Injury
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Observational Study
Examination of hemodynamics in patients in hemorrhagic shock undergoing Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA).
The objective of this study was to investigate the hemodynamic effects of aortic occlusion (AO) during Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) using a sophisticated continuous vital sign (CVS) monitoring tool. ⋯ Significant hemodynamic alterations occur before, during, and after AO. The effects of Zone 1 AO on blood pressure and heart rate appear different than Zone 3 AO. This may have important implications for cardiac or cerebral function and perfusion goals, particularly with concomitant injuries such as cardiac contusion or traumatic brain injury.
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Reviewing prehospital trauma deaths provides an opportunity to identify system improvements that may reduce trauma mortality. The objective of this study was to identify the number and rate of potentially preventable trauma deaths through expert panel reviews of prehospital and early in-hospital trauma deaths. ⋯ The number of potentially preventable or preventable trauma deaths in the pre-hospital and early in-hospital resuscitation phase was low. Specific circumstances were identified in which the trauma system could be further improved.
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Multicenter Study
Trajectory of functional outcome and health status after moderate-to-major trauma in Hong Kong: A prospective 5 year cohort study.
Trauma care systems in Asia have been developing in recent years, but there has been little long-term outcome data from injured survivors. This study aims to evaluate the trajectory of functional outcome and health status up to five years after moderate to major trauma in Hong Kong. ⋯ After injury, the most rapid improvement in PCS and MCS occurred in the first six to 12 months, but further recovery was still evident for MCS in patients aged under 65 years for up to five years.
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Observational Study
Deployment of the Surgical Life-saving Module (SLM) in 2017: Lessons learned in setting up and training operational surgical units.
The military operations carried out by the French armed forces, occasionally require the use of the Surgical Life-saving Module (SLM), to ensure the surgical support of its soldiers. Due to its extreme mobility and capacity of fast deployment, SLM is particularly useful in small-scale military operations, such as Special Forces missions. In 2017, the French SLM was for the first time used to ensure surgical support of allied forces, which were lacking forward surgical capabilities. ⋯ The numerous SLM deployments in larger operations highlighted its ability to adapt both in terms of equipment and personnel. Continuous management of equipment logistics, robust personnel training, and appropriate organization of the evacuation procedures, were the key elements for optimizing combat casualty care. As a consequence, the SLM appears to be an operational surgical unit of choice during deployments.
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Expanding or fragmenting bullets have been known to cause extensive injuries since they became available in the late 19th century. Although these bullets are now banned from international warfare, their use by civilians and law enforcement is still legal in the US. In this case report, we describe the complex injuries and subsequent complicated hospital course of a civilian trauma patient who was shot with a newly-designed fragmenting bullet, known as a Radically Invasive Projectile (RIP) bullet. ⋯ Expanding or fragmenting bullets are designed to inflict significantly more tissue damage than non-deformable bullets. This type of ammunition is prohibited in international warfare on the basis that it does not serve a military advantage but can result in excessive wounding and unnecessary suffering. There is no such ban for handgun ammunition for domestic use in most countries including the United States. Ammunition manufacturers have recently released a fragmenting bullet that is designed to inflict a maximum amount of tissue damage. In this case report, we described the devestating effects of this bullet on a civilian trauma patient.