"New Year's Eve, the first and second day of the Chinese New Year, three aortic dissection surgeries that came at random turned the Spring Festival holiday into a 'Labor Day'!" At 3 pm on the second day of the Chinese New Year, Li Haiyang, chief physician of the 5th ward of Cardiac Surgery Department of Beijing Anzhen Hospital, who had continuous emergency surgery, walked out of the operating room and breathed a sigh of relief. The average duration of the aortic dissection surgery of seven to eight hours made him feel a little tired. During the Spring Festival, the number of patients receiving aortic dissection patients in Beijing Anzhen Hospital increased significantly. From New Year's Eve to the second day of the first lunar month, 5 aortic dissection surgeries were completed in 3 days, and more than half of the patients were young.

Normal human artery blood vessels are composed of three layers of structures: the inner membrane, the middle membrane and the outer membrane. Once the high-speed blood flow breaks through the aortic wall, causing the inner membrane torn, and the middle membrane torn locally, a "aortic dissection" will form. Under the display of aortic CTA, the aorta is like an extra layer of black "sandwich", which divides the blood vessels into two cavitys. Once ruptured, it will directly lead to death. Li Haiyang introduced that the aortic dissection is called the "unfixed time bomb" in the body. Once the disease occurs, the average mortality rate within 48 hours exceeds 50%, and the risk of death increases by 1% every 1 hour. Judging from the time of onset, the disease has a clear seasonal pattern, with the high incidence rate in winter and spring, and the incidence rate increases significantly during holidays. It often suddenly occurs after gatherings, drinking or staying up late.

In addition, the age of onset of the disease has gradually decreased in recent years, causing serious social burden. Among the five surgeries completed by Anzhen Hospital, only one patient over 50 years old. And the three surgeries performed by Li Haiyang were all young people around 40 years old! "When the patients came, some of them had a large amount of bloody pericardial effusion, and their lives were in danger, so they needed surgery immediately!"

To summarize the incidence of aortic dissection, Li Haiyang found that there are about three categories: one is the people with heavier weight and BMI exceeding the standard. "Many patients are more than 200 kilograms, and sometimes they can't even fit the operating bed"; the second is the people with congenital heart disease and genetic diseases, especially those with Ma Fang syndrome, which is more likely to get sick; the third is the people with hypertension, which is also the most common in our country. "After hypertension, the impact force of blood flow on the arterial wall increases, and the risk of forming dissection increases significantly," Li Haiyang added.

The symptoms of aortic dissection are more obvious, mostly sudden, with severe torn chest pain, which has a very obvious sense of dying. "It seems that the whole person is torn apart. This pain is unbearable. Some people may faint immediately," Li Haiyang introduced that a patient suddenly started to get sick while driving, and a car accident occurred. Fortunately, no casualties were caused.

However, although the symptoms are relatively obvious, they are also easy to misdiagnose during clinical diagnosis and treatment. The aorta is connected from the brain to the legs, and dissection may cause many symptoms. Some patients may show cerebral infarction, some patients may show arterial embolism in the limbs, and some people may have severe abdominal pain. "After examination, it was found that it was caused by the aortic dissection, causing blood vessels torn according to the corresponding organs, causing blood supply disorders."

For aortic dissection, the classic early treatment method is open-thoracic surgery, but open-thoracic surgery has a long recovery period, great damage, and many complications. Some of them have been replaced by minimally invasive interventional surgery. According to the location and rupture of the aortic dissection, the surgical methods can include classical surgery of type A dissection, B dissection interventional surgery, surgical interventional hybrid surgery of type A dissection or B dissection, and stent intervention or artificial vascular replacement during the same period. "Two patients during the holidays underwent surgical interventional hybrid surgery, which not only treated the dissection but minimized the risk of surgery to the greatest extent," said Li Haiyang. Aortic dissection surgery is a very complex type of surgery in the cardiovascular surgery department. After the condition is quickly and accurately judged, a mature cardiac surgery team will carry out the surgery to save the patient's life. Patients with similar symptoms are advised to choose professional cardiovascular hospitals such as Beijing Anzhen Hospital.

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Seeing so many young patients getting sick, Li Haiyang felt very distressed. "The youngest patient is only 27 years old, but he still has not developed healthy living habits. He ignores overweight and blood pressure problems. "Li Haiyang reminds that at present, aortic dissection cannot be accurately prevented. For people with overweight, hypertension or related family history, they can go to the hospital for a heart ultrasound or aortic CTA regularly to understand whether there are any lesions in the aorta, and at the same time establish a healthy lifestyle. "Especially during the Spring Festival and other holidays, this type of population pays attention to controlling blood pressure, combining work and rest, and do not eat and drink hard. Once similar symptoms are present, seek medical treatment as soon as possible."

Every Spring Festival, every household likes to set off firecrackers to increase the festive atmosphere of the festival. It is understandable to set off normally, but every year when we are on duty in the hospital, we see too many accidents caused by firecracker injuries, even eyeball removal, amputation, and death.

I once summarized an article, published in the journal of the Burn Medical Association in the United States, and summarized the accidental injuries caused by firecrackers during the seven-day Spring Festival holiday from Jishuitan Hospital from 2007 to 2011.

In 2007, the number of firecrackers injured 139 people, 129 people in 2008, 150 people in 2009, and 178 people in 2011. In terms of age distribution, we can see that children aged 5-14 are the most. Children of this age are curious and playful, but they lack the corresponding safety awareness, which is often easy to cause injuries.

Among them, on New Year's Eve, the fifth day of the lunar calendar, and the number of injured people on the three days of the Lantern Festival has increased significantly, because these three days are the three days with the largest number of firecrackers. The fifth day of the lunar calendar is also called breaking the fifth day. People have the meaning of rushing to get out of the five, so firecrackers must also be set off.

We summarized and analyzed the data on the epidemic caused by injury. More than half of the injuries were caused by incorrect setting-up, including holding firecrackers in your hands, or failing to explode after setting-up, checking them, or putting them on the manhole cover, or burning them near flammable and explosive items.

Another 26% are because of illegal firecrackers purchased. Many small workshops have good sound effects and excessive use. Such firecrackers are very lethal. Once injured, the consequences will be serious.

Among the injured parts, the most common are the limbs, especially the hands and upper limbs, which are the closest parts to the firecrackers, followed by the torso and head and face. Although eye injuries only account for 10.5%, eye injuries are the most serious, and many people lead to blindness and even eye removal. Among the firecracker injuries, 61.7% are burns, and in addition, skin lacerations caused by explosions.

87.5% of patients can go home after emergency treatment and continue to change the dressing treatment in the outpatient clinic. Another 5% of patients are transferred to specialized hospitals for further treatment after treatment, mainly eye trauma.

Another 7.5% of patients are seriously injured and need to be hospitalized for surgery. Therefore, when setting off firecrackers, you must take safety protection measures. Do not buy illegal firecrackers produced in small workshops. Children must set off under the supervision of adults. Do not check them immediately when setting off firecrackers that cannot explode.

Once injured, you need to go to the hospital for treatment immediately. If you have eye injuries, you need to go to a specialist hospital to avoid delaying your condition.

Generally speaking, fireworks and firecrackers are damage caused by low-energy explosives, and the injury is relatively mild; but if other flammable and explosive products are exploded, it is very likely to cause serious injuries or even multiple casualties.

Non-primary explosion injury

Non-primary explosion injuries are generally treated with conventional trauma first aid, which emphasizes rapid transport.

First aid personnel should quickly complete hemostasis, bandage, fixation, infusion and other measures at the scene or in the ambulance, and then quickly transfer the patient to a hospital or trauma center and divide it into various specialties for further treatment.

It should be emphasized that it is not recommended to lower your head and feet when transferring the traffic, because this will increase the risk of coronary qi thrombosis.

Primary explosion injury

High-energy explosives can cause primary explosion injuries after explosions. The superpressure shock wave interacts with human tissue to produce stress and shear forces, resulting in microvascular damage and huge damage to inflatable organs such as the lungs, ears and intestines.

Compared with other types, primary explosion injuries are more special, and the clinical manifestations of primary explosion injuries survivors may be delayed within 24 to 48 hours.

1. Cracked tympanic membrane

During evaluation, rupture of the tympanum often indicates potential primary explosion injuries in other areas, and should be paid special attention. The symptoms and signs of tympanum rupture are often hearing loss and internal bleeding. Sometimes there is no perforation of the tympanum, and the possibility of primary explosion injuries in other areas cannot be ruled out.

However, tympanic membrane therapy does not fall into the priority range of treatment. Explosive deafness can basically return to normal within a few hours, but it may also be permanent.

2. Explosive lung injury

In addition, special attention should be paid to lung damage. Because the damage to the lungs by primary explosion injuries often causes the patient to die within minutes. The probability of death of the injured person significantly increases when the lung injury meets other types of injuries.

Primary explosion injury emphasizes on-site treatment and subsequent series of treatments. Patients with explosive lung injury combined with other injuries should pay attention to the following points during first aid:

Monitor for red foam sputum or dyspnea and monitor hemodynamic indicators as early as possible

Prepare oxygen or mechanical ventilation to masks. Patients using mechanical ventilation should limit the peak inhalation pressure to reduce the risk of air embolism or pneumothorax.

Infusion channels should be quickly established and rehydration should be done as much as possible while monitoring hemodynamic indicators. Rehydration is mainly crystal liquid, and colloidal liquid can be dispensed. After rehydration, the average arterial pressure should be maintained above 60mmHg to effectively perform liquid resuscitation.

Continuously monitor the injured and actively deal with complications such as pneumothorax and pulmonary edema

For those with TBI, hypercapnia should be prevented and increased cranial pressure should be avoided

3. Gastrointestinal injury

Gastrointestinal injury is not as common as the previous two, but it also requires a comprehensive examination. The lower gastrointestinal tract is often filled with gas, among which the ileocecal part is the most susceptible to first-degree explosive injuries. Its characteristic damage is multiple submucosal hematoma, and the treatment method is similar to other gastrointestinal injuries.

4. Traumatic brain injury

Traumatic brain injury is the most mortal injury among explosive injuries, with 71% of early deaths and 52% of late deaths closely related to it.

We previously believed that traumatic brain injury was caused by secondary or tertiary injury, but latest research has shown that important tissue damage and neurological dysfunction can be caused by explosive high pressure in primary injury.

Emergency treatment of traumatic brain injury is similar to others, including hemostasis, opening the airway, reasonable fluid replenishment, etc., while avoiding the occurrence of hypoxemia and hypotension.

5. Substantial organ damage

Inflictial organ damage is not common in air explosions. When the airway, breathing and circulation are basically stable during treatment, each relevant specialist will be treated symptomatically according to its professional scope.

What do ordinary people do?

Fireworks and firecrackers are generally not too serious. Eye trauma, blind tube/penetration injury and traumatic amputation are the most common. At this time, the correct treatment is very important:

Eye Trauma:

If firecrackers are set off to hurt the eyes or insert foreign objects such as nails into the eyes, do not rinse or pull them out. Use paper cups and other objects to cover the injured person's eyes without pressure and quickly send them to a hospital with an ophthalmology emergency and ask a doctor to deal with it;

If the fireworks gunpowder or other chemical substances enter the eyes, they should be washed with room temperature running water for at least half an hour and sent to the hospital;

Blind tube/penetration injury:

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This kind of wound is very effective in stopping bleeding by pressing alone, so clean fabric should be used to fill the wound before bandaging it.

Foreign objects embedded in the wound should not be pulled out, but should be properly fixed and sent to the hospital.

Broken limb:

If your fingers and toes are accidentally blown off, be careful to collect the broken limbs as much as possible at the site, place them in a sealed plastic bag and then place them in ice to send them to the hospital.

burn:

Rinse with tap water, then gently remove the affected area's clothing and jewelry, cover the affected area with plastic wrap or clean cloth, and send it to the hospital. It is not recommended to use any medicine to apply the affected area without authorization.

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The best thing is not to be injured

There is a saying that prevention is better than relief. It is even better if everyone who sets off fireworks and firecrackers can be safe during the Spring Festival.

For fireworks and firecrackers injuries, we only need to take some small measures to prevent the occurrence of injuries:

1. Purchase and set off fireworks that meet the regulations

In my country, fireworks and firecrackers are divided into four levels: A, B, C, and D. Among them, only C and D-level fireworks and firecrackers belonging to the personal setting category can be purchased and set off.

Class A, B and C and D fireworks for professionals are highly dangerous, and only professional qualifications can be used to set off, and ordinary consumers cannot buy or set off.

2 Correct storage and firing

Incorrect storage and setting-up will likely cause fires, explosions and other disasters and may cause personal injury. In particular, we must educate and monitor the children at home to use and set off fireworks correctly.

3. Choose the right location

Fireworks and firecrackers are likely to cause all Level 5 explosion injuries or even group injuries in prohibited areas such as liquefied gas distribution stations and gas stations. The sewer may be rich in biogas, and setting off fireworks and firecrackers can also easily cause all Level 5 explosion injuries.

4. Proper use of protective equipment

Since explosion injuries often occur in exposed positions of the skin, correctly wearing anti-impact goggles, soundproof earmuffs and flame retardant gloves when setting off fireworks can prevent and reduce most of the injuries caused by fireworks. Wearing clothes that are not combustible rather than flammable materials is more conducive to preventing the occurrence of explosion injuries.
Chapter completed!