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Thread: Homicide Rates vs Trauma Care

  1. #11
    Is there a way to read the actual journal article without paying $30?
    My posts only represent my personal opinion and do not necessarily reflect the opinions or official policies of any employer, past or present. Obvious spelling errors are likely the result of an iPhone keyboard.

  2. #12
    THE THIRST MUTILATOR Nephrology's Avatar
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    Quote Originally Posted by DanM View Post
    Is there a way to read the actual journal article without paying $30?
    It should be free open-access through PMC. Try this link.

    https://www.ncbi.nlm.nih.gov/pmc/art...5/pdf/615a.pdf

  3. #13
    THE THIRST MUTILATOR Nephrology's Avatar
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    Quote Originally Posted by ranger View Post
    I suggest the long wars have a positive impact also - I believe that a lot of doctors and other medical professionals have rotated through the war zone and gained a lot of knowledge and that knowledge has been shared back to the trauma centers. I believe some military medical professionals also spent time in CONUS Trauma center centers pre-deployment.
    There have been a few big changes in practice that have come from lessons gleaned during GWOT - increased use of ketamine as a pre-hospital sedative, for example, as well as changes to transfusion protocols (FFP : pRBC ratio). There are probably a few more than I am not thinking of/aware of.

  4. #14
    Quote Originally Posted by Nephrology View Post
    There have been a few big changes in practice that have come from lessons gleaned during GWOT - increased use of ketamine as a pre-hospital sedative, for example, as well as changes to transfusion protocols (FFP : pRBC ratio). There are probably a few more than I am not thinking of/aware of.
    Realizing that pumping people full of saline to keep the blood pressure up to an arbitrary number was counterproductive?

  5. #15
    THE THIRST MUTILATOR Nephrology's Avatar
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    Quote Originally Posted by peterb View Post
    Realizing that pumping people full of saline to keep the blood pressure up to an arbitrary number was counterproductive?
    No, IV crystalloid is still very much used to fluid resuscitate trauma patients alongside blood products. I honestly don't know the specific reasoning behind the specific ratio of FFP to packed red cells but I am going to guess it has to do with prevention of traumatic coagulopathy.

  6. #16
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    Widespread acceptance of the use of tourniquets has been a factor pre-transport. Every officer I know carries one on their person. We have had numerous instances in which they have been immediately applied to victims prior to EMS arrival, and have been instrumental in the survival of the person shot or stabbed.
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  7. #17
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    Quote Originally Posted by PD Sgt. View Post
    Widespread acceptance of the use of tourniquets has been a factor pre-transport. Every officer I know carries one on their person. We have had numerous instances in which they have been immediately applied to victims prior to EMS arrival, and have been instrumental in the survival of the person shot or stabbed.
    This. I remember when Army treated tourniquets like "professional installation only" then suddenly everyone was carrying tourniquets plus every vehicle had tourniquets hanging off any type attachment for quick access.

  8. #18
    Member John Hearne's Avatar
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    With options like the holster mounted tourniquet, there is no reason for everyone with a duty belt to not carry one on duty.

    https://centrifugetraining.com/produ...cessory-mount/
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  9. #19
    Quote Originally Posted by Nephrology View Post
    It should be free open-access through PMC. Try this link.

    https://www.ncbi.nlm.nih.gov/pmc/art...5/pdf/615a.pdf
    Thanks. I guess I thought there’d be more. I assumed the text linked in the OP was an abstract summarizing the article. I didn’t realize it was the entirety of it.
    My posts only represent my personal opinion and do not necessarily reflect the opinions or official policies of any employer, past or present. Obvious spelling errors are likely the result of an iPhone keyboard.

  10. #20
    Site Supporter Sensei's Avatar
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    Most trauma surgery advances were developed from wartime experiences going back to the ancient times. Most of the top surgeons in the 60s had WWII experience and many of the top surgeons when I was in med school served in Vietnam.

    In living memory, WII brought us penicillin and widespread use of blood products while Vietnam ushered in the era of mandatory surgical exploration for all penetrating neck and most torso injuries. Vietnam also saw advances in vascular surgery techniques that allowed limb-saving procedures that would have previously required amputation. We have recently pulled back a little from the mandatory exploration approach to neck and torso injuries in civilian trauma thanks to advances in CT imaging and the fact that civilian penetrating trauma is not the same as military (ie getting shanked is not the same as taking a 7.62X39 to the belly).

    The GWOT refined the concept of damage control surgery where we explore a torso wound, stop bleeding, but otherwise leave the abdomen open for future repair after adequate resuscitation. It also ushered in the era of hemostatic resuscitation where severe blood loss is replaced with components (PRBCs, platelets, and plasma) in a 1:1:1 ratio that mimics what is on the floor. Previously, we would lead with PRBCs and add FFP or platelets based on laboratory parameters that were often delayed or painted an incomplete story. In fact, many places are now leading with whole blood if plasma or platelets are not readily available. Most of us have moved away from crystalloid fluids for trauma resuscitation, but you may see hypertonic saline used to control ICP in head injury.
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