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Sökning: WFRF:(Holmér Ingvar) > Lunds universitet > Lundgren Peter

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1.
  • Henriksson, Otto, 1976-, et al. (författare)
  • Protection against cold in prehospital care : wet clothing removal or addition of a vapor barrier
  • 2015
  • Ingår i: Wilderness & environmental medicine (Print). - : Elsevier. - 1080-6032 .- 1545-1534. ; 26:1, s. 11-20
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: The purpose of this study was to evaluate the effect of wet clothing removal or the addition of a vapor barrier in shivering subjects exposed to a cold environment with only limited insulation available.METHODS: Volunteer subjects (n = 8) wearing wet clothing were positioned on a spineboard in a climatic chamber (-18.5°C) and subjected to an initial 20 minutes of cooling followed by 30 minutes of 4 different insulation interventions in a crossover design: 1) 1 woolen blanket; 2) vapor barrier plus 1 woolen blanket; 3) wet clothing removal plus 1 woolen blanket; or 4) 2 woolen blankets. Metabolic rate, core body temperature, skin temperature, and heart rate were continuously monitored, and cold discomfort was evaluated at 5-minute intervals.RESULTS: Wet clothing removal or the addition of a vapor barrier significantly reduced metabolic rate (mean difference ± SE; 14 ± 4.7 W/m(2)) and increased skin temperature rewarming (1.0° ± 0.2°C). Increasing the insulation rendered a similar effect. There were, however, no significant differences in core body temperature or heart rate among any of the conditions. Cold discomfort (median; interquartile range) was significantly lower with the addition of a vapor barrier (4; 2-4.75) and with 2 woolen blankets (3.5; 1.5-4) compared with 1 woolen blanket alone (5; 3.25-6).CONCLUSIONS: In protracted rescue scenarios in cold environments with only limited insulation available, wet clothing removal or the use of a vapor barrier is advocated to limit the need for shivering thermogenesis and improve the patient's condition on admission to the emergency department.
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2.
  • Henriksson, Otto, 1976-, et al. (författare)
  • Protection against cold in prehospital care — thermal insulation properties of blankets and rescue bags in different wind conditions
  • 2009
  • Ingår i: Journal of Prehospital and Disaster Medicine. ; 24:5, s. 408-415
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: In a cold,wet, or windy environment, cold exposure can be considerable for an injured or ill person. The subsequent autonomous stress response initially will increase circulatory and respiratory demands, and as body core temperature declines, the patient’s condition might deteriorate. Therefore, the application of adequate insulation to reduce cold exposure and prevent body core cooling is an important part of prehospital primary care, but recommendations for what should be used in the field mostly depend on tradition and experience, not on scientific evidence. Objective: The objective of this study was to evaluate the thermal insulation properties in different wind conditions of 12 different blankets and rescue bags commonly used by prehospital rescue and ambulance services. Methods: The thermal manikin and the selected insulation ensembles were setup inside a climatic chamber in accordance to the modified European Standard for assessing requirements of sleeping bags. Fans were adjusted to provide low (< 0.5 m/s), moderate (2–3 m/s) and high (8–9 m/s) wind conditions. During steady state thermal transfer, the total resultant insulation value, Itr (m2 °C/Wclo; where °C = degrees Celcius, and W = watts), was calculated from ambient air temperature (°C), manikin surface temperature (°C), and heat flux (W/m2). Results: In the low wind condition, thermal insulation of the evaluated ensembles correlated to thickness of the ensembles, ranging from 2.0 to 6.0 clo (1 clo = 0.155 m2 °C/W), except for the reflective metallic foil blankets that had higher values than expected. In moderate and high wind conditions, thermal insulation was best preserved for ensembles that were windproof and resistant to the compressive effect of the wind, with insulation reductions down to about 60–80% of the original insulation capacity, whereas wind permeable and/or lighter materials were reduced down to about 30–50% of original insulation capacity. Conclusions: The evaluated insulation ensembles might all be used for prehospital protection against cold, either as single blankets or in multiple layer combinations, depending on ambient temperatures. However, with extended outdoor, on-scene durations, such as during prolonged extrications or in multiple casualty situations, the results of this study emphasize the importance of using a windproof and compression resistant outer ensemble to maintain adequate insulation capacity.
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3.
  • Kuklane, Kalev, et al. (författare)
  • Moisture and clothing layers: effect of ambient temperature on heat loss and insulation
  • 2010
  • Ingår i: 8I3M : Eighth International Meeting for Manikins and Modeling : Victoria, BC, Canada, August 22-26, 2010 - Eighth International Meeting for Manikins and Modeling : Victoria, BC, Canada, August 22-26, 2010.
  • Konferensbidrag (refereegranskat)abstract
    • During the latest years the research on the effects of moisture on clothing system has been boosted. New information has revealed phenomena, e.g. “heat pipe” effect with its condensation-evaporation cycle(s) that has not been considered earlier in prediction of physiological reactions or evaluating clothing properties. Considering the material properties, e.g. the evaporative resistance measurements, the tests at homogenous conditions with registration of mass loss would be probably the correct approach. On the other hand, until there is no clear picture where condensation occurs, role of wicking and the probability of re-evaporation in multilayer clothing at different environmental conditions measuring the real heat losses in order to evaluate human thermal responses in realistic test conditions is important. An example of such need is the selection of proper means for protection against cold in prehospital care at accident sites. In this study thermal manikin was tested with wet underwear and wrapped in 1, 2 or 7 layers of woollen rescue blankets at -15 and +10 °C. This paper discusses the issues related to possibility to improve predictions for the cases when other situations, materials or exposure temperatures are involved. A method to quantify “heat pipe” effect was proposed, and for control the calculation of dry insulation from wet tests was applied. The measured apparent insulation, i.e. insulation based on total heat loss in wet conditions, was higher at -15 °C than at + 10 °C. That could be related to higher condensation rate in materials or suppressed evaporation. However, the measured weight loss rate (higher at 15 °C) and accumulation in layers (lower at 15 °C) did not support this conclusion. Effect could partly be related to the lower water pressure gradient between wet clothing at manikin surface and ambient air at +10 (2.5 kPa) than -15 °C (3.0 kPa). In the case of 7 layers the highest accumulation occurred in the layers near body and in the outermost layer while only minimal accumulation of moisture was observed in the middle layers. The total accumulation was divided into ratios for each layer, and expected condensation heat to environment was based on insulation (7 layers, 1/7 of the first and 7/7 of the outer layer leaves the system). When this correction was applied to “heat pipe” effect then the corrected heat loss did lead to insulation values similar to dry tests. The method worked also for 1 and 2 layer systems with highest difference for 1 layer system. The method could be tested more accurately on a sweating cylinder/torso, where layers may be separated in order to avoid wicking or vice versa set to allow it. Using different number of layers, layer thickness and less hygroscopic materials than wool may improve estimation of the “heat pipe” effects.
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4.
  • Lundgren, Peter, 1977-, et al. (författare)
  • Validity and reliability of the Cold Discomfort Scale : a subjective judgement scale for the assessment of patient thermal state in a cold environment.
  • 2014
  • Ingår i: Journal of clinical monitoring and computing. - : Springer Science and Business Media LLC. - 1387-1307 .- 1573-2614. ; 28:3, s. 287-291
  • Tidskriftsartikel (refereegranskat)abstract
    • Complementary measures for the assessment of patient thermoregulatory state, such as subjective judgement scales, might be of considerable importance in field rescue scenarios where objective measures such as body core temperature, skin temperature, and oxygen consumption are difficult to obtain. The objective of this study was to evaluate, in healthy subjects, the reliability of the Cold Discomfort Scale (CDS), a subjective judgement scale for the assessment of patient thermal state in cold environments, defined as test-retest stability, and criterion validity, defined as the ability to detect a difference in cumulative cold stress over time. Twenty-two healthy subjects performed two consecutive trials (test-retest). Dressed in light clothing, the subjects remained in a climatic chamber set to -20 °C for 60 min. CDS ratings were obtained every 5 min. Reliability was analysed by test-retest stability using weighted kappa coefficient that was 0.84 including all the 5-min interval measurements. When analysed separately at each 5-min interval the weighted kappa coefficients were was 0.48-0.86. Criterion validity was analysed by comparing median CDS ratings of a moving time interval. The comparison revealed that CDS ratings were significantly increased for every interval of 10, 15, and 30 min (p < 0.001) but not for every interval of 5 min. In conclusion, in a prehospital scenario, subjective judgement scales might be a valuable measure for the assessment of patient thermal state. The results of this study indicated that, in concious patients, the CDS may be both reliable and valid for such purpose.
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