Historically, the Australian Defence Force (ADF) has sourced all its blood supplies from the Australian Red Cross Blood Service. Recent ADF operations in the Middle East have highlighted a need to rely on other nations’ blood supply systems. In 2008, the ADF embedded a surgical and intensive care team into the Netherlands‐led forward health facility at the Uruzgan Medical Centre at Tarin Kowt in Afghanistan. To date, three teams have provided 2‐month rotations as part of the North Atlantic Treaty Organization International Security Assistance Force in Afghanistan. The Netherlands armed forces use a sophisticated system for supply of liquid and frozen blood products (frozen red cells, plasma and platelets). We review Australian experience with the Dutch system of supplying blood products for major trauma resuscitation in Afghanistan.
A prospective double-blind study compared the analgesic effectiveness of peribulbar lignocaine with peribulbar morphine and lignocaine for postoperative analgesia in pterygium surgery. Twenty patients were randomly divided to receive a peribulbar injection preoperatively of either 1% lignocaine 2 ml or 1% lignocaine 1.6 ml and 4 mg morphine. Effects on pain at injection and pain at 24 hours and 48 hours postoperatively were measured with a visual analog pain scale. Effects of the injections on sedation, pupil size and unwanted side-effects were also recorded. The groups were comparable for age, weight and surgical technique. There was a significantly lower pain score at 24 hours after operation in the morphine group (P=0.035). There were no significant differences in sedation or side-effects between the groups. The physiological effects of morphine on the eye are reviewed. The study suggests that orbital morphine may be an effective and safe form of analgesia for corneal surgery and further investigation is warranted.
A mobile intensive care module has been developed for aeromedical transport of the critical care patient. It incorporates monitoring, ventilator, oxygen and suction, and infusion pumps. The device clips to a lightweight stretcher, over the patient at hip to knee level. This system is compatible with nearly all patient transport vehicles and allows monitors to be run from vehicle power. An assessment of the system after more than 500 transports is that it represents a significant advance over systems used previously. The advantages and disadvantages of the system compared with unmounted or vehicle-mounted equipment are discussed.
Nonrebreathing valves have become widely used in conjunction with self-inflating bags and portable ventilators. The ease of use of these devices compared with Mapleson systems and more complex ventilators has led to their use by a wide range of medical, nursing and paramedical staff. There may be an erroneous tendency to regard these systems as foolproof. Four different critical events arising from IPPV with three different models of nonrebreathing valves are described. Casel A 67-year-old male who had remained unconscious since a cerebrovascular accident two weeks before, was discovered in cardiorespiratory arrest. Cardiopulmonary resuscitation was commenced. Ventilation was with an Ambu Mk I resuscitation bag with Ruben nonrebreathing valve, initially by mask, then endotracheal tube. His pupils remained fixed and dilated despite CPR. ECG showed slow idioventricular rhythm refractory to adrenaline. At this point, additional staff arrived and reassessment revealed inadequate ventilation. Investigations disclosed that the Ambu resuscitator was misassembled. The bag was attached to the patient connection and vice versa. Each delivered breath thereby passed out the expiratory port (Figure I). The system was immediately reassembled correctly, but the patient's heart rhythm and pupils remained unchanged and resuscitation was later discontinued.
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