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Helmet removal techniques in the absence of C-spine injuries have been developed and promulgated. Utilizing a cadaver model, these techniques were demonstrated to adversely affect pre-existing C-spine injury. Removal of helmets with cast cutters is recommended.
To better understand motion in the cervical spine related to helmet wearing and removal, normal volunteers underwent videotaped fluoroscopy during helmet removal and lateral spine X-rays in various positions. There was a tendency towards increased flexion in the supine position in the helmeted volunteers which disappeared with minimal traction. In forced hyperextension, the posterior lip of the helmet did not guillotine the cervical spine. There was no significant difference in cervical spine motion between a one-person and two-person technique of helmet removal, and in both techniques, a minimum amount of flexion occurred in clearing the occiput.
Bilateral first rib fractures can be caused by integral crash helmets in motorcyclists involved in an accident. Such an injury was sustained by two patients. A mechanical basis for such fractures is described.
Damage to a helmet worn by a motorcyclist or pedal cyclist involved in a crash can provide information of importance to those investigating impact responses of the helmeted head. In the past the retrieval of this information has been incomplete as it has involved the destructive dismantling of a helmet into its component layers. Conventional radiology, whilst being noninvasive, has the disadvantage that all structures traversed by the X-ray beam are superimposed in the final image. In an attempt to overcome the limitations of existing methods, computed tomography (CT) was evaluated in a study of 25 protective helmets. This was found to be an informative, noninvasive technique of investigation that provided faithful images of each helmet layer and delineated helmet damage that was not observed with other methods. Additional advantages of CT include the ease of computed data storage, the ability to reformat CT data into a variety of planes as either two- or three- dimensional images, and the facility to measure distance and density. Limiting factors include scanning cost and artefacts produced by metal in the helmet.
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Work performance with impervious clothing and full-face respirator was investigated during maximal and submaximal (40-60%) bicycle ergometer efforts. Such levels may be dictated by the requirements of emergency decontamination tasks while most studies have been concerned with lower levels of activity. Five different exercise protocols were administered. Heart rate (HR), oxygen consumption (Vo2), skin (Ts) and rectal (Tr) temperatures were monitored. The impervious suits resulted in decreased work performance, aerobic metabolism, and tolerance time. Stress indices of HR and mean Ts were found to be correlated with these differences. The study is being expanded for the purpose of establishing safe physiological guidelines for work tolerances at higher energy levels in impermeable suits.
PURPOSE: To describe the spectrum of ophthalmic injuries in children involved in all-terrain vehicle (ATV) crashes. METHODS: We retrospectively reviewed the medical records of a level 1 children's trauma center to identify cases with ICD-9 codes pertaining to crashes involving ATVs and cross-referenced for ophthalmic trauma. From these cases, we documented the nature of the crash, patient's age, ophthalmic injuries received, and length of hospitalization. RESULTS: Twenty children, 5 to 16 years of age (mean, 11.1 years), involved in ATV crashes were admitted between June 1997 and April 2002. One was riding with an adult and 3 with other children; 16 were operating the vehicles alone at the time of their crashes. None was wearing a helmet, and all had head trauma. Nine patients had ophthalmic injuries, including lacerations of the eyelid (n = 5), orbital fractures (n = 9), and traumatic optic neuropathies (n = 2). The latter two had final visual acuities of count fingers and no light perception. The average length of hospitalization was 6.6 days. CONCLUSIONS: Ophthalmic trauma is a frequent complication of ATV crashes involving children. Injuries may range from minor lacerations to complex orbital fractures; visual loss may be severe. We believe that the age of the vehicles' operators and their failure to wear protective helmets contribute to the severity of injuries.
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The simple T-piece is frequently used as a weaning system during respirator treatment. It is modified with an expiratory non-compliant reservoir (EnCR), an inspiratory compliant reservoir (ICR) and/or an expiratory one-way valve. The distribution of expiratory gases and rebreathing were studied in a model set-up in the corresponding systems at different fresh gas flows (FGF) and tidal volumes (VT). An EnCR produces no change, whereas an ICR causes the expiratory gas to flow into the inspiratory limb, an effect which is intensified by the presence of an expiratory valve. With a falling FGF and a rising VT, increasing amounts of expiratory gas are found in the inspiratory limb in the modifications with an ICR. However, this gives rise to rebreathing in the valve modification with a low FGF and high VT. The modification of the T-piece with an ICR but without a one-way valve is advantageous, as this system combines only slight dilution via the expiratory limb and a minimal risk of rebreathing.
The prevention of eye accidents is one part in the whole field of occupational safety which can be carried out in the most clear-cut manner. Solution patterns are easily mapped out and applied to use. Eye accidents occur mostly in the metal industry but are spreading through the whole field of industry from year to year. The principles of the prevention of eye accidents can be applied as an example for many other branches of occupational safety and thus models of functions created by the enterprise for sight protection can be projected to other prevention points.
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Military surgeons in a future conflict may face the problem of wounds contaminated with chemical warfare (CW) agents. No useful guidelines for this eventuality exist-nor any assessment of the specific CW risk to such casualties or to the surgical teams operating on them. The principal hazard to surgeons is direct contact with contaminated clothing in the wound. Practices are recommended to reduce this threat significantly. Thorough wound excision augmented by lavage with a specific proprietary hypochlorite solution will provide effective wound decontamination without producing unacceptable tissue damage. The vapour hazard at surgery is very low-respirators are unnecessary but goggles or glasses should be worn to prevent conjunctival splashes of potentially contaminated body fluids.
Men ran to a voluntary end point under the following conditions listed in increasing order to resistance, expressed as inspiratory/expiratory in mmH2O at a flow of 4 l-s-1: 1) bare-headed 0/0; 2) face mask 0/0; 3) face mask -6/14; 4) mouthpiece and valves -25/29; 5) face mask -96/62; and 6) face mask -148/60. Average endurance was 545, 490, 434, 392, 343, and 338 s, respectively. Despite the diverse features of the equipment in conditions 2-6, there seemed to be a rather smooth relation between resistance and endurance. There was no indication of a threshold below which endurance would be indifferent to resistance. The duration of the phases of the respiratory cycle was measured by means of a fine thermocouple in the airway. The variability in the duration of the expiratory phase at the end of the run seemed to weaken the concept that the attainment of a critically short expiratory time might be related to the subject's decision to halt running.
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As no other guide was found to illustrate and describe protective equipment and its fitting, we have prepared this treatise. Properly fitted protective equipment for football is a must to prevent injury from occurring. Many injuries result from improperly fitted equipment. The helmet and shoulder pads are the most important pieces of equipment that require proper fit. Adequate face masks and jaw pads are essential to the helmet. Cantilever shoulder pads are necessary for most positions, with straps for those with subluxating or dislocating shoulders. Other pieces of equipment that need attention are cervical collars, hip pads, thigh pads, knee pads, pants, and shoes. Elbow, forearm, wrist, hand, and mouthpieces are essential to the player and care must be taken to see that they are compatible with proper fit. Special materials such as Ensolite, Hexcelite, RTV-11, Orthoplast, Lightcast, or Therm-O-Foam may be utilized to construct special pads. Today's modern football equipment provides adequate protection. It is imperative that all personnel involved in fitting equipment be knowledgeable about the subject.
A total of 16 men (4 professional football players, 5 high school athletes, and 7 hospital personnel) was studied by cineradiography to evaluate the possible roles of the posterior rim of the football helmet in causing neck injuries. The men ranged from tall elongated neck individuals to short chunky neck individuals. Moving picture (16-mm) films were produced from a series of lateral view cineradiograms that were taken to document the path and position of the posterior rim of the helmet relative to the spinal column as the subject moved his head from the fully flexed to the fully extended positions under several loading conditions. Five different helmets, all from different companies, were used in the studies. No contact existed at any time between the posterior rim of any of the five helmets worn and the fourth cervical vertebral spinous process; in fact, it did not come close to the spinous process of vertebrae C1 through C6. The notion of the posterior rim of the helmet being capable of striking the cervical spine about the C4 to C5 level is without foundation.