U.S. Army Medical Department journal
-
Emergency airway management is a critical skill for military healthcare providers. Our goal was to describe the Emergency Department (ED) intubations at Brooke Army Medical Center (BAMC) over a 12-month period.
-
The active battlefield is an environment of chaos and confusion. Depending on the scale of combat, the chaos and confusion often extend into the prehospital combat setting with multiple personnel and units involved in the chain of care of casualties. ⋯ The Department of Defense (DoD) Joint Trauma System (JTS) Prehospital Trauma Registry (PHTR) was developed in conjunction with the updated Tactical Combat Casualty Care (TCCC) card and a TCCC after action report (AAR), and currently serves as the prehospital repository and module of the DoD Trauma Registry (DoDTR). We conducted a descriptive analysis of data from the DoDTR PHTR.
-
Randomized Controlled Trial
A randomized comparison between neurostimulation and ultrasound-guided lateral femoral cutaneous nerve block.
This prospective, randomized trial compared neurostimulation (NS) and ultrasound (US) guided lateral femoral cutaneous nerve (LFCN) block. We hypothesized that US would result in a shorter total anesthesia-related time (sum of performance and onset times). ⋯ Ultrasound guidance and NS provide similar success rates and total anesthesia-related times for LFCN block. The territory of the LFCN displays wide inter- and intra-individual variability.
-
To determine whether mandatory psychiatric admission laboratory tests yield results that change the disposition of a patient with primary psychiatric complaint from admission to a psychiatric service to admission to a medical service. ⋯ Patients presenting to the emergency department with a psychiatric chief complaint and no physical complaints, abnormal vital signs, or abnormal physical exam findings have less than 1% probability that an abnormal laboratory study will change their disposition from a psychiatric admission to a medical admission.
-
The lessons learned regarding the resuscitation of traumatic hemorrhagic shock are numerous and come from a better understanding of the epidemiology, pathophysiology, and experience in this population over 10-plus years of combat operations. We have now come to better understand that the greatest benefit in survival can come from improved treatment of hemorrhage in the prehospital phase of care. ⋯ Appreciation of the importance of shock and coagulopathy management underlies the emphasis on early hemostatic resuscitation. Most importantly, we have learned that there is still much more to understand regarding the epidemiology, pathophysiology, and the resuscitation strategies required to improve outcomes for casualties with hemorrhagic shock.