The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jul 2017
Relative device stability of anterior versus axillary needle decompression for tension pneumothorax during casualty movement: Preliminary analysis of a human cadaver model.
Tension pneumothorax (tPTX) remains a significant cause of potentially preventable death in military and civilian settings. The current prehospital standard of care for tPTX is immediate decompression with a 14-gauge 8-cm angiocatheter; however, failure rates may be as high as 17% to 60%. Alternative devices, such as 10-gauge angiocatheter, modified Veress needle, and laparoscopic trocar, have shown to be potentially more effective in animal models; however, little is known about the relative insertional safety or mechanical stability during casualty movement. ⋯ Therapeutic study, level III.
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J Trauma Acute Care Surg · Jul 2017
Combat surgical workload in Operation Iraqi Freedom and Operation Enduring Freedom: The definitive analysis.
Relatively few publications exist on surgical workload in the deployed military setting. This study analyzes US military combat surgical workload in Iraq and Afghanistan to gain a more thorough understanding of surgical training gaps and personnel requirements. ⋯ Epidemiologic study, level III; Care management, level III.
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J Trauma Acute Care Surg · Jul 2017
Inefficacy of standard vital signs for predicting mortality and the need for prehospital life-saving interventions in blunt trauma patients transported via helicopter: A repeated call for new measures.
The aim of this study was to investigate the efficacy of traditional vital signs for predicting mortality and the need for prehospital lifesaving interventions (LSIs) in blunt trauma patients requiring helicopter transport to a Level I trauma center. Our hypothesis was that standard vital signs are not sufficient for identifying or determining treatment for those patients most at risk. ⋯ Therapeutic/care management, level IV.
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J Trauma Acute Care Surg · Jul 2017
Do vented chest seals differ in efficacy? An experimental evaluation using a swine hemopneumothorax model.
Airways compromise was the second leading cause of potentially preventable death among combat casualties. We investigated the ability of five Food and Drug Administration-approved nonocclusive chest seals (CSs) to seal a bleeding chest wound and prevent tension hemopneumothorax (HPTX) in a swine model. ⋯ The sealant and valve function of vented CS differed widely in the presence of bleeding chest wounds. Medics should be equipped with more effective CSs for treating HPTX in the field.
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J Trauma Acute Care Surg · Jul 2017
Comparative StudyUnfractionated heparin versus low-molecular-weight heparin for venous thromboembolism prophylaxis in trauma.
Venous thromboembolism (VTE) is a common complication in trauma patients. Pharmacologic prophylaxis is utilized in trauma patients to reduce their risk of a VTE event. The Eastern Association for the Surgery of Trauma guidelines recommend use of low-molecular-weight heparin (LMWH) as the preferred agent in these patients. However, there is literature suggesting that unfractionated heparin (UFH) is an acceptable, and less costly, alternative VTE prophylaxis agent with equivalent efficacy in trauma patients. We examined data from the Michigan Trauma Quality Improvement Program to perform a comparative effectiveness study of UFH versus LMWH on outcomes for trauma patients. ⋯ Therapeutic, level III.