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Battlefield ultrasound

Christopher Hylkema
Ultrasound has been used for almost 30 years in a wide variety of clinical applications and environments. From the austerity of battlefields to the labor and delivery ward, ultrasound has the ability to give clinicians real-time, noninvasive diagnostic imaging. Ultrasound by emergency physicians (and all nonradiologists) has become more prevalent and has been used for examinations such as the transcranial Doppler to evaluate for stroke, cardiac function, FAST and EFAST examinations for trauma, and now increased intracranial pressure (ICP) via Optic Nerve Sheath Diameter Ultrasound (ONSD)...
March 2016: Critical Care Nursing Clinics of North America
Dean A Seehusen, Marjorie A Bowman, Anne Victoria Neale
This issue of the journal is filled with useful information for practicing family physicians. Several articles introduce new ideas for family physicians to use in the care of their patients, whereas other articles cover new approaches to old problems. Several studies report on procedures performed by family physicians: battlefield acupuncture, colonoscopy, and ultrasound. Some unique alternative care models are described and evaluated. An innovative method of delivering diabetes education seems to work well...
November 2015: Journal of the American Board of Family Medicine: JABFM
K Michael Sekins, Stephen R Barnes, Liexiang Fan, Jerry D Hopple, Stephen J Hsu, John Kook, Chi-Yin Lee, Caroline Maleke, A R Ramachandran, Xiaozheng Jenny Zeng, Romain Moreau-Gobard, Alexis Ahiekpor-Dravi, Gareth Funka-Lea, Stuart B Mitchell, Barbrina Dunmire, John C Kucewicz, John Eaton, Keith Wong, Scott Keneman, Lawrence A Crum
BACKGROUND: Bleeding from limb injuries is a leading cause of death on the battlefield, with deep wounds being least accessible. High-intensity focused ultrasound (HIFU) has been shown capable of coagulation of bleeding (cautery). This paper describes the development and refereed in vitro evaluation of an ultrasound (US) research prototype deep bleeder acoustic coagulation (DBAC) cuff system for evaluating the potential of DBAC in the battlefield. The device had to meet quantitative performance metrics on automated operation, therapeutic heating, bleeder detection, targeting accuracy, operational time limits, and cuff weight over a range of limb sizes and bleeder depths...
2015: Journal of Therapeutic Ultrasound
Andrew Beckett, Homer Tien
PURPOSE OF REVIEW: This article reviews the latest operative trauma surgery techniques and strategies, which have been published in the last 10 years. Many of the articles we reviewed come directly from combat surgery experience and may be also applied to the severely injured civilian trauma patient and in the context of terrorist attacks on civilian populations. RECENT FINDINGS: We reviewed the most important innovations in operative trauma surgery; the use of ultrasound and computed tomography in the preoperative evaluation of the penetrating trauma patient, the use of temporary vascular shunts, the current management of military wounds, the use of preperitoneal packing in pelvic fractures and the management of the multiple traumatic amputation patient...
December 2013: Current Opinion in Critical Care
David M Taylor, Martin Coleman, Paul J Parker
Despite improved body armor, hemorrhage remains the leading cause of preventable death on the battlefield. Trauma to the junctional areas such as pelvis, groin, and axilla can be life threatening and difficult to manage. The Abdominal Aortic Tourniquet (AAT) is a prehospital device capable of preventing pelvic and proximal lower limb hemorrhage by means of external aortic compression. The aim of the study was to evaluate the efficacy of the AAT. Serving soldiers under 25 years old were recruited. Basic demographic data, height, weight, blood pressure, and abdominal girth were recorded...
November 2013: Military Medicine
Michael Bodo, Timothy Settle, Joseph Royal, Eric Lombardini, Evelyn Sawyer, Stephen W Rothwell
Here we report results of non-invasive measurements of indirect markers of soft tissue healing of traumatic wounds in an observational swine study and describe the quantification of analog physiological signals. The primary purpose of the study was to measure bone healing of fractures with four different wound treatments. A second purpose was to quantify soft tissue wound healing by measuring the following indirect markers: (1) tissue oxygenation, (2) fluid content, and (3) blood flow, which were all measured by non-invasive modalities, measured with available devices...
December 2013: Journal of Clinical Monitoring and Computing
Roger P M Rushambuza
INTRODUCTION: The external genitalia are routinely included in the 'CT-Traumagram' at the Role 3 hospital in Afghanistan. Although the radiologist may have the opportunity to diagnose clinically undetected genital injury, little emphasis has been placed on the CT appearances of the external genitalia after Improvised Explosive Device related injury. METHODS: A prospective observational study was carried out on casualties admitted during 1 month in 2011. Genital findings on CT were correlated with clinical operative findings...
March 2013: Journal of the Royal Army Medical Corps
I M Samokhvalov, A A Pronchenko, V A Reva
External hemorrhage of extremities wounds is the leading cause of soldiers' death on the battlefield. In these cases control of massive arterial bleeding require not only prompt and effective measures, but also safety procedure. We assessed on volunteers the effectiveness, application time and pain intensity during the use of construction powerful quick-grip one-handed bar clamp. In results we found that the use of improvised quick-grip clamp for hemorrhage control in axillary and popliteal areas stops arterial blood flow in an extremity in all cases proven by Doppler ultrasound examination...
November 2012: Voenno-medit︠s︡inskiĭ Zhurnal
Stephanie Hightower, Eric J Chin, Jason D Heiner
Increases in intracranial pressure (ICP) may damage the brain by compression of its structures or restriction of its blood flow, and medical providers my encounter elevated ICP in conventional and non-conventional medical settings. Early identification of elevated ICP is critical to ensuring timely and appropriate management. However, few diagnostic methods are available for detecting increased ICP in an acutely ill patient, which can be performed quickly and noninvasively at the bedside. The optic nerve sheath is a continuation of the dura mater of the central nervous system and can be viewed by ocular ultrasound...
2012: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
R N J Graham
With the increasing tempo of military conflicts in the last decade, much has been learnt about imaging battlefield casualties in the acute setting. Ultrasound in the form of focused abdominal sonography in trauma (FAST) has proven invaluable in emergency triage of patients for immediate surgery. Multidetector CT allows accurate determination of battlefield trauma injuries. It permits the surgeons and anaesthetists to plan their interventions more thoroughly and to be made aware of clinically occult injuries...
December 2012: British Journal of Radiology
Michael Kent, Justin Upp, Christopher Spevak, Clarence Shannon, Chester Buckenmaier
Acute peripheral neuropathic pain after combat-related polytrauma is a common occurrence in the United States military that is often refractory to current drugs and regional anesthesia. Both spinal cord and peripheral nerve stimulation are successfully used for chronic neuropathic pain states, but are not reported for acute neuropathic pain. We present 2 cases of percutaneous ultrasound-guided sciatic peripheral nerve stimulation placement in soldiers who had conditions precluding them from spinal cord stimulation placement...
April 2012: Anesthesia and Analgesia
Laura J Brattain, Caspar Floryan, Oliver P Hauser, Michael Nguyen, Robert J Yong, Samuel B Kesner, Stephen B Corn, Conor J Walsh
In this paper, we describe our prototype of an ultrasound guidance system to address the need for an easy-to-use, cost-effective, and portable technology to improve ultrasound-guided procedures. The system consists of a lockable, articulating needle guide that attaches to an ultrasound probe and a user-interface that provides real-time visualization of the predicted needle trajectory overlaid on the ultrasound image. Our needle guide ensures proper needle alignment with the ultrasound imaging plane. Moreover, the calculated needle trajectory is superimposed on the real-time ultrasound image, eliminating the need for the practitioner to estimate the target trajectory, and thereby reducing injuries from needle readjustment...
2011: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Joel Anthony Nations, Robert F Browning
Combat medical care provides unique challenges and opportunities for military medical teams. The austerity of the environment severely limits access to many diagnostic and therapeutic tools. Because of their compact size, handheld ultrasound (US) machines are increasingly being used in these constrained environments. A growing body of literature documents the diagnostic utility of handheld US for trauma encountered in the battlefield. Furthermore, US guidance may assist in the performance of some procedures performed in battlefield medical care...
September 2011: Ultrasound Quarterly
David M Taylor, Gill M Vater, Paul J Parker
BACKGROUND: Hemorrhage remains the main cause of preventable death on the modern battlefield. As Improvised Explosive Devices in Afghanistan become increasingly powerful, more proximal limb injuries occur. Significant concerns now exist about the ability of the windlass tourniquet to control distal hemorrhage after mid-thigh application. To evaluate the efficacy of the Combat Application Tourniquet (CAT) windlass tourniquet in comparison to the newer Emergency and Military Tourniquet (EMT) pneumatic tourniquet...
September 2011: Journal of Trauma
Edward Allcock, Eliot Spencer, R Frazer, Gregory Applegate, Chester Buckenmaier
OBJECTIVES: The ongoing conflict in Afghanistan continues to generate a large number of complex trauma injuries and provides unique challenges to military anesthetists working in forward field hospitals. We report successful use of ultrasound-guided continuous transversus abdominis plane (TAP) block in two Afghan war casualties who sustained major trauma with coagulopathy. The use of bilateral continuous TAP blocks following major thoracoabdominal trauma in a combat environment is unique in the literature...
September 2010: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Keith S Boniface, Hamid Shokoohi, E Reed Smith, Kari Scantlebury
OBJECTIVES: The aim of this study was to examine the capability of ultrasound-naïve paramedics to obtain interpretable Focused Assessment With Sonography for Trauma (FAST) images under the remote direction of emergency physicians (EPs). METHODS: Paramedics without experience using ultrasound participated in a 20-minute lecture covering orientation to the ultrasound machine and the FAST examination. The paramedics subsequently performed FAST examinations on a model patient, whereas the EP remained in another room, out of visual contact...
June 2011: American Journal of Emergency Medicine
Wenbo Luo, Hamid Hosseini, Vesna Zderic, Frederick Mann, Grant O'Keefe, Shahram Vaezy
BACKGROUND: Hemorrhage from wounds in the extremities is the leading cause of preventable death on the battlefield. To successfully treat these injuries, the exact source of bleeding must be localized. OBJECTIVE: The purpose of this study was to determine the feasibility of using Doppler ultrasound to precisely detect and localize peripheral vascular bleeding. METHODS: Injuries were produced in common femoral arteries (diameter of ∼5 mm) of 28 pigs in vivo...
July 2011: Journal of Emergency Medicine
Kenneth H Wong, Shih-Chung Lob, Ching-Fang Lin, Bob Lasser, Seong K Mun
Combat medics have a vital role in the protection of wounded soldiers in the battlespace. However, their duties expose them to great risks. Furthermore, these medics are a limited resource and must be carefully tasked in order to provide maximum benefit to their units. For these reasons, we are applying the American GNC Corporation's (AGNC) Coremicro(R) Robotic System for autonomous evaluation of battlefield casualties. These robots are intended to navigate to a casualty, determine his/her overall health status, and perform limited diagnostic imaging in order to assess the presence of injuries that would prevent or complicate extraction...
2009: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Shahram Vaezy, Vesna Zderic
Hemorrhage control is a high priority task in advanced trauma care, because hemorrhagic shock can result in less than a minute in cases of severe injuries. Hemorrhage was found to be solely responsible for 40-50% of traumatic civilian and battlefield deaths in recent years. The majority of these deaths were due to abdominal and pelvic injuries with hidden and inaccessible bleeding of solid organs such as liver, spleen, and kidneys, as well as major blood vessels. High intensity focused ultrasound (HIFU) offers a promising method for hemorrhage control...
March 2007: International Journal of Hyperthermia
P J Parker, S A Adams, D Williams, A Shepherd
Two Air Assault Surgical Groups (AASGs) from 16 Close Support Medical Regiment deployed to Kuwait on Operation Telic in February 2003. Each AASG was comprised of a four-table resuscitation facility, a two table FST and a twin-bedded ITU facility. An A+E Consultant and nurse, an experienced radiographer and laboratory technician with two further RGNs and CMTs provided resuscitation support. Each FST had an orthopaedic and a general surgeon, two anaesthetists and eight operating department practitioners. Further equipment consisted of a Polymobil 111 X-ray unit, a Sonosite 180 ultrasound scanner and an ISTAT gas, haematocrit and electrolyte analyser...
September 2005: Journal of the Royal Army Medical Corps
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