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Military tourniquets

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https://www.readbyqxmd.com/read/28863083/for-the-patient-evolution-in-the-management-of-vascular-trauma
#1
David V Feliciano
There has been an evolution in the diagnosis and management of vascular trauma over the past 100 years. The primary stimulus to these changes has been the increased volume of patients with cervical, truncal, and peripheral vascular injuries during military conflicts and in civilian life.Patients with "hard" signs of a vascular injury are taken to surgery emergently with a few exceptions to be described. In contrast, patients with "soft" signs of a vascular injury undergo a careful physical examination including measurement of vascular index to determine if radiologic imaging is necessary...
August 31, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28835410/injury-profile-suffered-by-targets-of-antipersonnel-improvised-explosive-devices-prospective-cohort-study
#2
Shane Smith, Melissa Devine, Joseph Taddeo, Vivian Charles McAlister
OBJECTIVE: To describe pattern 1 injuries caused by the antipersonnel improvised explosive device (AP-IED) in comparison to those previously described for antipersonnel mines (APM). DESIGN: Prospective cohort study of 100 consecutive pedestrian victims of an AP-IED, with traumatic amputation without regard for gender, nationality or military status. SETTING: Multinational Medical Unit at Kandahar Air Field, Afghanistan. PARTICIPANTS: One hundred consecutive patients, all male, 6-44 years old...
August 7, 2017: BMJ Open
https://www.readbyqxmd.com/read/28810992/two-new-effective-tourniquets-for-potential-use-in-the-military-environment-a-serving-soldier-study
#3
Alastair Beaven, Rob Briard, Mark Ballard, Paul Parker
BACKGROUND: Limb tourniquets have been used extensively during modern Middle Eastern conflicts. Despite its undeniable successes, the combat applied tourniquet (C-A-T) has some shortfalls, principally its inability to reliably control lower limb bleeding when applied to the mid-thigh. We tested two tourniquets which may represent an improvement to the combat applied tourniquet; the tactical mechanical tourniquet and the tactical pneumatic tourniquet. METHODS: We recruited 12 healthy service personnel and applied the tactical mechanical tourniquet and tactical pneumatic tourniquet to both lower limbs in a randomly generated sequence...
July 2017: Military Medicine
https://www.readbyqxmd.com/read/28697026/smartphone-based-mobile-thermal-imaging-technology-to-assess-limb-perfusion-and-tourniquet-effectiveness-under-normal-and-blackout-conditions
#4
Morgan R Barron, John P Kuckelman, John M McClellan, Michael J Derickson, Cody J Phillips, Shannon T Marko, Joshua P Smith, Matthew J Eckert, Matthew J Martin
BACKGROUND: Over the past decade there has been a resurgence of tourniquet use in civilian and military settings. Several key challenges include assessment of limb perfusion and adequacy of tourniquet placement, particularly in the austere or pre-hospital environments. We investigated the utility of thermal imaging to assess adequacy of tourniquet placement. METHODS: The FLIR ONE™ smartphone-based thermal imager was utilized. Ten swine underwent tourniquet placement with no associated hemorrhage (n=5) or with 40% hemorrhage (n=5)...
July 8, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28657831/case-report-life-saving-application-of-commercial-tourniquet-in-pediatric-extremity-hemorrhage
#5
David W Callaway, Andrew Puciaty, Josh Robertson, Tony Hannon, Sarah E Fabiano
Hemorrhage is the leading preventable cause of death in civilian and military trauma. Recent data from the ongoing conflicts in Iraq and Afghanistan suggest that early and aggressive tourniquet utilization is a safe and effective way to dramatically reduce mortality from extremity hemorrhage. As a result, prehospital tourniquet use is now endorsed by a majority of professional emergency medicine, emergency medical service and trauma professional societies. However, there currently exists scant evidence supporting the efficacy of commercially available tourniquets in controlling extremity hemorrhage in pediatric trauma patients...
June 28, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28601208/bleeding-control-with-limb-tourniquet-use-in-the-wilderness-setting-review-of-science
#6
REVIEW
John F Kragh, Michael A Dubick
The purpose of this review is to summarize tourniquet science for possible translation to wilderness settings. Much combat casualty data has been studied since 2005, and use of tourniquets in the military has changed from a last resort to first aid. The US Government has made use of tourniquets a health policy aimed to improve public access to bleeding control items. International authorities believe that education in first aid should be universal, as all can and should learn first aid. The safety record of tourniquet use is mixed, but users are reliably safe if trained well...
June 2017: Wilderness & Environmental Medicine
https://www.readbyqxmd.com/read/28601205/remote-damage-control-resuscitation-in-austere-environments
#7
REVIEW
Ronald Chang, Brian J Eastridge, John B Holcomb
Hemorrhage is the leading cause of preventable military and civilian trauma death. Damage control resuscitation with concomitant mechanical hemorrhage control has become the preferred in-hospital treatment of hemorrhagic shock. In particular, plasma-based resuscitation with decreased volumes of crystalloids and artificial colloids as part of damage control resuscitation has improved outcomes in the military and civilian sectors. However, translation of these principles and techniques to the prehospital, remote, and austere environments, known as remote damage control resuscitation, is challenging given the resource limitations in these settings...
June 2017: Wilderness & Environmental Medicine
https://www.readbyqxmd.com/read/28599052/tccc-updates-two-decades-of-saving-lives-on-the-battlefield-tactical-combat-casualty-care-turns-20
#8
Frank K Butler
BACKGROUND: Twenty years ago, the original Tactical Combat Casualty Care (TCCC) article was published in this journal. Since TCCC is essentially a set of bestpractice prehospital trauma care guidelines customized for use on the battlefield, the presence of a journal with a specific focus on military medicine was a profound benefit to the initial presentation of TCCC to the US Military. METHODS: In the two ensuing decades, which included the longest continuous period of armed conflict in our nation's history, TCCC steadily evolved as the prehospital trauma care evidence base was augmented and as feedback from user medics, corpsmen, and pararescuemen was obtained...
December 0: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/28318990/junctional-hemorrhage-control-for-tactical-combat-casualty-care
#9
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/28291451/prehospital-blood-transfusion-during-aeromedical-evacuation-of-trauma-patients-in-israel-the-idf-csar-experience
#10
Jacob Chen, Avi Benov, Roy Nadler, Daniel N Darlington, Andrew P Cap, Ari M Lipsky, Elon Glassberg
BACKGROUND: Data regarding the effect of prehospital blood administration to trauma patients during short-to-moderate time evacuations is scarce. The Israel Air Force Airborne Combat Search and Rescue is the only organization that deals with aeromedical evacuation for both military and civilian casualties in Israel and the only one with the ability to give blood in the prehospital setting. METHODS: Data on packed red blood cells (PRBCs) administration in the evacuation missions from January 2003 to June 2010 were analyzed and actual transfusion practice was compared to clinical practice guidelines (CPGs)...
March 2017: Military Medicine
https://www.readbyqxmd.com/read/28290925/two-decades-of-saving-lives-on-the-battlefield-tactical-combat-casualty-care-turns-20
#11
Frank K Butler
BACKGROUND: Twenty years ago, the original Tactical Combat Casualty Care (TCCC) article was published in this journal. Since TCCC is essentially a set of best-practice prehospital trauma care guidelines customized for use on the battlefield, the presence of a journal with a specific focus on military medicine was a profound benefit to the initial presentation of TCCC to the U.S. Military. METHODS: In the two ensuing decades, which included the longest continuous period of armed conflict in our nation's history, TCCC steadily evolved as the prehospital trauma care evidence base was augmented and as feedback from user medics, corpsmen, and pararescuemen was obtained...
March 2017: Military Medicine
https://www.readbyqxmd.com/read/28285478/cat-on-a-hot-tin-roof-mechanical-testing-of-models-of-tourniquets-after-environmental-exposure
#12
Daniel K O'Conor, John F Kragh, James K Aden, Michael A Dubick
BACKGROUND: The purpose of the present study was to mechanically assess models of emergency tourniquet after 18 months of environmental exposure to weather to better understand risk of component damage. MATERIALS AND METHODS: An experiment was designed to test tourniquet performance on a manikin thigh. Three tourniquet models were assessed: Special Operations Forces Tactical Tourniquet Wide, Ratcheting Medical Tourniquet, and Combat Application Tourniquet. Unexposed tourniquets formed a control group stored in a laboratory; exposed tourniquets were placed outdoors on a metal roof for 18 months in San Antonio, Texas...
December 0: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/28159434/-and-if-it-happened-to-children-adapting-medical-care-during-terrorist-attacks-with-multiple-pediatric-victims
#13
L Alix-Séguin, N Lodé, G Orliaguet, E Chamorro, F Kerroué, C Lorge, A Moreira
In light of the recent terrorist attacks in Europe, we need to reconsider the organization of rescue and medical management and plan for an attack involving multiple pediatric victims. To ensure quick surgical management, but also to minimize risk for on-site teams (direct threats from secondary terrorist attacks targeting deployed emergency services), it is crucial to evacuate patients in a swift but orderly fashion. Children are vulnerable targets in terrorist attacks. Their anatomical and physiological characteristics make it likely that pediatric victims will suffer more brain injuries and require more, often advanced, airway management...
March 2017: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/28011033/cost-savings-and-patient-experiences-of-a-clinic-based-wide-awake-hand-surgery-program-at-a-military-medical-center-a-critical-analysis-of-the-first-100-procedures
#14
Peter C Rhee, Michelle M Fischer, Laura S Rhee, Ha McMillan, Anthony E Johnson
PURPOSE: Wide-awake, local anesthesia, no tourniquet (WALANT) hand surgery was developed to improve access to hand surgery care while optimizing medical resources. Hand surgery in the clinic setting may result in substantial cost savings for the United States Military Health Care System (MHS) and provide a safe alternative to performing similar procedures in the operating room. METHODS: A prospective cohort study was performed on the first 100 consecutive clinic-based WALANT hand surgery procedures performed at a military medical center from January 2014 to September 2015 by a single hand surgeon...
March 2017: Journal of Hand Surgery
https://www.readbyqxmd.com/read/27734438/evaluation-of-models-of-pneumatic-tourniquet-in-simulated-out-of-hospital-use
#15
John F Kragh, James K Aden, Michael A Dubick
BACKGROUND: Pneumatic field tourniquets have been recommended for Military medics to stop bleeding from limb wounds, but no comparison of commercially available pneumatic models of tourniquet has been reported. The purpose of this study is to provide laboratory data on the differential performance of models of pneumatic tourniquets to inform decision-making of potential field assessment by military users. METHODS: Models included the Emergency and Military Tourniquet (EMT), Tactical Pneumatic Tourniquet 2-inch (TPT2), and Tactical Pneumatic Tourniquet 3-inch (TPT3)...
2016: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/27724088/advances-in-military-resuscitation
#16
Sharon Edwards, Jason Smith
Trauma is a leading cause of death and disability worldwide, in civilian environments and on the battlefield. Trauma-induced haemorrhage is the principal cause of potentially preventable death, which is generally attributable to a combination of vascular injury and coagulopathy. Survival rates following severe traumatic injury have increased due to advanced trauma management initiatives and treatment protocols, influenced by lessons learned from recent conflicts in Iraq and Afghanistan. The use of tourniquets and intraosseous needles, early blood and blood product transfusion, administration of tranexamic acid in pre-hospital settings, and consultant-led damage control resuscitation incorporating damage control surgery have all played their part...
October 6, 2016: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
https://www.readbyqxmd.com/read/27661422/resuscitation-and-treatment-of-shock
#17
Michael J Beltran, Tyson E Becker, Richard K Hurley, Jennifer M Gurney, Roman A Hayda
Hemorrhage continues to be the most common cause of death among service members wounded in combat. Injuries that were previously nonsurvivable in previous wars are now routinely seen by combat surgeons in forward surgical units, the result of improvements in body armor, the universal use of field tourniquets to control extremity hemorrhage at the point of injury, and rapid air evacuation strategies. Combat orthopaedic surgeons remain a vital aspect of the forward surgical unit, tasked with assisting general surgical colleagues in the resuscitation of patients in hemorrhagic shock while also addressing traumatic amputations, open and closed long bone fractures, and mechanically unstable pelvic trauma...
October 2016: Journal of Orthopaedic Trauma
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
#18
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/27614373/does-practice-make-perfect-prospectively-comparing-effects-of-2-amounts-of-practice-on-tourniquet-use-performance
#19
RANDOMIZED CONTROLLED TRIAL
Erez N Baruch, Avi Benov, Avi Shina, Amy L Berg, Amir Shlaifer, Elon Glassberg, James K Aden, Tarif Bader, John F Kragh, Avraham Yitzhak
INTRODUCTION: Although a lifesaving skill, currently, there is no consensus for the required amount of practice in tourniquet use. We compared the effect of 2 amounts of practice on performance of tourniquet use by nonmedical personnel. METHODS: Israeli military recruits without previous medical training underwent their standard tactical first aid course, and their initial performance in use of the Combat Application Tourniquet (CAT; Composite Resources, Rock Hill, SC) was assessed...
December 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27614371/postischemic-conditioning-does-not-reduce-muscle-injury-after-tourniquet-induced-ischemia-reperfusion-injury-in-rats
#20
Vincent J Mase, Janet L Roe, Robert J Christy, Michael A Dubick, Thomas J Walters
BACKGROUND: The widespread application of tourniquets has reduced battlefield mortality related to extremity exsanguinations. Tourniquet-induced ischemia-reperfusion injury (I/R) can contribute to muscle loss. Postischemic conditioning (PostC) confers protection against I/R in cardiac muscle and skeletal muscle flaps. The objective of this study was to determine the effect of PostC on extremity muscle viability in an established rat hindlimb tourniquet model. METHODS: Rats were randomly assigned to PostC-1, PostC-2, or no conditioning ischemic groups (n = 10 per group)...
November 2016: American Journal of Emergency Medicine
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