Arterial Blood Gas and Rotational Thromboelastometry Parameters in Healthy Rescuers Incidentally Exposed to Nitroglycerin, Nitrogen Compounds, and Combustion Products

Abstract

Introduction-Acute exposure to nitrogen compounds combined with a massive inhalation of air pollutants can influence respiratory and cardiovascular symptoms and coagulation abnormalities in accidentally exposed healthy adults during cave detonation operations.Methods-Italian alpine and cave rescuers widened a cave in the Abisso Luca Kralj in Trieste, Italy. Volunteers inside the cave were accidentally exposed to the fumes from an uncontrolled detonation of blasting gelatin microcharges. We performed a retrospective cohort study on the clinical data, arterial blood gas analysis, and rotational thromboelastometry parameters from the rescuers involved in the accident.Results-Ninety-three healthy rescuers were involved in the uncontrolled detonation: 47 volunteers handled a mixture of nitrogen compounds (blaster group), and 46 volunteers did not (nonblaster group). After the accident, statistically significant differences (P<0.05) in arterial blood gas values were observed between the groups, with a pattern of mild respiratory acidosis with hypercapnia in the nonblaster group and severe mixed acid-base disorder with hypoxia and hypercapnia in the blaster group. Mild hyperfibrinolysis was observed in 44 volunteers in the blaster group, as were associated bleeding symptoms in 34 volunteers; no significant coagulation modifications were recorded in the nonblaster group.Conclusions-Respiratory acidosis with hypoxia, hypercapnia, a compensatory metabolic response, and mild hyperfibrinolysis were probably related to the combined effect of nitrogen compounds and the inhaled toxic products of detonation. Therefore, each element exerts a determinant effect on promoting the biological toxicity of the others.

Emergency Cricothyrotomy in a Harsh Environment: A Case Report of Complete Airway Obstruction Following a Lightning Strike

“…The resulting barotrauma may lead to rupture of the mucosa, and hyperacute inflammatory responses with reactive hyperemia of the subepithelial capillary network of the epiglottis. 10 We speculate that the oropharyngeal and hypopharyngeal mucosa directly exposed to the current of the lightning strike rapidly developed a hyperinflammatory response with mucosal architecture disruption, submucosal tissue swelling, and necrosis, as was observed during the orotracheal intubation attempts.…”

“…It is also possible that a single stroke of lightning can quickly heat the air around it to 30,000 °C, explosively and rapidly expanding gases. 10 The gas expansion creates a “microdetonation” with a shock wave in the upper airways. The resulting barotrauma may lead to rupture of the mucosa, and hyperacute inflammatory responses with reactive hyperemia of the subepithelial capillary network of the epiglottis.…”

“…The resulting barotrauma may lead to rupture of the mucosa, and hyperacute inflammatory responses with reactive hyperemia of the subepithelial capillary network of the epiglottis. 10 …”