are a few things to consider when applying a tourniquet. If the tourniquet is not tightened enough to stop the blood loss, blood loss continues and the injured person's life becomes dangerous. If excessive pressure is exerted, and if it is not relaxed and squeezed intermittently, it may cause gangrene in the extremity. The purpose of this study is to develop a pneumatic, intelligent tourniquet system that can successfully stop bleeding by automatically applying the necessary pressure to the proximal limb, where it is injured to stop excessive blood loss in extremity injuries. It is thought that the developed system will be widely used in ambulances, first aid kits for vehicles, emergency services for hospitals, first aid organizations, fire trucks, first aid kits for risky workplaces and many similar civilian areas. As the output of this study; an intelligent tourniquet system prototype has been produced that can be used for arm and leg, inflates with an air motor, has an advanced microcontroller that can manage many parameters, has a GPS module that can access the location of the injured person, has a RTC (Real Time Clock) that can calculate elapsed time since the start of the tourniquet, has a pressure sensor that can gage the tourniquet pressure, can display these information on the OLED screen, direct the user with the necessary instructions to apply the tourniquet correctly, and also send messages to the mobile phone via the GSM module on the collected data.Trafik kazaları, ateşli silah yaralanmaları ve patlama gibi olaylar sonucu oluşan ciddi ekstremite yaralanması ve kan kaybı durumlarında yaralının hayatta kalabilmesi için kanama olan ekstremitesine turnike uygulanması gerekmektedir. Turnike uygulanırken dikkat edilmesi gereken bazı hususlar vardır. Eğer turnike kanın durması gereken basıncı sağlayacak kadar sıkılmamışsa kan kaybı devam eder ve yaralının hayatı tehlikeye girer. Gerekenden fazla basınç uygulandığında ve ara ara gevşetilip tekrar sıkılmadığında da ekstremitenin kangren olmasına sebep olur. Bu çalışmanın amacı, ekstremite yaralanmalarında aşırı kan kayıplarını durdurabilmek için yaralanmanın olduğu ekstremitenin proksimaline bağlanarak gerekli basıncı otomatik olarak uygulayarak kanamayı başarıyla durdurabilen pnömatik, akıllı turnike sistemi geliştirilmesidir. Geliştirilen sistemin ambülanslarda, araçlardaki ilk yardım kitlerinde, hastanelerin acil servislerinde, ilk yardım kuruluşlarında, itfaiye araçlarında, iş sağlığı ve güvenliği kapsamında riskli iş yerlerinin ilk yardım kitlerinde ve benzeri çoğu sivil alanda kullanımının yaygın olacağı düşünülmektedir. Çalışmanın çıktısı olarak; kol ve bacak için uygulanabilen, hava motoru ile şişen, gelişmiş bir mikrodenetleyici ile birçok parametreyi yönetebilen, üzerindeki GPS modülü ile turnikenin uygulandığı konumu, RTC (Real Time Clock) ile turnikenin uygulanmaya başladıktan sonra geçen süreyi, hava basınç sensörüyle turnikenin uyguladığı basınç bilgilerini üzerindeki OLED ekranda görüntüleyebilen, kullanıcıyı turnikeyi doğru bir şekilde uygulayabilmesi için gerekli direktiflerle sesli olarak yönlendiren, ayrıca toplanan verileri üzerindeki GSM modülü ile cep telefonuna mesaj atabilen, en temel amacı hayat kurtarmak olan akıllı turnike sistemi prototipi üretilmiştir

Alpha-1 protease inhibitor and antichymotrypsin levels in acute pancreatitis

BACKGROUN

Alpha-1 protease inhibitor and antichymotrypsin levels in acute pancreatitis

BACKGROUN

Analysis of anatomical localization and severity of injury in patients with blood transfusion in urban terrain hospital

BACKGROUND: Blood loss is the most significant cause of mortality in trauma cases. In injured patients, rapid evaluation and appropriate transfusion is lifesaving. The present study aims to analyze the blood/blood products requirement based on available data and find any associations between the transfusion requirements and injury severity scores (ISS) and anatomical locations of injuries of transfused patients

Combat Application Tourniquet (CAT) Eradicates Popliteal Pulses Effectively by Correcting the Windlass Turn Degrees: a Trial on 145 Participants

INTRODUCTION: We aimed to define an ideal range of windlass turn degrees for 100 % success rates within the study population. METHODS: CAT was applied at mid-thigh level. Data included age, lower extremity circumference (LEC), body mass index (BMI), and mean arterial pressure (MAP). Windlass turn degrees were measured in failed and successful participants. The failed participants\u27 windlass mechanisms were twisted until the popliteal artery was occluded. Failure to success and additional turn degrees to secure the windlass mechanism of CAT was determined. Doppler ultrasound was used to examine the popliteal artery blood flow. RESULTS: 145 servicemen have participated in the study. Initially, 70 % successfully applied CAT. There was no statistically significant difference in BMI and MAP values between successful and failed participants. The mean LEC for failed and successful applications were 57.5 +/- 4 and 56.8 +/- 4, respectively. The required turn degrees for success ranged between 45 degrees and 270 degrees . After correction, the cumulative success rate of 93 and 100 % was reached at 990 degrees and 1170 degrees overall turn degrees. DISCUSSION: In order to adequately stop limb hemorrhage, soldiers should be taught their optimal turn degrees

Evaluation of Effect of Garlic Aged Extracts and Vitamin B12 on Noise-Induced Hearing Loss

Objective: This study investigated effects of S-allylmercaptocysteine (SAMC), diallyl disulfide (DADS), and vitamin B12 on inner ear functions and morphology after long-period high-level broadband noise exposure. Materials and Methods: Twenty-four healthy rats were randomly divided into four groups. First group was chosen as the control group. Vitamin B12, SAMC, and DADS were applied to other groups for 4 weeks. On the 14th day, each group was exposed to broadband noise. Auditory brainstem response test was performed before and immediately after noise exposure and repeated on the 2nd and 14th day. Results: Permanent threshold shifts were significantly lower in groups treated with vitamin B12, SAMC, and DADS. Histologically, cochleae of SAMC and DADS groups were found to be better preserved than the cochleae of vitamin B12 and control groups. Conclusion: Physiologically and histologically, SAMC and DADS reduced the long-term effects of noise. However, physiological recovery was not consistent with the morphological findings in vitamin B12 group