Aviat Space Envir Md
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Aviat Space Envir Md · Feb 1987
Case ReportsCases from the aerospace medicine residents' teaching file. Case #16. A student pilot with an avulsion fracture of C5.
A student pilot presented to the emergency room with neck pain after having received a blow to the back of the head during participation in a sports event. The clinical presentation, diagnosis, and aeromedical disposition of this patient are discussed. A review of radiologic findings in cervical fractures is also presented.
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Acceleration atelectasis is the absorptional collapse of alveoli in the dependent lung due to increased accelerative forces. It is exacerbated by breathing 100% oxygen and, during +Gz exposure, by the use of an anti-G suit. Experiments were conducted on 12 subjects using simulated aerial combat maneuvers (SACM) with G profiles having peak exposures of either 4.5 G or 9 G. ⋯ Acceleration atelectasis causes symptoms of chest pain, coughing, and shortness of breath. Subjective ratings of the severity of these symptoms were obtained from the subjects, and these were much greater following the 4.5-G SACM exposures than after the 9-G runs. Acceleration atelectasis was reduced by dilution of the inspired oxygen concentration by argon and nitrogen (evaluated at 95, 82.5, 70, 50, and 20% oxygen); the addition of unassisted positive pressure at 30 mm Hg (4 kPa) to the breathing mask; or the performance of the anti-G straining maneuver (AGSM).
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Aviat Space Envir Md · Oct 1986
Pulmonary barotrauma in divers and the treatment of cerebral arterial gas embolism.
A review of case records spanning 20 years revealed 140 cases of decompression pulmonary barotrauma (PBT) in divers. There were 23 cases of uncomplicated PBT and 117 cases of cerebral arterial gas embolism (AGE), of which 58 had respiratory manifestations. Details of presentation and precipitating factors were analysed. ⋯ No cases receiving steroids relapsed. Increasing the time to treatment reduced the likelihood of cure. Comparison of treatments proved difficult and it was concluded that, although most cases would probably respond satisfactorily to 2.8 bar (2100 mm Hg) of oxygen, there were no compelling reasons for altering the current treatment practice of beginning treatment of acute cases with a 30-min period at 6.0 bar (165 fsw) before returning to 2.8 bar (60 fsw) to complete the therapy.
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Prior attempts at establishing minimal federal air ambulance regulations and standards have been unsuccessful. However, reports of poor patient medical care during transport by some air ambulance services is now forcing many states to initiate air ambulance regulations. ⋯ Minimum air ambulance regulations were then established for aircraft configuration, flight crew requirements, minimal equipment and medications, and the responsibilities of the medical director or designee for each of the three levels of medical care. We conclude that the application of a levels approach based upon the patient's medical requirements may be useful in assisting other states attempting to establish flexible but specific regulations directed at the safe transport of patients by aeromedical evacuation.