HighlightsTension pneumopericardium is a cause of shock in thoracic trauma.It should be regarded in hemodynamically unstable patients with blunt chest trauma.Immediate pericardium decompression may save the patient’s life.

Background: Intra-abdominal hypertension (IAH) is relatively frequent in critical patients. According to the most recent consensus of the World Society of Abdominal Compartment Society (WSACS), there are no predictive factors for IAH diagnosis. Risk factors are the only motivators to date for early IAH diagnosis. Abdominal compartment syndrome (ACS) is defined as sustained intra-abdominal pressure (IAP) maintained above 20 mm Hg (> 3 kPa), with or without abdominal perfusion pressure below 60 mm Hg (< 8 kPa), associated with a new organ dysfunction. Sepsis is a recognized cause of secondary ACS, but to date there is no correlation with admission SOFA (sequential organ failure assessment) score and ACS onset incidence. The objective of the present study is to determine the profile of extra-abdominal septic shock patients with IAH/ACS admitted to the intensive care unit (ICU) and correlating with admission SOFA score. Better understanding of this population may bring to light clinical predictive factors for IAH/ACS early diagnosis.Methods: In this observational study IAH/ACS incidence was correlated with SOFA score calculated at ICU admission. The study enrolled all critically ill patients more than 18 years old admitted to the Medical Intensive Care Unit (MICU) of a university teaching hospital between April and October 2016, who had been diagnosed with extraabdominal septic shock, according to the Surviving Sepsis Campaign and SEPSIS-3.Results: Twenty-five patients were evaluated during 10 hospitalization days. The average age was 51.13 ± 16.52 years, and 64% of the patients were male. Most patients (76%) had pneumonia. On admission, the SOFA score was 6.54 ± 2.71. Mortality rate in the population studied was 52%. The incidence of IAH was 43.5%, while the incidence of ACS in the IAH population was 28%. SOFA admission score in patients with the diagnosis of ACS was of 8.42 ± 1.27. In this study SOFA score higher than 7 is correlated with IAH, with an accuracy of 68.8% (P < 0.03). Conclusions:The incidence of ACS in patients with extra-abdominal septic shock admitted to a university teaching hospital MICU was higher than those found in the literature. Higher admission and consecutive SOFA score of more than 7 was associated with higher ACS incidence and higher mortality rate.

The Public-Private-Partnership between ESA and Airbus Defense and Space (Germany) has created the European Data Relay System (EDRS), which is operational since 2016. The joint teams are running the Phase B of the globalisation of the European Data Relay System (EDRS) with an addition to the programme called EDRS Global (former GlobeNet). EDRS Global is planning to increase the capacity of EDRS by adding a geostationary data relay payload, called EDRS-D, over the Asia-Pacific regionin cooperation with Airbus DS partner JSAT (Japan). The heart of the system will be multiple laser terminals, based on TESATs upgraded design, featuring also a dual wavelength capability (1064 nm and 1550 nm) to serve more customers at the same time. The 1550 nm capabilities will be implemented in a cooperation between Airbus and TESAT (Germany), and NEC (Japan). The evolution of the service will also aim for security sensitive user missions, including RPAS missions. The Laser Communication Technology on-board EDRS-D will be the starting point for the world's first global laser based network in space, providing Global Secure Quasi-Real-Time-Services at Gigabit per second speed back to Europe by connecting its EDRS GEO nodes (EDRS-A/-C and EDRS-D) over 80,000 km distance by the means of optical communication. The paper will provide details of the project and information about the latest status.

The use of corticosteroid for the prophylaxis of fat embolism syndrome in patients with long bone fracture TBE-CITE TBE-CITE TBE-CITE TBE-CITE TBE-CITEThe use of corticosteroid for the prophylaxis of fat embolism The use of corticosteroid for the prophylaxis of fat embolism The use of corticosteroid for the prophylaxis of fat embolism The use of corticosteroid for the prophylaxis of fat embolism The use of corticosteroid for the prophylaxis of fat embolism syndrome in patients with long bone fracture syndrome in patients with long bone fracture syndrome in patients with long bone fracture syndrome in patients with long bone fracture syndrome in patients with long bone fracture Uso de corticoide na profilaxia para síndrome de embolia gordurosa em Uso de corticoide na profilaxia para síndrome de embolia gordurosa em Uso de corticoide na profilaxia para síndrome de embolia gordurosa em Uso de corticoide na profilaxia para síndrome de embolia gordurosa em Uso de corticoide na profilaxia para síndrome de embolia gordurosa em pacientes pacientes pacientes pacientes pacientes com fratura de osso longo com fratura de osso longo com fratura de osso longo com fratura de osso longo com fratura de osso longo The "Evidence-based Telemedicine -Trauma & Acute Care Surgery" (EBT-TACS) Journal Club conducted a critical review of the literature and selected three recent studies on the use of corticosteroids for the prophylaxis of fat embolism syndrome (FES). The review focused on the potential role of corticosteroids administration to patients admitted to the intensive care unit (ICU) at risk of developing post-traumatic fat embolism. The first study was prospective and aimed at identifying reliable predictors, which could be detected early and were associated with the onset of fat embolism syndrome in trauma patients. The second manuscript was a literature review on the role of corticosteroids as a prophylactic measure for FES. The last manuscript was a meta-analysis on the potential for corticosteroids to prophylactically reduce the risk of fat embolism syndrome in patients with long bone fractures. The main conclusions and recommendations reached were that traumatized patients should be monitored with non-invasive pulse oximetry and lactate levels since these commonly-available tests may predict the development of FES, and the lack of evidence to recommend the use of steroids for the prophylaxis of this syndrome.

Selective non-operative management of hepatic injuries from blunt trauma has become an accepted practice over the past 20 years [1]. The advent of abdominal computed tomography (CT) scanning following blunt abdominal trauma has facilitated the selective nonsurgical management of liver and other intra-abdominal solid organ injuries in stable patients [1,2]. The conservative non-operative approach requires close monitoring in an intensive care unit (ICU) setting with fluid resuscitation and correction of any underlying hypovolemia or coagulopathy. There are only few case reports of isolated hepatic trauma in patients with haemophilia [3][4][5].Trauma patients who are haemodynamically stable and who have no indications for laparotomy are ideal candidates for evaluation by emergency abdominal CT. In this select group, criteria for nonoperative management include (i) simple hepatic parenchymal laceration of intrahepatic haematoma, (ii) absence of active haemorrhage, (iii) haemoperitoneum of less than 500 mL, (iv) limited need for liverrelated blood transfusions, (v) absence of diffuse peritoneal signs in patients not neurologically impaired, and (vi) absence of other peritoneal injuries that would otherwise require an operation [1,2]. In fact, the main indication of the operative approach to the blunt liver injury is haemodynamic instability, not the grading of the injury.Here, we describe the successful non-surgical management of an isolated blunt liver trauma patient with severe haemophilia A. The objective of this report is to present a severe haemophilia A patient with a complex blunt hepatic trauma treated non-operatively to reinforce that this approach is possible in selected situations under established protocol.A 21-year-old carpenter with severe haemophilia A, without history of inhibitors, and treated in on-demand manner, sustained direct blunt trauma to the right upper abdominal quadrant (RUQ) while working up to split a big longitudinal piece of wood into two parts using a circular saw. One of the parts escaped from the saw guide wire and was launched 65 feet away tangentially hitting the carpenter on its initial trajectory. The accident happened in a rural zone located 1.24 mile distant from the referenced regional trauma centre. At the impact moment, the patient felt excruciating abdominal pain and sudden dyspnoea, followed by weakness feeling and dark vision. A haematoma and important swelling appeared to the whole injury topography. The patient immediately received at home the administration of a single dose of 2 000 IU of plasma-derived factor VIII (pdFVIII) concentrate (30 IU kg )1 ), and was referred to the closest emergency hospital. Approximately 40 min after the injury, the patient was admitted to the local rural hospital. The patient arrived conscious, but his physical examination revealed tachypnea, tachycardia, with heart rate of 96 bpm, local pain, pallor and blood pressure of 80/40 mmHg. There was no active external bleeding manifestation. The abdominal examination revealed normal bowel soun...