Journal of the Royal Army Medical Corps
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The pre-hospital care of patients with suspected spinal injuries involves early immobilisation of the whole spine and the institution of measures to prevent secondary injury from hypoxia, hypoperfusion or further mechanical disruption. Early ventilation and differentiation of haemorrhagic from neurogenic shock are the key elements of pre-hospital resuscitation specific to spinal injuries. Falls from a significant height, high-impact speed road accidents, blast injuries, direct blunt or penetrating injuries near the spine and other high energy injuries should all be regarded as high risk for spinal injury but clinical examination should determine whether the patient requires full, limited or no spinal immobilisation. ⋯ In the remote or operational environment where pre-hospital times are prolonged, full immobilisation, analgesia and re-assessment may allow localisation of the injury and a reduction in the degree of immobilisation. Common reasons for missing significant spinal injuries include failing to consider the possibility of spinal injuries in patients who are either unconscious, intoxicated or uncooperative (54,55). The application of the decision rule discussed here will ensure that no clinically significant spinal injuries are missed in pre-hospital care.
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Historical Article
The evolution of casualty evacuation in the British Army 20th century (Part 1)--Boer War to 1918.
This is the first in a series of papers which describe the evolution of the British casualty evacuation system in the 20th Century. This paper describes the formation of the Field Ambulance after the Boer War and the development of the Casualty Clearing Station during the First World War. It also discusses how the effects of an improved understanding of triage, shock and wound infection contributed to changes in the internal organization of hospitals in the field.
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Current pre-hospital trauma triage systems are based mainly on physiological parameters, but in compensated shock injury severity may not be immediately obvious, as the physiological parameters remain normal for some time. Serum lactate, measured in hospital, is known to be a predictor of injury severity and outcome. ⋯ We found that capillary lactate is elevated in trauma patients in the early phase of the response to injury. There is a moderate correlation (R2 = 0.44) between early lactate levels and injury severity, in patients who might otherwise be difficult to triage.
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To evaluate the Sonosite 180 handheld ultrasound in the diagnosis of haemoperitoneum in blunt abdominal trauma. ⋯ Handheld ultrasound using the Sonosite 180 system can be successfully used by appropriately trained doctors as the primary investigation in the acute evaluation of blunt abdominal trauma.