Journal of the Royal Army Medical Corps
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Review Case Reports
Freedom from frozen: the first British military use of lyophilised plasma in forward resuscitation.
Prehospital use of blood products may improve survival. However, transfusion support with frozen blood components is logistically burdensome and constrains the configuration of prehospital medical support. Alternatives to frozen plasma, including lyophilised plasma, offer the potential for advanced resuscitation in the prehospital environment. We describe the successful use of lyophilised plasma by a UK patrol in the prehospital environment during operations in Afghanistan in 2012 and reflect on recent military experience and the need for further developments.
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It is known that the first radiological units were widely used during war conflicts, whereas the first application of military radiology took place during the Greco-Turkish War in 1897. However, until recently automobile radiology units were assumed to be used for the first time during World War I. ⋯ This short historical note describes the first use of a mobile radiology unit during the Balkan Wars (1912-1913), predating its previously presumed first use in World War I. It also briefly highlights the contributions of some notable figures in 20th Century Greek scientific development.
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To report the clinical features of ocular injuries associated with explosive military ammunition in insurgent attacks in Turkey. ⋯ The clinical results for eye injuries caused by explosive military ammunition sustained during insurgent attacks in Turkey are disappointing irrespective of the explosive material. The use of protective eyeglasses might improve the outcomes and should be encouraged.
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Case Reports
Predictive utility of cardiac ultrasound in traumatic cardiac arrest in a combat casualty.
We report a case of traumatic cardiac arrest in a combat casualty who was resuscitated to return of spontaneous circulation despite asystole and no visible cardiac activity on initial ultrasound examination. This return of spontaneous circulation suggests that survival may be possible in traumatic cardiac arrest due to exsanguination, even when there is no demonstrable cardiac activity on ultrasound. ⋯ We suggest that cardiac ultrasonography should be performed for a minimum of 1 min during volume resuscitation. If absence of cardiac activity is confirmed once the heart is full, and there are no other signs of life (including pupillary reaction), then termination of resuscitation should be considered.
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Post-traumatic hypothermia often occurs as a direct consequence of haemorrhage and shock. Environmental exposure in austere environments may also contribute to its pathogenesis. In those casualties that present in cardiac arrest following injury, coexisting hypothermia may be the primary cause of the arrest, or a marker of the severity of shock. A case of a 25-year-old combat casualty is presented, illustrating some of the technical challenges faced by clinicians while resuscitating hypothermic trauma patients in cardiac arrest.