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Safari S, Aghili SH, Shahlaee MA, Jamshidi Kerachi A, Farhang Ranjbar M. Incidence of Electrolyte Imbalances Following Traumatic Rhabdomyolysis: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e59333. [PMID: 38817473 PMCID: PMC11137607 DOI: 10.7759/cureus.59333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
Rhabdomyolysis, a medical condition caused by the destruction of striated muscle fibers, can have many etiologies, with the most common one being traumatic etiologies, that is, crushing injuries, heavy exertion, and being trapped under rubbles, and so forth. Rhabdomyolysis causes many complications, including acute kidney injury and different electrolyte imbalances, which later can cause cardiac dysrhythmia and even death as a result. This systematic review and meta-analysis investigate the incidence of imbalances of four important electrolytes among patients diagnosed with traumatic rhabdomyolysis. PubMed, Scopus, Web of Science, and Embase databases were searched for any article related to traumatic rhabdomyolysis using keywords related to the topic of our study, excluding case studies and case series. Relevant data were extracted from the included articles, and finally, a meta-analysis was performed on them to calculate the pooled incidence of each electrolyte imbalance. Collectively, 32 articles were included in our study (through the database and citation checking). The following were the pooled incidence of each electrolyte imbalance: hyperkalemia, 31% (95%CI 22%-41%); hypokalemia, 10% (95%CI 4%-17%); hypernatremia, 3% (95%CI 0%-8%); hyponatremia, 23% (95%CI 7%-44%); hypercalcemia, 0% (95%CI 0%-1%); hypocalcemia, 57% (95%CI: 22%-88%); hyperphosphatemia, 33% (95%CI 11%-59%); hypophosphatemia, 4% (95%CI 0%-16%). According to the meta-analyses, the rate of hyperkalemia, hyponatremia, hypocalcemia, and hyperphosphatemia is higher than their counterpart in patients diagnosed with traumatic rhabdomyolysis.
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Affiliation(s)
- Saeed Safari
- Emergency Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IRN
- Research Center for Trauma in Police Operations, Directorate of Health, Rescue & Treatment, Police Headquarter, Tehran, IRN
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IRN
| | - Seyed Hadi Aghili
- Research Center for Trauma in Police Operations, Directorate of Health, Rescue & Treatment, Police Headquarter, Tehran, IRN
- Neurosurgery, Imam Khomeini Hospital Complex, Tehran, IRN
- Neurosurgery, Valiasr Hospital, Tehran, IRN
| | - Mohammad A Shahlaee
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IRN
| | | | - Mehri Farhang Ranjbar
- Research Center for Trauma in Police Operations, Directorate of Health, Rescue & Treatment, Police Headquarter, Tehran, IRN
- Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, IRN
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Zimmerman EM, Stewart IJ, Graham TL, Kovacs TJ, Guliashvili T, Golobish TD, Ross JD. A Novel Peritoneal Packing Method for Management of Hyperkalemia During Acute Kidney Injury in Trauma. Mil Med 2024:usae018. [PMID: 38421742 DOI: 10.1093/milmed/usae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 12/18/2023] [Accepted: 02/21/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION United States Military operations in resource limited areas are increasing. Furthermore, future peer or near-peer conflicts will require caring for larger numbers of casualties with limited resources. In this setting, traditional renal replacement therapy is not feasible and novel methods are required to address severe acute kidney injury in austere environments lacking definitive therapies. Here, we describe experiments designed to determine the efficacy of a novel peritoneal packing material (Potassium Binding Pack-PBP, CytoSorbents INC) for the acute management of severe hyperkalemia. MATERIALS AND METHODS Male swine (52 ±1 kg) were nephrectomized via midline laparotomy under a plane of anesthesia and randomized into one of two experimental groups (PBP & CON). Exogenous potassium was infused to achieve a serum potassium level of 7.5 mEq/L. Novel potassium absorbing packs (PBP) or sham packs (CON) were placed in the right and left upper quadrants, and the right and left paracolic gutters of the abdomen to simulate four-quadrant packing (n = 6, n = 5, respectively). Two liters of peritoneal dialysis fluid was instilled into the abdomen and temporary closure performed. Animals were observed for 12 hours. Serum and peritoneal fluid (dialysate) potassium levels were sampled at T = 15, 30, 60 min, and Q60min thereafter. Animals were humanely euthanized at the end of the observation period. RESULTS Baseline characteristics were similar between groups. Pairwise analysis showed that serum potassium concentrations were significantly lower in the PBP group compared to CON at T = 540 and T = 720 (P = 0.006 and P = 0.015, respectively). Potassium concentrations were significantly lower in dialysate of the PBP group compared to CON at all time points after T = 15 (T = 30, P = 0.017; T = 60 through T = 720, P < 0.001). CONCLUSIONS This is the first demonstration of an effective technology for the management of hyperkalemia in trauma in the absence of standard of care; renal replacement therapy. We identified that PBP was able to consistently maintain a concentration gradient between dialysate in the peritoneum and system potassium concentration throughout the experiment. Furthermore, systemic potassium concentrations were reduced in a clinically relevant manner in the PBP group compared to CON. This suggests that peritoneal packing technology for the management of metabolic disturbances in trauma has potential for clinical application. These results are preliminary and should be interpreted with caution.
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Affiliation(s)
- Eric M Zimmerman
- Knight Cardiovascular Institute, Oregon Health Science University, Portland, OR 97239, USA
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR 97239, USA
- Department of Surgery, New York Presbyterian, Queens, NY 10065, USA
| | - Ian J Stewart
- Department of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Todd L Graham
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR 97239, USA
| | | | | | | | - James D Ross
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR 97239, USA
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Koyuncu S, Sipahioglu H, Bol O, İlik HKZ, Dilci A, Elmaağaç M, Yalçınkaya M, Gencer V, Ozan F, Günal Aİ, Kocyigit I. The Evaluation of Different Treatment Approaches in Patients With Earthquake-Related Crush Syndrome. Cureus 2023; 15:e47194. [PMID: 37854473 PMCID: PMC10580897 DOI: 10.7759/cureus.47194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND On February 6, 2023, an earthquake occurred in Kahramanmaras, Turkey, resulting in loss of life, injuries, and the displacement of thousands of people. The aim of this study is to determine the factors affecting amputation and fasciotomy decisions in patients with crush syndrome, along with clinical laboratory parameters. MATERIALS AND METHODS The study included patients over 18 years of age who presented with crush injuries and exhibited systemic symptoms. Inclusion criteria comprised patients with creatine kinase (CK) levels exceeding 1,000 IU/L, oliguria (urine output less than 400 mL per day), elevated blood urea nitrogen (BUN) levels surpassing 40 mg/dL, serum creatinine exceeding 1.5 mg/dL, potassium levels over 6 mEq/L, phosphorus levels surpassing 8 mg/dL, and serum calcium levels below 8 mg/dL. Multiple parameters were evaluated, including blood glucose, serum sodium, potassium, calcium, phosphorus, BUN, creatinine, uric acid, CK, albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, direct bilirubin, prothrombin time (international normalized ratio (INR)), urinalysis, C-reactive protein (CRP), venous blood gas, ECG, and chest radiography. RESULTS Following the Maraş earthquake, a total of 3,184 patients were admitted to our hospital within the first seven days. Out of these patients, 2,216 received outpatient treatment, 639 were hospitalized in the general ward, and 128 were admitted to the intensive care unit. Among the admitted patients, 237 were diagnosed with crush syndrome, with 126 being male and 111 being female. The average duration of being trapped under debris was eight hours, ranging from four to 36 hours. In the study population, extremity trauma was observed in 84 patients, thoracic trauma in 32 patients, and abdominal trauma in 20 patients. Erythrocyte replacement was administered to 123 patients, while fresh frozen plasma was given to 69 patients, for a total of 1008 units utilized. Mannitol infusions were provided to 58 patients, while bicarbonate infusions were administered to 116 patients. Among the cohort, 71 patients underwent dialysis, with nine of them receiving hemodialysis along with mannitol. Additionally, 67 patients experienced stage 3 acute kidney injury, and 41 patients were deceased. None of the patients required permanent hemodialysis. CONCLUSION Earthquakes are considered to be one of nature's most significant and inevitable disasters. While it is impossible to prevent them, effective management strategies are crucial in mitigating the ensuing chaos and reducing casualties. In order to achieve this, it is imperative to draw lessons from past seismic events and apply appropriate treatment protocols to the affected individuals.
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Affiliation(s)
| | - Hilal Sipahioglu
- Internal Medicine, Kayseri City Training and Research Hospital, Kayseri, TUR
| | - Oğuzhan Bol
- Emergency Medicine, University of Health Sciences, Kayseri City Hospital, Kayseri, TUR
| | | | - Aslıhan Dilci
- Internal Medicine, Kayseri City Hospital, Kayseri, TUR
| | | | | | - Vedat Gencer
- Internal Medicine, Kayseri City Hospital, Kayseri, TUR
| | - Fırat Ozan
- Orthopaedics, Kayseri City Hospital, Kayseri, TUR
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Jin H, Lin X, Liu Z, Wang J, Wang J, Zhang Y, Cao C, Chai Y, Shou S. Remote ischemic postconditioning protects against crush-induced acute kidney injury via down-regulation of apoptosis and senescence. Eur J Trauma Emerg Surg 2022; 48:4585-4593. [PMID: 35224648 PMCID: PMC9721311 DOI: 10.1007/s00068-022-01910-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 01/29/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acute renal failure due to crush syndrome is one of the leading causes of death in disasters. Ischemic Postconditioning (IPC) is a potentially effective strategy to protect against ischemic reperfusion injury, but a few studies noted its protective effect in crush induced acute kidney injury (AKI). Hence, this study investigated the optimal IPC strategy to prevent crush induced AKI and reveal related cellular mechanisms. METHODS The right lower extremities of rabbits were constantly compressed for 8 h and then performed five cycles of clamping and releasing the femoral artery and vein before depression using a clip. In terms of the duration of clamping and releasing, the animals were randomly divided into 5 groups, Control, IPC-5sec, IPC-30sec, IPC-1min, and IPC-5min groups; 6 rabbits for each group. Biomarkers of inflammation, renal function, renal tubular injury, and muscular injury, apoptosis, and cellular senescence in kidney were detected. RESULTS Six hours after decompression, the levels of Serum Creatine (SCr), Blood Urea Nitrogen (BUN), K+, and Interleukin-6 (IL-6) in IPC-1min and IPC-5min groups were lower than Control, with a statistically significant difference. The morphological study of Periodic Acid-Schiff (PAS) staining demonstrated that 6 h after decompression, IPC-1min can attenuate renal tubular damage renal tubule. Meanwhile, the level of Neutrophil Gelatinase-Associated Lipocalin (NGAL) in circulation in the IPC-30sec, IPC-1min, and IPC-5min groups was significantly decreased compared with the Control group, 2 h after decompression. On the other hand, the levels of serum Creatine Kinase (CK) and Myoglobin (Mb), and the morphological change of muscular damage detected by hematoxylin and eosin (H&E) staining in IPC-1min-treated group were significantly lower than Control group 6 hours after decompression. Further results of the cellular mechanism showed that the apoptotic markers of Terminal deoxynucleotidyl Transferase-mediated dUTP Nick End Labeling (TUNEL) and Caspase3 and the cell senescent markers of senescence-associated β-galactosidase (SA-β-Gal) and nuclear LAMNB1 have changed significantly in the IPC-1min group, compared with the control group. CONCLUSIONS Performing 5 cycles of 1-min IPC would be a convenient, time-saving, and effective method to prevent crush-induced AKI by attenuating the release of nephrotoxic substances after decompression and downregulation of the expression of apoptosis and cellular senescence biomarkers.
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Affiliation(s)
- Heng Jin
- Department of Emergency Medicine, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300050 China
| | - Xiaoxi Lin
- Department of Emergency Medicine, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300050 China
| | - Ziquan Liu
- Institute of Disaster Medicine, University of Tianjin, No. 92, Weijin Road, Nankai District, Tianjin, 300072 China
| | - Jinqiang Wang
- The People’s Hospital of XuChang, No. 1366, Jian’an Street, Xuchang, 461099 Henan Province China
| | - Jinxiang Wang
- Department of Emergency Medicine, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300050 China
| | - Yan Zhang
- Department of Emergency Medicine, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300050 China
| | - Chao Cao
- Department of Emergency Medicine, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300050 China
| | - Yanfen Chai
- Department of Emergency Medicine, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300050 China
| | - Songtao Shou
- Department of Emergency Medicine, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300050 China
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Haruta Y, Kobayakawa K, Saiwai H, Hata K, Tamaru T, Iura H, Ono G, Kitade K, Kijima K, Iida K, Kawaguchi K, Matsumoto Y, Kubota K, Maeda T, Konno DJ, Okada S, Nakashima Y. Zinc chelator treatment in crush syndrome model mice attenuates ischemia-reperfusion-induced muscle injury due to suppressing of neutrophil infiltration. Sci Rep 2022; 12:15580. [PMID: 36114355 PMCID: PMC9481620 DOI: 10.1038/s41598-022-19903-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/06/2022] [Indexed: 11/21/2022] Open
Abstract
In crush syndrome, massive muscle breakdown resulting from ischemia-reperfusion muscle injury can be a life-threatening condition that requires urgent treatment. Blood reperfusion into the ischemic muscle triggers an immediate inflammatory response, and neutrophils are the first to infiltrate and exacerbate the muscle damage. Since free zinc ion play a critical role in the immune system and the function of neutrophils is impaired by zinc depletion, we hypothesized that the administration of a zinc chelator would be effective for suppressing the inflammatory reaction at the site of ischemia-reperfusion injury and for improving of the pathology of crush syndrome. A crush syndrome model was created by using a rubber tourniquet to compress the bilateral hind limbs of mice at 8 weeks. A zinc chelator N,N,N',N'-tetrakis-(2-pyridylmethyl)-ethylenediamine (TPEN) was administered immediately after reperfusion in order to assess the anti-inflammatory effect of the chelator for neutrophils. Histopathological evaluation showed significantly less muscle breakdown and fewer neutrophil infiltration in TPEN administration group compared with control group. In addition, the expression levels of inflammatory cytokine and chemokine such as IL-6, TNFα, CXCL1, CXCL2, CXCR2, CCL2 in ischemia-reperfusion injured muscle were significantly suppressed with TPEN treatment. Less dilatation of renal tubules in histological evaluation in renal tissue and significantly better survival rate were demonstrated in TPEN treatment for ischemia-reperfusion injury in crush syndrome. The findings of our study suggest that zinc chelators contributed to the resolution of exacerbation of the inflammatory response and attenuation of muscle breakdown in the acute phase after crush syndrome. In addition, our strategy of attenuation of the acute inflammatory reaction by zinc chelators may provide a promising therapeutic strategy not only for crush syndrome, but also for other diseases driven by inflammatory reactions.
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Affiliation(s)
- Yohei Haruta
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kazu Kobayakawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hirokazu Saiwai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Kazuhiro Hata
- Department of Orthopaedic Surgery, Spinal Injuries Center, 550-4 Igisu, Iizuka, Fukuoka, 820-8508, Japan
| | - Tetsuya Tamaru
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hirotaka Iura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Gentaro Ono
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kazuki Kitade
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Ken Kijima
- Department of Orthopaedic Surgery, Spinal Injuries Center, 550-4 Igisu, Iizuka, Fukuoka, 820-8508, Japan
| | - Keiichiro Iida
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kenichi Kawaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshihiro Matsumoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kensuke Kubota
- Department of Orthopaedic Surgery, Spinal Injuries Center, 550-4 Igisu, Iizuka, Fukuoka, 820-8508, Japan
| | - Takeshi Maeda
- Department of Orthopaedic Surgery, Spinal Injuries Center, 550-4 Igisu, Iizuka, Fukuoka, 820-8508, Japan
| | - Dai-Jiro Konno
- Department of Pathophysiology, Medical Institute of Bioregulation, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Seiji Okada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Yang X, Tang N, Li L, Xu G, Dai J, Tao K, He C, Huangfu C. Management of a patient with cardiac arrest, intestinal ischemia necrosis, multiple fractures, hemorrhagic shock, renal failure, disseminated intravascular coagulation, and thrombosis after severe abdominal crush injury: A case report. Exp Ther Med 2022; 23:386. [PMID: 35495585 PMCID: PMC9019741 DOI: 10.3892/etm.2022.11313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/28/2022] [Indexed: 11/06/2022] Open
Abstract
Abdominal crush injury has been widely reported. However, abdominal crush injury cases involving most of the organ systems have seldom been reported. In the present case report, a 58-year-old man was hit in the abdomen by a 4-ton machine tool. The case described a rare combination of cardiac arrest, intestinal ischemia necrosis, multiple fractures, hemorrhagic shock, renal failure, disseminated intravascular coagulation and thrombosis after severe abdominal crush injury. During the treatment, crush syndrome, anemia, electrolyte disorder, pleural effusion, pulmonary emphysema, compartment syndrome, respiratory failure, pulmonary hemorrhage, injury of the right common peroneal nerve and tibial nerve, septum abscess and malnutrition were also observed. Systemic and symptomatic treatments were performed for >3 months, after which the patient was discharged from hospital without any further risk of fatality. The related treatments were also described in detail in the present case report. This case represented one of the most complicated cases among abdominal crush injuries that have been reported, and the treatment experiences reported here will hopefully provide suitable reference points for similar cases.
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Affiliation(s)
- Xiaokun Yang
- Department of Emergency Medicine, The General Hospital of Western Theater Command, Chengdu, Sichuan 610083, P.R. China
| | - Nan Tang
- School of Nursing, Lanzhou University, Lanzhou, Gansu 730010, P.R. China
| | - Le Li
- Department of Emergency Medicine, The General Hospital of Western Theater Command, Chengdu, Sichuan 610083, P.R. China
| | - Guisen Xu
- Department of Emergency Medicine, The General Hospital of Western Theater Command, Chengdu, Sichuan 610083, P.R. China
| | - Juan Dai
- Department of Emergency Medicine, The General Hospital of Western Theater Command, Chengdu, Sichuan 610083, P.R. China
| | - Kai Tao
- Department of Emergency Medicine, The General Hospital of Western Theater Command, Chengdu, Sichuan 610083, P.R. China
| | - Chunyang He
- Department of Hyperbaric Oxygenation Medicine, The General Hospital of Western Theater Command, Chengdu, Sichuan 610083, P.R. China
| | - Chaoji Huangfu
- Center for Disease Control and Prevention, Western Theater Command, Lanzhou, Gansu 730020, P.R. China
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Abstract
OBJECTIVES To date, we have only limited evidence of the determinants of earthquake inpatient mortality-related factors. This study is among the first to explore related factors of inpatient deaths using data from multiple hospitals and multiple earthquakes. METHODS We included and retrospectively analyzed data on 32,976 earthquake inpatients in the West China Earthquake Patients Database. Of these, we analyzed the records of 284 patients who died during hospitalization. We collected 12 dichotomous variables with reference to previous reports: patients' age (both ≤ 15 years and ≥ 65 years), gender, prehospital treatment, intensive care unit (ICU) admission, the presence of severe traumatic brain injury (TBI), trunk injury, severe poly-trauma, crush syndrome, multiple-system organ failure (MSOF), infection, and cardiac/respiratory disease. We performed multivariate logistic regression analysis to explore independent related factors of mortality. RESULTS Ultimately, we identified severe TBI, MSOF, old age (≥ 65 years), ICU admission, crush syndrome, and cardiac/respiratory disease as independent mortality-related factors. Severe TBI was the greatest risk factor of inpatient death (ods ratio [OR], 31.913, 95% confidence interval [CI], 20.484-49.720), followed by MSOF (OR 30.905, 95% CI, 21.733-43.947). CONCLUSION To reduce earthquake inpatient mortalities, the related factors analyzed in this study should be prioritized in future inpatient earthquake response strategies.
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Improvised Field Expedient Method for Renal Replacement Therapy in a Porcine Model of Acute Kidney Injury. Disaster Med Public Health Prep 2020; 15:741-749. [PMID: 32484129 DOI: 10.1017/dmp.2020.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Dialysis patients may not have access to conventional renal replacement therapy (RRT) following disasters. We hypothesized that improvised renal replacement therapy (ImpRRT) would be comparable to continuous renal replacement therapy (CRRT) in a porcine acute kidney injury model. METHODS Following bilateral nephrectomies and 2 hours of caudal aortic occlusion, 12 pigs were randomized to 4 hours of ImpRRT or CRRT. In the ImpRRT group, blood was circulated through a dialysis filter using a rapid infuser to collect the ultrafiltrate. Improvised replacement fluid, made with stock solutions, was infused pre-pump. In the CRRT group, commercial replacement fluid was used. During RRT, animals received isotonic crystalloids and norepinephrine. RESULTS There were no differences in serum creatinine, calcium, magnesium, or phosphorus concentrations. While there was a difference between groups in serum potassium concentration over time (P < 0.001), significance was lost in pairwise comparison at specific time points. Replacement fluids or ultrafiltrate flows did not differ between groups. There were no differences in lactate concentration, isotonic crystalloid requirement, or norepinephrine doses. No difference was found in electrolyte concentrations between the commercial and improvised replacement solutions. CONCLUSION The ImpRRT system achieved similar performance to CRRT and may represent a potential option for temporary RRT following disasters.
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Yang XY, Song J, Hou SK, Fan HJ, Lv Q, Liu ZQ, Ding H, Zhang YZ, Liu JY, Dong WL, Wang X. Ulinastatin ameliorates acute kidney injury induced by crush syndrome inflammation by modulating Th17/Treg cells. Int Immunopharmacol 2020; 81:106265. [PMID: 32044661 DOI: 10.1016/j.intimp.2020.106265] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is the main complication of crush syndrome (CS), and it is also a cause of lethality in CS. However, effective treatments for AKI are still lacking. Ulinastatin (UTI) is a broad-spectrum serine protease inhibitor extracted from human urine that reportedly modulates innate immunity and pro-inflammatory responses in sepsis. Here, we explored the effect and the potential mechanism of ulinastatin on crush syndrome-induced acute kidney injury (CSAKI). METHODS A CSAKI rat model was established by using a digital crush injury device platform. Forty-six male Wistar rats were randomly divided into five groups: the normal control (n = 6), CSAKI model (n = 10), CSAKI plus UTI1 (50,000 U/kg) (n = 10), CSAKI plus UTI2 (100,000 U/kg) (n = 10) and CSAKI plus UTI3 (200,000 U/kg) (n = 10) groups. Hematoxylin-eosin (HE) staining was used to investigate the reliability of the CSAKI model. The percentage of Th17/Treg lymphocytes in peripheral blood was measured by flow cytometry, and the expression of transcription factors associated with Th17/Treg cells was evaluated by quantitative real-time polymerase chain reaction (PCR). In addition, specific cytokines released by Th17/Treg cells in serum and kidney tissues were detected by enzyme-linked immunosorbent assay (ELISA). RESULTS Treatment with ulinastatin could significantly decrease serum BUN, CK, Scr, Mb and K+ levels compared with CSAKI group. HE staining results showed that ulinastatin could inhibit inflammatory cells infiltration, decrease sarcomere rupture in muscle tissues induced by extrusion, and alleviate the glomerular congestion and edema, as well as decrease myoglobin cast in kidney tissues. The proportion of CD4+CD25+Foxp3+ regulatory T (Treg) cells and Foxp3 expression levels were decreased in the CSAKI animals, while IL-17 expression levels were significantly increased, compared with those of the normal control group. Treatment with ulinastatin upregulated the proportion of Treg cells in CD4+ T cells and downregulated the expression of IL-17 compared with those of the CSAKI group. CONCLUSION The findings of our study indicate that UTI attenuates CS-induced AKI and alleviate the inflammatory response during the early stage. The mechanism of UTI may be due to regulating the balance between Th17/Treg cells. Our study provides a new mechanism for the beneficial effect of ulinastatin on CSAKI.
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Affiliation(s)
| | - Jie Song
- Department of Nephrology, Characteristic Medical Center of Chinese People's Armed Police Forces, Tianjin, China
| | - Shi-Ke Hou
- Institute of Disaster Medicine, Tianjin University, Tianjin, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, China.
| | - Hao-Jun Fan
- Institute of Disaster Medicine, Tianjin University, Tianjin, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, China
| | - Qi Lv
- Institute of Disaster Medicine, Tianjin University, Tianjin, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, China.
| | - Zi-Quan Liu
- Institute of Disaster Medicine, Tianjin University, Tianjin, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, China
| | - Hui Ding
- Institute of Disaster Medicine, Tianjin University, Tianjin, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, China
| | - Yong-Zhong Zhang
- Institute of Disaster Medicine, Tianjin University, Tianjin, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, China
| | - Jin-Yang Liu
- Institute of Disaster Medicine and Public Health, Characteristic Medical Center of the Chinese People's Armed Police Force (PAP), Tianjin, China
| | - Wen-Long Dong
- Institute of Disaster Medicine, Tianjin University, Tianjin, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, China
| | - Xue Wang
- Institute of Disaster Medicine and Public Health, Characteristic Medical Center of the Chinese People's Armed Police Force (PAP), Tianjin, China
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Abstract
INTRODUCTION The standard of care for refractory hyperkalemia is renal replacement therapy (RRT). However, traditional RRT requires specialized equipment, trained personnel, and large amounts of dialysate. It is therefore poorly suited for austere environments. We hypothesized that a simplified hemoperfusion system could control serum potassium concentration in a swine model of acute hyperkalemia. METHODS Ten pigs were anesthetized and instrumented. A dialysis catheter was inserted. After bilateral nephrectomy, animals received intravenous potassium chloride and were randomized to the control or treatment group. In both groups, blood was pumped through an extracorporeal circuit (EC) with an in-line hemodialyzer. In the treatment arm, ultrafiltrate from the hemodialyzer was diverted through cartridges containing novel potassium binding beads and returned to the EC. Blood samples were obtained every 30 min for 6 h. RESULTS Serum potassium concentration was significantly lower in the treatment than in the control group over time (P = 0.02). There was no difference in serum total calcium concentration for group or time (P = 0.13 and 0.44, respectively) or platelet count between groups or over time (P = 0.28 and 1, respectively). No significant EC thrombosis occurred. Two of five animals in the control group and none in the treatment group developed arrhythmias. All animals survived until end of experiment. CONCLUSIONS A simplified hemoperfusion system removed potassium in a porcine model. In austere settings, this system could be used to temporize patients with hyperkalemia until evacuation to a facility with traditional RRT.
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Moitinho de Almeida M, van Loenhout JAF, Thapa SS, Kumar KC, Schlüter BS, Singh R, Banse X, Putineanu D, Mahara DP, Guha-Sapir D. Clinical and demographic profile of admitted victims in a tertiary hospital after the 2015 earthquake in Nepal. PLoS One 2019; 14:e0220016. [PMID: 31318948 PMCID: PMC6638971 DOI: 10.1371/journal.pone.0220016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/05/2019] [Indexed: 11/24/2022] Open
Abstract
Background In 2015, an earthquake killing 9,000 and injuring 22,000 people hit Nepal. The Tribhuvan University Teaching Hospital (TUTH), a reference tertiary hospital, was operational immediately after the earthquake. We studied the profile of earthquake victims admitted in TUTH and assessed what factors could influence hospital length of stay. Methods An earthquake victim dataset was created based on patient records, with information on sex, age, date of admission and discharge, diagnosis, and surgical intervention. We performed an initial descriptive overview of the earthquake victims followed by a time-to-event analysis to compare length of hospital stay in different groups, using log rank test and cox regression to calculate Hazard Ratios. Results There were in total 501 admitted victims, with the peak of admissions occurring on the fifth day after the earthquake. About 89% had injury as main diagnosis, mostly in lower limbs, and 66% of all injuries were fractures. Nearly 69% of all patients underwent surgery. The median length of hospital stay was 10 days. Lower limb and trunk injuries had longer hospital stays than injuries in the head and neck (HR = 0.68, p = 0.009, and HR = 0.62 p = 0.005, respectively). Plastic surgeries had longer hospital stays than orthopaedic surgeries (HR = 0.57 p = 0.006). Having a crush injury and undergoing an amputation also increased time to discharge (HR = 0.57, p = 0.013, and HR = 0.65 p = 0.045 respectively). Conclusions Hospital stay was particularly long in this sample in comparison to other studies on earthquake victims, indirectly indicating the high burden TUTH had to bear to treat these patients. To strengthen resilience, tertiary hospitals should have preparedness plans to cope with a large influx of injured patients after a large-scale disaster, in particular for the initial days when there is limited external aid.
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Affiliation(s)
- Maria Moitinho de Almeida
- Centre for Research on the Epidemiology of Disasters (CRED), Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
- * E-mail:
| | - Joris Adriaan Frank van Loenhout
- Centre for Research on the Epidemiology of Disasters (CRED), Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Sunil Singh Thapa
- Department of Orthopedics, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - K. C. Kumar
- Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Benjamin-Samuel Schlüter
- Centre for Research on the Epidemiology of Disasters (CRED), Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | | | - Xavier Banse
- Service d’orthopédie et de traumatologie de l’appareil locomoteur, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Dan Putineanu
- Service d’orthopédie et de traumatologie de l’appareil locomoteur, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Deepak Prakash Mahara
- Department of Orthopedics, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Debarati Guha-Sapir
- Centre for Research on the Epidemiology of Disasters (CRED), Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
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Chan EYY, Man AYT, Lam HCY. Scientific evidence on natural disasters and health emergency and disaster risk management in Asian rural-based area. Br Med Bull 2019; 129:91-105. [PMID: 30753325 PMCID: PMC6413858 DOI: 10.1093/bmb/ldz002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 01/04/2019] [Accepted: 01/11/2019] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Disaster epidemiological studies indicate that Asia has the highest frequency of natural disasters. Rural communities are heavily impacted by natural disasters and have different healthcare needs to urban ones. Referencing Asian countries, this paper's objective is to provide an overview of health impacts and the current evidence for designing programmes and policies related to rural health emergency and disaster risk management (health-EDRM). SOURCES OF DATA This paper uses published English-only reports and papers retrieved from PubMed, Google Scholar, Embase, Medline and PsycINFO on rural disaster and emergency responses and relief, health impact and disease patterns in Asia (January 2000-January 2018). AREAS OF AGREEMENT Earthquakes are the most studied natural disasters in rural communities. The medical burden and health needs of rural communities were most commonly reported among populations of extreme age. Most of the existing research evidence for rural interventions was reported in China. There lacks published peer-reviewed reports of programme impacts on personal and community preparedness. AREAS OF CONTROVERSY There is a lack of evidence-based health-EDRM interventions to evaluate implementation effectiveness in rural areas despite vast volumes of health-related disaster literature. GROWING POINTS Climate change-related disasters are increasing in frequency and severity. Evidence is needed for disaster risk reduction interventions to address the health risks specific to rural populations. AREAS TIMELY FOR DEVELOPING RESEARCH To support global policy development, urgent evidence is needed on the intervention effectiveness, long-term health outcomes, local and cultural relevance as well as sustainability of health relief produced by Health-EDRM programmes in rural areas.
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Affiliation(s)
- E Y Y Chan
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), Division of Global Health and Humanitarian Medicine, The Jockey Club School of Public Health and Primary Care, Division of Global Health and Humanitarian Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- François-Xavier Bagnoud Center for Health & Human Rights, Harvard University, Boston, MA, USA
| | - A Y T Man
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), Division of Global Health and Humanitarian Medicine, The Jockey Club School of Public Health and Primary Care, Division of Global Health and Humanitarian Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - H C Y Lam
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), Division of Global Health and Humanitarian Medicine, The Jockey Club School of Public Health and Primary Care, Division of Global Health and Humanitarian Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Systemic Inflammatory Response and Multiple Organ Dysfunctions Following Crush Injury: a New Experimental Model in Rabbits. Inflammation 2018; 41:240-248. [PMID: 29071515 DOI: 10.1007/s10753-017-0683-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In this study, we aim to develop a new, reproducible crush injury (CI) model in rabbits. Anesthetized rabbits were compressed on both hind limbs using a special instrument for 6 h followed by 3 h of reperfusion. Blood samples and injured muscles were collected for biochemical analysis and morphological evaluation. Survival observation lasted for 72 h. Bilateral compressions with 10 kg/kg body weight (BW), but not with 5 kg/kg BW, reduced serious systemic impairment. Bilateral compressions with 10 kg/kg BW resulted in severe lactic acidosis; increased serum K+, creatine phosphokinase, aspartate transaminase, alanine transaminase, blood urea nitrogen, and creatinine levels; and a sharply decreased mean arterial blood pressure after compression release. Serious tissue edema and inflammation were observed in the damaged muscles. The mortality rates in compression groups were 20% (5 kg/kg BW) and 60% (10 kg/kg BW). There was a significant increase in plasma concentrations of TNF-α and IL-1β after compression. Plasma IL-1β levels returned to control levels at 6 h after compression release, whereas TNF-α peaked at 12 h following reperfusion. Furthermore, antiinflammatory cytokines, including IL-4 and IL-10, were also increased after compression, and these two cytokines peaked at 12 h after compression release. Our data suggested that bilateral compression with 10 kg/kg BW on rabbits' hind limbs is a reproducible CI model, and we also reported the CI-induced systemic inflammatory responses and changes of cytokines over time.
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Nola IA. Earthquakes and their environmental, medical and public health impacts. SALUD PUBLICA DE MEXICO 2018. [DOI: 10.21149/9212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Zhang Z, Dou Q, Gao H, Bai B, Zhang Y, Hu D, Yetisen AK, Butt H, Yang X, Li C, Dai Q. 30 s Response Time of K + Ion-Selective Hydrogels Functionalized with 18-Crown-6 Ether Based on QCM Sensor. Adv Healthc Mater 2018; 7. [PMID: 29210514 DOI: 10.1002/adhm.201700873] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/30/2017] [Indexed: 11/11/2022]
Abstract
Potassium detection is critical in monitoring imbalances in electrolytes and physiological status. The development of rapid and robust potassium sensors is desirable in clinical chemistry and point-of-care applications. In this study, composite supramolecular hydrogels are investigated: polyethylene glycol methacrylate and acrylamide copolymer (P(PEGMA-co-AM)) are functionalized with 18-crown-6 ether by employing surface initiated polymerization. Real-time potassium ion monitoring is realized by combining these compounds with quartz crystal microbalance. The device demonstrates a rapid response time of ≈30 s and a concentration detection range from 0.5 to 7.0 × 10-3 m. These hydrogels also exhibit high reusability and K+ ion selectivity relative to other cations in biofluids such as Na+ , NH4+ , Mg2+ , and Ca2+ . These results provide a new approach for sensing alkali metal ions using P(PEGMA-co-AM) hydrogels.
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Affiliation(s)
- Zhenxiao Zhang
- Division of Nanophotonics; CAS Center for Excellence in Nanoscience; National Center for Nanoscience and Technology; Beijing 100190 P. R. China
- College of Material Science and Engineering; Beijing Institute of Fashion Technology; Beijing 10029 China
| | - Qian Dou
- Division of Nanophotonics; CAS Center for Excellence in Nanoscience; National Center for Nanoscience and Technology; Beijing 100190 P. R. China
| | - Hongkai Gao
- The Armed Police General Hospital; Beijing 100039 China
| | - Bing Bai
- Division of Nanophotonics; CAS Center for Excellence in Nanoscience; National Center for Nanoscience and Technology; Beijing 100190 P. R. China
| | - Yongmei Zhang
- The Armed Police General Hospital; Beijing 100039 China
| | - Debo Hu
- Division of Nanophotonics; CAS Center for Excellence in Nanoscience; National Center for Nanoscience and Technology; Beijing 100190 P. R. China
| | - Ali K. Yetisen
- Harvard Medical School and Wellman Center for Photomedicine; Massachusetts General Hospital; 65 Landsdowne Street Cambridge MA 02139 USA
| | - Haider Butt
- Harvard-MIT Division of Health Sciences and Technology; Massachusetts Institute of Technology; Cambridge MA 02139 USA
- University of Birmingham; Birmingham B15 2TT UK
| | - Xiaoxia Yang
- Division of Nanophotonics; CAS Center for Excellence in Nanoscience; National Center for Nanoscience and Technology; Beijing 100190 P. R. China
| | - Congju Li
- Beijing Institute of Nanoenergy and Nanosystems; Chinese Academy of Sciences; National Center for Nanoscience and Technology (NCNST); Beijing 100083 P. R. China
| | - Qing Dai
- Division of Nanophotonics; CAS Center for Excellence in Nanoscience; National Center for Nanoscience and Technology; Beijing 100190 P. R. China
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Yang L. Acute Kidney Injury in Asia. KIDNEY DISEASES 2016; 2:95-102. [PMID: 27921036 DOI: 10.1159/000441887] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 10/18/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is a common disorder and is associated with a high morbidity and mortality worldwide. The diversity of the climate and of the socioeconomic and developmental status in Asia has a great influence on the etiology and presentation of AKI in different regions. In view of the International Society of Nephrology's 0by25 initiative, more and more attention has been paid to AKI in Asian countries. SUMMARY In this review, we summarize the recent achievements with regard to the prevalence and clinical patterns of AKI in Asian countries. Epidemiological studies have revealed the huge medical and economic burden of AKI in Eastern Asian countries, whereas the true epidemiological picture of AKI in the tropical areas is still not well understood. In high-income Asian regions, the presentation of AKI resembles that in other developed countries in Europe and North America. In low-income regions and tropical areas, infections, environmental toxins, and obstetric complications remain the major culprits in most cases of AKI. Preventive opportunities are missed because of failure to recognize the risk factors and early signs of AKI. Patients often present late for treatment or are recognized late by physicians, which leads to more severe kidney injury, multiorgan involvement, and increased mortality. There is significant undertreatment of AKI in many regions, and medical resources for renal replacement therapy are not universally available. KEY MESSAGES More efforts should be made to increase public awareness, establish preventive approaches in communities, educate health-care practitioner entities to achieve better recognition, and form specialist renal teams to improve the treatment of AKI. The choice of renal replacement therapy should fit patients' needs, and peritoneal dialysis can be practiced more frequently in the treatment of AKI patients. FACTS FROM EAST AND WEST (1) More than 90% of the patients recruited in AKI studies using KDIGO-equivalent criteria originate from North America, Europe, or Oceania, although these regions represent less than a fifth of the global population. However, the pooled incidence of AKI in hospitalized patients reaches 20% globally with moderate variance between regions. (2) The lower incidence rates observed in Asian countries (except Japan) may be due to a poorer recognition rate, for instance because of less systematically performed serum creatinine tests. (3) AKI patients in South and Southeastern Asia are younger than in East Asia and Western countries and present with fewer comorbidities. (4) Asian countries (and to a certain extent Latin America) face specific challenges that lead to AKI: nephrotoxicity of traditional herbal and less strictly regulated nonprescription medicines, environmental toxins (snake, bee, and wasp venoms), and tropical infectious diseases (malaria and leptospirosis). A higher incidence and less efficient management of natural disasters (particularly earthquakes) are also causes of AKI that Western countries are less likely to encounter. (5) The incidence of obstetric AKI decreased globally together with an improvement in socioeconomic levels particularly in China and India in the last decades. However, antenatal care and abortion management must be improved to reduce AKI in women, particularly in rural areas. (6) Earlier nephrology referral and better access to peritoneal dialysis should improve the outcome of AKI patients.
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Affiliation(s)
- Li Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, and Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Peking University, Ministry of Education, Beijing, China
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Affiliation(s)
| | | | - Zhi-Hong Liu
- Department of Nephrology, Institute of Nephrology, Jinling Hospital, Nanjing University, Nanjing, Jiangsu 210002, China
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Feng Y, Ma L, Liu L, Hong HG, Zhang X, Guo F, Huang R, Shi M, Li Y, Zhang L, Fu P. Rhabdomyolysis induced AKI via the regulation of endoplasmic reticulum stress and oxidative stress in PTECs. RSC Adv 2016. [DOI: 10.1039/c6ra18865f] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Mechanism for the role of ER stress and oxidative stress activation in rhabdomyolysis-associated AKI.
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Abstract
OBJECTIVE Understanding who is most vulnerable during an earthquake will help health care responders prepare for future disasters. We analyzed the demography of casualties from the Christchurch earthquake in New Zealand. METHODS The demography of the total deceased, injured, and hospitalized casualties of the Christchurch earthquake was compared with that of the greater Christchurch population, the Christchurch central business district working population, and patients who presented to the single acute emergency department on the same month and day over the prior 10 years. Sex data were compared to scene of injury, context of injury, clinical characteristics of injury, and injury severity scores. RESULTS Significantly more females than males were injured or killed in the entire population of casualties (P20% were injured at commercial or service localities (444/2032 males [22%]; 1105/4627 females [24%]). Adults aged between 20 and 69 years (1639/2032 males [81%]; 3717/4627 females [80%]) were most frequently injured. CONCLUSION Where people were and what they were doing at the time of the earthquake influenced their risk of injury.
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Kong DY, Hao LR, Zhang L, Li QG, Zhou JH, Shi SZ, Zhu F, Geng YQ, Chen XM. Comparison of two fluid solutions for resuscitation in a rabbit model of crush syndrome. Clin Exp Nephrol 2015; 19:1015-23. [PMID: 25910455 DOI: 10.1007/s10157-015-1114-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 04/07/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Crush syndrome is a common injury, the main characteristics of which include acute kidney injury. However, there is still lack of reliable animal model of crush syndrome, and it also remains controversial as to which type of fluid should be chosen as a more appropriate treatment option for prevention and treatment of acute kidney injury. METHODS The rabbits were crushed at the lower limbs for 6 h with 36 times the body weight, which means the pressure of each leg was also 36 times the body weight. Fluid resuscitation was performed from 1 h prior to the end of the crush treatment until 24 h after the reperfusion. Tissue, blood and urine samples were collected at predetermined time points before and after reperfusion. Twelve rabbits in each group were taken for survival observation for 72 h. RESULTS The model group showed elevated serum creatine kinase, aspartate aminotransferase, alanine aminotransferase, and K(+) level, reduced serum Ca(2+) level and Na(+) level, and increased serum creatinine and blood urea nitrogen levels, neutrophil gelatinase-associated lipocalin, and kidney injury molecule-1 (p < 0.05). The 0.9 % normal saline (SAL) group and SAL plus 6 % hydroxyethyl starch 130/0.4 SAL/HES group showed reduced serum creatinine and blood urea nitrogen levels (p < 0.05). The SAL/HES group also showed reduced serum IL-6 and IL-10 levels (p < 0.05). The 72 h survival rate of the SAL/HES group was higher than that of the model group (p < 0.05). CONCLUSION The rabbit model of crush syndrome showed clinical features consistent with those of crush syndrome. There was no significant difference in the ability of preventing AKI after a crush injury between the two fluid solutions, while SAL/HES can improve the survival rate.
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Affiliation(s)
- De-yang Kong
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, China
- Department of Nephrology, 1st Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Li-rong Hao
- Department of Nephrology, 1st Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Li Zhang
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, China.
| | - Qing-gang Li
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, China
| | - Jian-hui Zhou
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, China
| | - Suo-zhu Shi
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, China
| | - Fei Zhu
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, China
| | - Yan-qiu Geng
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, China
| | - Xiang-mei Chen
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, China.
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Comparison of Injury Epidemiology Between the Wenchuan and Lushan Earthquakes in Sichuan, China. Disaster Med Public Health Prep 2014; 8:541-7. [DOI: 10.1017/dmp.2014.131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveWe aimed to compare injury characteristics and the timing of admissions and surgeries in the Wenchuan earthquake in 2008 and the Lushan earthquake in 2013.MethodsWe retrospectively compared the admission and operating times and injury profiles of patients admitted to our medical center during both earthquakes. We also explored the relationship between seismic intensity and injury type.ResultsThe time from earthquake onset to the peak in patient admissions and surgeries differed between the 2 earthquakes. In the Wenchuan earthquake, injuries due to being struck by objects or being buried were more frequent than other types of injuries, and more patients suffered injuries of the extremities than thoracic injuries or brain trauma. In the Lushan earthquake, falls were the most common injury, and more patients suffered thoracic trauma or brain injuries. The types of injury seemed to vary with seismic intensity, whereas the anatomical location of the injury did not.ConclusionsGreater seismic intensity of an earthquake is associated with longer delay between the event and the peak in patient admissions and surgeries, higher frequencies of injuries due to being struck or buried, and lower frequencies of injuries due to falls and injuries to the chest and brain. These insights may prove useful for planning rescue interventions in trauma centers near the epicenter. (Disaster Med Public Health Preparedness. 2014;8:541-547)
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Simon T, Adini B, El-Hadid M, Goldberg A, Aharonson-Daniel L. The race to save lives: demonstrating the use of social media for search and rescue operations. PLOS CURRENTS 2014; 6:ecurrents.dis.806848c38f18c6b7b0037fae3cd4edc5. [PMID: 25685618 PMCID: PMC4322004 DOI: 10.1371/currents.dis.806848c38f18c6b7b0037fae3cd4edc5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
IMPORTANCE Utilizing social media in an emergency can enhance abilities to locate and evacuate casualties more rapidly and effectively, and can contribute towards saving lives following a disaster, through better coordination and collaboration between search and rescue teams. OBJECTIVE An exercise was conducted in order to test a standard operating procedure (SOP) designed to leverage social media use in response to an earthquake, and study whether social media can improve joint Israeli-Jordanian search and rescue operations following a regional earthquake. DESIGN First responders from both Jordan and Israel were divided into two mixed groups of eight people each, representing joint (Israeli-Jordanian) EMS teams. Simulated patients were dispersed throughout the Ben-Gurion University Campus. The first search and rescue team used conventional methods, while the second team also used social media channels (Facebook and Twitter) to leverage search and rescue operations. PARTICIPANTS Eighteen EMS and medical professionals from Israel and Jordan, which are members of the Emergency Response Development and Strategy Forum working group, participated in the exercise. RESULTS The social media team found significantly more mock casualties, 21 out of 22 (95.45%) while the no-media team found only 19 out of 22 (86.36%). Fourteen patients (63.63%) were found by the social media team earlier than the no-media team. The differences between the two groups were analyzed using the Mann-Whitney U-test, and evacuation proved to be significantly quicker in the group that had access to social media. The differences between the three injury severities groups' extraction times in each group were analyzed using the Kruskal-Wallis test for variance. Injury severity influenced the evacuation times in the social media team but no such difference was noted in the no-media team. CONCLUSIONS Utilizing social media in an emergency situation enables to locate and evacuate casualties more rapidly and effectively. Social media can contribute towards saving lives during a disaster, in national and bi-national circumstances. Due to the small numbers in the groups, this finding requires further verification on a larger study cohort.
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Affiliation(s)
- Tomer Simon
- Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev; Ready.org.il - Emergency readiness and preparedness in Israel; PREPARED Center for Emergency Response Research, Ben-Gurion University of the Negev, Beer Sheba, Israel
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Lu M, Wang Y, Yue L, Chiu J, He F, Wu X, Zang B, Lu B, Yao X, Jiang Z. Follow-up evaluation with ultrasonography of peripheral nerve injuries after an earthquake. Neural Regen Res 2014; 9:582-8. [PMID: 25206859 PMCID: PMC4146238 DOI: 10.4103/1673-5374.130095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2014] [Indexed: 01/02/2023] Open
Abstract
Published data on earthquake-associated peripheral nerve injury is very limited. Ultrasonography has been proven to be efficient in the clinic to diagnose peripheral nerve injury. The aim of this study was to assess the role of ultrasound in the evaluation of persistent peripheral nerve injuries 1 year after the Wenchuan earthquake. Thirty-four patients with persistent clinical symptoms and neurologic signs of impaired nerve function were evaluated with sonography prior to surgical repair. Among 34 patients, ultrasonography showed that 48 peripheral nerves were entrapped, and 11 peripheral nerves were disrupted. There was one case of misdiagnosis on ultrasonography. The concordance rate of ultrasonographic findings with those of surgical findings was 98%. A total of 48 involved nerves underwent neurolysis and the symptoms resolved. Only five nerves had scar tissue entrapment. Preoperative and postoperative clinical and ultrasonographic results were concordant, which verified that ultrasonography is useful for preoperative diagnosis and postoperative evaluation of injured peripheral nerves.
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Affiliation(s)
- Man Lu
- Department of Ultrasound, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Yue Wang
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Linxian Yue
- Department of Ultrasound, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Jack Chiu
- Department of Radiology, University Hospital, University of Western Ontario, Ontario, Canada
| | - Fanding He
- Department of Ultrasound, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Xiaojing Wu
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Bin Zang
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Bin Lu
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Xiaoke Yao
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Zirui Jiang
- Chengdu Jiaxiang Foreign Languages School, Chengdu, Sichuan Province, China
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Confined space medicine and the medical management of complex rescues: a case series. Disaster Med Public Health Prep 2014; 8:20-9. [PMID: 24528883 DOI: 10.1017/dmp.2014.1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE A variety of hazards can precipitate the full or partial collapse of occupied structures. The rescue of entrapped survivors in these situations can be complex, require a multidisciplinary approach, and last for many hours. METHODS The modern discipline of Urban Search and Rescue, which includes an active medical component, has evolved to address such situations. This case series spans several decades of experience and highlights the medical principles in the response to collapsed structure incidents. RESULTS Recurring concepts of confined space medicine include rescuer safety, inter-disciplinary coordination, patient protection, medical resuscitation in austere environments, and technical extrications. CONCLUSION Strategies have been developed to address the varied challenges in the medical response to collapsed structure incidents.
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Electrocardiographic changes after injury in a rat model of combined crush injury. Am J Emerg Med 2013; 31:1661-5. [DOI: 10.1016/j.ajem.2013.08.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 08/22/2013] [Accepted: 08/24/2013] [Indexed: 11/21/2022] Open
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Genthon A, Wilcox SR. Crush syndrome: a case report and review of the literature. J Emerg Med 2013; 46:313-9. [PMID: 24199724 DOI: 10.1016/j.jemermed.2013.08.052] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 05/19/2013] [Accepted: 08/15/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Crush trauma to the extremities, even if not involving vital organs, can be life threatening. Crush syndrome, the systemic manifestation of the breakdown of muscle cells with release of contents into the circulation, leads to metabolic derangement and acute kidney injury. Although common in disaster scenarios, emergency physicians also see the syndrome in patients after motor-vehicle collisions and patients "found down" due to intoxication. OBJECTIVE The objectives of this review are to discuss the pathophysiology of crush syndrome, report on prehospital and emergency department treatment, and discuss the relationship between crush syndrome and compartment syndrome. DISCUSSION We present the case of a young man found down after an episode of intoxication, with compartment syndrome of his lower extremity and crush syndrome. Although he eventually required an amputation, aggressive fluid resuscitation prevented further kidney injury and metabolic derangement. CONCLUSIONS Early, aggressive resuscitation in the prehospital setting, before extrication if possible, is recommended to reduce the complications of crush syndrome. Providers must be aware of the risk of hyperkalemia shortly after extrication. Ongoing resuscitation with i.v. fluids is the mainstay of treatment. Compartment syndrome is a common complication, and prompt fasciotomies should be performed when compartment syndrome is present.
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Affiliation(s)
- Alissa Genthon
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Susan R Wilcox
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Disaster nephrology: crush injury and beyond. Kidney Int 2013; 85:1049-57. [PMID: 24107850 DOI: 10.1038/ki.2013.392] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/20/2013] [Accepted: 07/25/2013] [Indexed: 01/09/2023]
Abstract
Disasters result in a substantial number of renal challenges, either by the creation of crush injury in victims trapped in collapsed buildings or by the destruction of existing dialysis facilities, leaving chronic dialysis patients without access to their dialysis units, medications, or medical care. Over the past two decades, lessons have been learned from the response to a number of major natural disasters that have impacted significantly on crush-related acute kidney injury and chronic dialysis patients. In this paper we review the pathophysiology and treatment of the crush syndrome, as summarized in recent clinical recommendations for the management of crush syndrome. The importance of early fluid resuscitation in preventing acute kidney injury is stressed, logistic difficulties in disaster conditions are described, and the need for an implementation of a renal disaster relief preparedness program is underlined. The role of the Renal Disaster Relief Task Force in providing emergency disaster relief and the logistical support required is outlined. In addition, the importance of detailed education of chronic dialysis patients and renal unit staff in the advance planning for such disasters and the impact of displacement by disasters of chronic dialysis patients are discussed.
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Evaluation of the deaths secondary to entrapment under the debris in the Van earthquake. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2013. [DOI: 10.1016/j.ejfs.2013.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Scharman EJ, Troutman WG. Prevention of kidney injury following rhabdomyolysis: a systematic review. Ann Pharmacother 2013; 47:90-105. [PMID: 23324509 DOI: 10.1345/aph.1r215] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To conduct a systematic literature review to evaluate evidence-based recommendations for the prevention of rhabdomyolysis-associated acute renal failure (ARF). DATA SOURCES PubMed (1966-December 2012), International Pharmaceutical Abstracts, Science Citation Index, and Cochrane databases (1970-December 2012) were searched. There were no language restrictions. STUDY SELECTION AND DATA EXTRACTION Studies selected dealt with treatment of rhabdomyolysis (crush syndrome) or prevention of ARF in patients with rhabdomyolysis. Articles excluded did not present original data or described only the management of ARF after it developed. Single case reports were excluded. Extracted data included study type; population; definitions of rhabdomyolysis and ARF; fluid, sodium bicarbonate, and mannitol dosages; and study findings. DATA SYNTHESIS Twenty-seven studies met the inclusion criteria. No controlled trials compared intravenous fluid administration plus sodium bicarbonate to fluid administration alone. Three concluded that there was no significant difference in the rates of ARF between patients receiving and those not receiving sodium bicarbonate; however, urine alkalinization was not documented. Eight investigations concluded that delayed fluid administration increased the risk of ARF. No controlled study compared volumes of fluid administered or targeted urine output goals. Fluid type, therapy duration, and monitoring parameters varied widely; 4 used a urine output goal in adults of more than 300 mL/h or 300 mL/h or more. No evidence supported a preferred fluid type or that sodium bicarbonate with or without mannitol was superior to fluid therapy alone. CONCLUSIONS Intravenous fluids should be initiated as soon as possible, preferably within the first 6 hours after muscle injury, at a rate that maintains a urine output in adults of 300 mL/h or more for at least the first 24 hours. Sodium bicarbonate should be administered only if necessary to correct systemic acidosis and mannitol only to maintain urine output of 300 mL/h or more despite adequate fluid administration.
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Affiliation(s)
- Elizabeth J Scharman
- West Virginia Poison Center, and West Virginia University Department of Clinical Pharmacy, West Virginia University, Charleston Division, Charleston, WV, USA.
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Assessing Point-of-Care Device Specifications and Needs for Pathogen Detection in Emergencies and Disasters. POINT OF CARE 2012; 11:119-125. [PMID: 23049471 DOI: 10.1097/poc.0b013e31825a25cb] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND: We assessed point-of-care device specifications and needs for pathogen detection in urgent care, emergencies, and disasters. METHODS: We surveyed American Association for Clinical Chemistry members and compared responses to those of disaster experts. Online SurveyMonkey questions covered performance characteristics, device design, pathogen targets, and other specifications. RESULTS: For disasters, respondents preferred direct sample collection with a disposable test cassette that stores biohazardous material (P<0.001). They identified methicillin-resistant Staphylococcus aureus, Salmonella typhi, Vibrio cholerae, Escherichia coli, Staphylococcus aureus, and Streptococcus pneumoniae as high priority pathogens. First responders were deemed the professional group who should perform POC testing in disasters (P<0.001). CONCLUSIONS: Needs assessment now is requisite for competitive funding, so the results in this report will be useful to investigators preparing grant applications. Point-of-care devices used in disasters should address the needs of first responders, who give high priority to contamination-free whole-blood sampling, superior performance pathogen detection, and HIV-1/2 blood donor screening. There was surprising concordance of preferences among different professional groups, which presages formulation of global consensus guidelines to assist high impact preparedness.
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Zhang L, Liu X, Li Y, Liu Y, Liu Z, Lin J, Shen J, Tang X, Zhang Y, Liang W. Emergency medical rescue efforts after a major earthquake: lessons from the 2008 Wenchuan earthquake. Lancet 2012; 379:853-61. [PMID: 22386038 DOI: 10.1016/s0140-6736(11)61876-x] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Major earthquakes often result in incalculable environmental damage, loss of life, and threats to health. Tremendous progress has been made in response to many medical challenges resulting from earthquakes. However, emergency medical rescue is complicated, and great emphasis should be placed on its organisation to achieve the best results. The 2008 Wenchuan earthquake was one of the most devastating disasters in the past 10 years and caused more than 370,000 casualties. The lessons learnt from the medical disaster relief effort and the subsequent knowledge gained about the regulation and capabilities of medical and military back-up teams should be widely disseminated. In this Review we summarise and analyse the emergency medical rescue efforts after the Wenchuan earthquake. Establishment of a national disaster medical response system, an active and effective commanding system, successful coordination between rescue forces and government agencies, effective treatment, a moderate, timely and correct public health response, and long-term psychological support are all crucial to reduce mortality and morbidity and promote overall effectiveness of rescue efforts after a major earthquake.
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Affiliation(s)
- Lulu Zhang
- Institute of Military Health Management, Second Military Medical University, Shanghai, China.
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