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Junctional tourniquet

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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
#1
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
#2
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-ischemia-reperfusion
#3
R Rudolf
In 1718, French surgeon Jean-Louis Petit refined the methods to prevent haemorrhage from severely injured limbs by a combined screw and pad attached to a bandage (Kirkup, 2007). He named this device tourniquet (from French tourner = to turn), because the screw allowed fine adjustment of the application without moving the bandage component. Since then, tourniquet has undergone several modifications and its use is a matter of constant debate. Tourniquets serve primarily in combat but also in civilian emergency medicine to prevent fatal exsanguination and an estimated number of 15,000 daily tourniquet applications (McEwen and Casey, 2009) illustrates its present clinical relevance...
August 6, 2016: Acta Physiologica
https://www.readbyqxmd.com/read/27450597/preliminary-measures-of-instructor-learning-in-teaching-junctional-tourniquet-users
#4
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
#5
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...
June 16, 2016: Acta Physiologica
https://www.readbyqxmd.com/read/27230520/assessment-of-groin-application-of-junctional-tourniquets-in-a-manikin-model
#6
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
https://www.readbyqxmd.com/read/27172149/physiological-consequences-of-abdominal-aortic-and-junctional-tourniquet-aajt-application-to-control-hemorrhage-in-a-swine-model
#7
Bijan S Kheirabadi, Irasema B Terrazas, Nahir Miranda, Amber N Voelker, Rose Grimm, John F Kragh, Michael A Dubick
INTRODUCTION: Specialized tourniquets such as Abdominal Aortic and Junctional Tourniquet (AAJT) have been deployed for control of junctional hemorrhage with limited information concerning their efficacy and safety. We examined physiological effects of a 2-h abdominal application of AAJT to control groin hemorrhage in a swine model. METHODS: Anesthetized pigs were subjected to 25% controlled hemorrhage and a groin arterial injury. Resulting hemorrhage from the groin wound was controlled for 2 h by applying AAJT on each pig's abdomen...
September 2016: Shock
https://www.readbyqxmd.com/read/27100757/surgical-adjuncts-to-noncompressible-torso-hemorrhage-as-tools-for-patient-blood-management
#8
Joseph F Rappold, Grant V Bochicchio
Despite the tremendous advances and successes in the care of combat casualties over the past 15 years of war, noncompressible torso hemorrhage (NCTH) remains the most likely source of potentially preventable death (approx. 25%) on the battlefield. This is also likely true for civilian victims of blunt and penetrating trauma. Various devices and therapeutic interventions have been, and are being, developed in an attempt to reduce morbidity and mortality for patients with NCTH. Examples include the use of prehospital blood and blood products, tranexamic acid, specially designed tourniquets for junctional hemorrhage control, retrograde endovascular balloon occlusion of the aorta, intracavity foam, expandable hemostatic sponges, and intravascular nanoparticles to suspended animation...
April 2016: Transfusion
https://www.readbyqxmd.com/read/27046574/junctional-and-inguinal-hemorrhage-simulation-tourniquet-master-training
#9
Calvin Kwan, Shlomi Laufer, Montserrat Calixto Contreras, Peter Weyhrauch, James Niehaus, Noa Palmon, Benjamin Bauchwitz, Carla Pugh
Hemorrhages are the leading cause of potentially survivable combat mortalities when patients are unable to reach a treatment facility in time. New tourniquet devices have been developed to combat hemorrhages in the field. However, there is a lack in training systems to properly teach and assess users on tourniquet device application. We have developed an objective feedback system applicable to various full body manikins. We tested the system with expert users and received improvement feedback and verified the system's usefulness in instructing and assessing correct tourniquet device use...
2016: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/27045493/evaluation-and-testing-of-junctional-tourniquets-by-special-operation-forces-personnel-a-comparison-of-the-combat-ready-clamp-and-the-junctional-emergency-treatment-tool
#10
COMPARATIVE STUDY
Charalampos A Theodoridis, Kelly E Kafka, Alejandro M Perez, Jeremy B Curlee, Paul C J Yperman, Nico Oppermann, Eirik Holmstroem, Derek D Niegsch, Antonio Mannino, Nicola Ramundo
BACKGROUND: Previous research has shown that external hemorrhage from proximal leg amputations and junctional sites represents 19.2% of potentially survivable lethal hemorrhage. A recent effort to address this problem has resulted in the development of various junctional tourniquets. This study assessed and compared two Tactical Combat Casualty Care Committee-approved junctional tourniquets, the Combat Ready Clamp (CRoC) and the Junctional Emergency Treatment Tool (JETT), to contribute to their future development and to better inform on the decisions for device selection by military units...
2016: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/27045492/testing-of-junctional-tourniquets-by-medics-of-the-israeli-defense-force-in-control-of-simulated-groin-hemorrhage
#11
COMPARATIVE STUDY
Jacob Chen, Avi Benov, Roy Nadler, Geva Landau, Alex Sorkin, James K Aden, John F Kragh, Elon Glassberg
BACKGROUND: Junctional hemorrhage is a common cause of battlefield death but little is known about testing of junctional tourniquet models by medics. The purpose of the testing described herein is to assess military experience in junctional tourniquet use in simulated prehospital care. METHODS: Fourteen medics were to use the following four junctional tourniquets: Combat Ready Clamp (CRoC), Abdominal Aortic Junctional Tourniquet (AAJT), Junctional Emergency Treatment Tool (JETT), and SAM Junctional Tourniquet (SJT)...
2016: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/26540712/control-of-junctional-hemorrhage-in-a-consensus-swine-model-with-hemostatic-gauze-products-following-minimal-training
#12
Sean P Conley, Lanny F Littlejohn, Jose Henao, Sara S DeVito, Gregory J Zarow
OBJECTIVE: Uncontrolled hemorrhage from junctional wounds that cannot be controlled by traditional tourniquets accounts for one in five preventable battlefield exsanguination deaths. Products for treating these wounds are costly and require special training. However, chemically treated gauze products are inexpensive, potentially effective, and require only minimal training. This study was designed to assess the efficacy of three hemostatic gauze products following brief training, using a consensus swine groin injury model...
November 2015: Military Medicine
https://www.readbyqxmd.com/read/26406432/prehospital-use-of-hemostatic-dressings-by-the-israel-defense-forces-medical-corps-a-case-series-of-122-patients
#13
Avi Shina, Ari M Lipsky, Roy Nadler, Moran Levi, Avi Benov, Yuval Ran, Avraham Yitzhak, Elon Glassberg
BACKGROUND: Hemostatic dressings are advanced topical dressings designed to control hemorrhage by enhancing clot formation. These dressings may be effective when used on injuries sustained in junctional zones. The Israeli Defense Forces Medical Corps (IDF-MC) chose to equip its medical personnel with the QuikClot Combat Gauze. There is a paucity of data describing clinical use and results of hemostatic dressing especially at the point of injury. The purpose of this article was to report the IDF-MC experience with prehospital use of the QuikClot Combat Gauze in junctional zones in a case series retrieved from the IDF Trauma Registry...
October 2015: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/26360350/junctional-tourniquet-training-experience
#14
REVIEW
John F Kragh, James J Geracci, Donald L Parsons, John B Robinson, Kimberlie A Biever, Erling B Rein, Elon Glassberg, Geir Strandenes, Jacob Chen, Avi Benov, David Marcozzi, Stacy Shackelford, Kevin M Cox, Elizabeth A Mann-Salinas
Since 2009, out-of-hospital care of junctional hemorrhage bleeding from the trunk-appendage junctions has changed, in part, due to the newly available junctional tourniquets (JTs) that have been cleared by the US Food and Drug Administration. Given four new models of JT available in 2014, several military services have begun to acquire, train, or even use such JTs in care. The ability of users to be trained in JT use has been observed by multiple instructors. The experience of such instructors has been broad as a group, but their experience as individuals has been neither long nor deep...
2015: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/26125162/saving-lives-on-the-battlefield-part-ii-one-year-later-a-joint-theater-trauma-system-and-joint-trauma-system-review-of-prehospital-trauma-care-in-combined-joint-operations-area-afghanistan-cjoa-a-final-report-30-may-2014
#15
Samual W Sauer, John B Robinson, Michael P Smith, Kirby R Gross, Russ S Kotwal, Robert L Mabry, Frank K Butler, Zsolt T Stockinger, Jeffrey A Bailey, Mark E Mavity, Duncan A Gillies
The United States has achieved unprecedented survival rates, as high as 98%, for casualties arriving alive at the combat hospital. Our military medical personnel are rightly proud of this achievement. Commanders and Servicemembers are confident that if wounded and moved to a Role II or III medical facility, their care will be the best in the world. Combat casualty care, however, begins at the point of injury and continues through evacuation to those facilities. With up to 25% of deaths on the battlefield being potentially preventable, the prehospital environment is the next frontier for making significant further improvements in battlefield trauma care...
2015: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/25877427/descending-phlebography-in-patients-with-venous-ulceration-hemodynamic-implications
#16
K G Papadakis, D Christopoulos, J T Hobbs, A N Nicolaides
AIM: The aim of this paper is to report on the hemodynamic significance of the various degrees reflux as demonstrated on descending phlebography, by comparing the phlebographic findings with ambulatory venous pressure (AVP) measurements. METHOD: Thirty-two patients (45 affected limbs) with active or healed venous ulceration were admitted to the study. Descending phlebography with grading of reflux (0-4 using Herman's grading), AVP and refilling time 90 (RT90) were performed in all patients...
June 2015: International Angiology: a Journal of the International Union of Angiology
https://www.readbyqxmd.com/read/25704877/application-of-current-hemorrhage-control-techniques-for-backcountry-care-part-two-hemostatic-dressings-and-other-adjuncts
#17
REVIEW
Lanny Littlejohn, Brad L Bennett, Brendon Drew
Decade-long advances in battlefield medicine have revolutionized the treatment of traumatic hemorrhage and have led to a significant reduction in mortality. Part one of this review covered the use of tourniquets on the extremities and the newer devices for use in junctional areas. Part two focuses on the use of hemostatic agents or dressings, pelvic binders, and tranexamic acid. Field applicable hemostatic dressings are safe and effective in controlling hemorrhage not amenable to extremity tourniquet application, and newer agents with increasing efficacy continue to be developed...
June 2015: Wilderness & Environmental Medicine
https://www.readbyqxmd.com/read/25704875/application-of-current-hemorrhage-control-techniques-for-backcountry-care-part-one-tourniquets-and-hemorrhage-control-adjuncts
#18
REVIEW
Brendon Drew, Brad L Bennett, Lanny Littlejohn
Decade-long advancements in battlefield medicine have revolutionized the treatment of traumatic hemorrhage and have led to a significant reduction in mortality. Older methods such as limb elevation and pressure points are no longer recommended. Tourniquets have had a profound effect on lives saved without the commonly feared safety issues that have made them controversial. Unique tourniquet designs for inguinal and abdominal regions are now available for areas not amenable to current fielded extremity tourniquets...
June 2015: Wilderness & Environmental Medicine
https://www.readbyqxmd.com/read/25674988/topical-hemostatic-agents-and-dressings-in-the-prehospital-setting
#19
REVIEW
Thomas E Grissom, Raymond Fang
PURPOSE OF REVIEW: Death from exsanguinating hemorrhage remains a priority in the management of combat casualties and civilian trauma patients with truncal and junctional injuries. Appropriate use of hemostatic agents and dressings in the prehospital setting may allow for earlier control and an improved survival rate. RECENT FINDINGS: Third-generation chitosan-based hemostatic agents and dressings appear to be equally efficacious to the dressing currently deployed by the US military forces in the management of hemorrhage not amenable to tourniquet placement...
April 2015: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/25494825/performance-of-junctional-tourniquets-in-normal-human-volunteers
#20
John F Kragh, Russ S Kotwal, Andrew P Cap, James K Aden, Thomas J Walters, Bijan S Kheirabadi, Robert T Gerhardt, Robert A DeLorenzo, Heather F Pidcoke, Leopoldo C Cancio
BACKGROUND: Inguinal bleeding is a common and preventable cause of death on the battlefield. Four FDA-cleared junctional tourniquets (Combat Ready Clamp [CRoC], Abdominal Aortic and Junctional Tourniquet [AAJT], Junctional Emergency Treatment Tool [JETT], and SAM Junctional Tourniquet [SJT]) were assessed in a laboratory on volunteers in order to describe differential performance of models. OBJECTIVE: To examine safety and effectiveness of junctional tourniquets in order to inform the discussions of device selection for possible fielding to military units...
July 2015: Prehospital Emergency Care
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