J Trauma
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Blunt carotid artery injuries (BCI) are being recognized and treated with increasing frequency because of improved screening protocols. Recent advances in endovascular techniques using microcoils, angioplasty, and stenting offer a new treatment strategy for those patients with traumatic pseudoaneurysms (PA) (BCI and PA). Experience with these techniques is limited because of the rarity of these injuries. ⋯ Carotid artery stenting is safe and effective initial therapy for patients with nonocclusive BCI and PA. Initial intermediate-term follow-up also fails to demonstrate significant morbidity for up to 4 years.
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Incomplete or delayed fasciotomies are associated with muscle necrosis and death in civilian trauma. Combat explosions severely damage tissue and distort normal anatomy making fasciotomies challenging. Rapid air evacuation may delay treatment of patients with evolving extremity compartment syndrome. We investigated the impact of fasciotomy revision and delayed compartment release on combat casualties after air evacuation. ⋯ Fasciotomy revision was associated with a fourfold increase in mortality. The most common revision procedures were extension of fascial incisions and opening new compartments. The most commonly unopened compartment was the anterior compartment of the lower leg. Patients who underwent delayed fasciotomies had twice the rate of major amputation and a threefold higher mortality.
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Case Reports
Inferior vena cava filter migration to right ventricle with destruction of tricuspid valve: a case report.
Inferior vena cava filter migration is an uncommon event. Temporary inferior vena cava filters offer protection against pulmonary embolism in the trauma patient in whom anticoagulation is contraindicated. ⋯ One week later the IVC filter had migrated to the right ventricle and destroyed the tricuspid valve. Although there are a limited number of cases describing the migration of IVC filters to the heart, there have been no cases in the literature, to our knowledge, where an IVC filter has destroyed the tricuspid valve and required valve replacement.
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Since the onset of military operations in Iraq and Afghanistan, there has been a marked increased in multidrug resistant bacterial infections among combat casualties. We describe the rates of ventilator-associated pneumonia (VAP) before and after the implementation of aggressive infection control measures at the Air Force Theater Hospital in Iraq. ⋯ Implementation of aggressive infection control procedures in a combat military hospital was associated with a significant decrease in the rate of VAP. Despite the numerous challenges in theater, infection control can have measurable and sustainable impact in a combat theater hospital.
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Operations Enduring Freedom and Iraqi Freedom have resulted in severe burns to the hands. Because of the frequency and severity of hand burns, an All Army Activity (ALARACT) message was distributed emphasizing the importance of hand protection (HP). Our purpose was to assess the effectiveness of the ALARACT in reducing the incidence and severity of hand burns. ⋯ Post-ALARACT, the incidence of hand burns remained unchanged. Despite an increase in burn severity, ratio of hand burn to TBSA decreased, suggesting a possible relationship between increased awareness and use of HP and decreased injury. Based on the data collected, the impact of the ALARACT is unclear. The importance of HP remains a priority. The fact that the incidence of hand burns remains unchanged demands our continued awareness and increased efforts.