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Junctional tourniquet

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https://www.readbyqxmd.com/read/29661286/comparison-of-zone-3-resuscitative-endovascular-balloon-occlusion-of-the-aorta-and-the-abdominal-aortic-and-junctional-tourniquet-in-a-model-of-junctional-hemorrhage-in-swine
#1
Jason M Rall, Theodore T Redman, Elliot M Ross, Jonathan J Morrison, Joseph K Maddry
BACKGROUND: Traumatic injuries to the pelvis and high junctional injuries are difficult to treat in the field; however, Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) and the Abdominal Aortic and Junctional Tourniquet (AAJT) constitute two promising treatment modalities. The aim of this study is to use a large animal model of pelvic hemorrhage to compare the survival, hemostatic, hemodynamic, and metabolic profile of both techniques. METHODS: Yorkshire swine (n = 10, 70-90 kg) underwent general anesthesia, instrumentation, and surgical isolation of the femoral artery...
June 2018: Journal of Surgical Research
https://www.readbyqxmd.com/read/29615933/dexamethasone-protects-against-tourniquet-induced-acute-ischemia-reperfusion-injury-in-mouse-hindlimb
#2
Ryan M Corrick, Huiyin Tu, Dongze Zhang, Aaron N Barksdale, Robert L Muelleman, Michael C Wadman, Yu-Long Li
Extremity injuries with hemorrhage have been a significant cause of death in civilian medicine and on the battlefield. The use of a tourniquet as an intervention is necessary for treatment to an injured limb; however, the tourniquet and subsequent release results in serious acute ischemia-reperfusion (IR) injury in the skeletal muscle and neuromuscular junction (NMJ). Much evidence demonstrates that inflammation is an important factor to cause acute IR injury. To find effective therapeutic interventions for tourniquet-induced acute IR injuries, our current study investigated effect of dexamethasone, an anti-inflammatory drug, on tourniquet-induced acute IR injury in mouse hindlimb...
2018: Frontiers in Physiology
https://www.readbyqxmd.com/read/29589042/-hemostyptics-for-treatment-of-junctional-vascular-injuries-management-of-traumatic-vascular-injuries-at-the-transition-from-trunk-to-extremities
#3
REVIEW
D C Hinck, S Wipper, E S Debus
BACKGROUND: Uncontrolled post-traumatic bleeding is still the leading cause of death among trauma patients. In situations of mass casualty incidents (MASCAL) and military conflicts the treatment of uncontrolled critical bleeding is a challenge and associated with a worse outcome due to the austere environment; however, even under optimal treatment circumstances in situations of individual medicine the severity of vascular trauma is underestimated. As a consequence, this leads to a poorer prognosis for patients with (vascular) injuries...
March 27, 2018: Der Unfallchirurg
https://www.readbyqxmd.com/read/29547925/the-platinum-5-min-in-tccc-analysis-of-junctional-and-extremity-hemorrhage-scenarios-with-a-mathematical-model
#4
Thorsten Tjardes, Markus Luecking
Introduction: To achieve the aim of zero preventable deaths on the battlefield a deeper understanding of uncontrolled hemorrhage from junctional or proximal extremity sources is mandatory. While tourniquet application to the extremities has drastically reduced morbidity and mortality, there is still room for improvement regarding the timing of tourniquet placement as the available evidence clearly points out a tight correlation between timing of tourniquet application and outcome. To save as many lives as possible the "point of no return" regarding the circulatory breakdown due to hemorrhage, colloquially addressed as platinum 5 min, needs to be determined...
March 14, 2018: Military Medicine
https://www.readbyqxmd.com/read/29487207/how-many-patients-could-benefit-from-reboa-in-prehospital-care-a-retrospective-study-of-patients-rescued-by-the-doctors-of-the-paris-fire-brigade
#5
Oscar Thabouillot, K Bertho, E Rozenberg, N-C Roche, G Boddaert, D Jost, J-P Tourtier
INTRODUCTION: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique to control haemorrhage by placing a retrograde catheter in an artery and inflating a balloon at its tip. This retrospective study aimed to evaluate the proportion of injured people who could potentially have benefited from this technique prior to hospitalisation, including on the scene or during transport. METHODS: A retrospective analysis was conducted of all patients with trauma registered in the Paris Fire Brigade emergency medical system between 1 January and 31 December 2014...
February 27, 2018: Journal of the Royal Army Medical Corps
https://www.readbyqxmd.com/read/29370063/fresh-whole-blood-resuscitation-does-not-exacerbate-skeletal-muscle-edema-and-long-term-functional-deficit-after-ischemic-injury-and-hemorrhagic-shock
#6
Amit Aurora, Janet L Roe, Nsini A Umoh, Michael Dubick, Joseph C Wenke, Thomas J Walters
BACKGROUND: Hemorrhagic shock due to extremity vascular injuries is common in combat injuries. Fluid resuscitation is the standard treatment for severe hemorrhage. Tourniquets (TK) used for hemorrhage control cause ischemia-reperfusion (I/R) injury that induces edema formation in the injured muscle. Resuscitation fluids affect edema formation; however, its effect on long-term functional response remains unknown. The objectives of this study are 1) compare acute muscle damage; 2) determine long-term functional recovery of ischemic muscle, and 3) compare local and systemic inflammatory response including the expression of junctional proteins following early resuscitation with Hextend (HEX) and Fresh Whole Blood (FWB) using a rodent model of combined hemorrhage and TK-induced limb I/R...
January 24, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29242798/anterior-elbow-pain-caused-by-compression-of-the-lateral-antebrachial-cutaneous-nerve
#7
Sean M Booth, Abdulbaset Abosala, Chris Peach
Introduction: The complex anatomy and biomechanics of the elbow joint can lead to diagnostic uncertainty when a clinician is determining the cause of a patient's anterior elbow pain. We present a case of anterior elbow pain with an uncommon and often overlooked etiology. Elbow pain due to compression of the lateral antebrachial nerve (LACN) has an unknown incidence or prevalence. Case Report: A 27-year-old left-hand dominant male presented to our orthopedic elbow clinic complaining of bilateral elbow clicking and discomfort which had been present for several years...
September 2017: Journal of Orthopaedic Case Reports
https://www.readbyqxmd.com/read/29239852/management-specificities-for-abdominal-pelvic-and-vascular-penetrating-trauma
#8
E Hornez, F Béranger, T Monchal, Y Baudouin, G Boddaert, H De Lesquen, S Bourgouin, Y Goudard, B Malgras, G Pauleau, V Reslinger, N Mocellin, C Natale, L Meyrat, J-P Avaro, P Balandraud, S Gaujoux, S Bonnet
Management of patients with penetrating trauma of the abdomen, pelvis and their surrounding compartments as well as vascular injuries depends on the patient's hemodynamic status. Multiple associated lesions are the rule. Their severity is directly correlated with initial bleeding, the risk of secondary sepsis, and lastly to sequelae. In patients who are hemodynamically unstable, the goal of management is to rapidly obtain hemostasis. This mandates initial laparotomy for abdominal wounds, extra-peritoneal packing (EPP) and resuscitative endovascular balloon occlusion of the aorta (REBOA) in the emergency room for pelvic wounds, insertion of temporary vascular shunts (TVS) for proximal limb injuries, ligation for distal vascular injuries, and control of exteriorized extremity bleeding with a tourniquet, compressive or hemostatic dressings for bleeding at the junction or borderline between two compartments, as appropriate...
November 24, 2017: Journal of Visceral Surgery
https://www.readbyqxmd.com/read/29077240/training-and-assessing-critical-airway-breathing-and-hemorrhage-control-procedures-for-trauma-care-live-tissue-versus-synthetic-models
#9
Danielle Hart, Robert Rush, Gregory Rule, Joseph Clinton, Gregory Beilman, Shilo Anders, Rachel Brown, Mary Ann McNeil, Troy Reihsen, Jeffrey Chipman, Robert Sweet
INTRODUCTION: Optimal teaching and assessment methods and models for emergency airway, breathing, and hemorrhage interventions are not currently known. The University of Minnesota Combat Casualty Training consortium (UMN CCTC) was formed to explore the strengths and weaknesses of synthetic training models (STMs) versus live tissue (LT) models. In this study, we compare the effectiveness of best in class STMs versus an anesthetized caprine (goat) model for training and assessing seven procedures: junctional hemorrhage control, tourniquet (TQ) placement, chest seal, needle thoracostomy (NCD), nasopharyngeal airway (NPA), tube thoracostomy, and cricothyrotomy (Cric)...
February 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28885969/the-use-of-the-abdominal-aortic-and-junctional-tourniquet-during-cardiopulmonary-resuscitation-following-traumatic-cardiac-arrest-in-swine
#10
Jason Rall, Jennifer M Cox, Joseph Maddry
BACKGROUND: Standard cardiopulmonary resuscitation (CPR) is ineffective in treating traumatic cardiac arrest (TCA) following hemorrhagic shock despite fluid resuscitation. CPR adjuncts, including abdominal compressions and external counter pressure, have shown some success in laboratory settings. The Abdominal Aortic and Junctional Tourniquet (AAJT) is a device that occludes both venous and arterial blood at the level of the aortic bifurcation and likely increases thoracic pressure when applied to the abdomen...
September 2017: Military Medicine
https://www.readbyqxmd.com/read/28599033/assessment-of-trainer-skill-to-control-groin-wound-bleeding-use-of-junctional-tourniquet-models-on-a-manikin
#11
John F Kragh, James K Aden, Stacy Shackelford, Virgil K Moore, Michael A Dubick
BACKGROUND: The purpose of this study was to assess the skills of trainers using different junctional tourniquet models to control groin bleeding in a manikin. MATERIALS AND METHODS: In 204 assessments, 17 trainers used four junctional tourniquet models three times each to control simulated hemorrhage. The models included the Combat Ready Clamp (CRoC), Junctional Emergency Treatment Tool (JETT), Abdominal Aortic and Junctional Tourniquet (AAJT), and SAM Junctional Tourniquet (SJT)...
December 0: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/28550903/hemodynamic-effects-of-the-abdominal-aortic-and-junctional-tourniquet-in-a-hemorrhagic-swine-model
#12
Jason M Rall, James D Ross, Michael S Clemens, Jennifer M Cox, Theresea A Buckley, Jonathan J Morrison
BACKGROUND: Torso hemorrhage constitutes a leading cause of battlefield mortality. The Abdominal Aortic and Junctional Tourniquet (AAJT) uses a pneumatic bladder to compress the aorta reducing pelvic and lower extremity perfusion; however, concern exists over the risk of caval compression exacerbating hypotension after application. METHODS: Male swine (70-90 kg) were randomized into four groups of 10: presence or absence of hemorrhage and AAJT placement. After a 40% hemorrhage, a 15-min period of hypovolemia was observed before the AAJT application...
May 15, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28428759/morphological-regeneration-and-functional-recovery-of-neuromuscular-junctions-after-tourniquet-induced-injuries-in-mouse-hindlimb
#13
Huiyin Tu, Dongze Zhang, Ryan M Corrick, Robert L Muelleman, Michael C Wadman, Yu-Long Li
Tourniquet application and its subsequent release cause serious injuries to the skeletal muscle, nerve, and neuromuscular junction (NMJ) due to mechanical compression and ischemia-reperfusion (IR). Monitoring structural and functional repair of the NMJ, nerve, and skeletal muscle after tourniquet-induced injuries is beneficial in exploring potential cellular and molecular mechanisms responsible for tourniquet-induced injuries, and for establishing effective therapeutic interventions. Here, we observed long-term morphological and functional changes of the NMJ in a murine model of tourniquet-induced hindlimb injuries...
2017: Frontiers in Physiology
https://www.readbyqxmd.com/read/28318990/junctional-hemorrhage-control-for-tactical-combat-casualty-care
#14
REVIEW
Russ S Kotwal, Frank K Butler
During historic, as well as more recent, conflicts, most combat casualties who die from their injuries do so in the prehospital setting. Although many of the injuries incurred by these casualties are nonsurvivable, a number of injuries are still potentially survivable. Of those injuries that are potentially survivable, the majority are truncal, junctional, and extremity hemorrhage. Novel and effective approaches directed toward prehospital hemorrhage control have emerged in recent years, some of which can prove useful in the management of junctional hemorrhage whether in a military or civilian setting...
June 2017: Wilderness & Environmental Medicine
https://www.readbyqxmd.com/read/27734441/evaluation-of-two-junctional-tourniquets-used-on-the-battlefield-combat-ready-clamp%C3%A2-versus-sam%C3%A2-junctional-tourniquet
#15
RANDOMIZED CONTROLLED TRIAL
Jean-Guillaume Meusnier, Charles Dewar, Erti Mavrovi, Frederic Caremil, Pierre-Francois Wey, Jean-Yves Martinez
BACKGROUND: Junctional hemorrhage (i.e., between the trunk and limbs) are too proximal for a tourniquet and difficult to compress. These hemorrhages are responsible for 20% of preventable deaths by bleeding on the battlefield. The majority of these involve the groin area. Devices allowing a proximal compression for arterial axes have been recently developed. OBJECTIVE: The purpose of this study was to compare the use of two junctional- tourniquet models, the Combat Ready Clamp (CRoC®) and the SAM® Junctional Tourniquet (SJT), in simulated out-of-hospital trauma care when tourniquets were ineffective to stop the arterial flow...
2016: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/27623805/prehospital-control-of-life-threatening-truncal-and-junctional-haemorrhage-is%C3%A2-the-ultimate-challenge-in-optimizing-trauma-care-a-review-of-treatment-options-and-their-applicability-in-the-civilian-trauma-setting
#16
REVIEW
S E van Oostendorp, E C T H Tan, L M G Geeraedts
INTRODUCTION: Exsanguination following trauma is potentially preventable. Extremity tourniquets have been successfully implemented in military and civilian prehospital care. Prehospital control of bleeding from the torso and junctional area's remains challenging but offers a great potential to improve survival rates. This review aims to provide an overview of potential treatment options in both clinical as preclinical state of research on truncal and junctional bleeding. Since many options have been developed for application in the military primarily, translation to the civilian situation is discussed...
September 13, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/27497271/avoiding-long-term-muscle-damage-upon-ischaemia-reperfusion
#17
EDITORIAL
R Rudolf
No abstract text is available yet for this article.
August 6, 2016: Acta Physiologica
https://www.readbyqxmd.com/read/27450597/preliminary-measures-of-instructor-learning-in-teaching-junctional-tourniquet-users
#18
John F Kragh, James K Aden, Stacy Shackelford, Michael A Dubick
BACKGROUND: The objective of the present study was to assess the effect of instructor learning on student performance in use of junctional tourniquets. METHODS: From a convenience sample of data available after another study, we used a manikin for assessment of control of bleeding from a right groin gunshot wound. Blood loss was measured by the instructor while training users. The data set represented a group of 30 persons taught one at a time. The first measure was a plot of mean blood loss volumes for the sequential users...
2016: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/27306588/dexamethasone-promotes-long-term-functional-recovery-of-neuromuscular-junction-in-a-murine-model-of-tourniquet-induced-ischaemia-reperfusion
#19
D Zhang, D Wang, I I Pipinos, R L Muelleman, Y-L Li
AIM: Tourniquet-induced ischaemia and subsequent reperfusion cause serious ischaemia-reperfusion (IR) injury in the neuromuscular junction (NMJ) and skeletal muscle. Here, we investigated whether dexamethasone (Dex) promotes long-term functional recovery of the NMJ and skeletal muscle in tourniquet-induced hindlimb IR. METHODS: Unilateral hindlimb of C57/BL6 mice was subjected to 3 h of ischaemia following 6 weeks of reperfusion (6-wk IR). Dex treatment began on the day of IR induction and lasted for different periods...
February 2017: Acta Physiologica
https://www.readbyqxmd.com/read/27230520/assessment-of-groin-application-of-junctional-tourniquets-in-a-manikin-model
#20
John F Kragh, Matthew P Lunati, Chetan U Kharod, Cord W Cunningham, Jeffrey A Bailey, Zsolt T Stockinger, Andrew P Cap, Jacob Chen, James K Aden, Leopoldo C Cancio
UNLABELLED: Introduction To aid in preparation of military medic trainers for a possible new curriculum in teaching junctional tourniquet use, the investigators studied the time to control hemorrhage and blood volume lost in order to provide evidence for ease of use. Hypothesis Models of junctional tourniquet could perform differentially by blood loss, time to hemostasis, and user preference. METHODS: In a laboratory experiment, 30 users controlled simulated hemorrhage from a manikin (Combat Ready Clamp [CRoC] Trainer) with three iterations each of three junctional tourniquets...
August 2016: Prehospital and Disaster Medicine
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