Traumatic Tension Pneumothorax: A Tale of Two Pathologies.

Pneumothorax resulting from injury is a common phenomenon in both civilian and military trauma. A pneumothorax or simple pneumothorax is defined as air in the pleural space. A tension pneumothorax can evolve from a simple pneumothorax if there is a continued air leak from the lung without mechanism for egress.

Vascular Repair in Wartime Casualties.

In the third installment of the "Lest We Forget" series, the authors discuss a critical advance-vascular repair, pioneered by Dr. Carl Hughes-in the care of the war-wounded during the Korean War. This article reviews the management of large vessel injuries in wartime, the challenges and advances in military medicine during the Korean War, and the application of these lessons to current practices.

An Analysis of the Association of Arrival Hemoglobin With Overtransfusion at 24 Hours in a Trauma Population.

Background: Hemorrhage control and resuscitative concepts have evolved in recent years, leading to aggressive use of blood products in trauma patients. There is subsequently a potential risk for overtransfusion, adverse effects, and waste associated with unnecessary transfusion. Methods for conserving blood products are of particular importance in future large-scale combat operations where supply chains are likely to be strained.

Putting Medical Boots on the Ground: Lessons from the War in Ukraine and Applications for Future Conflict with Near-Peer Adversaries.

In the past 20 years of the Global War on Terror, the US has seen substantial improvements in its system of medical delivery in combat. However, throughout that conflict, enemy forces did not have parity with the weaponry, capability, or personnel of the US and allied forces. War against countries like China and Russia, who are considered near-peer adversaries in terms of capabilities, will challenge battlefield medical care in many different ways.

Genomic surveillance of SARS-CoV-2 in US military compounds in Afghanistan reveals multiple introductions and outbreaks of Alpha and Delta variants.

Background: With the emergence and spread of SARS-CoV-2 variants, genomic epidemiology and surveillance have proven invaluable tools for variant tracking. Here, we analyzed SARS-CoV-2 samples collected from personnel located at the US/NATO bases across Afghanistan.

Results: Sequencing and phylogenetic analyses revealed at least 16 independent introductions of SARS-CoV-2 into four of these relatively isolated compounds during April and May 2021, including multiple introductions of Alpha and Delta variants.

Joint Trauma System Clinical Practice Guideline (JTS CPG): Prehospital Blood Transfusion. 30 October 2020.

This Clinical Practice Guideline (CPG) provides a brief summary of the scientific literature for prehospital blood use, with an emphasis on the en route care environment. Updates include the importance of calcium administration to counteract the deleterious effects of hypocalcemia, minimal to no use of crystalloid, and stresses the importance of involved and educated en route care medical directors alongside at a competent prehospital and en route care providers (see Table 1). With the paradigm shift to use FDA-approved cold stored low titer group O whole blood (CS-LTOWB) along with the operational need for continued use of walking blood banks (WBB) and point of injury (POI) transfusion, there must be focused, deliberate training incorporating the different whole blood options.

AB569, a non-toxic combination of acidified nitrite and EDTA, is effective at killing the notorious Iraq/Afghanistan combat wound pathogens, multi-drug resistant Acinetobacter baumannii and Acinetobacter spp.

Multi-drug resistant (MDR) Acinetobacter baumannii (Ab) and Acinetobacter spp. present monumental global health challenges. These organisms represent model Gram-negative pathogens with known antibiotic resistance and biofilm-forming properties.

Effect of Out-of-Hospital Tranexamic Acid vs Placebo on 6-Month Functional Neurologic Outcomes in Patients With Moderate or Severe Traumatic Brain Injury.

Importance: Traumatic brain injury (TBI) is the leading cause of death and disability due to trauma. Early administration of tranexamic acid may benefit patients with TBI.

Objective: To determine whether tranexamic acid treatment initiated in the out-of-hospital setting within 2 hours of injury improves neurologic outcome in patients with moderate or severe TBI.

Effects of Early Altitude Exposure on the Open Abdomen After Laparotomy in Trauma.

Introduction: While damage control surgery and resuscitation techniques have revolutionized the care of injured service members who sustain severe traumatic hemorrhage, the physiologic and inflammatory consequences of hemostatic resuscitation and staged abdominal surgery in the face of early aeromedical evacuation (AE) have not been investigated. We hypothesized that post-injury AE with an open abdomen would have significant physiologic and inflammatory consequences compared to AE with a closed abdomen.

Materials And Methods: Evaluation of resuscitation and staged abdominal closure was performed using a murine model of hemorrhagic shock with laparotomy.

Pulsed Dose Oxygen Delivery During Mechanical Ventilation: Impact on Oxygenation.

Introduction: Adequate oxygenation is one of the primary goals of mechanical ventilation. Maintenance of adequate oxygenation and prevention of hypoxemia are the primary goals for the battlefield casualty, but military operations have unique concerns. In military operations, oxygen is a limited resource.

Sooner is better: use of a real-time automated bedside dashboard improves sepsis care.

Background: Minimizing the interval between diagnosis of sepsis and administration of antibiotics improves patient outcomes. We hypothesized that a commercially available bedside clinical surveillance visualization system (BSV) would hasten antibiotic administration and decrease length of stay (LOS) in surgical intensive care unit (SICU) patients.

Methods: A BSV, integrated with the electronic medical record and displayed at bedside, was implemented in our SICU in July 2016.

Bullet retrieval from the right hepatic vein using a controlled endovascular and transhepatic approach.

Venous bullet embolism is a rare complication of trauma. We describe a patient who sustained a gunshot wound. Computed tomography revealed antegrade embolization of the bullet to the right hepatic vein (RHV).

Management of Suspected Tension Pneumothorax in Tactical Combat Casualty Care: TCCC Guidelines Change 17-02.

This change to the Tactical Combat Casualty Care (TCCC) Guidelines that updates the recommendations for management of suspected tension pneumothorax for combat casualties in the prehospital setting does the following things: (1) Continues the aggressive approach to suspecting and treating tension pneumothorax based on mechanism of injury and respiratory distress that TCCC has advocated for in the past, as opposed to waiting until shock develops as a result of the tension pneumothorax before treating. The new wording does, however, emphasize that shock and cardiac arrest may ensue if the tension pneumothorax is not treated promptly. (2) Adds additional emphasis to the importance of the current TCCC recommendation to perform needle decompression (NDC) on both sides of the chest on a combat casualty with torso trauma who suffers a traumatic cardiac arrest before reaching a medical treatment facility.

Ketamine versus hydromorphone patient-controlled analgesia for acute pain in trauma patients.

Background: It is unknown whether ketamine administered via patient-controlled analgesia (PCA) provides adequate analgesia while reducing opioid consumption in the traumatically injured patient. Differences in opioid consumption, pain scores, and adverse effects between ketamine and hydromorphone PCA were studied.

Materials And Methods: This is an investigator-initiated, single-center, double-blinded, randomized, pilot trial conducted from 2014 to 2016 at a level 1 trauma center.

Proximal penetrating extremity injuries-An opportunity to decrease overtriage?

Background: Penetrating injuries to the extremity proximal to the elbow or knee are anatomic criteria for full trauma team activation (FFTA) by the American College of Surgeon's Committee on Trauma standards. This criterion lacks objective evidence-based support. Overtriage of trauma team activation may result in excessive costs and resource burden at trauma centers.

System Design Verification for Closed Loop Control of Oxygenation With Concentrator Integration.

Background: Addition of an oxygen concentrator into a control loop furthers previous work in autonomous control of oxygenation. Software integrates concentrator and ventilator function from a single control point, ensuring maximum efficiency by placing a pulse of oxygen at the beginning of the breath. We sought to verify this system.

Evaluation of Oxygen Concentrators and Chemical Oxygen Generators at Altitude and Temperature Extremes.

Oxygen cylinders are heavy and present a number of hazards, and liquid oxygen is too heavy and cumbersome to be used in far forward environments. Portable oxygen concentrators (POCs) and chemical oxygen generators (COGs) have been proposed as a solution. We evaluated 3 commercially available POCs and 3 COGs in a laboratory setting.

Performance of Portable Ventilators Following Storage at Temperature Extremes.

In the current theater of operation, medical devices are often shipped and stored at ambient conditions. The effect of storage at hot and cold temperature extremes on ventilator performance is unknown. We evaluated three portable ventilators currently in use or being evaluated for use by the Department of Defense (731, Impact Instrumentation; T1, Hamilton Medical; and Revel, CareFusion) at temperature extremes in a laboratory setting.

Hypoxemia during aeromedical evacuation of the walking wounded.

Background: Hypobaric hypoxemia is a well-known risk of aeromedical evacuation (AE). Validating patients as safe to fly includes assessment of oxygenation status as well as oxygen-carrying capability (hemoglobin). The incidence and severity of hypoxemia during AE of noncritically injured casualties have not been studied.

Oxygen requirement to reverse altitude-induced hypoxemia with continuous flow and pulsed dose oxygen.

Background: Hypoxemia secondary to reduced barometric pressure is a complication of ascent to altitude. We designed a study to compare the reversal of hypobaric hypoxemia at 14,000 ft with continuous flow oxygen from a cylinder and pulsed dose oxygen from a portable concentrator.

Methods: There were 30 healthy volunteers who were randomized to one of three study groups, placed in an altitude chamber, and ascended to 14,000 ft.