Injury
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Expanding or fragmenting bullets have been known to cause extensive injuries since they became available in the late 19th century. Although these bullets are now banned from international warfare, their use by civilians and law enforcement is still legal in the US. In this case report, we describe the complex injuries and subsequent complicated hospital course of a civilian trauma patient who was shot with a newly-designed fragmenting bullet, known as a Radically Invasive Projectile (RIP) bullet. ⋯ Expanding or fragmenting bullets are designed to inflict significantly more tissue damage than non-deformable bullets. This type of ammunition is prohibited in international warfare on the basis that it does not serve a military advantage but can result in excessive wounding and unnecessary suffering. There is no such ban for handgun ammunition for domestic use in most countries including the United States. Ammunition manufacturers have recently released a fragmenting bullet that is designed to inflict a maximum amount of tissue damage. In this case report, we described the devestating effects of this bullet on a civilian trauma patient.
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Once injured in the battlefield in Iraq and Afghanistan, U.S. and NATO troops receive medical treatment through tiered echelons of care with varying resources, from austere to state-of-the-art. Similar to civilian trauma systems, the aim is to provide rapid and safe patient movement toward definitive management. A consequence of the rapid transfer of patients is the possibility of missed or delayed diagnosis of injuries. With the new injury patterns seen during these conflicts, we aimed to identify and characterize which injuries are missed and what consequences do they have on our troops' road to recovery. ⋯ As healthcare practitioners prepare for future deployments, this analysis may serve as a resource to focus on frequently missed injuries and possibly improve their detection.
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Many injured patients or their families make the difficult decision to withdraw life-sustaining therapies (WLST) following severe injury. While this population has been studied in the setting of severe traumatic brain injury (TBI), little is known about patients who undergo WLST without TBI. We sought to describe patients who may benefit from early involvement of end-of-life resources. ⋯ WLST occurs in two-thirds of injured patients without severe TBI who die in the hospital. In-hospital complications are more frequent in this patient group than those who die with FSC. Early palliative care consultation may improve patient and family satisfaction after acute injury when the timeframe to leverage such services is significantly condensed.
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Efforts to improve teamwork in trauma include simulation-based team training with a non-technical skills (NTS) focus. However, there is a lack of evidence to inform the development of team training programs for maximum uptake of NTS in clinical practice. This descriptive paper aims to evaluate the extent NTS were practiced by the trauma team in a Level 1 trauma hospital after NTS training and to identify facilitators and barriers to use of NTS in clinical practice. ⋯ NTS were being used by frontline clinicians in real world trauma resuscitations to varying degrees, depending on organisational, team and cognitive facilitators and barriers. Facilitators to the implementation of NTS skills during trauma emergencies included team composition, roles and responsibilities, procedural compliance and leadership. Barriers included decision making and communication. This study described team members experience of using NTS in 'real world trauma resuscitation' to inform future team training interventions.