The journal of trauma and acute care surgery
-
J Trauma Acute Care Surg · Aug 2013
Frequency and relevance of acute peritraumatic pulmonary thrombus diagnosed by computed tomographic imaging in combat casualties.
Posttraumatic pulmonary embolism is historically diagnosed after clinical deterioration within the first week after injury. An increasing prevalence of immediate and asymptomatic pulmonary embolism have been reported in civilian and military trauma, termed hereafter as acute peritraumatic pulmonary thrombus (APPT). The objective of this study was to define the frequency of APPT diagnosed by computed tomographic (CT) imaging in wartime casualties. An additional objective was to identify factors, which may be associated with this radiographic finding ⋯ This report is the first to characterize acute, peritraumatic pulmonary thrombus in combat injured. Nearly 1 in 10 patients with severe wartime injury has findings of pulmonary thrombus on CT imaging, although many instances require repeat examination of initial images to identify the clot. APPT is a phenomenon of severe injury and associated with deep venous thrombosis and lower-extremity traumatic amputation. Additional study is needed to characterize the natural history of peritraumatic pulmonary thrombus and the indications for anticoagulation or vena cava filter devices.
-
J Trauma Acute Care Surg · Aug 2013
Primary blast lung injury prevalence and fatal injuries from explosions: insights from postmortem computed tomographic analysis of 121 improvised explosive device fatalities.
Primary blast lung injury (PBLI) is an acknowledged cause of death in explosive blast casualties. In contrast to vehicle occupants following an in-vehicle explosion, the injury profile, including PBLI incidence, for mounted personnel following an external explosion has yet to be as well defined. ⋯ Following IED strikes, mounted fatalities are primarily caused by head and chest injuries. Lower extremity trauma is the leading cause of death in dismounted fatalities. Mounted fatalities have a high incidence of PBLI, suggesting significant exposure to primary blast. This has not been reported previously. Further work is required to determine the incidence and clinical significance of this severe lung injury in explosive blast survivors. In addition, specific characteristics of the vehicles should be considered.
-
J Trauma Acute Care Surg · Aug 2013
Clinical TrialFeasibility of blind aortic catheter placement in the prehospital environment to guide resuscitation in cardiac arrest.
Aortic catheter-based resuscitation therapies are emerging with laboratory investigations showing benefit in models of trauma-related noncompressible torso hemorrhage and nontraumatic cardiac arrest. For these investigational aortic catheter-based therapies to reach their greatest potential clinical benefit, the ability to initiate them in the prehospital setting will be important. Feasibility of prehospital aortic catheterization without imaging capability supports this potential and is described in this report. ⋯ This report demonstrates the feasibility of successful blind aortic and central venous catheterizations in the prehospital environment and supports the potential feasibility of other emerging aortic catheter-based resuscitation therapies.