Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti
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War wounds are the most complex type of non-targeted injuries due to uncontrolled tissue damage of varied and multifold localizations, exposing sterile body areas to contamination with a huge amount of bacteria. Wound contamination is caused by both the host microflora and exogenous agents from the environment (bullets, cloth fragments, dust, dirt, water) due to destruction of the host protective barriers. War wounds are the consequence of destructive effects of various types of projectiles, which result in massive tissue devitalization, hematomas, and compromised circulation with tissue ischemia or anoxia. ⋯ The expected incidence of infection, according to literature data, is 35%-40%. If the time elapsed until surgical debridement exceeds 12 hours, or the administration of antibiotics exceeds 6 hours of wound infliction, primary infection of the war wound occurs (early infection) in more than 50% of cases. The keys for the prevention of infection are prompt and thorough surgical exploration of the wound, administration of antibiotics and antitetanic prophylaxis, awareness of the probable pathogens with respect to localization of the wound, and optimal choice of antibiotics and length of their administration.
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The purpose of this retrospective study was to review and discuss the outcome of surgical management and other clinical predictors influencing the prognosis of war missile penetrating brain injuries. ⋯ The state of consciousness on admission was the most sensitive criterion as far as the prognosis is concerned. The outcome also depended on the extent of brain damage since the wounds associated with a high mortality rate were predominantly bihemispheric. Concerning survival, the time between injury and hospital admission also appeared to be important, as well as intracranially retained foreign bodies and bone fragments, and development of complications. There was no relationship between the presence of retained fragments and development of infection, suggesting that it is not necessary to reoperate for retained fragments. We assume that early surgery is essential for treatment outcome, although it is not necessary to reoperate for retained fragments.
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The Yugoslav People's Army as aggressor on Croatia was well organized and equipped with weapons and medical supplies. On the other hand, the Republic of Croatia as a new country had no army of nor medical corps of its own. At the beginning of aggression we decided to establish an integrated civilian-military medicine system. This system started as a civilian organization, to develop along with the army structure. The aim of the study was to analyze the overall result of such organization all over the Croatian territory throughout war period. ⋯ Despite the lack of diagnostic equipment and medical vehicles, and the availability of improvised military hospitals, good results were achieved in overall patient survival. The very high rate of success in hospital treatment and very low mortality rate were the result of excellent medical staff and integrated civilian-military medical service.
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The organization of care for the casualties and diseased in situations caused by terrorism, fire and other disasters, epidemic and pandemics is presented. In these situations, the experience acquired during the war in Croatia would be applied at all levels of health care organization.
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This preliminary study examined the sources of work stress in military physicians. ⋯ Our preliminary results suggest that military physicians recognize different stressors and to a greater extent than civilian physicians. The reported stressors suggest specific professional environment of military physicians. Stress at work needs careful and thorough consideration, not only because it can cause health problems and emotional suffering in military physicians, but also because it can diminish the quality of medical care that they are expected to provide. The stressors that are remediable should be identified and the job stress reduction procedures should be performed.