J Trauma
-
Case Reports
Biological foreign body implantation in victims of the London July 7th suicide bombings.
On the morning of July 7, 2005, a co-ordinated attack by suicide bombers on the London public transport system resulted in four explosions at densely packed civilian targets. Of the victims of these attacks, 194 were treated at the Royal London Hospital, where among the most severely injured an unusual pattern of injury was seen. ⋯ We present case reports of five of these patients, and discuss problems arising from the management of their injuries. Allogenic bony foreign bodies, rarely reported in the medical literature, present unusual problems in their management, in particular the risk of transmitting blood borne diseases, which should be anticipated and addressed in a hospital's major incident planning.
-
The optimal abdominal closure in critically ill surgical/trauma patients remains controversial with a wide variety of commonly employed techniques. We sought to evaluate clinical equipoise by surveying Canadian surgeons regarding the use of temporary abdominal closure strategies in damage control and emergency situations. ⋯ Reported opinions suggest an overall appreciation for markers of "Damage Control," although clinical equipoise exists regarding the preferred technique and a frequent early use of mesh. These results highlight the necessity for further research but suggest challenges in defining a common standard for multicenter trials.
-
Noncompressible hemorrhage is a major cause of death in combat and civilian trauma. When surgery is unavailable, one potential solution to such hemorrhage might be the introduction of an agent into the closed body cavity to provide hemostasis via a combination of coagulative and tamponade effects. FloSeal is an agent containing collagen and thrombin with proven hemostatic efficacy when applied with manual pressure to a bleeding site. The current studies were conducted to analyze the ability of FloSeal to reduce blood loss and increase survival time when applied directly, immediately, and without additional pressure to a severe liver injury in rats. ⋯ Reductions in fluid loss after liver injury and hemorrhage in FloSeal-treated rats in the absence of additional applied pressure are encouraging, and provide evidence for the ability of FloSeal to reduce blood loss when applied immediately and directly to a bleeding tissue.
-
An optimal protocol for clearing the cervical spine in unconscious patients with traumatic brain injury remains controversial. Protocols include plain radiographs and computed tomography (CT), and ligamentous injury may be identified with flexion-extension radiographs. We questioned whether cervical CT with three-dimensional (3D) reconstructions may obviate the need for flexion-extension radiology in the detection of occult ligamentous injury. ⋯ Dynamic flexion-extension X-ray studies with fluoroscopy delayed cervical spine clearance and were almost always reported as normal. In a cervical spine clearance protocol for unconscious traumatic brain injury patients, dynamic flexion-extension X-ray studies with fluoroscopy did not identify any patients with cervical fracture or instability not already identified by plain radiographs and fine-cut CT (C0 to T2) with 3D reconstructions.
-
Recent events have refocused attention on certain principles regarding the surgical management of casualties on the battlefield. Extremity vascular injuries predominate, representing 50 to 70% of all injuries treated during Operation Iraqi Freedom, and exsanguination from extremity wounds is the leading cause of preventable death on the modern battlefield. Recent advances in military medicine have translated into a greater percentage of wounded soldiers surviving during Operations Enduring and Iraqi Freedom than in any other previous American conflict. The combat-experienced military surgeon, a fraction of those in uniform until recently, rarely has had the opportunity to convey lessons learned to the newly indoctrinated war surgeon. The purpose of this review is to do exactly that. ⋯ The management of extremity vascular injuries on the modern battlefield presents many unique and demanding challenges to even the most seasoned of surgeons. Preparation goes a long way in overcoming some of the obstacles to seamless patient care.