The American journal of emergency medicine
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Comparative Study
Assessing the evolution of pre-hospital combat casualty care: A comparative study of two conflicts a decade apart.
Combat casualty care has advanced significantly with the implementation of evidence-based protocols designed to lower combat-related mortality. Over the last decade, two major urban conflicts in southern Israel have challenged the evolving military trauma system. This study aimed to assess differences in prehospital care and compare the outcomes of aeromedically evacuated casualties from the 2014 and 2023 conflicts. ⋯ Over the past decade, there has been a decline in prehospital airway interventions and thoracostomies, coupled with an increase in early blood transfusions. Despite greater injury severity, mortality rates have remained stable. Although not statistically significant, lower mortality rates were recorded among the severely and critically injured. These findings support the "less is more" approach in modern prehospital combat casualty care.
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Testicular torsion (TT) is an emergency requiring timely surgery to prevent testicular loss. There is a lack of reports on the clinical significance of the time of admission (on-hours vs. off-hours) on the long-term surgical outcome of TT. ⋯ Testicular torsion is a time-dependent diagnosis, and any delay in treatment could cause testicular loss. Our data suggest that the DoS before admission, rather than the admission time, influences the testicular outcome. The efficient management of emergencies regardless of the time of day is a key factor for the reduced probability that admission timing affects outcomes.
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Ketamine is an NMDA receptor antagonist commonly used as a dissociative anesthetic and analgesic. Though it is conventionally administered via the intravenous, intramuscular, or intranasal route, use as a compounded analgesic cream is becoming increasingly common. This is a case report of a 61-year-old man who was detained by the police for erratic driving. ⋯ His clinical presentation was consistent with ketamine toxicity, and mass spectrometry demonstrated an elevated urine ketamine concentration (32,300 ng/mL). His symptoms resolved spontaneously within a few hours and he was discharged. This is a unique case of systemic toxicity following dermal application of a ketamine pain cream in a patient with impaired skin barrier function due to pyoderma gangrenosum.