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Background Diffuse microvascular bleeding remains a common problem after myocardial revascularization with cardiopulmonary bypass. Objectives The effi cacy of locally administered tranexamic acid (topical application) was compared with systemically administered tranexamic acid to reduce postoperative bleeding after cardiopulmonary bypass in elective nonredo coronary artery bypass grafting ( CABG). Methods The study included 60 patients of both sexes, aged between 35 and 65 years, and scheduled for elective CABG; patients were randomly assigned to two groups: group I (the intravenous tranexamic acid group; 30 patients) and group II (the topical tranexamic acid group; 30 patients). For each patient in each group, postoperative blood loss, number of units of packed red blood cells (RBCs) and fresh frozen plasma ( FFP) transfused, frequency of resternotomy, duration of hospital and ICU stay, and mortality were recorded. Results There were statistically signifi cant differences between the two groups with regard to total postoperative blood loss and need for packed RBCs and FFP transfusion, being much greater in group I than in group II. There was no mortality in either group. Frequency of resternotomy was higher in group I than in group II, although the difference was statistically nonsignifi cant. The duration of hospital and ICU stay revealed no statistically signifi cant differences between the two groups. Conclusion Intraoperative topical administration of tanexamic acid into the pericardial cavity before sternal closure during CABG surgery has reduced the incidence of postoperative blood loss and the need for postoperative packed RBCs and FFP transfusion. [ABSTRACT FROM AUTHOR]

In fire events, smoke inhalation is the leading cause of death in survivors of the primary fire mortality. Direct upper airway thermal injury is only one of the contributing mechanisms. Others may be related to the nature of the combusted (or incomplete combusted) materials in the scene; eg.; aldehydes, sulphur oxides and nitrogen as a cotton combustion products, while burning polyvinylchloride (PVC's) releases carbon monoxide (CO) and hydrochloric acid, among more than 75 potentially toxic compounds including cyanide. Hot carbonated gaseous materials and soot may lead to supraglottic, glottic, or infraglottic airway obstruction however; significant hypoxemia is not the typical sign in acute cases without aspiration or parenchymal lung injuries. Injury may not manifest until after 48 hours. [ABSTRACT FROM AUTHOR]