Articles: trauma.
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The integration of Point of Care Ultrasound (POCUS) into the care of trauma patients, specifically the E-FAST, has improved the accuracy of initial diagnoses and improved time to surgical intervention in critically ill patients. Physician assistants (PAs) are critically important members of any military trauma resuscitation team and are often team leaders in a pre-hospital setting. They may receive training in ultrasound but there are little data to support their use or evaluate their effectiveness in using POCUS. We designed a study to evaluate the image quality of an E-FAST Exam performed by Emergency Medicine Physician Assistant (EMPA) Fellows and Emergency Medicine (EM) Interns following identical training. Our hypothesis is that image quality obtained by EMPAs will be non-inferior to those images obtained by EM Interns. ⋯ POCUS is an imaging modality which is very portable and relatively inexpensive which makes it ideal for military medicine. PAs are essential members of military trauma teams, and often run an initial trauma resuscitation. Being able to correctly identify patients who have free fluid early in the course of treatment allows for more correct evacuation criteria to ensure the sickest patients get to care the fastest. Although there are limited data to support POCUS use by non-physicians, our data support a growing body of evidence that it is not the profession or baseline medical education that determines an individual's ability to use and incorporate ultrasound into bedside and clinical practice. Our study shows that with training and experience PAs or other members of the military health care team can use the EFAST to better care for trauma patients.
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Finnish military divers perform a great variety of tasks all year round, all of which require good physical health and fitness. Poor physical fitness can hinder the ability to cope with different situations. A high body fat percentage has been suggested to increase the risk of decompression sickness, whereas low muscle mass has been associated with an increased risk of musculoskeletal disorders and trauma. However, a low-fat composition may render divers vulnerable to cold and hypothermia during a dive in cold Arctic conditions. The aim of this study was to evaluate possible changes in body composition of Finnish military divers during a 15-year follow-up period (2007-2021). ⋯ According to this study, Finnish military divers have managed to maintain a surprisingly good muscle mass in all age groups despite body composition changes due to aging in older subjects. A slight increase in fat mass can be observed with increasing age; nevertheless, the values have remained within fit-to-dive target levels. The current training routines of Finnish military divers are adequate for maintaining solid physical fitness and body composition over the course of the diving career.
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Observational Study
Seasonal Association With Hypothermia in Combat Trauma.
Hypothermia increases mortality in trauma populations and frequently occurs in military casualties due to the nature of combat environments. The association between hypothermia and the time of year when injured remains unclear. We sought to determine the association between seasonal changes in temperature and hypothermia among combat casualties. ⋯ We found a seasonal variation in the occurrence of hypothermia in a large cohort of trauma casualties. Despite adjustment for multiple known confounders, our findings substantiate probable ambient temperature variations to trauma-induced hypothermia. Furthermore, our findings, when taken in the context of other studies on the efficacy of current hypothermia prevention and treatment strategies, support the need for better methods to mitigate hypothermia in future cold-weather operations.
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Intraosseous (IO) infusion, the pressurized injection of fluids into bone through a catheter, is a life-preserving resuscitative technique for treating trauma patients with severe hemorrhage. However, little is known regarding the application times, placement accuracy, and end-user ratings of battery-powered and manual IO access devices. This study was specifically designed to fill these knowledge gaps on six FDA-approved IO access devices. ⋯ The battery-powered EZ-IO performed best and remains the IO access device of choice. The present findings suggest that the TALON should be considered as a manual backup to the EZ-IO.