Military medicine
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The objective of this report was to compare the prevalence of acute respiratory distress syndrome (ARDS) and associated mortality between military service members with burns sustained during or in support of combat operations and civilian burn patients treated at a single burn center. ⋯ In a retrospective cohort study, burned military patients on mechanical ventilation had a significantly lower overall and ARDS mortality despite larger burns and more severe injury when compared to civilian burn patients. This difference appears to be largely because of age.
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Human cadavers have been used successfully as training models to practice airway management, but the lack of lifelike conditions reduces the utility of this model when softness of tissue and the ability to bleed are required for training scenarios. This report describes our "live cadaver" model, which combines lifelike conditions with real human anatomy. Five human cadavers were prepared as "live cadavers". ⋯ Multiple techniques related to airway management were practiced in setting simulating the treatment of casualties with multiple trauma to include emergency cricothyroidotomy. With this model, participants were confronted with medical situations similar to those found in traumatized live patients (e.g., blood and other body fluids filling the mouth and nose, edema of the tongue and face). With the combination of lifelike conditions and real human anatomy, our experience demonstrated that the "live cadaver" increased the training value of traditionally prepared cadaver models.
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Tranexamic acid (TXA) is an antifibrinolytic that competitively inhibits the activation of plasminogen to plasmin. In recent years, the military has adapted TXA's use in combat casualties suffering severe hemorrhagic injuries. The purpose of this study is to examine the association between TXA on complications such as venous thromboembolic events (VTEs) and flap-related thrombosis in combat trauma patients undergoing tissue transfer for extremity reconstruction. ⋯ Given the increasing use of TXA in the combat casualties, concern over its impact on VTE rates and flap complications is of interest. However, in this early review, we did not find significant differences in patients who received TXA and those that did not. Further research is indicated to better determine the significance and the effect of TXA on complex limb salvages.
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Lower body negative pressure (LBNP) simulates hemorrhage, and tolerance to LBNP (time to presyncope [TTP]) is indicative of tolerance to blood loss. The purpose of this study was to predict TTP based on demographic characteristics (sex, age, height, and body mass index) and physiological variables (heart rate [HR], systolic arterial pressure, diastolic arterial pressure [DAP], pulse pressure, stroke volume, total peripheral resistance [TPR], and baroreflex sensitivity [BRS]) at baseline, and during 2 levels of LBNP (-15, -30 mm Hg). ⋯ Most significantly, our analysis demonstrated a lesser survival trajectory for females given the same rate and magnitude of hemorrhage compared to males. Young age and female sex are predictors of low tolerance to blood loss, and should be considered for early triage in the prehospital setting.
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Pain management is vitally important to injured patients being evacuated from the warzone. A prospective assessment of real-time ratings of pain acceptability, intensity, and satisfaction of a convenience sample of 114 less severely ill and injured U. S. military patients being evacuated on Aeromedical Evacuation (AE) missions from Ramstein Air Field, Germany, to Andrews Air Force Base, Maryland, was conducted. ⋯ Over 47% of patients experienced pain that exceeded their acceptable intensity level, but of those patients with pain that was more severe than acceptable, only 10% rated their satisfaction with their pain management as poor or fair. This is the first study to provide real-time concurrent assessment of pain and pain management during en route care. The worst pain was reported for the hospital to aircraft arrival, suggesting the need for interventions to safely optimize pain management during this handoff period.