An 87-year-old male with old myocardial infarction was referred to the hospital due to left femur neck fracture and intermittent dizziness. Significant 2:1 atrioventricular block was demonstrated on initial electrocar...An 87-year-old male with old myocardial infarction was referred to the hospital due to left femur neck fracture and intermittent dizziness. Significant 2:1 atrioventricular block was demonstrated on initial electrocardiogram (Figure 1). Transthoracic echocardiography showed reduced left ventricular function (LVEF = 47%) with regional wall motion abnormality of right coronary artery (RCA) and left circumflex coronary artery (LCx) artery. Coronary angiography showed patent previous proximal RCA and distal LCx stents. Temporary pacemaker was inserted initially and the patient was planned for permanent pacemaker insertion after the surgery.展开更多
INTRODUCTIONScrub typhus, a tropical febrile vector borne disease also known as ＂Tsutsugamushi disease＂, is caused by Orientia tsutsugamushi, a gram negative obligate intracellular slow growing bacteria. The infecti...INTRODUCTIONScrub typhus, a tropical febrile vector borne disease also known as ＂Tsutsugamushi disease＂, is caused by Orientia tsutsugamushi, a gram negative obligate intracellular slow growing bacteria. The infection is transmitted by the bite of larval stage （chiggers） mites belonging to the family Trombiculidae.展开更多
Background:Tension pneumothorax is one of the leading causes of preventable death on the battlefield.Current prehospital diagnosis relies on a subjective clinical impression complemented by a manual thoracic and respi...Background:Tension pneumothorax is one of the leading causes of preventable death on the battlefield.Current prehospital diagnosis relies on a subjective clinical impression complemented by a manual thoracic and respiratory examination.These techniques are not fully applicable in field conditions and on the battlefield,where situational and environmental factors may impair clinical capabilities.We aimed to assemble a device able to sample,analyze,and classify the unique acoustic signatures of pneumothorax and hemothorax.Methods:Acoustic data was obtained with simultaneous use of two sensitive digital stethoscopes from the chest wall of an ex-vivo porcine model.Twelve second samples of acoustic data were obtained from the in-house assembled digital stethoscope system during mechanical ventilation.The thoracic cavity was injected with increasing volumes of 200,400,600,800,and 1000 ml of air or saline to simulate pneumothorax and hemothorax,respectively.The data was analyzed using a multi-objective genetic algorithm that was used to develop an optimal mathematical detector through the process of artificial evolution,a cutting-edge approach in the artificial intelligence discipline.Results:The in-house assembled dual digital stethoscope system and developed genetic algorithm achieved an accuracy,sensitivity and specificity ranging from 64%to 100%,63%to 100%,and 63%to 100%,respectively,in classifying acoustic signal as associated with pneumothorax or hemothorax at fluid injection levels of 400 ml or more,and regardless of background noise.Conclusions:We present a novel,objective device for rapid diagnosis of potentially lethal thoracic injuries.With further optimization,such a device could provide real-time detection and monitoring of pneumothorax and hemothorax in battlefield conditions.展开更多
An 89-year-old woman[body mass index(BMI)=20.27 kg/m^2)]with hypertension underwent implantation of a dual-chamber pacemaker because of dizziness and syncope due to sick sinus syndrome.Pacemaker implantation via the l...An 89-year-old woman[body mass index(BMI)=20.27 kg/m^2)]with hypertension underwent implantation of a dual-chamber pacemaker because of dizziness and syncope due to sick sinus syndrome.Pacemaker implantation via the left subclavian approach was performed on June 3,2017.A right ventricular active lead(TendrilTM STS 2088TC,St Jude Medical,Penang,Malaysia)and an atrial active lead(OptisenseTM 1999,St Jude Medical,Penang,Malaysia)were placed in the right ventricular apex and anterior wall of the right atrium,respectively.展开更多
BACKGROUND:Tension pneumothorax(TPX) is an uncommon but life-threatening condition.It is important that this uncommon presentation,managed by needle decompression,is practised by paramedics using a range of educationa...BACKGROUND:Tension pneumothorax(TPX) is an uncommon but life-threatening condition.It is important that this uncommon presentation,managed by needle decompression,is practised by paramedics using a range of educationally sound and realistic mannequins.The objective of this study is to identify if the chest wall thickness(CWT) of training mannequins used for chest decompression is an anatomically accurate representation of a human chest.METHODS:This is a two-part study.A review of the literature was conducted to identify chest wall thickness in humans and measurement of chest wall thickness on two commonly used mannequins.The literature search was conducted using the Cochrane Central Register of Controlled Trials,MEDLINE,CINAHL,and EMBASE databases from their beginning until the end of May 2012.Key words included chest wall thickness,tension pneumothorax,pneumothorax,thoracostomy,needle thoracostomy,decompression,and needle test.Studies were included if they reported chest wall thickness.RESULTS:For the literature review,4 461 articles were located with 9 meeting the inclusion criteria.Chest wall thickness in adults varied between 1.3 cm and 9.3 cm at the area of the second intercostal space mid clavicular line.The Laerdal? manikin in the area of the second intercostal space mid clavicular line,right side of the chest was 1.1 cm thick with the left 1.5 cm.The MPL manikin in the same area or on the right side of the chest was 1.4 cm thick but on the left 1.0 cm.CONCLUSION:Mannequin chests are not an accurate representation of the human chest when used for decompressing a tension pneumothorax and therefore may not provide a realistic experience.展开更多
文摘An 87-year-old male with old myocardial infarction was referred to the hospital due to left femur neck fracture and intermittent dizziness. Significant 2:1 atrioventricular block was demonstrated on initial electrocardiogram (Figure 1). Transthoracic echocardiography showed reduced left ventricular function (LVEF = 47%) with regional wall motion abnormality of right coronary artery (RCA) and left circumflex coronary artery (LCx) artery. Coronary angiography showed patent previous proximal RCA and distal LCx stents. Temporary pacemaker was inserted initially and the patient was planned for permanent pacemaker insertion after the surgery.
文摘INTRODUCTIONScrub typhus, a tropical febrile vector borne disease also known as ＂Tsutsugamushi disease＂, is caused by Orientia tsutsugamushi, a gram negative obligate intracellular slow growing bacteria. The infection is transmitted by the bite of larval stage （chiggers） mites belonging to the family Trombiculidae.
基金supported by the Israel Defense Forces(IDF)Medical Corps and Directorate of Defense Research&Development,Israeli Ministry of Defense(IMOD DDR&D)。
文摘Background:Tension pneumothorax is one of the leading causes of preventable death on the battlefield.Current prehospital diagnosis relies on a subjective clinical impression complemented by a manual thoracic and respiratory examination.These techniques are not fully applicable in field conditions and on the battlefield,where situational and environmental factors may impair clinical capabilities.We aimed to assemble a device able to sample,analyze,and classify the unique acoustic signatures of pneumothorax and hemothorax.Methods:Acoustic data was obtained with simultaneous use of two sensitive digital stethoscopes from the chest wall of an ex-vivo porcine model.Twelve second samples of acoustic data were obtained from the in-house assembled digital stethoscope system during mechanical ventilation.The thoracic cavity was injected with increasing volumes of 200,400,600,800,and 1000 ml of air or saline to simulate pneumothorax and hemothorax,respectively.The data was analyzed using a multi-objective genetic algorithm that was used to develop an optimal mathematical detector through the process of artificial evolution,a cutting-edge approach in the artificial intelligence discipline.Results:The in-house assembled dual digital stethoscope system and developed genetic algorithm achieved an accuracy,sensitivity and specificity ranging from 64%to 100%,63%to 100%,and 63%to 100%,respectively,in classifying acoustic signal as associated with pneumothorax or hemothorax at fluid injection levels of 400 ml or more,and regardless of background noise.Conclusions:We present a novel,objective device for rapid diagnosis of potentially lethal thoracic injuries.With further optimization,such a device could provide real-time detection and monitoring of pneumothorax and hemothorax in battlefield conditions.
文摘An 89-year-old woman[body mass index(BMI)=20.27 kg/m^2)]with hypertension underwent implantation of a dual-chamber pacemaker because of dizziness and syncope due to sick sinus syndrome.Pacemaker implantation via the left subclavian approach was performed on June 3,2017.A right ventricular active lead(TendrilTM STS 2088TC,St Jude Medical,Penang,Malaysia)and an atrial active lead(OptisenseTM 1999,St Jude Medical,Penang,Malaysia)were placed in the right ventricular apex and anterior wall of the right atrium,respectively.
文摘BACKGROUND:Tension pneumothorax(TPX) is an uncommon but life-threatening condition.It is important that this uncommon presentation,managed by needle decompression,is practised by paramedics using a range of educationally sound and realistic mannequins.The objective of this study is to identify if the chest wall thickness(CWT) of training mannequins used for chest decompression is an anatomically accurate representation of a human chest.METHODS:This is a two-part study.A review of the literature was conducted to identify chest wall thickness in humans and measurement of chest wall thickness on two commonly used mannequins.The literature search was conducted using the Cochrane Central Register of Controlled Trials,MEDLINE,CINAHL,and EMBASE databases from their beginning until the end of May 2012.Key words included chest wall thickness,tension pneumothorax,pneumothorax,thoracostomy,needle thoracostomy,decompression,and needle test.Studies were included if they reported chest wall thickness.RESULTS:For the literature review,4 461 articles were located with 9 meeting the inclusion criteria.Chest wall thickness in adults varied between 1.3 cm and 9.3 cm at the area of the second intercostal space mid clavicular line.The Laerdal? manikin in the area of the second intercostal space mid clavicular line,right side of the chest was 1.1 cm thick with the left 1.5 cm.The MPL manikin in the same area or on the right side of the chest was 1.4 cm thick but on the left 1.0 cm.CONCLUSION:Mannequin chests are not an accurate representation of the human chest when used for decompressing a tension pneumothorax and therefore may not provide a realistic experience.
