5 research outputs found
What is the best way to keep the patient warm during technical rescue? Results from two prospective randomised controlled studies with healthy volunteers
No full textAbstract Background Accidental hypothermia is a manifest problem during the rescue of entrapped victims and results in different subsequent problems as coagulopathy and wound infection. Different warming methods are available for the preclinicial use. However, their effectiveness has hardly been evaluated. Methods In a first step a survey among German fire brigades was performed with questions about the most used warming methods. In a second step two crossover studies were conducted. In each study two different warming method were compared with forced air warming – which is the most frequently used and highly effective warming method in operation rooms (Study A: halogen floodlight vs. forced air warming; Study B: forced air warming vs. fleece blanket). In both studies healthy volunteers (Study A: 30 volunteers, Study B: 32 volunteers) were sitting 60 min in a cold store. In the first 21 min there was no subject warming. Afterwards the different warming methods were initiated. Every 3 min parameters like skin temperature, core body temperature and cold perception on a 10-point numeric rating scale were recorded. Linear mixed models were fitted for each parameter to check for differences in temperature trajectories and cold perception with regard to the different warming methods. Results One hundred fifty-one German fire brigades responded to the survey. The most frequently used warming methods were different rescue blankets (gold/silver, wool) and work light (halogen floodlights). Both studies (A and B) showed significantly (p < 0.05) higher values in mean skin temperature, mean body temperature and total body heat for the forced air warming methods compared to halogen floodlight respectively fleece blanket shortly after warming initiation. In contrast, values for the cold perception were significantly lower (less unpleasant cold perception) during the phase the forced air warming methods were used, compared to the fleece blanket or the halogen floodlight was used. Conclusion Forced air warming methods used under the standardised experimental setting are an effective method to keep patients warm during technical rescue. Halogen floodlight has an insufficient effect on the patient’s heat preservation. In healthy subjects, fleece blankets will stop heat loss but will not correct heat that has already been lost. Trial registration The studies were registered retrospectively on 14/02/2022 on the German Clinical Trials registry (DRKS) with the number DRKS00028079
A Comparison of the Preclinical Treatment Options for Accidental Hypothermia after Entrapment Trauma - A Simulation with Test Subjects
No full textJährlich erleiden allein in Deutschland über 62 000 Personen eine schwere Verletzung nach einem Verkehrsunfall. Neben den persönlichen Verletzungsfolgen für die Patienten sind auch die volkswirtschaftlichen Kosten dabei nicht unerheblich. Die Summe der entstehenden Behandlungskosten wird durch das Statistische Bundesamt mit über 13,5 Milliarden Euro jährlich angegeben. Hinzu kommen weitere Aufwendungen, die sich durch Erwerbsminderung als Folge der Verletzungen ergeben. Durch Tod und Invalidität ergibt sich schließlich ein volkswirtschaftlicher Gesamtschaden von 41 Milliarden Euro jährlich (Statistisches Bundesamt 2012).
Auch die häufig mit den Verletzungen einhergehende akzidentelle Hypothermie hat auf den innerklinischen Behandlungsverlauf einen entscheidenden Einfluss und stellt einen unabhängigen Mortalitätsfaktor dar (Lier et al. 2007; Tryba und Leban 1996). Dabei ist die Hypothermie Teil der „Lethal Triad“, die das gleichzeitige Auftreten einer Koagulopathie, einer Azidose und einer Hypothermie beschreibt und zu einer gesteigerten Letalität führt (Kashuk et al. 1982).
Nach einer Studie von Helm et al. (Helm et al. 1995b) ist mit 49,6% jeder zweite Traumapatient hypotherm bei Einlieferung in den Schockraum des aufnehmenden Krankenhauses. Dabei ist der Schweregrad der Hypothermie unabhängig von Außentemperatur- und Witterungseinflüssen.
Ziel muss daher sein, die akzidentelle Hypothermie zu verhindern oder zumindest eine frühzeitige Wiedererwärmung einzuleiten.
Zur Durchführung einer Patientenerwärmung in der präklinischen Phase gibt es bisher jedoch neben der passiven Erwärmung mit Decken o.ä. nur wenige Ansätze. Eine in der Literatur beschriebene Möglichkeit der aktiven Wärmetherapie ist der Einsatz eines Halogenstrahlers, wie er von den Feuerwehren und Hilfsorganisationen als Lichtquelle mitgeführt wird. Dabei soll die Strahlungswärme (Radiation) die Körpertemperatur des Patienten stabilisieren.
Eine weitere Möglichkeit stellt der in vielen innerklinischen Studien beschriebene Einsatz von konvektiven Luftwärmern dar, die erfolgreich im innerklinischen Intensiv- und Operationsalltag Anwendung finden. Dieses stellt jedoch an Einsatzstellen bisher eine Rarität dar.
Zu beiden Methoden fehlen bisher Studien über die Wirksamkeit unter präklinischen Bedingungen.
Dieses sollte mit dieser Arbeit untersucht werden. Dazu führten wir eine Studie an 30 gesunden Probanden bei einer standardisierten Umgebungstemperatur von 3°C durch. Die Probanden mussten jeweils zwei Versuchsteile durchlaufen, wobei sich die ersten 21 Minuten jeweils identisch gliederten. In dieser Zeit saßen die Studienteilnehmer bekleidet mit T-Shirt, Shorts, Strümpfen, Schuhen und Unterwäsche auf einem Fahrzeugsitz und waren schutzlos der Umgebungs-temperatur ausgesetzt. Diese Zeit sollte dem Zeitverzug im präklinischen Rettungswesen zwischen Unfallzeitpunkt und Beginn der Hilfsmaßnahmen entsprechen. Danach erfolgte dann für weitere 39 Minuten die Erwärmung mittels Halogenstrahler bzw. konvektivem Luftwärmer. Bei der Erwärmung mit dem konvektiven Luftwärmer diente eine Kunststofffolie, mit der der Proband eingehüllt wurde, als Wärmedecke, Als konvektiver Luftwärmer wurde das Gerät „Polarn 4000“ der Firma Eberspächer ausgewählt, da dieses für den präklinischen Einsatz vorgesehen ist.
Während des Versuchszeitraumes wurde neben der Überwachung von Herz-frequenz, Blutdruck und Sauerstoffsättigung die Körpertemperatur an verschiedenen festgelegten Messpunkten in drei-minütlichem Abstand gemessen.Als Ergebnis konnte festgestellt werden, dass die Erwärmung mittels konvektivem Luftwärmer hoch effektiv und signifikant besser ist, als die mit einem Halogenstrahler. Bei der Erwärmung mittels Halogenstrahler konnte keine Stabilisierung und kein Anstieg der Körpertemperatur beobachtet werden.
Prinzipiell ist der Einsatz eines konvektiven Luftwärmern unter präklinischen Bedingungen auch mit einfachsten Mitteln möglich.
Ein Kritikpunkt muss jedoch die hohe Temperatur der erzeugten Warmluft sein. Hier sollte durch den Hersteller eine Temperaturregelung nachgebessert werden, um Verbrennungen der Patienten zu vermeiden. Bis dahin kann diese Methode in der jetzigen Form nicht allgemein empfohlen werden.Every year over 62,000 people suffer severe injuries after a car accident in Germany alone. Both the personal traumatopathy for the patient and the economic costs are not inconsiderable. The Federal Statistical Office (Statistische Bundesamt) cites the annual sum of the incurred costs for treatment as 13.5 billion euros. Further expenses arise from the reduction in earning capacity due to the injuries incurred. Death and disability ultimately cause a total economic loss of 41 billion euros per annum (Statistische Bundesamt, 2012).
Accidental hypothermia, which often accompanies the injuries, has a decisive influence on the course of the treatment within the hospital and is an independent mortality factor (Lier et al. 2007; Tryba and Leban 1996). Hypothermia is part of the “Trauma Triad of Death,” which describes the simultaneous occurrence of coagulopathy, acidosis and hypothermia and increases the mortality rate (Kashuk et al. 1982).
According to a study by Helm et al. (Helm et al. 1995b), 49.6%, that is, every second trauma patient, is hypothermic when delivered to the emergency department of the admitting hospital. The severity of the hypothermia is independent on the outdoor temperature and weather influences.
The target must thus be to prevent accidental hypothermia or at least to commence early rewarming.
To date, there are however few approaches to rewarming the patient in the prehospital emergency care phase, excluding passive rewarming with blankets or the like. A possibility described in the literature is rewarming the patient with a halogen spotlight, as carried by firefighters and aid organizations as light source. The radiation should stabilize the patient’s body temperature.
Another possibility described in many clinical studies is the use of convective air heaters, which are successfully utilized in intensive care and surgery within hospitals on a routine basis. These are however rarely used at the accident site to date.
Studies on the efficacy of both methods under preclinical conditions are still lacking.
This survey was to investigate this. For this purpose, we carried out a study on 30 healthy test subjects at a standardized ambient temperature of 3°C. The subjects had to participate in two study elements each, of which the first 21 minutes were always identical. During this time the participants sat – dressed in a t-shirt, shorts, socks, shoes and underwear – on a car seat and were exposed unprotected to the ambient temperature. This time was supposed to represent the delay in preclinical service between the time of the accident and the onset of emergency measures. This was followed by 39 minutes of rewarming with a halogen spotlight or convective air heater. Plastic foil was wrapped around the subject as hypothermia blanket during the rewarming with the convective air heater. The convective air heater selected was the “Polarn 4000” manufactured by Eberspächer, because this is intended for preclinical utilization.
During the test period, the body temperature was measured at different predefined points every three minutes in addition to the monitoring of the heart rate, blood pressure and oxygen saturation. The result showed that rewarming with convective air heaters is highly effective and significantly better than with a halogen spotlight. Rewarming with a halogen spotlight did not lead to stabilization and an increase in body temperature could not be registered.
The use of a convective air heater is basically also possible under preclinical conditions with the simplest of means.
One criticism does however remain and that is the high temperature of the warm air generated. The manufacturer should improve this by incorporating a temperature control to prevent burning the patients. Until such time this method cannot generally be recommend in its current form.2014-03-1
eMotionSpheres: A New Design for Human-Friendly UAVs
No full textHere we present a new design for humanfriendly UAVs (Unmanned Aerial Vehicles). Contrary to conventional UAVs like gyrocopters or quadrocopters, the so called eMotionSpheres feature high process stability, long endurance and furthermore allow for a safe human-machine interaction. Since these features are essential for UAVs used in a production environment the eMotionSpheres will open up new applications of UAVs in the future. Each flying object consists of a helium filled ballonet and is driven by eight small propellers, which are attached to the outer shell. The propellers are a novelty when it comes to flying objects. They consist of a laser-sintered rigid outer frame which is spanned by a thin foil. This design, inspired by the dragonfly wing, results in a light-weight drive, which is adaptive and most interestingly supplies the same efficient thrust in a forward and a reverse direction. One or several of the eMotion-Spheres can move in an autonomous or coordinated manner within a defined space. Therefore the flying objects communicate via active markers with a camera system. The cameras reconstruct a 3D space and together with a central master computer specify the flight paths of the spheres. Since the camera system is easy to install and calibrated in few minutes it offers, together with, but also without the spheres, several interesting applications in guidance and monitoring of the networked factory of the future
Conversion, continuity, and moral dilemmas among Christian Bidayuhs in Malaysian Borneo
No full textThis is the author's final version of the article (under the title "Speaking of continuity... Religious change and moral dilemmas among Christian Bidayuhs in Malaysian Borneo"). The final publication is available from the link below. Copyright @ 2012 by the American Anthropological Association.The nascent anthropology of Christianity highlights rupture as central to conversion. Yet thick ethnography of a Bidayuh village in Malaysian Borneo reveals how conversion can also foster modes of thinking and speaking about continuity between Christianity and “the old ways.” Through a study of the shifting moral and religious topography of a community in which three churches coexist alongside a few elderly animist practitioners, I argue that such discourses and practices of continuity highlight the pluralistic and sometimes contradictory nature of Christianization. At the same time, they generate an understanding of conversion as a temporal and relational positioning that encompasses both converts and nonconverts.William Wyse Fund, Evans Fund, Smuts Memorial Fund, and Sir Bartle
Frere’s Memorial Fund at the University of Cambridge and a Horniman/Sutasoma Award from the Royal Anthropological Institute
Re-os isotope constraints on the age of the Lithospheric mantle beneath western Greenland.
No full textAlkaline magmatic activity across Western Greenland (W.G.) provides a record of lithosphere evolution over the last 600 Ma. Ultra Mafic Lamprophyre (UML) magmatism in particular has erupted an exceptional inventory of mantle xenoliths allowing a detailed look at the lithospheric root beneath both the exposed craton and the re-worked Archean terrane (RAT) of the Kangerlussuaq region, S.W Greenland. Samples from within the re-worked Archean terrane more commonly have diopside plus garnet, i.e. they are more lherzolitic whereas highly depleted harzburgites and dunitic lithologies are prevalent amongst xenoliths erupted through the undisturbed Archean craton. W. Greenland peridotite xenoliths show a large range in bulk composition. The peridotites are MgO - rich (44-51 wt%), with most samples overlapping the range for cratonic peridotites and being generally more MgO-rich than non-cratonic or massif peridotites. In contrast SiO(_2) contents are relatively low (36-43 wt%), being at the lower end of the range for both cratonic and non-cratonic/massif peridotites, indicating that the W.G. mantle has not experienced significant SiO(_2) enrichment. The low SiO(_2) of most residual, minimally metasomatised harzburgites indicate particularly othopyroxene poor protoliths. This contributes to growing evidence that the Kaapvaal cratonic lithosphere is the exception rather than the rule in terms of craton lithosphere bulk compositions and evolution. A selection of dunitic, harzburgitic and lherzolitic lithologies have been analysed for Re-Os isotopes and PGE abundances. Os ranges from 0.86 to 5.02 ppb, scattering around the typical average for cratonic residues. Re contents range from 0.009 to 0.290 ppb, and are all less than primitive mantle. However, in extended PGE patterns Re can be seen to be anomalously high in numerous samples and has obviously experienced secondary enrichment, possibly by UML infiltration. Pt and particularly Pd demonstrate their incompatible behaviour during high degrees of melting, with Pt as low as 0.035 and Pd depleted to 0.007 ppb, comparable to highly depleted residues from other cratons (Pearson et al, 2004). The effects of metasomatism are also seen on Pd in some samples but this element is less disturbed than Re and, for some samples, (Pd/Ir) n correlates well with indices of melt depletion such as AI(_2)O(_3) consistent with high degrees of melting. Some disturbance relates to metasomatic introduction of clinopyroxene in certain rocks. Re-depletion ages for the most residual W.G. peridotites, corrected to the 600 My eruption age for the host UML, range from 1.8 to 3.0 Ga, with Archean depletion ages clearly evident in the lithosphere beneath the RAT of the Nagssugtoqidian. Archean (>2.5 Ga) ages are found in even the deepest derived (> 200 km) samples indicating that the basal lithosphere is of this age. The ages for W.G. peridotites together with pressure and temperature investigations by Sand (2007) indicate clearly that an Archean keel existed beneath the region that extended well into the diamond stability field at 600 Ma, both on the recognised craton and beneath the region of re-worked Archean crust suggesting that further exploration in this area can be targeted right across the region where UML's occur. The validity of these findings is emphasised by the recent new finds of macro-diamonds in the Kangerlussuaq region (Hudson Resources Website)
