Journal of the Royal Army Medical Corps
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The accepted mechanism of blast-mediated traumatic amputation (TA) is blast wave induced fracture followed by limb avulsion from the blast wind, generating a transosseous amputation. Blast-mediated through-joint TAs were considered extremely rare with published prevalence <2%. Previous studies have also suggested that TA is frequently associated with fatal primary blast lung injury (PBLI). However, recent evidence suggests that the mechanism of TA and the link with fatal primary blast exposure merit review. ⋯ The previously reported link between TA and PBLI was not present, calling into question the significance of primary blast injury in causation of blast mediated TAs. Furthermore, the accepted mechanism of injury can't account for the significant number of through-joint TAs. The high rate of through-joint TAs with either no associated fracture or a non-contiguous fracture (74%) is supportive of pure flail as a mechanism for blast-mediated TA.
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Editorial Historical Article
The fentanyl 'lozenge' story: from books to battlefield.
This article outlines the process that led to the introduction of the fentanyl lozenge for acute pain management. It starts with the historical context before discussing the recognition of an ongoing problem and then identifies the options that were considered. ⋯ This leads into an outline of the meetings and committees that had to be engaged with before the final acceptance and subsequent ushering in. The final section describes an option that was unsuccessful.
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Wound infection is a key determinant of outcome in survivors of armed conflict. One factor having potential for promoting healing, decreasing bacterial burden and influencing prognosis is the dressing that covers the ballistic-injured extremity. Although antiseptic and silver dressings are applied to acute wounds, evidence to support their use is scarce with no controlled studies reported of antimicrobial wound dressings in extremity trauma. ⋯ This model was developed to support a series of randomised controlled trials to determine the impact of antimicrobial dressings on decreasing the bacterial burden of combat related extremity wounds. The results of the initial trial indicated that over a 48-h period, dressings augmented with antiseptic or silver offer no advantage over saline-soaked gauze in reducing the bacterial burden of a contaminated soft tissue injury. The model has subsequently been used to investigate the efficacy of dressings over a 7-day study period and impact of antibiotics and to evaluate biofilm formation and wound cytokines.