Resp Care
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Office spirometers are now widely used to detect obstructive lung diseases. To test the technical characteristics of these devices, simulation of different forced expiratory maneuvers is performed, using computer generated waveforms. However, the tests with human subjects are also useful to detect technical flaws. The procedure used by some authors to test the accuracy of office spirometers is to compare measurements made by 2 spirometers connected in series. ⋯ Connecting the spirometers in series gives variable results, depending on the position of the spirometer in the assembly. Individual tests are therefore essential, as results are not interchangeable.
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Asthma and COPD are obstructive airway diseases related to chronic airway inflammation. However, it is known that in real practice the 2 diseases overlap. ⋯ We have identified and characterized an intermediate type between asthma and COPD in clinical characteristics. Further investigations are required to determine whether these 3 conditions are part of the chronic obstructive airway diseases spectrum or are rather distinct clinical entities.
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The conflicts in Iraq and Afghanistan have seen the advancement of combat medicine. The nature of the conflicts, with troops located in remote areas and faced with explosive ordinance designed to focus massive injuries on dismounted personnel, have forced military medical personnel to adapt accordingly. There has been a rekindling of interest in the use of tourniquets to stop exsanguination from extremity wounds, as well as in the transfusion of fresh whole blood from walking blood banks. ⋯ The field of combat medicine has taken several concepts initially designed in civilian settings, such as temporary abdominal packing and vascular shunting, and adapted them to the military setting to provide state of the art trauma management to our troops in combat. In turn, developments in the resuscitation of the trauma patient, using increased blood and plasma products and less crystalloid, have been pioneered in conflict and transitioned to the civilian sector. Advancements made during the wars in Iraq and Afghanistan, as well as those still being developed, will shape the care of the injured patient, in both civilian and military settings, for the foreseeable future.