Military medicine
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Most of the facial trauma in the United States is treated in trauma centers in large urban or university medical centers, with limited trauma care taking place in our military medical treatment facilities. In many cases, active duty facial trauma surgeons may lack the current experience necessary for the optimal care of facial wounds of our inquired military personnel in the early stages of the conflict. ⋯ These "trauma-current" reservists may act as a cadre of practiced surgeons to aid those with less experience. A plan for refresher training of active duty facial trauma surgeons is presented.
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32 Field Hospital was one of two forward British field hospitals deployed during the 1990-1991 Gulf War in northern Saudi Arabia. We describe the use of Battlefield Trauma Life Support (BATLS), a military derivation of Advanced Trauma Life Support (ATLS) as used in the hospital's resuscitation department and discuss the application of ATLS principles in the military environment. Teaching BATLS to doctors, nurses, and combat medical technicians provided a common system for all department members to work toward. This proved to be an efficient system for horizontal casualty management by a trauma team of three people.
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The rigid character of the skull provides protection for the brain; in trauma, however, concomitant brain swelling, contusion, and possible hematoma create increased intracranial pressure and likely further injury to brain and components. Rapid alleviation of such pressure reduces mortality and morbidity. ⋯ Such is not available at forward echelons of deployed military medical units. The author compares the austerity of forward-located neurosurgery against that farther to the rear and recommends the former on the merits of the major reduction of time between injury and surgery.
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U. S military medical personnel are currently trained to care for combat casualties using the principles taught in the Advanced Trauma Life Support (ATLS) course. The appropriateness of many of the measures taught in ATLS for the combat setting is unproven. ⋯ We will review some of the factors that must be considered in caring for wounded patients on the battlefield with an emphasis on the Special Operations environment. A basic management protocol is proposed that organizes combat casualty care into three phases and suggests appropriate measures for each phase. A scenario-based approach is needed to plan in more detail for casualties on specific Special Operations missions, and several sample scenarios are presented and discussed.
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Bullet emboli to the heart are rare and are typically treated by operative extraction through a median sternotomy and cardiotomy. This report details the case of an 18-year-old male who sustained two gunshot wounds, one of which lodged in his left renal vein. ⋯ Under fluoroscopic guidance the bullet was retrieved with a snare introduced percutaneously through the right internal jugular vein. Sternotomy and possible cardiopulmonary bypass were avoided.