Military medicine
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Peripheral nerve crush injury (PNCI) models are commonly used to study nerve damage and the potential beneficial effects of novel therapeutic strategies. Current models of PNCI rely on inter-device and operator precision to limit the variation with applied pressure. Although the inability to accurately quantify the PNCI pressure may result in reduced reproducibility between animals and studies, there is very limited information on the standardization and quantification of applied pressure with PNCI. To address this deficit, we constructed a novel device comprised of an Arduino UNO microcontroller board and Force Sensitive Resistor capable of reporting the real-time pressure applied to a nerve. ⋯ This is the first demonstration of real-time pressure measurements in PNCI models and it reveals that the applied pressures are dependent on the types of device used. The large disparity in pressure represents an inability to apply graded accurate and consistent intermediate pressure gradients in PNCI. These findings indicate a need for documentation of pressure severity as a screening for PNCI in animals, and the real-time pressure sensor could be a useful tool in monitoring and applying consistent pressure, reducing the outcome variability within the same experimental model of PNCI.
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Operationalizing the Deployment of Low-Titer O-Positive Whole Blood Within a Regional Trauma System.
The implementation of a low-titer O+ whole blood (LTOWB) resuscitation algorithm, particularly in the prehospital environment, has several inherent challenges, including cost, limited and inconsistent supply, and the logistics of cold-chain management. The Southwest Texas Regional Advisory Council has implemented the nation's first multidisciplinary, multi-institutional regional LTOWB program. This research effort was to illustrate the successful deployment of LTOWB within a regional trauma system. ⋯ This work demonstrates a novel model for the development of a trauma system LTOWB program. The program's implementation augments remote damage control resuscitation strategies and requires the integration and collaboration of a multidisciplinary stakeholder team to optimize efficiency, performance, and safety of the program.
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Measures of normal and abnormal physiology are interrelated and vary continuously. Our ability to detect and predict changes in physiology in real time has been limited in part by the requirement for blood sampling and the lack of a continuous data stream of various "signals", i.e., measurements of vital signs. It is important to determine which signals are most revealing for detection and treatment of, e.g., internal bleeding, managing fluid balance for mission/combat readiness, and hydration. Although our current algorithm for PV[O]H reflects changes in hematocrit and blood and plasma volumes, additional algorithms utilizing the whole raw PV[O]H data stream, along with other variables, can be constructed. We present a working prototype demonstrating that acceptable size, power, and complexity footprints for military needs can be achieved. Results of previous studies involving humans have demonstrated that PV[O]H can provide simultaneous, noninvasive, in vivo continuous monitoring of hematocrit, vascular volume, hemoglobin oxygen saturation, pulse rate, and breathing rate using a single light source with a reporting frequency of every 3 seconds. ⋯ Simultaneous noninvasive continuous monitoring of peripheral vessels using a previous PV[O]H system demonstrates large, physiology revealing data sets. The technologies enable the methodical search for relevant physiological signals allowing the use of discriminant analysis, Bayesian approaches, and artificial intelligence to create predictive algorithms enabling timely interventions in medical care and troop training.
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Hypocalcemia is a known sequela of citrated blood product transfusion. Civilian data suggest hypocalcemia on hospital admission is associated with worse outcomes. Initial calcium levels in military casualties have not previously been analyzed. The objective of this retrospective review aimed to assess the initial calcium levels in military trauma casualties at different Forward Surgical Teams (FST) locations in Afghanistan and describe the effects of prehospital blood product administration on arrival calcium levels. ⋯ Hypocalcemia develops rapidly in military casualties and is prevalent on admission even before transfusion of citrated blood products. Blast injuries may confer an increased risk of developing hypocalcemia. This data support earlier use of calcium supplementation during resuscitation.
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Vancomycin-resistant enterococci (VRE) are classified by the Centers for Diseases Control and Prevention as a serious antibiotic resistance threat. Our study aims to characterize the epidemiology, associated conditions, and outcomes of VRE infections among hospitalized patients in the U.S. military health system (MHS). ⋯ VRE infections carry a considerable burden for hospitalized patients given their impact on length of stay, hospitalization costs, and in-hospital mortality. Active surveillance and infection control efforts should target those identified as high-risk for VRE infection. Antimicrobial stewardship programs should focus on limiting exposure to 4th generation cephalosporins.