[Emergency ultrasound for trauma]

The use of ultrasound is now widespread within the field of Emergency Medicine. The availability of lightweight and relatively cheap ultrasound devices has enabled clinicians to obtain more detailed information about the condition of acutely ill and injured patients than can be done with a clinical exam only. This paper discusses the standardized E-FAST exam for trauma; the technical details of the exam and the reliability of the information gained by each of it's components. Other advanced use of ultrasound for evaluation of trauma patients is introduced. Investing in the equipment and physician training to provide emergency ultrasound evaluation of injured and acutely ill patients in Iceland may be a relatively inexpensive way to improve patient care.Á síðustu árum hefur ómskoðun verið æ meira notuð við bráðalækningar. Tilkoma ódýrra og handhægra ómtækja hefur gert læknum kleift að afla mun nákvæmari upplýsinga um ástand slasaðra og bráðveikra en fæst með hefðbundinni líkamsskoðun eingöngu. Hér er fjallað um staðlaða bráðaómskoðun vegna áverka, hvernig hún er framkvæmd og nákvæmni ýmissa þátta skoðunarinnar. Kynntir verða aðrir þættir sem hægt er að bæta við hina stöðluðu áverkaómun til frekari greiningar. Að mati höfunda er fjárfesting í tækjabúnaði og þjálfun lækna til áverkaómunar líklega hagkvæm leið til að bæta þjónustu við slasaða á Íslandi

Role of copper on Laves phase morphology in 9-12%Cr steels

In this work the Laves phase was found to appear in two different morphologies, namely granular shapes and in an elongated shape. No difference in crystallography could be detected between these morphologies. The Laves phase was only observed in its elongated form in Cu-containing steels, where it was the primary morphology present after short term ageing. After long term ageing, the elongated Laves phase was replaced by the granular morphology. It is speculated that Cu precipitates act as nucleation sites for the elongated Laves phase, resulting in an unstable orientation relationship with the matrix, an in the meta-stable elongated morphology of Laves phase precipitates

Severely increased serum lipid levels in diabetic ketoacidosis – case report

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked FilesVeruleg hækkun á blóðfitum er þekktur en sjaldgæfur fylgikvilli ketónblóðsýringar. Hér er lýst tilfelli 23 ára konu sem leitaði á bráðamóttöku Landspítala vegna kviðverkja. Blóðvökvi reyndist það fituríkur að ekki var unnt að mæla blóðhag. Hún var með hraða og djúpa öndun (Kussmaul-­öndun) og aceton-lykt úr vitum. Hún reyndist hafa insúlínháða sykursýki með ketónblóðsýringu (ketoacidosis). Veitt var hefðbundin meðferð með vökva í æð, insúlíni og kalíum gjöf og leiðréttust gildi blóðsykurs og blóðfitu hratt. Mögulegar skýringar á háum blóðfitugildum eru nýlegar mataræðisbreytingar ásamt undirliggjandi, ógreindri sykursýki. Sjúkratilfellið undirstrikar mikilvægi þess að hafa í huga ólíkar birtingarmyndir ketónblóðsýringar.Severe hypertriglyceridemia is a known, but uncommon complication of diabetic ketoacidosis. We discuss the case of a 23-year-old, previously healthy, woman who initially presented to the emergency department with abdominal pain. Grossly lipemic serum due to extremely high triglyceride (38.6 mmol/L) and cholesterol (23.2 mmol/L) levels were observed with a high blood glucose (23 mmol/L) and a low pH of 7.06 on a venous blood gas. She was treated successfully with fluids and insulin and had no sequale of pancreatitis or cerebral edema. Her triglycerides and cholesterol was normalized in three days and she was discharged home on insulin therapy after five days. Further history revealed a recent change in diet with no meat, fish or poultry consumption in the last 12 months and concomitantly an increase in carbohydrate intake which might have contributed to her extremely high serum lipid levels. This case demonstrates that clinicians should be mindful of the different presentations of diabetic ketoacidosis

Cardiac arrest over the Atlantic

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenThe following case report is of the cardiac arrest of a 63 year old male on board a transatlantic passenger aircraft. Medical doctors on board the aircraft used an automated external defibrillator (AED) which restored the patient circulation. On arrival at the hospital in Iceland two hours later he was unconscious and had EKG signs of an antero-septal myocardial infarction. He received thrombolytic therapy, was intubated and kept hypothermic in the ICU. On coronary angiography he had stenosis of the left anterior diagonal artery which was dilated and stented. Twelve days after the cardiac arrest the patient was discharged from the hospital and was scheduled to return to his prior occupation shortly thereafter. Automated external defibrillators have proven to be save and effective in the resuscitation of cardiac arrest patient in hospital and prehospital settings. We review the literature on their use, and the benefits and costs involved for the major Icelandic airline company installing the AEDs.Lýst er hjartastoppi 63 ára karlmanns um borð í farþegaþotu á flugi yfir Íslandi. Læknar í flugvélinni beittu sjálfvirku stuðtæki og tókst að koma aftur á blóðflæði. Við komu á Landspítala reyndist sjúklingur vera með merki um framveggsdrep í hjarta, fékk hann segaleysandi meðferð og síðan kælingu í svæfingu á gjörgæslu. Hjartaþræðing leiddi í ljós þrengingu á LAD sem var víkkuð og fóðruð. Tólf dögum eftir hjartastoppið var sjúklingur útskrifaður af sjúkra­húsi við góða líðan og fyrirsjáanlegt að hann gæti snúið til fyrri starfa fljótlega. Sjálfvirk hjartastuðtæki hafa reynst örugg í notkun og auka árangur endurlífgunar utan sem innan veggja sjúkrahúsa. Í greininni er fjallað um helstu rannsóknir á gagnsemi tækjanna, ásamt ávinningi og kostnaði við að sjálfvirk hjartastuðtæki væru sett í íslenskar flugvélar í millilandaflugi

Use of Fish Skin Graft in Management of Combat Injuries Following Military Drone Assaults in Field-Like Hospital Conditions

© The Association of Military Surgeons of the United States 2023.INTRODUCTION: The 2020 Nagorno-Karabakh war was an armed conflict between Azerbaijan and Armenia over an ethnically and historically significant region. This manuscript is a report on the forward deployment of acellular fish skin graft (FSG) from Kerecis™, a biologic, acellular matrix derived from the skin of wild-caught Atlantic cod that contains intact epidermis and dermis layers. The usual intention of treatment under adverse circumstances is to temporize wounds until better treatment can be attained, although ideally, rapid coverage and treatment are necessary to prevent long-term complications and loss of life and limb. An austere environment, such as the one experienced during the conflict described here, presents considerable logistical barriers for the treatment of wounded soldiers. MATERIALS AND METHODS: Dr H. Kjartansson from Iceland and Dr S. Jeffery from the United Kingdom traveled to Yerevan, near the heart of the conflict, to deliver and train on using FSG in wound management. The primary goal was to use FSG in patients where stabilization and improvement in the wound bed were needed before skin grafting. Other goals were to improve healing time, achieve earlier skin grafting, and have better cosmetic outcomes upon healing. RESULTS: Over the course of two trips, several patients were managed with fish skin. Injuries included large-area full-thickness burn and blast injuries. Management with FSG induced wound granulation several days sooner in all cases, and even weeks in some instances, allowing a stepdown in the reconstruction ladder with earlier skin grafting procedures and a reduction in requirement of flap surgery. CONCLUSIONS: This manuscript describes a successful first instance of forward deployment of FSGs to an austere environment. FSG, in this military context, has shown great portability, with easy transfer of knowledge. More importantly, management with fish skin has shown faster granulation rates in burn wounds for skin grafting, resulting in improved patient outcomes with no documented infections.Peer reviewe