J Trauma
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Combat casualties with traumatic amputations (TA) and requiring laparotomy present unique clinical challenges. The purpose of this study was to determine the association of TA on blood/blood product usage, emergency department (ED) and operating room (OR) times, and mortality in those undergoing exploratory laparotomy after combat injury. ⋯ TA with penetrating abdominal injuries are associated with increased transfusions of blood products beginning at patient arrival. Massive transfusion protocols should be activated as soon as this injury is identified. The severity of this injury pattern was only manifested by an increased heart rate at admission. TA with abdominal injury spent less time in ED and a longer time in OR; however, there was no increase in mortality.
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Controversy persists regarding the optimal treatment regimen for Pseudomonas ventilator-associated pneumonia (VAP). Combination antibiotic therapy is used to broaden the spectrum of activity of empiric treatment and provide synergistic bacteriocidal activity. The relevance of such "synergy" is commonly supposed but poorly supported. The purpose of this study was to evaluate the efficacy of monotherapy in the treatment of Pseudomonas VAP as measured by microbiological resolution. ⋯ Monotherapy in the treatment of Pseudomonas VAP has an excellent success rate in patients with trauma. Empiric monotherapy therapy should be modified once susceptibility of the microorganism is documented (all isolates were sensitive to cefepime) and antibiotic choice should be based on local patterns of susceptibilities. The routine use of combination therapy for synergy is unnecessary. Combination therapy should be reserved for patients with persistent microbiological evidence of Pseudomonas VAP despite adequate therapy.
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United States Army Forward Surgical Teams (FSTs) consist of twenty personnel and are the Army's smallest surgical units. Currently, they provide the majority of resuscitative surgical care for combat casualties in Afghanistan where the mission of the FST has been further extended to include "split-based operations." The effectiveness of these 10-person teams is unknown and outcome data has not been previously reported in the literature. This article evaluates the effectiveness of one split FST during a 14-month period in remote Afghanistan. ⋯ Small two-surgeon surgical teams can achieve acceptable DOW rates when compared with other larger surgical units currently operating in the Global War on Terror.
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Comparative Study
A comparison of posttraumatic stress disorder between combat casualties and civilians treated at a military burn center.
Posttraumatic stress disorder (PTSD) has been identified in 12% to 20% of noninjured veterans and in 32% of combat casualties. Eight percent of the US general population experience PTSD symptoms, whereas 25.5% of civilians with major burns have PTSD. Known predictors of physical outcomes of patients with burn are age, total body surface area (TBSA) burned, and Injury Severity Score (ISS). The United States Army Institute of Surgical Research Burn Center provides burn care for combat casualties and civilians. We hypothesized that we would find no difference in PTSD incidence between these two populations and that age, TBSA, and ISS are associated with PTSD. ⋯ The incidence of PTSD is not significantly different in burned combat casualties and civilians treated at the same burn unit. These findings suggest that PTSD is related to the burn trauma and not to the circumstances surrounding the injury.
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Prehospital management of exsanguinating extremity injuries (EEI) includes direct compression or tourniquets or both. Direct compression may be ineffective in deep wounds and requires a person committed to compressing. Tourniquets may cause severe ischemic damage and may be ineffective in proximal wounds. This study aims to examine a new self-expanding hemostatic polymer (SEHP) for control of EEI. In contact with blood, the polymer absorbs the aqueous component of blood and exerts a tamponade effect by expanding against the walls of the wound cavity. ⋯ SEHP is a novel, light, and portable material to control EEI effectively. It does not require another person for compression nor does it compromise the circulation. As EEI occurs with alarming frequency in the battlefield, SEHP may not only present an optimal hemostatic method for military applications but also be useful in the civilian prehospital setting.