Journal of the Royal Army Medical Corps
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Historical Article
Military intensive care part 1. A historical review.
ICU is a product of clinical developments, technological advances, social changes and history. Military ICU reflects all of these as well as deployed operational experience. Having considered how military ICU got to where it is, the next article will consider current practice.
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To determine the prevalence of tourniquet use in combat trauma, the contribution to lives saved and the complications of their use in this environment. ⋯ ISS and TRISS are poorly representative of injury severity and outcome for combat trauma involving isolated multiple limb injuries and cannot be used to discriminate whether a tourniquet is life-saving. The presence of severe isolated limb injuries, profound hypovolaemic shock and the requirement for massive transfusion reasonably identifies a cohort where the use of one or more tourniquets pre-hospital to control external bleeding can be said to be life-saving.
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This case is of an 8-year-old child who had a cardiac arrest and an Emergency Department thoracotomy (EDT) following a penetrating fragmentation injury to the chest. The management included damage control resuscitation, recombinant Factor VIIa and a successful emergency department thoracotomy.
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Military trauma produces predominantly blast and fragmentation injury, commonly resulting in haemorrhagic shock. Injury patterns to limbs are such that the conventional sites for venous cannulation may be unsuitable. The EZ-IO (Vidacare, San Antonio) system is one of a number of novel products designed for intraosseous (IO) access in adults or children. ⋯ A total of 32 needles were inserted, with 97% effective function. IO needles were used to administer fluid (crystalloid, packed red cells and fresh frozen plasma) and drugs (analgesics, cardiac arrest drugs, antibiotics, drugs for both rapid sequence induction and maintenance of anaesthesia). No complication of infection was noted, but pain was observed in responsive patients with the pain of infusion exceeding that of the underlying injuries in 3 cases.