Massive transfusion protocol: the reason it is necessary

Objective. The purpose of this study is to identify problems of emergency transfusion at the bedside and to determine need for massive transfusion protocol. Methods. We included patients who met the criteria for “trauma team activation” and were admitted to division of trauma. The amount of blood product transfused in each unit was investigated for balanced transfusion. We also investigated the compliance with assessment of blood consumption score. The correlation between the time elapsed from patient visit to first transfusion order and time elapsed from first transfusion order to transfusion start was analyzed. Finally, we investigated various factors which serve to influence the decision-making process regarding early transfusion order. Results. Ratio of packed Red blood cells (pRBC): Fresh frozen plasma (FFP) was well-balanced, but platelet transfusion done was much lower than pRBC and FFP in emergency room. The application of emergency blood release did not match the criteria of assessment of blood consumption (ABC) score. The time from the first transfusion order to the transfusion start was found to be constant irrespective of time from patient visit to first transfusion order. And, the time from the first transfusion order to transfusion start did not differ significantly among patients with early transfusion order and delayed transfusion order. Only systolic blood pressure of < 90 mmHg was identified as a major predictor for early transfusion order. Conclusion. Balanced transfusion is not easy and emergency transfusion could be delayed at the bedside. Integrated and systematic structures for massive transfusion protocol would be invaluable and indispensable

Anticholinesterase Therapy for Patients with Ophthalmoplegia Following Snake Bites: Report of Two Cases

Although ophthalmoplegia following snake bites is not indicative of a serious neurotoxic complication, symptoms of diplopia, dizziness and ocular discomfort can be emotionally devastating for patients. The authors experienced two cases of ophthalmoplegia following snake bites in Korea. The patients complained of diplopia that had developed several hours after the snake bites. The diplopia did not improve with antivenom treatment, but resolved completely after several injections of neostigmine

Retrospective study on the impact of ulnar nerve dislocation on the pathophysiology of ulnar neuropathy at the elbow

Introduction High resolution ultrasonography (US) has been used for diagnosis and evaluation of entrapment peripheral neuropathy. Ulnar neuropathy at the elbow (UNE) is the second most common focal entrapment neuropathy. The ulnar nerve tends to move to the anteromedial side and sometimes subluxates or dislocates over the medial epicondyle as the elbow is flexed. Dislocation of the ulnar nerve during elbow flexion may contribute to friction injury. We aimed to investigate the effects which the dislocation of ulnar nerve at the elbow could have on the electrophysiologic pathology of UNE. Materials We retrospectively reviewed 71 arms of UNE. The demographic data, electrodiagnosis findings and US findings of ulnar nerve were analyzed. We classified the electrodiagnosis findings of UNE into three pathologic types; demyelinating, sensory axonal loss, and mixed sensorimotor axonal loss. The arms were grouped into non-dislocation, partial dislocation, and complete dislocation groups according to the findings of nerve dislocation in US examination. We compared the electrodiagnosis findings, ulnar nerve cross sectional areas in US and electrodiagnosis pathology types among the groups. Results A total of 18 (25.3%) arms showed partial dislocation, and 15 (21.1%) arms showed complete dislocation of ulnar nerve in US. In the comparison of electrodiagnosis findings, the partial and complete dislocation groups showed significantly slower conduction velocities and lower amplitudes than non-dislocation group in motor conduction study. In the sensory conduction study, the conduction velocity was significantly slower in partial dislocation group and the amplitude was significantly lower in complete dislocation group than non-dislocation group. In the comparison of US findings, patients in partial and complete dislocation groups showed significantly larger cross sectional areas of the ulnar nerve. The comparison of electrodiagnosis pathologic types among the groups revealed that there were significantly larger proportions of the axonal loss (sensory axonal loss or mixed sensorimotor axonal loss) in partial and complete dislocation groups than non-dislocation group. Conclusion The ulnar nerve dislocation could influence on the more severe damage of the ulnar nerve in patients with UNE. It might be important to evaluate the dislocation of the ulnar nerve using US in diagnosing ulnar neuropathy for predicting the prognosis and determining the treatment direction of UNE

Response of different cultivation substrates on the chilling injury symptom of sweet pepper grown in hydroponics

This study determined the chilling injury interactions of sweet peppers with their hydroponic growth substrate. The treatments were cocopeat, perlite, and a mixture of 50:50 cocopeat and perlite (coco-perlite). The fruits, when harvested, were stored for 50 days using the modified atmosphere package (MAP) at 5 °C. The results revealed no significant interactions between the growth substrate and the chilling injury indicators (respiration and ethylene production rates, electrolyte leakage, malondialdehyde), even though a significant interaction existed with the chilling injury index (a water-soaked area). This is believed to be due to the growth substrate’s significant interactions with soluble solids and dry matter, which aided cellular balance and increased chilling injury tolerance in perlite and coco-perlite treatment. Weight loss rate and firmness loss were insignificant in all treatments, and cocopeat treatment may be considered the worst of all treatments

Radiation exposure from computed tomography in blunt trauma patients

Introduction. Computed tomography (CT) has many diagnostic advantages, spurring growth in the number of CT examinations. As the use of CT increases, the potential for radiation-induced adverse effects has become an issue. The primary objective of this study was to assess the liberal use of CT induced radiation exposure in patients with multiple blunt traumas. The secondary objective was to investigate the factors affecting the estimated effective dose resulting from CTs unrelated to final diagnosis. Methods. Using data from our hospital information system, we selected patients assigned a trauma code, according to the Korean Standard Classification of Diseases, and with three or more body lesions assessed by CT at the same time in the emergency department. Each CT conducted was categorized into ‘CT related to the final diagnosis’ or ‘CT unrelated to final diagnosis’. The characteristics and estimated effective dose of CTs unrelated to the final diagnosis were analyzed. The factors affecting the estimated effective dose of CTs unrelated to final diagnosis were investigated. Results. More than half of all CT examinations were not associated with the final diagnosis. The additional estimated effective dose due to CTs being unrelated to the final diagnosis in each patient was a sufficient amount of radiation exposure to increase the possibility of fatal cancer. Conclusion. A considerable number of CT scans were unrelated to the patient’s final diagnosis, which exposes the patient to additional radiation exposure

Dissociating stable nitrogen molecules under mild conditions by cyclic strain engineering

All quiet on the nitrogen front. The dissociation of stable diatomic nitrogen molecules (N-2) is one of the most challenging tasks in the scientific community and currently requires both high pressure and high temperature. Here, we demonstrate that N-2 can be dissociated under mild conditions by cyclic strain engineering. The method can be performed at a critical reaction pressure of less than 1 bar, and the temperature of the reaction container is only 40 degrees C. When graphite was used as a dissociated N* receptor, the normalized loading of N to C reached as high as 16.3 at/at %. Such efficient nitrogen dissociation is induced by the cyclic loading and unloading mechanical strain, which has the effect of altering the binding energy of N, facilitating adsorption in the strain-free stage and desorption in the compressive strain stage. Our finding may lead to opportunities for the direct synthesis of N-containing compounds from N-2