Journal of the Royal Army Medical Corps
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Case Reports
Tetraplegia following cervical spine cord contusion from indirect gunshot injury effects.
We present the case of a 31 year old British soldier who sustained a high energy gunshot injury to the neck with delayed onset tetraplegia. The bullet's transcervical track was subsequently shown to have had no direct contact with the spinal cord, but four to five minutes after injury the patient developed tetraplegia. Subsequent Magnetic Resonance Imaging confirmed this to be due to contusion of the cervical spinal cord. This case illustrates the high levels of energy potentially transferred to surrounding tissues by the passage of a high available energy projectile, causing significant injury to nearby structures not actually impacted by the missile.
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Haemorrhage control is a major priority in the care of trauma patients in military as in the civilian setting. About 50% of combat deaths are due to fatal bleeding. The aim of this analysis was to assess the efficacy and safety of recombinant activated factor VII (rFVIIa; NovoSeven, Novo Nordisk A/S, Bagsvaerd, Denmark) when used to treat trauma-related blood loss. ⋯ As this analysis has several limitations that are unavoidable when using global registries to collect and analyse data, our findings are not conclusive. However, these preliminary observations especially in those patients who underwent very early rFVIIa treatment offer further support for the use of rFVIIa in trauma.