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combat clinical hemorrhage

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
John P Lichtenberger, Andrew M Kim, Dane Fisher, Peter S Tatum, Brian Neubauer, P Gabriel Peterson, Brett W Carter
Introduction: Combat-related thoracic trauma is a significant contributor to morbidity and mortality of the casualties from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Penetrating, blunt, and blast injuries were the most common mechanisms of trauma. Imaging plays a key role in the management of combat-related thoracic trauma casualties. This review discusses the imaging manifestations of thoracic injuries from penetrating trauma, emphasizing epidemiology and diagnostic clues seen during OEF and OIF...
March 1, 2018: Military Medicine
Pedro O Miranda, Beatrice Cubitt, Nicholas T Jacob, Kim D Janda, Juan Carlos de la Torre
Several arenaviruses cause hemorrhagic fever (HF) disease in humans and represent important public health problems in their en-demic regions. In addition, evidence indicates that the worldwide-distributed prototypic arenavirus lymphocytic choriomeningitis virus is a neglected human pathogen of clinical significance. There are no licensed arenavirus vaccines and current anti-arenavirus therapy is limited to an off-label use of ribavirin that is only partially effective. Therefore, there is an unmet need for novel therapeu-tics to combat human pathogenic arenaviruses, a task that will be facilitated by the identification of compounds with anti-arenaviral activity that could serve as probes to identify arenavirus-host interactions suitable for targeting, as well as lead com-pounds to develop future anti-arenaviral drugs...
February 6, 2018: ACS Infectious Diseases
Steven Sanders, Homer Tien, Jeannie Callum, Barto Nascimento, Henry Peng, Chris Funk, Joanne Schmid, Sandro Rizoli, Shawn Rhind, Andrew Beckett
Introduction: Hemorrhage is the most common cause of death among Special Operations Force (SOF) soldiers. Bringing remote damage control resuscitation into the far-forward combat environment is logistically challenging, as it requires blood products that generally require a robust cold chain. Alternatively, lyophilized products such as fibrinogen concentrate, which does not require thawing or blood group compatibility testing before use, might be advantageous in damage control resuscitation in the battlefield...
January 1, 2018: Military Medicine
Nicolas J Prat, Andrew D Meyer, Nichole K Ingalls, Julie Trichereau, Joseph J DuBose, Andrew P Cap
BACKGROUND: Up to 40% of combat casualties with a truncal injury die of massive hemorrhage before reaching a surgeon. This hemorrhage can be prevented with damage control resuscitation (DCR) methods, which are focused on replacing shed whole blood by empirically transfusing blood components in a 1:1:1:1 ratio of platelets:fresh frozen plasma:erythrocytes:cryoprecipitate (PLT:FFP:RBC:CRYO). Measurement of hemostatic function with rotational thromboelastometry (ROTEM) may allow optimization of the type and quantity of blood products transfused...
September 2017: Journal of Trauma and Acute Care Surgery
Nicole Vilardo, Jacqueline Feinberg, Jonathan Black, Elena Ratner
QuikClot combat gauze is a synthetic hemostatic dressing used for hemorrhage control. There is a paucity of data describing the clinical use and hemostatic results of combat gauze in the obstetric and gynecologic setting. This case series demonstrates the use of combat gauze as an effective hemostatic agent when used as vaginal packing in cervical and vaginal hemorrhage. Hemostasis was achieved rapidly in all cases and further interventions were avoided. The combat gauze remained in place for a mean time of 15 h with no adverse side effects observed...
August 2017: Gynecologic Oncology Reports
Askiel Bruno, Desiree D Brooks, Taryn A Abrams, Mitra D Poorak, Drew Gunio, Prianka K Kandhal, Aleena Lakhanpal, Arun K Nagabandi, Abiodun E Akinwuntan, Stephen Looney, Pascha E Schafer
BACKGROUND: Despite effective treatments, hypertension remains uncontrolled in nearly half of the people with hypertension in the United States. Uncontrolled hypertension leads to end organ damage, such as left ventricular hypertrophy (LVH). To identify reasons for uncontrolled hypertension, we interviewed acute stroke patients with a history of hypertension and evaluated for LVH. METHODS: Using a standardized questionnaire, we collected demographic, socioeconomic, and health-care data in 300 acute ischemic and hemorrhagic stroke patients in one hospital...
July 19, 2017: Clinical and Experimental Hypertension: CHE
Nicolas J Prat, Andrew D Meyer, Nichole K Ingalls, Julie Trichereau, Joseph J DuBose, Andrew P Cap
BACKGROUND: Up to 40% of combat casualties with a truncal injury die of massive hemorrhage before reaching a surgeon. This hemorrhage can be prevented with damage control resuscitation (DCR) methods, which are focused on replacing shed whole blood (WB) by empirically transfusing blood components in a 1:1:1:1 ratio of platelets:plasma:erythrocytes:cryoprecipitate (PLT:FFP:RBC:CRYO). Measurement of hemostatic function with thromboelastometry (ROTEM) may allow optimization of the type and quantity of blood products transfused...
June 6, 2017: Journal of Trauma and Acute Care Surgery
Steven G Schauer, Michael D April, Erica Simon, Joseph K Maddry, Robert Carter, Robert A Delorenzo
BACKGROUND: Mass-casualty (MASCAL) events are known to occur in the combat setting. There are very limited data at this time from the Joint Theater (Iraq and Afghanistan) wars specific to MASCAL events. The purpose of this report was to provide preliminary data for the development of prehospital planning and guidelines. METHODS: Cases were identified using the Department of Defense (DoD; Virginia USA) Trauma Registry (DoDTR) and the Prehospital Trauma Registry (PHTR)...
August 2017: Prehospital and Disaster Medicine
Brad L Bennett
Based on lessons learned, many military battlefield trauma advances ultimately transition to enhance civilian trauma care. However, even with major strides to enhance battlefield hemorrhage control, it is unclear how effectively these techniques and products are being translated to civilian trauma. The purpose of this brief review is to present the evidence of current hemostatic product effectiveness, determine the evidence for transitioning of this technology to prehospital civilian application, and provide recommendations about potential use in the wilderness/austere setting...
June 2017: Wilderness & Environmental Medicine
George R Ambalathingal, Ross S Francis, Mark J Smyth, Corey Smith, Rajiv Khanna
BK polyomavirus (BKV) causes frequent infections during childhood and establishes persistent infections within renal tubular cells and the uroepithelium, with minimal clinical implications. However, reactivation of BKV in immunocompromised individuals following renal or hematopoietic stem cell transplantation may cause serious complications, including BKV-associated nephropathy (BKVAN), ureteric stenosis, or hemorrhagic cystitis. Implementation of more potent immunosuppression and increased posttransplant surveillance has resulted in a higher incidence of BKVAN...
April 2017: Clinical Microbiology Reviews
Benjamin Donham, Robby Frondozo, Michael Petro, Andrew Reynolds, Jonathan Swisher, Ryan M Knight
Military prehospital providers frequently have to make important clinical decisions with only limited objective information and vital signs. Because of this, accurate estimation of blood loss, at the point of injury, can augment any available objective information. Prior studies have shown that individuals significantly overestimate the amount of blood loss when the amount of hemorrhage is small, and they tend to underestimate the amount of blood loss with larger amounts of hemorrhage. Furthermore, the type of surface on which the blood is deposited can impact the visual estimation of the amount of hemorrhage...
December 0: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
Parli R Ravi, Bipin Puri
This brief update reviews the recent literature available on fluid resuscitation from hemorrhagic shock and considers the applicability of this evidence for use in resuscitation of combat casualties in the combat casualty care (CCC) environment. A number of changes need to be incorporated in the CCC guidelines: (1) dried plasma (DP) is added as an option when other blood components or whole blood are not available; (2) the wording is clarified to emphasize that Hetastarch is a less desirable option than whole blood, blood components, or DP and should be used only when these preferred options are not available; (3) the use of blood products in certain tactical field care settings where this option might be feasible (FSC, GH) is discussed; (4) 1:1:1 damage control resuscitation (DCR) with plasma: packed red blood cells (PRBC): platelets is preferred to 1:1 DCR with plasma: PRBC when platelets are available; and (5) the 30-min wait between increments of resuscitation fluid administered to achieve clinical improvement or target blood pressure has been eliminated...
2017: Disaster and Military Medicine
Amir Shlaifer, Avraham Yitzhak, Erez N Baruch, Avi Shina, Alexandra Satanovsky, Amiram Shovali, Ofer Almog, Elon Glassberg
BACKGROUND: Hemorrhage is a leading cause of preventable death on the battlefield. Timely tourniquet application to massively bleeding extremity wounds is critical for casualty survival albeit with reported adverse effects to extremity integrity. The aim of this study was to describe the immediate- and short-term outcomes of point of injury (POI) tourniquet applications during "Operation Protective Edge" (OPE). METHODS: A case series study regarding tourniquet application at the POI during OPE was collected...
August 2017: Journal of Trauma and Acute Care Surgery
Xinran Ji, Dayong Peng, Yiling Zhang, Jun Zhang, Yuning Wang, Yuan Gao, Ning Lu, Peifu Tang
BACKGROUND: Traumatic brain injury (TBI) produces lasting neurological deficits that plague patients and physicians. To date, there is no effective method to combat the source of this problem. Here, we utilized a mild, closed head TBI model to determine the modulatory effects of a natural dietary compound, astaxanthin (AST). AST is centrally active following oral administration and is neuroprotective in experimental brain ischemia/stroke and subarachnoid hemorrhage (SAH) models. We examined the effects of oral AST on the long-term neurological functional recovery and histological outcomes following moderate TBI in a mice model...
March 15, 2017: Brain Research
Jenna L Leclerc, Juan Santiago-Moreno, Alex Dang, Andrew S Lampert, Pedro E Cruz, Awilda M Rosario, Todd E Golde, Sylvain Doré
Following intracerebral hemorrhage (ICH), extracellular heme precipitates secondary brain injury, which results in irreversible brain damage and enduring neurological deficits. Hemopexin (Hpx) is an endogenous protein responsible for scavenging heme, thereby modulating its intrinsic proxidant/proinflammatory properties. Although Hpx is present in the brain, the endogenous levels are insufficient to combat the massive heme overload following ICH. We hypothesized that increasing brain Hpx levels would improve ICH outcomes...
January 1, 2016: Journal of Cerebral Blood Flow and Metabolism
Elizabeth R Lusczek, Sydne L Muratore, Michael A Dubick, Greg J Beilman
BACKGROUND: Previous studies have indicated that hemorrhagic shock and injury cause significant early changes in metabolism. Recently, global changes in metabolism have been described using metabolomics in animal models and civilian trauma. We evaluated metabolic changes associated with combat injury to identify early biomarkers and aid in triage. METHODS: Plasma obtained at emergency department presentation and intervals thereafter from patients injured during combat operations in Iraq (n = 78) were compared with healthy control subjects (n = 40)...
February 2017: Journal of Trauma and Acute Care Surgery
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
Mustafa Uğur, Seçkin Akküçük, Yavuz Savaş Koca, Cem Oruç, Akın Aydoğan, Erol Kılıç, İbrahim Yetim, Muhyittin Temiz
BACKGROUND: Transport of casualties from a combat area to a fully equipped hospital where all techniques of damage control surgery (DCS) can be performed requires a great deal of time. Therefore, prior to transport, prompt control of hemorrhage and contamination should be achieved, and resuscitative procedures should be performed at the nearest health center. The aim of the present study was to investigate the effect of the location at which DCS was performed on rates of mortality. METHODS: The present retrospective study included 51 combat casualties who underwent DCS at the present clinic or at hospitals nearest the combat area due to high kinetic energy gunshot injuries to the abdomen between 2010 and 2015...
May 2016: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
Raymond Devlin, Laura Bonanno, Jennifer Badeaux
BACKGROUND: Rapid replacement of blood loss is critical in patients suffering from traumatic hemorrhage. When the availability of blood products is limited, certain interventions have shown promise in conserving blood supplies. Recombinant factor (rF) VIIa has been administered, as an off-label use, to assist in controlling hemorrhage in trauma patients. Although rFVIIa has a tendency to remain localized to areas of vascular insult, there may be an increase in thromboembolism formation when patients suffer multiple sites of injury as seen in blunt force trauma...
March 2016: JBI Database of Systematic Reviews and Implementation Reports
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