Relationships between early acute pain scores, autonomic nervous system function, and injury severity in wounded soldiers.

Background: Acute pain after injury affects the comfort and function of the wounded soldier and the physiology of multiple body systems. In the civilian population, pain alters the function of the autonomic nervous system, causing increased heart rate and blood pressure. However, there are no data regarding the impact of combat-related pain on physiologic responses.

Virtual reality pain control during burn wound debridement of combat-related burn injuries using robot-like arm mounted VR goggles.

Background: This is the first controlled study to explore whether adjunctive immersive virtual reality (VR) can reduce excessive pain of soldiers with combat-related burn injuries during wound debridement.

Methods: Patients were US soldiers burned in combat attacks involving explosive devices in Iraq or Afghanistan. During the same wound care session using a within-subject experimental design, 12 patients received half of their severe burn wound cleaning procedure (~6 minutes) with standard of care pharmacologies and half while in VR (treatment order randomized).

Use of ultra rapid opioid detoxification in the treatment of US military burn casualties.

Background: The purpose of this case series was to review the management of burn patients who requested ultrarapid opioid detoxification under anesthesia after extended duration of narcotic use for chronic pain related to burn injury.

Methods: The treatment plan of six opioid-dependent burn patients was analyzed to assess the effectiveness of our detoxification practice to date. Demographic and clinical information was used to characterize the patient population served: age, burn size, injury severity, duration of narcotic use before detoxification intervention, and length of hospitalization stay.

Combining ketamine and virtual reality pain control during severe burn wound care: one military and one civilian patient.

Background: US soldiers injured in Iraq, and civilian burn trauma patients are treated at the US Army Institute of Surgical Research. Burn patients experience extreme pain during wound care, and they typically receive opioid analgesics and anxiolytics for debridement. Virtual Reality (VR) has been applied as an adjunct to opioid analgesics for procedural pain.

The relationship of early pain scores and posttraumatic stress disorder in burned soldiers.

Early acute pain after injury has been linked to long-term patient outcomes, including the development of posttraumatic stress disorder (PTSD). Several studies have identified a negative correlation between early anesthetic/analgesic usage and subsequent development of PTSD. This retrospective study examined the relationship between early acute pain and severity of PTSD symptoms in soldiers with burn injuries.

The relationship of intravenous midazolam and posttraumatic stress disorder development in burned soldiers.

Background: Midazolam, a short-acting benzodiazepine, is administered preoperatively and intraoperatively for amnesia and anxiolysis. Subsequently, patients often do not recall events which occurred while they were sedated. Recent studies have also reported retrograde facilitation after midazolam exposure.

Coagulopathy in trauma patients: what are the main influence factors?

Purpose Of Review: Coagulopathy and bleeding after severe injury is a common problem. Whenever caring for critically ill patients, clinicians must anticipate, recognize and manage the coagulopathy of trauma. When left untreated, cardiovascular shock and multiorgan system failure ensue.

The effect of propranolol on posttraumatic stress disorder in burned service members.

Posttraumatic stress disorder (PTSD) is reported to affect almost one third of the civilian burn patient population. Predisposing factors for PTSD include experiencing a traumatic event. Of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) soldiers returning home after deployment without injury, 17% reported cognitive symptoms of PTSD.