Committee on Surgical Combat Casualty Care position statement on the use of single surgeon teams and invited commentaries.

Background: Over the last 20 years of war, there has been an operational need for far forward surgical teams near the point of injury. Over time, the medical footprint of these teams has decreased and the utilization of mobile single surgeon teams (SSTs) by the Services has increased. The increased use of SSTs is because of a tactical mobility requirement and not because of proven noninferiority of clinical outcomes.

Lessons Learned During Prolonged Care of Combat Casualties by a Minimally Manned Surgical Team.

In the current deployed environment, small teams are dispersed to provide damage control surgical capabilities within an hour of injury. Given the well-developed evacuation system, these teams do not typically have a significant patient hold capability. Improved understanding of the shortfalls and problems encountered when caring for combat casualties in prolonged care situations will facilitate improved manning, training, and equipping of these resource-limited teams.

Failure Rate of Prehospital Needle Decompression for Tension Pneumothorax in Trauma Patients.

Tension pneumothorax is commonly treated with needle decompression (ND) at the 2nd intercostal space midclavicular line (2nd ICS MCL) but is thought to have a high failure rate. Few studies have attempted to directly measure the failure rate in patients receiving the intervention. We performed a retrospective analysis of 10 years of patients receiving prehospital ND.

Blast injury: impact on brain and internal organs.

Blast trauma can kill or injure by multiple different mechanisms, not all of which may be obvious on initial presentation. Patients injured by blast effects should be treated as having multisystem trauma and managed according to Advanced Trauma Life Support guidelines. For the most severely injured patients, damage control resuscitation should be practiced until definitive hemorrhage control has been achieved.

Acute coagulopathy in a porcine venous hemorrhage and ischemia reperfusion model.

Background: Injury-related coagulopathy is a complex process. We analyzed coagulation in a swine model of shock using rotational thromboelastometry (ROTEM).

Methods: Forty-eight swine underwent laparotomy, 35% hemorrhage, supraceliac aortic cross-clamp, then reperfusion and resuscitation.

Recombinant factor VIIa is effective at reversing coagulopathy in a lactic acidosis model.

Background: The interplay of coagulopathy, acidosis, and hypothermia contributes to the death of the most seriously injured trauma patients. Because of in vitro testing and retrospective series, current recommendations advise correcting acidosis before administering recombinant factor VII (rFVIIa).

Methods: A lactic acidosis was induced in 40 kg swine, and 10 blood samples were withdrawn for testing.

Perceived effects of deployments on surgeon and physician skills in the US Army Medical Department.

Background: The military health care system is unique in that almost every physician deploys for ≥6 months to a combat or far-forward setting. The aim of this study was to determine the perceived changes in clinical skills in this deployed population.

Methods: A survey was sent out to all specialty consultants to the Army Surgeon General to query active duty staff physicians in their specialty areas who have deployment experience in August 2007.

Hypoxemic versus normoxemic reperfusion in a large animal model of severe ischemia-reperfusion injury.

Background: Prior studies have suggested a significant benefit of using deliberate hypoxemia to reperfuse ischemic tissue beds, primarily by reducing free radical injury. We sought to examine the effects of a hypoxemic reperfusion strategy in a large animal model of severe truncal ischemia.

Materials And Methods: Adult swine were subjected to 30 min of supraceliac aortic occlusion and randomized to two groups: normoxemia group (n = 9), with resuscitation at a pO2 >100 mmHg or hypoxemia group (n = 10), with initial resuscitation at a pO2 of 30-50.

Early postoperative fever and the "routine" fever work-up: results of a prospective study.

Background: Fever in the postoperative period frequently results in a battery of diagnostic tests in search of an etiology. We sought to evaluate the incidence and utility of extensive postoperative fever evaluations in a teaching hospital setting.

Materials And Methods: Prospective observational study of all adult patients undergoing in-patient general surgical procedures during a 13-mo period.

Retrograde stent-graft angioplasty of superficial femoral artery occlusion in a claudicant.

Endovascular therapy has become an accepted mode of therapy for lifestyle-limiting claudication, especially if the disease is confined to the superficial femoral artery (SFA). The standard approach to these lesions is from the contralateral femoral artery and crossing over the aortic bifurcation. In patients who have an aortobifemoral bypass (AFB), this technique is usually not feasible secondary to the angles of the graft.

Colorectal complications of external beam radiation versus brachytherapy for prostate cancer.

Background: Although radiation therapy plays a central role in the management of prostate cancer, complications remain a troubling byproduct. We sought to determine the prevalence and significance of colorectal complications after external beam radiation (EBRT) versus brachytherapy (BT) for prostate cancer.

Methods: We performed a retrospective review of all patients undergoing EBRT or BT for prostate cancer from January 1999 to October 2005.

The Gaussian derivative model for spatial-temporal vision: II. Cortical data.

Receptive fields of simple cells in the primate visual cortex were well fit in the space and time domains by the Gaussian Derivative (GD) model for spatio-temporal vision. All 23 fields in the data sample could be fit by one equation. varying only a single shape number and nine geometric transformation parameters.

The Gaussian derivative model for spatial-temporal vision: I. Cortical model.

How do we see the motion of objects as well as their shapes? The Gaussian Derivative (GD) spatial model is extended to time to help answer this question. The GD spatio-temporal model requires only two numbers to describe the complete three-dimensional space-time shapes of individual receptive fields in primate visual cortex. These two numbers are the derivative numbers along the respective spatial and temporal principal axes of a given receptive field.

Development and testing of the Resistiveness to Care Scale.

A conceptual model and objective scale for measuring resistiveness to care in individuals with advanced dementia of the Alzheimer type (DAT) were empirically generated from the perspective of nursing staff caregivers and through observation of residents with DAT. The resistiveness to care scale (RTC-DAT) was judged to have content validity and reduced to 13 items. Quantifiable scoring procedures and methods for rating videotapes and conducting clinical observations were developed.

Intracranial hemorrhage as a predictor of occult cervical-spine fracture.

Study Objective: To determine whether intracranial hemorrhage is a predictor of occult cervical-spine fracture.

Design: A prospective, cross-sectional study.

Setting: University-affiliated Level I trauma center.