Browsing by Subject "Shock"
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Item Embargo Injury Risks in Behind Armor Blunt Trauma(2024) Op 't Eynde, JoostBody armor protects law enforcement and military personnel from gunshot wounds to the thorax. However, even when a round is stopped, armor can deform into the thorax at high rate and produce injuries. To evaluate armor protection against this behind armor blunt trauma (BABT), an outdated standard developed in the 1970s is currently used. The applicability of the standard to modern design and its biofidelity are questionable. There is a need for biofidelic models and accurate injury criteria for BABT.
To support numerical modeling of high rate insults, material property characterizations are essential. Pure shear tests at high rate and high shear strain were performed on porcine dorsal skin, ventral skin, liver, and lung tissue post-mortem. Synthetic gelatin was subjected to the same shear tests, to evaluate its validity as a tissue surrogate. Instantaneous elastic shear properties of the tissues were determined, and their stress relaxation over short and long timescales. Dorsal skin tissue was found to have the highest shear stiffness, followed by ventral skin, liver, and lung. Synthetic 10-20% gelatin approximates the instantaneous elastic shear properties of porcine dorsal skin but does not show the same viscoelastic relaxation behavior. Synthetic 10% gelatin behaved similarly to 20% gelatin in stress relaxation, but with significantly reduced shear stiffness. Shear moduli of biological tissues increase with increased shear strain, suggesting a non-linear model is appropriate for computational purposes.
To recreate BABT in an experimental setting, a 3D-printed acrylic indenter was developed. This indenter replicates the backface deformation of the body armor into the chest, matching velocity and aerial density of hard body armor. The performance of the indenter was evaluated using the current clay testing standard (n = 52). The obtained deformations in clay match those from previous hard armor experiments. The limitations of using clay as a surrogate for behind armor blunt trauma are discussed in relation to the indenter performance: clay is inconsistent and produces and unpredictable elastic rebound obfuscating the final deformation measurement used in the standard. Equivalent exposures comparing indenter velocity to rifle round velocity are used to translate indenter impacts to in-field scenarios.
Indenter BABT impacts (n = 117) were performed on porcine (n = 16) and human (n = 18) cadavers to establish injury scaling from pig to human. Impactor dynamics were determined using an onboard accelerometer and high-speed video, and rib fractures were assessed using post-test micro-CT imaging and necropsy. Regional injury risk curves were developed for different impact locations on the human cadaver (n = 6) thorax and different injury severity levels, indicating the risk might not be uniform. The injury threshold for anterior ribcage injuries is lower than for the posterior ribcage. The kinetic energy of the impact was scaled according to body mass based on equal velocity scaling, widely used in injury biomechanics. Confidence intervals of injury risk curves substantially overlap for the human and swine cadavers, suggesting that this scaling is appropriate for transferring risk across these species. Residual energy differences of 20 to 30% for similar injury risk between the human and swine cadavers suggest an additional bone quality scaling is desirable since the swine cadavers are generally at an earlier developmental age than available human cadavers. The structural scaling relationships between the human and swine cadavers are valuable in interpreting injury results from live animal BABT tests.
In vivo swine (n = 18) were subjected to BABT impacts to the ribcage. Chest wall and lung injuries were assessed using necropsy and histology, and injury risk curves were developed for different severity injuries based on the kinetic energy of the impact. The resulting injury risks are compared to those obtained for human cadavers. Chest wall injury risk corresponds closely with lung injury risk severity. Injury risks for lateral ribcage impacts in the live swine are close to posterior ribcage impact injury risks in the human cadaver, but injury risks are lower than for frontal impacts in human cadavers. Acoustic emissions of rib fractures were non-invasively detected during BABT impact with the use of hydrophones. Obtained injury risks and fracture detection may guide future armor design and injury monitoring.
A novel modality of lung injury was observed in the live swine impacts. Advancement of the chest wall into the lung tissue at high velocity produces a local compressive shock that can damage alveolar walls and cause bleeding within the lung tissue. A theoretical basis for shock development, experimental shock pressure measurements, and characteristic injuries are presented.
Item Open Access Ischemic limb necrosis in septic shock: What is the role of high-dose vasopressor therapy?(Journal of thrombosis and haemostasis : JTH, 2019-11) Levy, Jerrold H; Ghadimi, Kamrouz; Faraoni, David; van Diepen, Sean; Levy, Bruno; Hotchkiss, Richard; Connors, Jean M; Iba, Toshiaki; Warkentin, Theodore EItem Open Access Methods of creatine kinase-MB analysis to predict mortality in patients with myocardial infarction treated with reperfusion therapy.(Trials, 2013-05-02) Lopes, Renato D; Lokhnygina, Yuliya; Hasselblad, Victor; Newby, Kristin L; Yow, Eric; Granger, Christopher B; Armstrong, Paul W; Hochman, Judith S; Mills, James S; Ruzyllo, Witold; Mahaffey, Kenneth WBACKGROUND: Larger infarct size measured by creatine kinase (CK)-MB release is associated with higher mortality and has been used as an important surrogate endpoint in the evaluation of new treatments for ST-segment elevation myocardial infarction (STEMI). Traditional approaches to quantify infarct size include the observed CK-MB peak and calculated CK-MB area under the curve (AUC). We evaluated alternative approaches to quantifying infarct size using CK-MB values, and the relationship between infarct size and clinical outcomes. METHODS: Of 1,850 STEMI patients treated with reperfusion therapy in the COMplement inhibition in Myocardial infarction treated with Angioplasty (COMMA) (percutaneous coronary intervention (PCI)-treated) and the COMPlement inhibition in myocardial infarction treated with thromboLYtics (COMPLY) (fibrinolytic-treated) trials, 1,718 (92.9%) (COMMA, n = 868; COMPLY, n = 850) had at least five of nine protocol-required CK-MB measures. In addition to traditional methods, curve-fitting techniques were used to determine CK-MB AUC and estimated peak CK-MB. Cox proportional hazards modeling assessed the univariable associations between infarct size and mortality, and the composite of death, heart failure, shock and stroke at 90 days. RESULTS: In COMPLY, CK-MB measures by all methods were significantly associated with higher mortality (hazard ratio range per 1,000 units increase: 1.09 to 1.13; hazard ratio range per 1 standard deviation increase: 1.41 to 1.62; P <0.01 for all analyses). In COMMA, the associations were similar but did not reach statistical significance. For the composite outcome of 90-day death, heart failure, shock and stroke, the associations with all CK-MB measures were statistically significant in both the COMMA and COMPLY trials. CONCLUSIONS: Sophisticated curve modeling is an alternative to infarct-size quantification in STEMI patients, but it provides information similar to that of more traditional methods. Future studies will determine whether the same conclusion applies in circumstances other than STEMI, or to studies with different frequencies and patterns of CK-MB data collection.Item Open Access Physical Insights, Steady Aerodynamic Effects, and a Design Tool for Low-Pressure Turbine Flutter(2016) Waite, Joshua JosephThe successful, efficient, and safe turbine design requires a thorough understanding of the underlying physical phenomena. This research investigates the physical understanding and parameters highly correlated to flutter, an aeroelastic instability prevalent among low pressure turbine (LPT) blades in both aircraft engines and power turbines. The modern way of determining whether a certain cascade of LPT blades is susceptible to flutter is through time-expensive computational fluid dynamics (CFD) codes. These codes converge to solution satisfying the Eulerian conservation equations subject to the boundary conditions of a nodal domain consisting fluid and solid wall particles. Most detailed CFD codes are accompanied by cryptic turbulence models, meticulous grid constructions, and elegant boundary condition enforcements all with one goal in mind: determine the sign (and therefore stability) of the aerodynamic damping. The main question being asked by the aeroelastician, ``is it positive or negative?'' This type of thought-process eventually gives rise to a black-box effect, leaving physical understanding behind. Therefore, the first part of this research aims to understand and reveal the physics behind LPT flutter in addition to several related topics including acoustic resonance effects. A percentage of this initial numerical investigation is completed using an influence coefficient approach to study the variation the work-per-cycle contributions of neighboring cascade blades to a reference airfoil. The second part of this research introduces new discoveries regarding the relationship between steady aerodynamic loading and negative aerodynamic damping. Using validated CFD codes as computational wind tunnels, a multitude of low-pressure turbine flutter parameters, such as reduced frequency, mode shape, and interblade phase angle, will be scrutinized across various airfoil geometries and steady operating conditions to reach new design guidelines regarding the influence of steady aerodynamic loading and LPT flutter. Many pressing topics influencing LPT flutter including shocks, their nonlinearity, and three-dimensionality are also addressed along the way. The work is concluded by introducing a useful preliminary design tool that can estimate within seconds the entire aerodynamic damping versus nodal diameter curve for a given three-dimensional cascade.
Item Open Access Seven unconfirmed ideas to improve future ICU practice.(Crit Care, 2017-12-28) Marini, John J; De Backer, Daniel; Ince, Can; Singer, Mervyn; Van Haren, Frank; Westphal, Martin; Wischmeyer, PaulWith imprecise definitions, inexact measurement tools, and flawed study execution, our clinical science often lags behind bedside experience and simply documents what appear to be the apparent faults or validity of ongoing practices. These impressions are later confirmed, modified, or overturned by the results of the next trial. On the other hand, insights that stem from the intuitions of experienced clinicians, scientists and educators-while often neglected-help place current thinking into proper perspective and occasionally point the way toward formulating novel hypotheses that direct future research. Both streams of information and opinion contribute to progress. In this paper we present a wide-ranging set of unproven 'out of the mainstream' ideas of our FCCM faculty, each with a defensible rationale and holding clear implications for altering bedside management. Each proposition was designed deliberately to be provocative so as to raise awareness, stimulate new thinking and initiate lively dialog.Item Open Access Shock Index Predicts Patient-Related Clinical Outcomes in Stroke.(Journal of the American Heart Association, 2018-09) Myint, Phyo Kyaw; Sheng, Shubin; Xian, Ying; Matsouaka, Roland A; Reeves, Mathew J; Saver, Jeffrey L; Bhatt, Deepak L; Fonarow, Gregg C; Schwamm, Lee H; Smith, Eric EBackground The prognostic value of shock index ( SI ), heart rate divided by systolic blood pressure, in stroke for clinical outcomes other than mortality is not well understood. Methods and Results We examined the Get With The Guidelines-Stroke ( GWTG -Stroke) data to explore the usefulness of SI in predicting in-hospital outcomes in 425 808 acute stroke cases (mean age: 71.0±14.5 years; 48.8% male; 89.7% ischemic stroke and 10.3% intracerebral hemorrhage) admitted between October 2012 and March 2015. Compared with patients with SI of 0.5 to 0.7, patients with SI >0.7 (13.6% of the sample) had worse outcomes, with adjusted odds ratios of 2.00 (95% confidence interval [ CI ], 1.92-2.08) for in-hospital mortality, 1.46 (95% CI , 1.43-1.49) for longer length of hospital stay >4 days, 1.50 (95% CI , 1.47-1.54) for discharge destination other than home, 1.41 (95% CI , 1.38-1.45) for inability to ambulate independently at discharge, and 1.52 (95% CI , 1.47-1.57) for modified Rankin Scale score of 3 to 6 at discharge. Results were similar when analyses were confined to those with available National Institutes of Health Stroke Scale (NIHSS) or within individual stroke subtypes or when SI was additionally included in the models with or without blood pressure components. Every 0.1 increase in SI >0.5 was associated with significantly worse outcomes in linear spline models. The addition of SI to existing GWTG -Stroke mortality prediction models without NIHSS demonstrated modest improvement, but little to no improvement was noted in models with NIHSS . Conclusions SI calculated at the point of care may be a useful prognostic indicator to identify those with high risk of poor outcomes in acute stroke, especially in hospitals with limited experience with NIHSS assessment.Item Open Access Temporal trends in the utilization of vasopressors in intensive care units: an epidemiologic study.(BMC pharmacology & toxicology, 2016-05) Thongprayoon, Charat; Cheungpasitporn, Wisit; Harrison, Andrew M; Carrera, Perliveh; Srivali, Narat; Kittamongkolchai, Wonngarm; Erdogan, Aysen; Kashani, Kianoush BBackground
The choice of vasopressor use in the intensive care unit (ICU) depends primarily on provider preference. This study aims to describe the rate of vasopressor utilization and the trends of each vasoactive agent usage in the ICU over the span of 7 years in a tertiary referral center.Methods
All adult ICU admissions, including medical, cardiac, and surgical ICUs from January 1st, 2007 through December 31st, 2013 were included in this study. Vasopressor use was defined as the continuous intravenous administration of epinephrine, norepinephrine, phenylephrine, dopamine, or vasopressin within a given ICU day. The vasopressor utilization index (VUI) was defined as the proportion of ICU days on each vasoactive agent divided by the total ICU days with vasopressor usage.Results
During the study period, 72,005 ICU admissions and 272,271 ICU days were screened. Vasopressors were used in 19,575 ICU admissions (27 %) and 59,811 ICU days (22 %). Vasopressin was used in 24,496 (41 %), epinephrine in 23,229 (39 %), norepinephrine in 20,648 (34 %), dopamine in 9449 (16 %), and phenylephrine in 7508 (13 %) ICU days. The VUInorepinephrine increased from 0.24 in 2007 to 0.46 in 2013 and VUIphenylephrine decreased from 0.20 in 2007 to 0.08 in 2013 (p < 0.001 both). For epinephrine, dopamine, and vasopressin VUI did not change over the course of study.Conclusion
Vasopressors were used in about one fourth of ICU admissions and about one-fifth of ICU days. Although vasopressin is the most commonly used vasopressor, the use of norepinephrine found to have an increasing trajectory.