J Trauma
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Comparative Study
Feasibility of using rotational thromboelastometry to assess coagulation status of combat casualties in a deployed setting.
Coagulopathy in trauma patients is currently defined by the results of standard laboratory tests (prothrombin time and activated partial thromboplastin time). These results offer little in the hemostatic resuscitation that occurs in the treatment of battlefield patients who receive massive transfusions. Thromboelastometry (TEM) is a technique that can offer rapid, near-patient testing of coagulation status. ⋯ It is feasible to use TEM in a deployed military setting. We have shown that rotational thromboelastometry significantly detects more abnormalities in the coagulation status than the standard laboratory tests (prothrombin time, and activated partial thromboplastin time).
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Comparative Study
A large animal survival model (Sus scrofa) of extremity ischemia/reperfusion and neuromuscular outcomes assessment: a pilot study.
Extremity ischemia/reperfusion has been studied mostly in small-animal models with limited characterization of neuromuscular or functional outcome. The objective of this experiment was to report a large-animal survival model of extremity ischemia/reperfusion using circulating, electromyographic (EMG), gate, and histologic measures of injury and limb recovery. ⋯ This study reports a new large-animal survival model of extremity ischemia/reperfusion using circulating, functional, and histologic markers of neuromuscular recovery. Findings provide insight into an extremity ischemic threshold after which functional neuromuscular recovery is lost. Additional study is necessary to define this threshold and factors that may move it to a more or less favorable position in the setting of extremity injury.
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This study evaluated the progress in the treatment and prevention of hypothermia in combat wounded since the October 2, 2006 Joint Theater Trauma System Clinical Practice Guideline (CPG) publication and evaluated the frequency of use and effectiveness of the methods described in the CPG. ⋯ (1) The incidence of hypothermia decreased after the issuance of the JTTS CPG. (2) The standard Army wool blanket is the most commonly used thermoregulatory method during transport in theater. (3) This study did not find a significant difference in the capability of maintaining temperatures between the different thermoregulatory methods used in theater during either prehospital or interfacility transport, or in the incidence of hypothermia between patients presenting from the site of injury or from interfacility transport. (4) Data collected before a Level III facility is not consistently entered into the Joint Theater Trauma Registry.
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Comparative Study
Response to infection control challenges in the deployed setting: Operations Iraqi and Enduring Freedom.
Infections caused by multidrug-resistant organisms (MDROs), including Acinetobacter, have complicated the care of military personnel injured in Operations Iraqi and Enduring Freedom. Cumulative data suggest that nosocomial transmission of MDROs in deployed medical treatment facilities (MTFs) has contributed to these infections. A 2008 review of deployed MTFs identified multiple factors impeding the performance of infection prevention and control (IC) practices. In response, efforts to emphasize IC basics, improve expertise, and better track MDRO colonization were pursued. ⋯ Maintaining a strong IC effort in the deployed setting, even in a stabilized operational environment, is difficult. Use of innovative strategies to enhance expertise and practice were implemented to reduce MDRO infections.
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Comparative Study
Preventing hypothermia: comparison of current devices used by the US Army in an in vitro warmed fluid model.
The purpose of this study was to develop an in vitro torso model constructed with fluid bags and to determine whether this model could be used to differentiate between the heat prevention performance of devices with active chemical or radiant forced-air heating systems compared with passive heat loss prevention devices. ⋯ Our in vitro fluid bag "torso" model seemed sensitive to detect heat loss in the evaluation of several active or passive warming devices. All active and most passive devices were better than wool blankets. Under conditions near room temperature, passive warming methods (Blizzard blanket or the Hot Pocket) were as effective as active warming devices other than the original HPMK. Further studies are necessary to determine how these data can translate to field conditions in preventing heat loss in combat casualties.