Clinical Experiences in the Early Management of the Most Severely Injured Battle Casualties

Centennial Changes in Surgical Care and Research

“…41 Fluid resuscitation volumes were adjusted upward on the basis of those studies and a striking reduction in the incidence of acute renal failure in the severely wounded was observed, which has persisted in subsequent conflicts and in civilian practice (Table 3). [42][43][44] A renal failure treatment unit with hemodialysis capability was established in the theater of operations.…”

Treatment of Shock with Dextrans and Gelatins

“…A basic requirement for such studies is that shock be kept within the range of reversibility, since irreversible shock as defined in the laboratory is that late stage of shock which no longer responds to volume replacement with whole blood alone. Studies on irreversible experimental shock are of obvious interest for the treatment of re fractory clinical shock as seen in recovery rooms and shock units, but as shown by the experience of the U S Army shock groups working in Italy and in Korea [11,15], they have no bearing on the emergency treatment of hemorrhagic-traumatic shock in man [33,124,125,126].…”

“…For the final outcome, however, the nature of the injury sustained is a much more critical factor, provided the patient reaches hospital in a state still responding to resuscitation. Even with optimum treatment employing liberal amounts of whole blood, mortality in Korean battle casualties rose almost linearly with the number of transfusions required: It was 2% in patients requiring less than 10 pints, but 53% in cases demanding from 20 to 55 pints of blood [11]. In the most severely injured requiring more than 15 transfusions, blood pressure level upon admission to forward hospitals influenced mortality sur prisingly little, a 10% difference only being recorded between patients with and those without measurable blood pressure.…”

“…In the most severely injured requiring more than 15 transfusions, blood pressure level upon admission to forward hospitals influenced mortality sur prisingly little, a 10% difference only being recorded between patients with and those without measurable blood pressure. In the most desperate group of all, admitted without measurable blood pressure and requiring more than 15 transfusions, the nature of the injury sustained was the prime determinant of ultimate survival: 90% of abdominal wounds proved fatal against 22% of extremity wounds [11]. Thus, emergency treatment must carry the patient through to hospital admission, but it will influence the ultimate fate of severely injured man to a limited extent only if resuscitation and adequate surgical treatment are not available within a relatively short period of time.…”

Bilateral Transfemoral/Transtibial Amputations Due to Battle Injuries: A Comparison of Vietnam Veterans with Iraq and Afghanistan Servicemembers

“…Multiple limb loss due to battle injury involves a unique group of servicemembers who are often severely injured [1]. Those who live require intensive rehabilitation and diverse prosthetic and mobility assistive devices.…”