It is assumed that tactical medicine encompasses all therapeutic activities performed by a military medical service during military and humanitarian missions. Its scope is only apparently limited by the standards which, when referred to the NATO member countries, have been collected in the Joint Theater Trauma System – Clinical Practice Guidelines. The stage-structured character of medical assistance and treatment of the wounded, injured and sick patients assumes that the scope of therapeutic activities performed at each stage is limited only to essential actions. Consequently, more injured patients may be saved – those for whom life-saving activities are performed prior to their transfer to a higher level. The second level is represented by a field hospital. Its first structure is the trauma room in which a rescue team saves and qualifies the injured for further medical activities. Each injured patient undergoes an eFAST ultrasound examination which allows for a quick decision about a surgical treatment to be provided. Moreover, this technique is helpful in vascular cannulation. The authors present their own experiences with using an ultrasound examination during the work in the Field Hospital of the Polish Military Contingent in Afghanistan.
PL
Za medycynę taktyczną przyjęto uznawać wszelkie czynności terapeutyczne wykonywane przez wojskową służbę zdrowia w czasie prowadzenia operacji militarnych i humanitarnych. Jej zakres jest tylko pozornie ograniczony przez standardy, które w odniesieniu do państw NATO zostały zgromadzone w Joint Theater Trauma System – Clinical Practice Guidelines. Etapowy charakter niesienia pomocy rannym, poszkodowanym i chorym oraz leczenia ich zakłada, że zakres terapii na każdym poziomie ogranicza się do wykonania niezbędnych czynności. Dzięki temu możliwe jest uratowanie większej liczby poszkodowanych, u których wykonano czynności niezbędne dla przeżycia do momentu przetransportowania na następny poziom. Drugi poziom reprezentowany jest przez szpital polowy. Jego pierwszą strukturę stanowi trauma room, w którym zespół urazowy ratuje i kwalifikuje rannego do dalszych czynności medycznych. Każdy ranny ma wykonywane badanie ultrasonograficzne o charakterze eFAST, dzięki czemu bez zbędnej zwłoki podejmowana jest decyzja o operacji. Ponadto technika ta służy pomocy w kaniulacji naczyń. Autorzy przedstawili doświadczenia własne z wykorzystania badania USG w pracy Szpitala Polowego Polskiego Kontyngentu Wojskowego w Afganistanie.
This study aims to present a case of acute mercuric chloride poisoning at a potentially lethal dose treated with the antidote – 2,3-dimercapto- 1-propanesulfonic acid (DMPS) and continuous renal replacement therapy (CRRT) combined with CytoSorb. A 21-year-old woman was admitted to a hospital with abdominal pain, vomiting, and suspected gastrointestinal bleeding after taking 5000 mg of mercuric chloride for suicidal purposes. Due to the patient deteriorating general condition and multiple organ damage, on the third day she was transported to the Clinic of Anaesthesiology and Intensive Care (CAaIC), Łódź, Poland. Laboratory tests confirmed features of acute kidney injury and high mercury levels in the blood (1051 μg/l) and urine (22 960 μg/l) – DMPS therapy and CRRT combined with CytoSorb were instituted. Due to nervous system complaints (headache, dizziness), a lumbosacral puncture was performed – the mercury concentration in the cerebrospinal fluid (CSF) was 5.45 μg/l. During a colonoscopy, significant diagnostic abnormalities revealed features of colonic mucosal necrosis. The treatment resulted in a decrease in subjective complaints, decreased mercury levels in biological material, and improved parenchymal organ function. On the 15th day of therapy, the patient was transferred to the primary care center for further treatment. The case confirms the possibility of improvement of patient condition following ingestion of a potentially lethal dose (5 g) as a result of the initiation of appropriate therapy even on the third day. The presence of mercury in CSF confirms that inorganic mercury compounds (mercuric chloride) can pass through the blood-brain barrier after oral ingestion.
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