Military medicine
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Uncontrolled bleeding remains the leading cause of preventable death in trauma. Hemostatic agents are effective in hemorrhage control but often fail following high-volume crystalloid resuscitation. Aggressive fluid resuscitation increases the blood pressure which may dislodge the newly formed clot causing rebleeding. ⋯ The control group underwent the same procedures but without the hemostatic agent. After 30 minutes, dressings were removed and the SBP was increased incrementally using intravenous phenylephrine until rebleeding occurred or until the arterial blood pressure reached 210 mm/Hg. The SBP and MAP were significantly higher in the BleedArrest, TraumaDex, and Celox groups compared to a control group (p < 0.05).
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To provide an analysis of casualties treated during medical evacuation (MEDEVAC) or/and at the Spanish Role 2 in Herat, Afghanistan, including type of weapon, injuries, and effects of protective measures. ⋯ The injury score indices of firearm casualties were higher than the explosive device casualties' injury score indices. The possible reasons for this finding are discussed.
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To assess factors associated with medical disability in the U.S. Marine Corps. ⋯ Continued surveillance of the disability evaluation system is needed to help develop preventive measures and to help policy makers establish evidence-based policies on accession, deployment, and retention standards over the lifecycle of service members.
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The effectiveness of the intraosseous (IO) route for fluid resuscitation remains uncertain. This study compares IO infusion rates and estimated volume expansion using clinically relevant infusion pressures with lactated Ringer's (LR) and hetastarch (HES). ⋯ HES flow rates are lower than LR flow rates in the sternum and tibia of swine. Sternal infusion of HES is likely to provide greater estimated intravascular volume expansion than LR despite the lower infusion rates.