Golden hour

For battlefield trauma, the concept of the golden hour , where a patient must be treated within 60 min of multiple traumas, was identified in data gathered by the French during the First World War. In order to achieve rapid treatment, trauma therapies must be administered directly by the combatants themselves (or their colleagues), trained military medical officers or by a mobile army surgical hospital (MASH) unit located close to the combat zone. 

The golden hour is the first 60 minutes following trauma or the onset of acute illness. The chances of survival are great if surgery or advanced trauma life support can be provided within that hour. Combat wounds, as well as accidental or inflicted civilian wounds, often occur where immediate medical assistance is not available, and emergency care becomes the responsibility of the victim of wounds. Therefore, self-care or care-giving can be of critical importance and too often the tools and methods have not been available. 

Boersma E, Maas AC, Deckers JW, Simoons ML. Early thrombolytic therapy in acute myocardial infarction reappraisal of the golden hour. Lancet 1996 348 771-775. 

Wood KE. Major pulmonary embolism Review of a pathophysiologic approach to the golden hour of hemodynamically significant pulmonary embolism. Chest 2002 121 877-905. 

Golden hour —A principle that states that unstable victims must be stabilized within one hour following injury to reduce the risk of death. 

Following the concept of the golden hour in trauma, time matters substantially in CT examinations of severely injured patients (Cowley 1976 Clarke et al. 2002). Not only the minimum achievable scanning speed, but also other factors have influence on total examination time. 

It was realised after the Vietnam War that early life-support interventions after injury were critical to clinical outcome, and the American traumatologist R. Adams Cowley introduced the concept of the Golden Hour to emphasise this fact. Deaths following physical trauma come in three distinct waves. The first comprises persons who die within 30 min as a result of complex and overwhelming injury from which survival is impossible, such as major brain or vascular damage. The second wave, which comprises 30 % of the injuries, occurs after about 4 h and is the result of a combination of blood loss leading to shock and cellular damage and failure to maintain an adequate airway and ventilation. Airway obstraction, in particular, has been estimated to contribute to the death of 40 % of the victims. 

In a 500 ml. Pyrex round-bottomed flask, provided with a reflux condenser, place a mixture of 40 g. of freshly-distUled phenylhydrazine (Section IV.89) and 14 g. of urea (previously dried for 3 hours at 100°). Immerse the flask in an oil bath at 155°. After about 10 minutes the urea commences to dissolve accompanied by foaming due to evolution of ammonia the gas evolution slackens after about 1 hour. Remove the flask from the oil bath after 135 minutes, allow it to cool for 3 minutes, and then add 250 ml. of rectified spirit to the hot golden-yellow oil some diphenylcarbazide will crystallise out. Heat under reflux for about 15 minutes to dissolve the diphenylcarbazide, filter through a hot water funnel or a pre-heated Buchner fuimel, and cool the alcoholic solution rapidly in a bath of ice and salt. After 30 minutes, filter the white crystals at the pump, drain well, and wash twice with a little ether. Dry upon filter paper in the air. The yield of diphenylcarbazide, m.p. 171 °, is 34 g. A further 7 g. may be obtained by concentrating the filtrate under reduced pressure. The compound may be recrystallised from alcohol or from glacial acetic acid. 

Experiment.—Anilinoquinone.1 Dissolve 4 g. of quinone in 400 c.c. of water. Cool the solution and add 1 -72 g. of aniline dissolved in 10 c.c. of 20 per cent acetic acid. Leave the mixture in the cold for three hours with frequent shaking, then collect the reddish-brown crystalline precipitate at the pump, dry it in vacuo, and free it from the monoanilino-compound by repeated careful boiling with petrol ether (boiling point 80°-90°). From the petrol ether this compound separates on cooling in the form of small golden-brown needles. Melting point 119°. The insoluble portion consists of dianilinoquinone. 

Cured specimens were a transparent golden brown color. DSC indicated less than lOX residual exotherm. Following the cure cycle described above the specimens ware postcured for 1 hour at 300°C in nitrogen. The extent of cure was determined by DSC to be greater than 95% following postcure. The cure cycle and postcure described above have been used in the fabrication of all cured BCB specimens. 

Cured BCB/BMI specimens are a transparent golden brown in color, similar to what was seen for the BCB oligomer. Once the specimens have been removed from the mold they are postcured for 1 hour at 300 C in nitrogen resulting in an extent-of-cure of greater than 95X. 

Kibrit (sulphur) 1 (pt), sulfur (manuscript gloss says id est auripigmentum ) Asphar ( ) 1, quicklime, 1 part. Place in a pot (cacabo) with ox urine and heat 1 hour and you will see a golden color. Put in a glazed jar and put this water into your operations. 

After 36 hours the furnace is allowed to cool, the bomb is removed, cooled to dry-ice temperatures, and opened carefully as there may be residual pressure. The golden brown liquid is poured into a 200-ml. flask, and the methyl iodide is removed on a rotary evaporator (iCautionI Hood). The residue from the flask and the bomb is washed into a 500-ml. separatory funnel with 100 ml. each of ether and 1 1 solution of Claisen s alkali and water (Note 8). The funnel is shaken, and the alkali layer is removed. The ether layer is extracted four additional times with 100 ml. portions of the alkali (Note 9), washed twice with 75-ml. portions of water, once with saturated aqueous salt solution, and... 

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