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Health, safety, security, and the environment
Published in Andrew Livesey, Motorcycle Engineering, 2021
Switch off any power source.Do not move the person if injury to the back or neck is suspected.In the case of electric shock, turn off the electricity supply.In the case of a gas leak, turn off the gas supply.Do not give the person any drink or food, especially alcohol, in case surgery is needed.Keep the person warm with a blanket or coat.If a wound is bleeding heavily, apply pressure to the wound with a clean bandage to reduce the loss of blood.If a limb has been trapped, use a safe jack to free the limb.
Health, safety, security and the environment
Published in Andrew Livesey, Bicycle Engineering and Technology, 2020
You are not expected to be a first aid expert, nor are you advised to attempt to give first aid unless you are properly qualified. However, as a professional in the bicycle industry you should be able to preserve the scene, that is, prevent further injury and make the injured person comfortable. The following points are suggested as ones worth remembering:Switch off any power source.Do not move the person if an injury to the back or neck is suspected.In the case of electric shock turn off the electricity supply.In the case of a gas leak, turn off the gas supply.Do not give the person any drink or food, especially alcohol, in case surgery is needed.Keep the person warm with a blanket or coat.If a wound is bleeding heavily, apply pressure to the wound with a clean bandage to reduce the loss of blood.If a limb has been trapped, use a safe jack to free the limb.
Platelet dynamics in blood flow
Published in Annie Viallat, Manouk Abkarian, Dynamics of Blood Cell Suspensions in Microflows, 2019
Jawaad Sheriff, Danny Bluestein
Non-physiological shear stresses and short exposure times found in cardiovascular devices, such as VADs, may also induce platelets to shed their αIIbβ3, GPIbα, and GPVI receptors, leading to platelet dysfunction and bleeding complications [22–24]. At sufficiently high enough shear rates (10500 s−1, 315 dyne/cm2), procoagulant microparticles are formed and released from the platelet surface by an exocytotic budding process [88].
Management of out-of hospital cardiac arrest patients with extracorporeal cardiopulmonary resuscitation in 2021
Published in Expert Review of Medical Devices, 2021
Christopher Gaisendrees, Matias Vollmer, Sebastian G Walter, Ilija Djordjevic, Kaveh Eghbalzadeh, Süreyya Kaya, Ahmed Elderia, Borko Ivanov, Stephen Gerfer, Elmar Kuhn, Anton Sabashnikov, Heike a Kahlert, Antje C Deppe, Axel Kröner, Navid Mader, Thorsten Wahlers
Although VA-ECMO circuits have massively improved in terms of anticoagulatory means, the need for systemic anticoagulation, due to the large area of artificial surfaces, remains.The management of (anti)-coagulation in patients on VA-ECMO following OHCA can be challenging. Patients after refractory cardiac arrest often enter sepsis or sepsis-like states and may develop relevant coagulopathy, while possibly suffering from multiple injuries with a significant risk of potentially fatal bleeding. Bleeding is one of the most frequent complications associated with in-hospital mortality in these patients [56]. On the other hand, some form of anticoagulation therapy must be used to prevent the VA-ECMO circuit from clotting. Recent ELSO – guidelines recommend a bolus injection of 50 - 100 IE/kg unfractionated heparin followed by continuous infusion of 20 – 50 IE/kg/h to achieve a therapeutic effect measured as an activated clotting time (ACT) of 180 – 220 s [57].In recent years, anti-factor-Xa tests were evaluated as a replacement [58,59]. Anti Xa assays show promising results in anticoagulation strategies but need further clinical testing. Also, there are various factor-Xa testing assays, thus leading to a lack of standardization.Other test methods of adequate anticoagulation include aPTT testing. A general aPTT of 1.5-2.5 of the normal range is suggested in VA-ECMO therapy. In most centers, aPTT levels are measured through the laboratory and are not point of care measurements; they lack practicability to assess fast results and thus immediate response.Beside factor Xa-testing, there is limited evidence on the use of thromboelastography (TEG) in VA-ECMO patients. Some pilot-studies revealed promising results. Its use was associated with lower heparin doses compared to an aPTT-based protocol [60,61]. Nevertheless, extensive randomized studies are lacking, especially in the case of eCPR patients. Therefore TEG-mediated anticoagulation regimes remain promising, but until now, we do not advocate its use, based on the lack of data.We recommend using a body-weight adjusted dose of unfractionated heparin before cannulation on the lower limit of ELSO – recommendations (50 IE/kg), followed by regularly repeated ACT measurements before starting continuous heparin infusion to achieve an ACT of 180s, depending on the used ACT-device. Potential causes of bleeding must be taken into account, and ACT targets have to be adjusted accordingly.