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St. Mike’s hospital trauma surgeons are using battlefield techniques to treat victims of gun violence

Published

5 années ago

décembre 27, 2018

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“One major difference is that today, when someone comes in, we start to give them a blood transfusion very early on,” he said, noting that until just over a decade ago, these patients were immediately given saline IV fluids with blood to follow.

But a 2007 study, of which Rizoli was a contributing author, showed that trauma patients suffering from major hemorrhagic bleeding have much better outcomes if they are immediately given massive blood transfusions.

“They do much better if they get blood from the start,” he said.

Many of these survivors owe their lives to the health professionals such as Rizoli.

St. Mike’s — one of three trauma centres in the city — sees about one shooting victim a week and is able save approximately 80 per cent of them, Rizoli said.

The Star recently spent some time with a Rizoli and the team of trauma surgeons at the hospital to learn how they are trying to keep more of these patients alive.

Rizoli said it stands to reason that shooting victims are faring better today. The increase in gun violence sadly means trauma surgeons are getting much more experience in dealing with these patients.

These days, St. Mike’s averages about one victim of gun violence a week.

“During my training 25 years ago, gunshot wounds were uncommon and many Canadian surgeons had to train in the U.S. to gain experience in treating them. The growth in the number of victims to gun violence and the progression to more lethal weapons had been fortunately balanced by enormous advances in trauma science and practice,” Rizoli said.

Advancements have been made in research, technology, drugs hospital design, workflow, protocols and best practices, he noted.

Much of the learning has come from the battlefield.

“We have learned from wars that patients who have lost a lot of blood cannot clot appropriately,” Rizoli explained.

They suffer from what is known as “trauma-induced coagulopathy,” and if not treated quickly, it can lead to a patient bleeding to death.

“We give them blood, and tons of blood, to start with. Then we try to diagnose, as quickly as possible, exactly what is wrong with their coagulation,” Rizoli said.

They do this by using a piece of equipment, purchased by the hospital about five years ago, which quickly analyzes blood-clotting properties. Called ROTEM, short for rotational thromboelastometry, it guides health professionals in determining what blood products trauma patients require so that their blood clots properly.

St. Mike’s surgeons have recently begun to use another technique developed on the battlefield, this one to stop traumatic bleeding.

The minimally invasive procedure is known as REBOA, or Resuscitative Endovascular Balloon Occlusion of the Aorta. It involves running a catheter up the femoral artery and into the aorta. A balloon at the tip of the catheter is inflated, stopping the flow of blood.

The procedure can be done in the trauma bay. Previously, patients would have been moved to the opening room where their chests would be opened and aortas clamped. That took much longer, was more invasive and carried a higher risk of death.

Before using the new REBOA catheter on patients, St. Mike’s tested it out on a high-tech mannequin. The simulation served to educate those in the trauma program — including nurses, respiratory therapists and surgeons — on how it works.

“It’s like crash-testing a car. You wouldn’t drive a car if it hadn’t been crash-tested first. We do the same thing with new processes. We crash-test them and make sure they work like we anticipate they will,” said Dr. Andrew Petrosoniak.

He and colleague Dr. Chris Hicks are emergency physicians, trauma team leaders and simulation educators at St. Mike’s. Their work on simulation exercises has helped improve the workflow in trauma resuscitation care. It has also informed the design of a new trauma bay at the hospital, scheduled to open in 2019.

One of their exercises involved tracking the movements of three nurses treating a simulated trauma patient. It was videotaped and the movements of each nurse were followed, using an overlay tracing tool, with a different colour for each nurse.

The end result looked like colourful child’s scrawl to the untrained eye. But to Petrosoniak and Hicks, it revealed how the nurses lost time criss-crossing the trauma bay to get different pieces of equipment.

If the equipment needed was closer at hand, nurses would need to criss-cross the room and seconds could be saved. There would be less risk of nurses bumping into each other and dropping instruments.

“So now we understand where they’re moving and we can improve their efficiency,” Petrosoniak said. “The whole point of efficiency is to get the care faster. If you are thinking about gunshot wound patients, time matters significantly.”

Hicks said the information has also been used in the design of the new trauma bay to show how much room is needed around each bed.

The pair have also worked on creating a new “massive transfusion protocol.” They examined steps taken by everyone involved in the transfusing large amounts of blood into trauma patients.

That includes, as an example, porters charged with picking up blood from the blood bank at the other end of the hospital and carrying it over to the trauma bay.

Petrosoniak and Hicks realized seconds could be lost by waiting for an elevator, so now porters must take the stairs. As well porters must announce themselves when entering the trauma bay instead of waiting to be noticed.

Through changes such as this, delivery time for blood has been cut by 12.5 per cent to nine minutes.

“In the past you might have been waiting for blood,” Hicks said, citing research showing that every minute blood is delayed results in a 5 per cent increase in mortality.

Trauma surgeons at St. Mike’s are also working to reduce the need for their services by campaigning to reduce access to guns. Two surgeons with much to say on this happened to be on duty the night of the Danforth shooting in July. Drs. Najma Ahmed and Bernard Lawless say that the Danforth shooting prompted them to increase their activism.

“I think there is greater public awareness that this is a public health crisis. I think there is also greater awareness that guns can be lethal beyond just crimes. They are very often used in adolescent suicide in Canada,” Ahmed said.

This past fall, she helped draft a position statement, calling for limited civilian access to firearms, and then assisted in getting endorsements for it from medical associations, including the Trauma Association of Canada and the Canadian Association of General Surgeons.

She and Lawless have also been lobbying politicians to take steps to crack down on gun violence.

“Dr. Ahmed and I have been contacting decision-makers at all levels,” Lawless said. “It’s going to take political fortitude to make change. When you look at this from a common sense perspective, it’s really not a difficult issue.”

Calling gun violence a “disease,” Ahmed said it makes perfect sense for physicians to be involved in trying to eradicate it.

“It has its own risk factors and own epidemiology, its preventable strategy,” she said.

Lawless said the profession has a long history in working on injury prevention: “Trauma surgeons have long played a role in injury prevention, whether it’s around seatbelt use, drinking and driving, and even working with engineers on how cars and roads are designed.”

Rizoli said diseases can be eradicated and points to smallpox as an example.

“No one should be injured by a disease that is completely preventable. No one in Canada should he a victim of gun violence. There could come a time when this could end.”

Theresa Boyle is a Toronto-based reporter covering health. Follow her on Twitter: @theresaboyle

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Anglais

Nostalgia and much more with Starburst XXXtreme

Published

3 années ago

août 10, 2021

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Get a taste of adventure with Starburst XXXtreme based on the legendary NetEnt Game. The nostalgic themes are sure to capture fans of the classic version as they get treated to higher intensity, better visuals, and features. The most significant element of the game is its volatility. Patience will not be an essential virtue considering the insane gameplay, and there is a lot of win potential involved. It retains the original makeup of the previous game while adding a healthy dose of adrenaline.

Starburst Visuals and Symbols

The game is definitely more conspicuous than before. The setting happens over a 5-reel, 3-row game grid with nine fixed win lines, which function if a succession from the left to the right reel is present. Only those players that that attain the highest win per bet line are paid. From a visual standpoint, the Starburst XXXtreme slots illustrates lightning effects behind the reels, which is not surprising as it is inherited from the original version. Available themes include Classic, Jewels, and Space. The game is also available in both desktop and mobile versions, which is advantageous for players considering the global pandemic. According to Techguide, American gamers are increasingly having more engaging gaming experiences to socialize to fill the gap of in-person interaction. Starburst XXXtreme allows them to fill the social void at a time when there is so much time to be had indoors.

Starburst XXXTreme Features

Players get to alternate on three features which are Starburst Wilds, XXXtreme Spins, and Random Wilds. The first appears on reels 2,3, or 4. When these land, they expand to cover all positions while also calculating the wins. They are also locked for a respin. If a new one hits, it also becomes locked while awarding another respin. Starburst XXXtreme offers a choice between two scenarios for a higher stake. In one scenario with a ten times stake, the Starburst Wild is set on random on reels 2,3, or 4, and a multiplier starts the respin. The second scenario, which has a 95 times stake, starts with two guaranteed starburst wilds on reels 2,3, or 4. it also plays out using respin game sequence and features. The game also increases the potential with the Random Wilds feature to add Starburst Wilds to a vacant reel at the end of a spin. Every Starburst Wild gives a random multiplier with potential wins of x2, x3, x5, x10, x25, x50, x100, or even x150.

The new feature is sure to be a big hit with the gaming market as online gambling has shown significant growth during the lockdown. AdAge indicates the current casino customer base is an estimated one in five Americans, so Starburst XXXtreme’s additional features will achieve considerable popularity.

What We Think About The Game

The gambling market has continued to diversify post-pandemic, so it is one of the most opportune times to release an online casino-based game. Thankfully Starburst XXXtreme features eye-catching visuals, including the jewels and space themes. These attract audience participation and make the gameplay inviting. The game also has a nostalgic edge. The previous NetEnt iteration featured similar visuals and gameplay, so the audience has some familiarity with it. The producers have revamped this version by tweaking the features to improve the volatility and engagement.

That is characterized by the potential win cap of 200,000 times the bet. Starburst XXXtreme does not just give betting alternatives for players that want to go big. The increase of multipliers also provides a great experience. If the respins in the previous version were great, knowing that multipliers can go hundreds of times overtakes the game to a new level.

Players should get excited about this offering. All of the features can be triggered within a single spin. Whether one plays the standard game or takes the XXXtreme spin route, it is possible to activate all of the features. Of course, the potential 200,000 times potential is a huge carrot. However, the bet size is probably going to be restricted and vary depending on the casino. It is also worth pointing out that a malfunction during the gameplay will void all of the payouts and progress. Overall, the game itself has been designed to provide a capped win of 200,000 times the original bet.

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Anglais

‘We’re back’: Montreal festival promoters happy to return but looking to next year

Published

3 années ago

juillet 23, 2021

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In downtown Montreal, it’s festival season.

In the city’s entertainment district, a musical act was conducting a sound check on stage Friday evening — the second day of the French-language version of the renowned Just For Laughs comedy festival. Tickets for many of the festival’s free outdoor shows — limited by COVID-19 regulations — were sold out.

Two blocks away, more than 100 people were watching an acoustic performance by the Isaac Neto Trio — part of the last weekend of the Festival International Nuits d’Afrique, a celebration of music from the African continent and the African diaspora.

With COVID-19 restrictions continuing to limit capacity, festival organizers say they’re glad to be back but looking forward to next year when they hope border restrictions and capacity limits won’t affect their plans.

Charles Décarie, Just For Laughs’ CEO and president, said this is a “transition year.”

“Even though we have major constraints from the public health group in Montreal, we’ve managed to design a festival that can navigate through those constraints,” Décarie said.

The French-language Juste pour rire festival began on July 15 and is followed by the English-language festival until July 31.

When planning began in February and March, Décarie said, organizers came up with a variety of scenarios for different crowd sizes, ranging from no spectators to 50 per cent of usual capacity.

“You’ve got to build scenarios,” he said. “You do have to plan a little bit more than usual because you have to have alternatives.”

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Anglais

MELS new major movie studio to be built in Montreal

Published

3 années ago

juillet 23, 2021

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MONTREAL — MELS Studios will build a new film studio in Montreal, filling some of the gap in supply to meet the demand of Hollywood productions.

MELS president Martin Carrier said on Friday that MELS 4 studio construction will begin « as soon as possible », either in the fall or winter of next year. The studio could host productions as early as spring 2023.

The total investment for the project is $76 million, with the Quebec government contributing a $25 million loan. The project will create 110 jobs, according to the company.

The TVA Group subsidiary’s project will enable it to stand out « even more » internationally, according to Quebecor president and CEO Pierre Karl Péladeau. In the past, MELS Studios has hosted several major productions, including chapters of the X-Men franchise. The next Transformers movie is shooting this summer in Montreal.

Péladeau insisted that local cultural productions would also benefit from the new facility, adding that the studio ensures foreign revenues and to showcase talent and maintain an industry of Quebec producers.

STUDIO SHORTAGE

The film industry is cramped in Montreal.

According to a report published last May by the Bureau du cinéma et de la télévision du Québec (BCTQ), there is a shortage of nearly 400,000 square feet of studio space.

With the addition of MELS 4, which will be 160,000 square feet, the company is filling part of the gap.

Carrier admitted that he has had to turn down contracts because of the lack of space, representing missed opportunities of « tens of millions of dollars, not only for MELS, but also for the Quebec economy. »

« Montreal’s expertise is in high demand, » said Montreal Mayor Valérie Plante, who was present at the announcement.

She said she received great testimonials from « Netflix, Disney, HBO and company » during an economic mission to Los Angeles in 2019.

« What stands out is that they love Montreal because of its expertise, knowledge and beauty. We need more space, like MELS 4, » she said.

There is still not enough capacity in Quebec, acknowledged Minister of Finance, the Economy and Innovation Eric Girard.

« It is certain that the government is concerned about fairness and balance, so if other requests come in, we will study them with the same seriousness as we have studied this one, » he said.

Grandé Studios is the second-largest player in the industry. Last May, the company said it had expansion plans that should begin in 2022. Investissement Québec and Bell are minority shareholders in the company.

For its part, MELS will have 400,000 square feet of production space once MELS 4 is completed. The company employs 450 people in Quebec and offers a range of services including studio and equipment rentals, image and sound postproduction, visual effects and a virtual production platform.