Polytrauma in a Jet Pilot After Low-Altitude Ejection Without Parachute Deployment.

Background: Ejection seats are designed to be a lifesaving device for aircrew in emergencies. Modern ejection seats are widely prevalent in fighter and bomber aircraft and are occasionally associated with acceleration injury from axial loading (Gz) during the catapult phase of ejection, limb flail injury due to windblast, or parachute landing fall, especially if the ejection is outside of the seat's performance envelope.

Case Report: We present the first known case in the medical literature of a military pilot who survived a low-altitude, high-angulation (>90° of bank angle) ejection where the pilot's ejection seat parachute did not deploy due to contact with the ground before completion of the ejection sequence.

Quantifying the Impact of Sustained Acceleration on Critical Care Transport Medical Equipment.

Introduction: Military and commercial stakeholders are investing to explore the use of hypersonic aircraft and orbital spacecraft to transport cargo, medical supplies, passengers, and casualties. These vehicle platforms require periods of sustained acceleration, but to date, these dynamic forces have not been comprehensively considered in the environment of critical care patient movement because injured patients and advanced aeromedical evacuation (AE) equipment are rarely subjected to these conditions. While military AE equipment does undergo crash hazard acceleration testing, equipment functionality during or after sustained acceleration remains to be evaluated.

Quantifying the Volume of Residual Air in Commercial Intravenous Fluids and Assessing the Stability of Airless Intravenous Fluid Containers.

Introduction: Commercial off-the-shelf (COTS) intravenous fluid (IVF) containers contain residual air, introducing the risk of venous air embolism (VAE). Venous air embolism occurs when air displaces blood flow in vasculature. The danger from residual air is often negligible in terrestrial settings, where gravitational forces generate buoyancy, pushing residual air to the top of the IVF container.

Acute exposure to hydrazine reported to four United States regional poison centers: reconsidering a paradigm.

Introduction: Exposures to hydrazines occur during aeronautic and space operations and pose a potential risk to personnel. Historically, extensive preparatory countermeasures have been taken due to concern for severe toxicity. This study seeks to better understand manifestations of acute occupational exposures to hydrazine to guide recommendations for management.

Endovascular aortic occlusion improves return of spontaneous circulation after longer periods of cardiopulmonary resuscitation: A translational study in pigs.

Introduction: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as an adjunct to CPR for nontraumatic cardiac arrest (NTCA). This translational study investigated the impact of varying low-flow duration (15- vs 30-mins) on REBOA's hemodynamic performance and ability to achieve return of spontaneous circulation (ROSC) in a porcine model.

Methods: Thirty-two pigs were anesthetized and placed into ventricular fibrillation.

Spaceflight Recovery Considerations for Acute Inhalational Exposure to Hydrazines.

Inhalation of hydrazine or hydrazine-derivative (for example, monomethylhydrazine) vapors during spaceflight operations remains a risk to crew and ground support personnel. Here we sought to provide an evidence-based approach to inform acute clinical treatment guidelines for inhalational exposures during a noncatastrophic contingency spaceflight recovery scenario. A review of published literature was conducted concerning hydrazine/hydrazine-derivative exposure and clinical sequelae.

High risk and low prevalence diseases: Blast injuries.

Introduction: Blast injury is a unique condition that carries a high rate of morbidity and mortality, often with mixed penetrating and blunt injuries.

Objective: This review highlights the pearls and pitfalls of blast injuries, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.

Discussion: Explosions may impact multiple organ systems through several mechanisms.

Automated aortic endovascular balloon volume titration prevents re-arrest immediately after return of spontaneous circulation in a swine model of nontraumatic cardiac arrest.

Objectives: Endovascular aortic occlusion as an adjunct to cardiopulmonary resuscitation (CPR) for non-traumatic cardiac arrest is gaining interest. In a recent clinical trial, return of spontaneous circulation (ROSC) was achieved despite prolonged no-flow times. However, 66% of patients re-arrested upon balloon deflation.

The Use of Portable Oxygen Concentrators in Low-Resource Settings: A Systematic Review.

Introduction: Portable oxygen concentrators (POCs) are medical devices that use physical means to separate oxygen from the atmosphere to produce concentrated, medical-grade gas. Providing oxygen to low-resources environments, such as austere locations, military combat zones, rural Emergency Medical Services (EMS), and during disasters, becomes expensive and logistically intensive. Recent advances in separation technology have promoted the development of POC systems ruggedized for austere use.

Development of a Critical Care Air Transport Team "Go Bag": Slimming Down ICU Capability to Augment Pararescue or Civilian Contract Medical Evacuation Personnel.

Introduction: Critical Care Air Transport Team (CCATT) is a three-person United States Air Force (USAF) medical asset, typically providing intercontinental medical evacuation on large military aircraft. The CCATT equipment Allowance Standard (AS) weighs approximately 272 kg (600 lbs). In austere locations, CCATT teams may augment contract medical evacuation (CME) personnel or Pararescue (PJ) in small aircraft with limited space for medical equipment.

Evaluation of High Altitude Interstitial Pulmonary Edema in Healthy Participants Using Rapid 4-View Lung Ultrasound Protocol During Staged Ascent to Everest Base Camp.

Introduction: Prior research identified possible interstitial pulmonary fluid, concerning for early high altitude pulmonary edema (HAPE), in a large percentage of trekkers above 3000 m using a comprehensive 28-view pulmonary ultrasound protocol. These trekkers had no clinical symptoms of HAPE despite these ultrasound findings. The more common 4-view lung ultrasound protocol (LUP) is accurate in rapidly detecting interstitial edema during resource-rich care.

Everything you wanted to know about space radiation but were afraid to ask.

The space radiation environment is a complex combination of fast-moving ions derived from all atomic species found in the periodic table. The energy spectrum of each ion species varies widely but is prominently in the range of 400-600 MeV/n. The large dynamic range in ion energy is difficult to simulate in ground-based radiobiology experiments.

The Use of Whole Blood Transfusion During Non-Traumatic Resuscitation.

Background: Evidence from military populations showed that resuscitation using whole blood (WB), as opposed to component therapies, may provide additional survival benefits to traumatically injured patients. However, there is a paucity of data available for the use of WB in uninjured patients requiring transfusion. We sought to describe the use of WB in non-trauma patients at Brooke Army Medical Center (BAMC).

Crucial considerations: Sex differences in the epidemiology, diagnosis, treatment, and outcomes of acute pulmonary embolism in non-pregnant adult patients.

Acute pulmonary embolism (PE) affects over 600,000 Americans per year and is a common diagnostic consideration among emergency department patients. Although there are well-documented differences in the diagnosis, treatment, and outcomes of cardiovascular conditions, such as ischemic heart disease and stroke, the influence of sex and gender on PE remains poorly understood. The overall age-adjusted incidence of PE is similar in women and men, but women have higher relative rates of PE during early and mid-adulthood (ages 20-40 years); whereas, men have higher rates of PE after age 60 years.

Evaluation of Serial Chest Radiographs of High-Altitude Pulmonary Edema Requiring Medical Evacuation from South Pole Station, Antarctica: From Diagnosis to Recovery.

Introduction: Chest radiography is a diagnostic tool commonly used by medical providers to assess high-altitude pulmonary edema (HAPE). Although HAPE often causes a pattern of pulmonary edema with right lower lung predominance, previous research has shown that there is no single radiographic finding associated with the condition. The majority of research involves a retrospective analysis of chest radiographs taken at the time of HAPE diagnosis.

The Toxicity, Pathophysiology, and Treatment of Acute Hydrazine Propellant Exposure: A Systematic Review.

Introduction: Hydrazines are highly toxic inorganic liquids that are used as propellants in military and aviation industries, such as the U.S. Air Force F-16 Emergency Power Unit and SpaceX SuperDraco Rockets.

The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for non-traumatic cardiac arrest: A review.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been proposed as a novel approach to managing non-traumatic cardiac arrest (NTCA). During cardiac arrest, cardiac output ceases and perfusion of vital organs is compromised. Traditional advanced cardiac life support (ACLS) measures and cardiopulmonary resuscitation are often unable to achieve return of spontaneous circulation (ROSC).

Effects of Continuous Albuterol Inhalation on Serum Metabolome in Healthy Subjects: More Than Just Lactic Acid.

Treatment with β2-agonists may cause elevated lactic acid, the end product of anaerobic metabolism of glucose. It has been proposed that lactic acidosis associated with β2-agonists is caused by changes to direct biochemical impacts on glycolysis, gluconeogenesis, pyruvate metabolism, and free fatty acid production. However, much remains unknown, and there is a paucity of evidence regarding the underlying chemical changes associated with this lactic acidosis.

Zone 3 REBOA does not provide hemodynamic benefits during nontraumatic cardiac arrest.

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be a novel intervention to improve cardiopulmonary resuscitation (CPR) quality during cardiac arrest. Zone 1 supraceliac aortic occlusion improves coronary and cerebral blood flow. It is unknown if Zone 3 occlusion distal to the renal arteries offers a similar physiologic benefit while maintaining blood flow to organs above the point of occlusion.

Push-Dose Vasopressin for Hypotension in Septic Shock.

Background: Peri-intubation cardiac arrest and hypotension in patients with septic shock occur often in the emergency department (ED) and ultimately lead to worse clinical outcomes. In recent years, the use of push-dose, or bolus-dose, vasopressors in the ED have become common practice for transient hypotension and bridging to continuous infusion vasopressors. Push-dose epinephrine and phenylephrine are the agents used most frequently in this scenario.

Challenges in Clinical Management of Radiation-Induced Illnesses During Exploration Spaceflight.

Analysis of historical solar particle events (SPEs) provides context for some understanding of acute radiation exposure risk to astronauts who will travel outside of low-Earth orbit. Predicted levels of radiation exposures to exploration crewmembers could produce some health impacts, including nausea, emesis, and fatigue, though more severe clinical manifestations are unlikely. Using current models of anticipated physiological sequelae, we evaluated the clinical challenges of managing radiation-related clinical concerns during exploration spaceflight.

Resuscitation and Evacuation from Low Earth Orbit: A Systematic Review.

Introduction: Provision of critical care and resuscitation was not practical during early missions into space. Given likely advancements in commercial spaceflight and increased human presence in low Earth orbit (LEO) in the coming decades, development of these capabilities should be considered as the likelihood of emergent medical evacuation increases.

Methods: PubMed, Web of Science, Google Scholar, National Aeronautics and Space Administration (NASA) Technical Server, and Defense Technical Information Center were searched from inception to December 2018.

A Preliminary Study of U.S. Air Force Pilot Perceptions of the Pilot-Flight Surgeon Relationship.

Introduction: Flight surgeons play a vital role in U.S. Air Force aviation operations by ensuring that pilots are medically prepared to meet the demands of military aviation.