Military medicine
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Observational Study
Potential Concussive Event Narratives of Post-9/11 Combat Veterans: Chronic Effects of Neurotrauma Consortium Study.
Deployment-related mild traumatic brain injury (mTBI) affects a significant proportion of those who served in Post-9/11 combat operations. The prevalence of head injuries, including those that lead to mTBI, is often reported quantitatively. However, service member (SM) and Veteran firsthand accounts of their potential concussive events (PCEs) and mTBIs can serve as a rich resource for better understanding the nuances and context of these exposures. ⋯ Prevalence of deployment-related close-range blast exposure, non-blast impact PCEs, and mTBIs among this Post-9/11 combatant sample was substantial, and in many cases potentially preventable. The use of detailed semi-structured interviews may help health care providers and policymakers to better understand the context and circumstances of deployment-related PCEs and mTBIs.
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Rapid sequence intubation of patients experiencing traumatic hemorrhage represents a precarious phase of care, which can be marked by hemodynamic instability and pulseless arrest. Military combat trauma guidelines recommend reduced induction dose and early blood product resuscitation. Few studies have evaluated the role of induction dose and preintubation transfusion on hemodynamic outcomes. We compared rates of postintubation systolic blood pressure (SBP) of < 70 mm Hg, > 30% drop in SBP, pulseless arrest, and mortality at 24 hours and 30 days among patients who did and did not receive blood products before intubation and then examined if induction agent and dose influenced the same outcomes. ⋯ Within the context of this historical cohort, the early use of blood products conferred a statistically significant benefit in reducing postintubation hypotension and pulseless arrest among combat trauma victims exposed to traumatic hemorrhage. Induction agent choice and dose did not significantly influence the hemodynamic or mortality outcomes.
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Measures of normal and abnormal physiology are interrelated and vary continuously. Our ability to detect and predict changes in physiology in real time has been limited in part by the requirement for blood sampling and the lack of a continuous data stream of various "signals", i.e., measurements of vital signs. It is important to determine which signals are most revealing for detection and treatment of, e.g., internal bleeding, managing fluid balance for mission/combat readiness, and hydration. Although our current algorithm for PV[O]H reflects changes in hematocrit and blood and plasma volumes, additional algorithms utilizing the whole raw PV[O]H data stream, along with other variables, can be constructed. We present a working prototype demonstrating that acceptable size, power, and complexity footprints for military needs can be achieved. Results of previous studies involving humans have demonstrated that PV[O]H can provide simultaneous, noninvasive, in vivo continuous monitoring of hematocrit, vascular volume, hemoglobin oxygen saturation, pulse rate, and breathing rate using a single light source with a reporting frequency of every 3 seconds. ⋯ Simultaneous noninvasive continuous monitoring of peripheral vessels using a previous PV[O]H system demonstrates large, physiology revealing data sets. The technologies enable the methodical search for relevant physiological signals allowing the use of discriminant analysis, Bayesian approaches, and artificial intelligence to create predictive algorithms enabling timely interventions in medical care and troop training.
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Lung injury has several inciting etiologies ranging from trauma (contusion and hemorrhage) to ischemia reperfusion injury. Reflective of the injury, tissue and cellular injury increases proportionally with the injury stress and is an area of potential intervention to mitigate the injury. This study aims to evaluate the therapeutic benefits of recombinant human MG53 (rhMG53) protein in porcine models of acute lung injury (ALI). ⋯ MG53 is an endogenous protein that circulates in the bloodstream. Therapeutic treatment with exogenous rhMG53 may be part of a strategy to restore (partially or completely) structural morphology and/or functional lung integrity. Systemic administration of rhMG53 constitutes a potential effective therapeutic means to combat ALI.
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During training and combat operations, military personnel may be exposed to repetitive low-level blast while using explosives to gain entry or by firing heavy weapon systems such as recoilless weapons and high-caliber sniper rifles. This repeated exposure, even within allowable limits, has been associated with cognitive deficits similar to that of accidental and sports concussion such as delayed verbal memory, visual-spatial memory, and executive function. This article presents a novel framework for accurate calculation of the human body blast exposure in military heavy weapon training scenarios using data from the free-field and warfighter wearable pressure sensors. ⋯ This framework has numerous advantages including easier model setup and shorter simulation times. The framework is an important step towards developing an advanced field-applicable technology to monitor low-level blast exposure during heavy weapon military training and combat scenarios.