Sedat Bilge

Safest light in a combat area while performing intravenous access in the dark

Introduction Cannulation for the administration of intravenous fluids is integral to the prehospital management of injured military patients. However, this may be technically challenging to undertake during night-time conditions where the use of light to aid cannulation may give the tactical situation away to opponents. The aim of this study was to investigate the success and tactical safety of venepuncture under battlefield conditions with different colour light sources. Method The procedure was carried out with naked eye in a bright room in the absence of a separate light source, with a naked eye in a dark room under red, white, blue and green light sources and under an infrared light source while wearing night vision goggles (NVGs). The success, safety, degree of difficulty and completion time for each procedure were then explored. Results All interventions made in daylight and in a dark room were found to be 100% successful. Interventions performed under infrared light while wearing NVGs took longer than under other light sources or in daylight. Interventions performed under blue light were tactically safer when compared with interventions performed under different light sources. Conclusion Blue light offered the best tactical safety during intravenous cannulation under night-time conditions and is recommended for future use in tactical casualty care. The use of NVGs using infrared light cannot be recommended if there is the possibility of opponents having access to the technology.

Savaş alanında hayat kurtarıcı prosedürlere yeni bir bakış: Gece görüş gözlükleri ile acil krikotroidotomi, iğne torakostomi ve göğüs tüp torakostomi

BACKGROUND In the patients with multiple and serious trauma, early applications of life-saving procedures are related to improved survival. We tried to experimentally determine the feasibility of life-saving interventions that are performed with the aid of night vision goggles (NVG) in nighttime combat scenario. METHODS Chest tube thoracostomy (CTT), emergency cricothyroidotomy (EC), and needle thoracostomy (NT) interventions were performed by 10 combatant medical staff. The success and duration of interventions were explored in the study. Procedures were performed on the formerly prepared manikins/models in a bright room and in a dark room with the aid of NVG. Operators graded the ease of interventions. RESULTS All interventions were found successful. Operators stated that both CTT and EC interventions were more difficult in dark than in daytime (p<0.05). No significant difference was observed in the difficulty in the NT interventions. No significant difference was observed in terms of completion times of interventions between in daytime and in dark scenario. CONCLUSION The operators who use NVGs have to be aware of that they can perform their tactic and medical activities without taking off the NVGs and without the requirement of an extra light source.

US-Guided Axillary Approach of Brachial Plexus Block for Forearm Fracture

Background: In Emergency Departments (EDs), procedural sedation analgesia, hematoma block, intravenous regional anaesthesia and peripheral nerve blocks are usually used for pain control in forearm fractures. We aimed to review the results of Visual Analog Scale (VAS) scores (during examination and reduction), post reduction neurovascular examinations and complications of forearm fractures which were applied US-guided axillary approach of brachial plexus block (AABPB). Patients and Methods: We described fourteen patients, who presented to the ED with forearm fractures, and were reduced using US-guided AABPB performed by emergency physicians. The same technique was used for all fourteen nerve blocks. We reviewed the results of VAS scores (during examination and reduction), post reduction neurovascular examinations and complications of forearm fractures who were applied AABPB. Results: Of the 14 patients admitted to study, the mean age was 59.92 ±12,81 (36.00 – 82.00). Mean VAS score of patients before procedures was 91.57 ± 3.99 (85,00 – 98.00) mm. The US-guided AABPB was performed by emergency physicians and nerve block fracture was reduced. 20 minutes after reduction, mean VAS score of patients was 10.21 ± 5.36 (0 – 19.00) mm. performed (Table 1). All patients were discharged after approximately eight hours’ observation period and post-reduction neurovascular examinations were normal. There were no complications during block and reduction. Conclusion: US-guided axillary approach of brachial plexus block is a technique that can be applied easily in the ED by emergency physicians for forearm fractures. In this technique, the procedural success rate is high, and it was noticed a high level of patient and physician satisfaction.

Acute dystonic reaction leading to lingual hematoma mimicking angioedema

Lingual hematoma is a severe situation, which is rare and endangers the airway. It can develop due to trauma, vascular abnormalities, and coagulopathy. Due to its sudden development, it can be clinically confused with angioedema. In patients who applied to the doctor with complaints of a swollen tongue, lingual hematoma can be confused with angioedema, in particular, at the beginning if the symptoms occurred after drug use. It should especially be considered that dystonia in the jaw can present as drug-induced hyperkinetic movement disorder. Early recognition of this rare clinical condition and taking precautions for providing airway patency are essential. In this case report, we will discuss mimicking angioedema and caused by a bite due to dystonia and separation of the tongue from the base of the mouth developing concurrently with lingual hematoma.