Tag: war

Categories : Injury & TraumaTags :

Diagnosing and Managing Blast Injuries

On By ModernMedia
Photo by Jeff Kingma on Unsplash

The prevalence of armed conflicts, terrorist attacks and industrial accidents necessitates clinician understanding of blast injuries in both civilian and military settings. Blast injuries are a complex form of trauma, resulting from the explosive release of energy. The severity and types of injury depend on the proximity to the blast, blast pressure and the presence of other elements like fragments and heat.

In a new video published in the New England Journal of Medicine‘s “Video in Clinical Medicine” section, authors from Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center (BMC), in collaboration with the department of anaesthesiology at Walter Reed National Military Medical Center, focus on the mechanisms and classifications of blast injuries and present essential knowledge for initial diagnosis and management.

“Blast injuries present a unique challenge in trauma medicine due to their complex mechanisms and varied presentations. A comprehensive understanding and approach to managing these injuries is essential to improve patient outcomes,” explains corresponding author Rafael Ortega, MD, FASA, chair & professor of anaesthesiology at the school.

The video provides a review on blast injury types including: primary injuries to the lungs, ears and bowels due to the blast wave; secondary injuries caused by trauma from propelled debris; tertiary injuries due to blast wind impacts on the body; quaternary injuries like burns, asphyxiation and exposure to toxic substances; and quinary injuries, clinical repercussions of chemical, radiologic or biologic contaminants occurring post-detonation. Also considered are the types of explosives, such as dynamite and Molotov cocktails.

The authors point out that explosions can inflict injuries on many organ systems and that the diagnosis of blast injuries requires a high index of suspicion to identify silent blunt injuries. They suggest initial assessment should follow advanced trauma life support (ATLS) protocols including imaging methods, such as radiographs, CT scans, and ultrasonography, which are critical for detecting internal injuries. Injuries to the pulmonary, gastrointestinal system, along with neurological, cardiovascular, facial and auditory, musculoskeletal systems are also reviewed.

In terms of diagnosis, the authors indicate that ATLS guidelines offer a structured approach to trauma care after explosions. “However, their application should be tailored to the specific situation and patient needs, with the order of interventions potentially varying based on clinical judgment and immediate life threats,” says Ortega who also is chief of anaesthesiology at BMC.

According to the authors, blast injuries should be managed using a multidisciplinary approach tailored to the individual patient’s injuries. “When possible, involve different specialties such as emergency medicine, trauma surgery, neurosurgery, orthopaedic surgery, maxillofacial surgery, otolaryngology and anaesthesiology to ensure the best possible patient outcomes,” he adds.

In terms of preventive strategies, the authors recommend public education, improved safety regulations for handling explosives, and the use of personal protective equipment which can help reduce the impact of blast injuries and designing public spaces to minimise the impact of blasts.

Source: Boston University School of Medicine

Categories : General InterestTags :

Gift of the Givers is on the Ground in Gaza

On By ModernMedia

Imtiaz Sooliman calls for negotiations and compromise. “The only way to solve the problem is to do what is just.”

Haitham Najjar (left) of The Gift of the Givers Foundation helping to distribute water in Gaza. Photo supplied

By Matthew Hirsch for GroundUp

Dr Imtiaz Sooliman, founder of The Gift of the Givers Foundation, has appealed for negotiations, compromise and peace in the Middle East. The respected South African aid organisation has had a presence in Gaza for nine years.

Gift of the Givers doesn’t have an office in Gaza. Instead, the team of three people moves around distributing medical supplies, food and water. They are also involved in a women and child care centre, a health facility, and schools.

Sooliman says the organisation wants to send more people. “We are preparing to send medical teams but only if it’s not any risk to them.” He says a ceasefire or safe corridor is needed before the teams can enter Gaza. The organisation has 40 medical personnel ready to go in, Sooliman told GroundUp.

On Sunday Gift of the Givers reported that the team has been under severe physical and mental stress.

In 2014 Israel attacked Gaza for seven weeks. Sooliman said his team is reporting that this time it’s completely different. “They said it’s so difficult to move around. There’s so much anxiety and so much fear. The amount of bombs being dropped has never happened before.”

On Tuesday the UN High Commissioner for Human Rights said that 4200 people have been killed, and over one million people displaced, in just ten days, while large areas of the Gaza strip have been reduced to rubble.

The death toll includes a large number of women and children, as well as at least 11 Palestinian journalists, 28 medical staff and 14 UN workers. It also includes over 1300 Israelis, mostly civilians, killed by Hamas on 7 October.

Sooliman said that Gaza’s people face challenges with access to food and water. “Because there’s no electricity, the sewage plants don’t work. Because they can’t do burials, the decomposed bodies are going to cause infections. Because hospitals don’t have antibiotics, there’s a threat of infection there.

“They managed to do some mass funerals yesterday. As the bodies are coming in they are doing it straight away. There are thousands of bodies lying under the rubble that they can’t reach. They don’t have the equipment, they don’t have the personnel, but above all, it’s bloody dangerous to get there,” said Sooliman.

Sooliman said that he had a meeting with the Egyptian ambassador and South Africa’s Foreign Affairs Department on Monday in an attempt to get a humanitarian aid corridor open. “We are also looking at flying supplies on a cargo plane from South Africa and sending trucks to the border in Cairo.”

Asked how this situation compared to other humanitarian relief efforts the organisation had been involved in, Sooliman responded: “This is the worst situation in the world because there is no exit route. You can’t get out. The area is so small. It’s so easy to bomb it … Nobody can have a safety plan. Where are you going to hide? There’s no such thing as safety in Gaza.”

Gaza is only 350km2. It could fit into Cape Town nearly seven times, yet it has half Cape Town’s population.

Sooliman described Israel’s call to evacuate more than one million people from the north to the south of Gaza as “quite ludicrous”. “How can you move 1 million people in 24 hours when there’s no fuel and no cars? Where are you going to go to? Everything is bombed. How do you move an intensive care unit patient?”

He also called for restraint from both sides. “Civilians cannot be attacked in a war and that applies to both sides … At the end of the day, both sides must remember that there is no winner in war. Everybody loses out. The only way to solve this problem in the Middle East is to make peace, act rationally and make compromises.”

“This is not a thing about Jews against Muslims; it’s human against human. It’s not a religious thing, it’s a human thing … it’s about humanity. It’s in the interests of all parties to make compromises. The only way to solve the problem is to do what is just,” he stressed.

“When you act justly you will have peace, prosperity and peace in the entire region. Nobody loses out. Actually everybody gains more. They should go to the negotiating table, make compromises and give a just solution. If you do that then we never have to send any more supplies to the Middle East again,“ Sooliman added.

He said Gift of the Givers were accepting donations for their work in Gaza.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

Categories : Antibiotics HospitalsTags :

‘Nothing Compares’ to Antibiotic Resistance Discovered in War-torn Ukraine

On By ModernMedia
Photo by Vony Razom 🇺🇦 on Unsplash

Researchers assisting microbiologists in Ukraine have found an extremely high level of bacterial resistance among the war-wounded patients treated in hospitals. The study, recently published in The Lancet Infectious Diseases, found resistance in many hospital-acquired infections stemming from damaged and overwhelmed healthcare infrastructure, with many samples resistant to the last-resort antibiotic colistin.

“I am quite thick-skinned and have witnessed numerous situations involving patients and bacteria. However, I must admit that I have never encountered bacteria as resistant as this before,” says Kristian Riesbeck, professor of Clinical Bacteriology at Lund University in Sweden.

There was never any doubt about helping out when Dr Oleksandr Nazarchuk, a microbiologist at a university in Vinnytsia, Ukraine, got in touch, says Kristian Riesbeck. Help was needed in Ukraine to assess the extent of antibiotic resistance in bacteria among severely injured patients in hospital.

In addition to all the human suffering caused by the war in Ukraine, another battle is being fought — an invisible war against resistant bacteria. This became evident when Kristian Riesbeck and his research colleagues analysed patient samples from seriously wounded patients, many of whom had burn injuries, in Ukraine. The patients had acquired infections while in hospital, primarily due to the overwhelmed wards and destroyed infrastructure.

Samples were collected from a total of 141 war victims, 133 adults who sustained injures during the war and eight infants diagnosed with pneumonia. These patients were admitted to three different hospitals in Ukraine, where they received emergency surgeries and intensive care to address their conditions.

“We observed that several the Gram-negative bacteria exhibited resistance to broad-spectrum antimicrobial agents, including newly developed enzyme-inhibiting antibiotics that are not yet available in the market. Moreover, nearly ten per cent of the samples contained bacteria that demonstrated resistance even to our ‘last-resort’ antibiotic, colistin. While we have encountered similar cases in India and China before, nothing compares to the extent of resistance observed in this study. As much as six per cent of all the samples contained bacteria resistant to every antibiotic we tested,” says Kristian Riesbeck.

He emphasizes that this clearly highlights the challenges posed by resistant bacteria in times of war. In particular, Kristian Riesbeck expresses concern regarding the resistance displayed by Klebsiella pneumoniae bacteria, as they have the potential to cause illness in individuals with a healthy and well-functioning immune system.

“This makes me very worried. It’s rare to encounter Klebsiella with such high levels of resistance, and it was not what we anticipated. While isolated cases have been documented in China, the magnitude of this situation surpasses anything we have seen before. While many countries are providing military aid and resources to Ukraine, it is equally crucial to assist them in addressing this ongoing situation. There is an evident risk of further spread of resistant bacteria, and this threatens the entire European region,” remarks Kristian Riesbeck.

Source: Lund University