The journal of trauma and acute care surgery
-
J Trauma Acute Care Surg · Aug 2012
Therapeutic correction of thrombin generation in dilution-induced coagulopathy: computational analysis based on a data set of healthy subjects.
Prothrombin complex concentrates (PCCs), which contain different coagulation proteins, are attractive alternatives to the standard methods to treat dilution-induced (and, generally, traumatic) coagulopathy. We investigated the ability of a novel PCC composition to restore normal thrombin generation in diluted blood. The performance of the proposed PCC composition (coagulation factors [F] II, IX, and X and the anticoagulant antithrombin), designated PCC-AT, was compared with that of FVIIa and PCC-FVII, which is the PCC composition containing FII, FVII, FIX, and FX (main components of most PCCs). ⋯ Our computational results suggest that PCC-AT may demonstrate a superior ability to restore normal thrombin generation compared with FVIIa and PCC-FVII.
-
J Trauma Acute Care Surg · Aug 2012
The effects of standardized trauma training on prehospital pain control: have pain medication administration rates increased on the battlefield?
The US Military has served in some of the most austere locations in the world. In this ever-changing environment, units are organized into smaller elements operating in very remote areas. This often results in longer evacuation times, which can lead to a delay in pain management if treatment is not initiated in the prehospital setting. Early pain control has become an increasingly crucial military prehospital task and must be controlled from the pain-initiating event. The individual services developed their standardized trauma training based on the recommendations by Frank Butler and the Defense Health Board Committee on Tactical Combat Casualty Care. This training stresses evidence-based treatment modalities, including pain control, derived from casualty injury analysis. Inadequate early pain control may lead to multiple acute and potentially chronic effects. These effects encompass a wide range from changes in blood pressure to delayed wound healing and posttraumatic stress disorder. Therefore, it is essential that pain be addressed in the prehospital environment. ⋯ Standardized trauma training has increased the administration of prehospital pain medication and the awareness of the importance of early pain control.
-
J Trauma Acute Care Surg · Aug 2012
Timing and location of blood product transfusion and outcomes in massively transfused combat casualties.
Hemostatic resuscitation using blood components in a 1:1:1 ratio of platelets:fresh frozen plasma:red blood cells (RBCs) is based on analyses of massive transfusion (MT, ≥10 RBC units in 24 hours). These 24-hour analyses are weakened by survival bias and do not describe the timing and location of transfusions. Mortality outcomes associated with early (first 6 hours) resuscitation incorporating platelets, for combat casualties requiring MT, have not been reported. ⋯ Early (first 6 hours) hemostatic resuscitation incorporating platelets and plasma is associated with improved 24-hour and 30-day survival in combat casualties requiring MT.
-
J Trauma Acute Care Surg · Aug 2012
Comparative StudyInsertion of central venous catheters induces a hypercoagulable state.
Central venous catheters (CVCs) increase the risk of venous thromboembolism. We have previously demonstrated that pulmonary artery catheters are associated with a hypercoagulable state in an animal model and in patients. The purpose of this study is to determine whether the insertion of a CVC is associated with a similar response. ⋯ In healthy swine and patients with critical illness, a systemic hypercoagulable state occurred after CVC insertion, and this may partially account for an increased risk of venous thromboembolism. However, because the sample size was small and not powered to detect changes in coagulation proteins, no inferences can be made about the mechanism for the hypercoagulable response.
-
J Trauma Acute Care Surg · Aug 2012
Impact of critical care-trained flight paramedics on casualty survival during helicopter evacuation in the current war in Afghanistan.
The US Army pioneered medical evacuation (MEDEVAC) by helicopter, yet its system remains essentially unchanged since the Vietnam era. Care is provided by a single combat medic credentialed at the Emergency Medical Technician - Basic level. Treatment protocols, documentation, medical direction, and quality improvement processes are not standardized and vary significantly across US Army helicopter evacuation units. This is in contrast to helicopter emergency medical services that operate within the United States. Current civilian helicopter evacuation platforms are routinely staffed by critical care-trained flight paramedics (CCFP) or comparably trained flight nurses who operate under trained EMS physician medical direction using formalized protocols, standardized patient care documentation, and rigorous quality improvement processes. This study compares mortality of patients with injury from trauma between the US Army's standard helicopter evacuation system staffed with medics at the Emergency Medical Technician - Basic level (standard MEDEVAC) and one staffed with experienced CCFP using adopted civilian helicopter emergency medical services practices. ⋯ These findings demonstrate that using an air ambulance system based on modern civilian helicopter EMS practice was associated with a lower estimated risk of 48-hour mortality among severely injured patients in a combat setting.