Journal of the Royal Army Medical Corps
-
Burn casualties will inevitably occur in the military environment during both conflict and peacetime. The number and type of casualties will vary on the nature of warfare and the type of troops deployed. New preventative measures have decreased the number and severity of burns found on the battlefield however with new weapon systems casualties suffering from thermal injuries are still to be expected in modern warfare. ⋯ These advances are reviewed here with emphasis on those that can be accomplished in the Role 3 facility by non-specialist clinicians. It is beyond the scope of this review to produce didactic treatment protocols but it is hoped that in the near future Clinical Guidelines for Operations will soon reflect these. Where advances have occurred that can not be mirrored in the field hospital early evacuation to specialist facilities back at Role 4 facilities should be a priority.
-
The majority of neurological admissions to military Intensive Care will be for Traumatic Brain Injury (TBI). These injuries will be either penetrating from fragmentation or missiles or blunt due to blast or impact. ⋯ This management is based largely on comprehensive evidence based guidelines produced by the Brain Trauma Foundation. The most significant dilemma faced by UK military intensivists is whether we should be measuring Intracranial Pressure in patient with severe TBI in the deployed setting; and if so what technique should be used.
-
The Surviving Sepsis Campaign (SSC) Guidelines collate the evidence for managing sepsis. Most of the interventions suggested by the SSC guidelines are very relevant to military critical care, including rapid microbiologic investigation, early antibiotic administration and many aspects of early goal directed therapy. Other interventions may be more difficult to provide in remote theatres of operation where resources may be limited. This article discusses the application of the SSC guidelines to deployed military hospitals, with suggestions as to which interventions are feasible, and which may not be indicated.
-
Emergency thoracotomy is a dramatic and controversial intervention which may be life saving after major torso trauma. Success rates are variable and differ widely according to mechanism of injury. This article outlines the current indications and contraindications to emergency thoracotomy and examines the evidence to support it accumulated over 40 years.
-
The mechanism of injury on the modern battlefield results in a pattern of wounding which is associated with both nociceptive and neuropathic pain. Nociceptive pain is managed using the WHO Analgesic Ladder but neuropathic pain requires the use of co-analgesic drugs, e.g. antidepressants and anticonvulsants. ⋯ During the first week post injury, 30% of casualties had a LANSS pain score > 12, suggesting a neuropathic element to their pain. The early detection (using LANSS) and management of neuropathic pain using robust protocols represent the most effective strategy to address this significant problem.