Lessons Learned from Modern Military Surgery

Beekley, Alec C.; Starnes, Benjamin W.; Sebesta, James A.

doi:10.1016/j.suc.2006.09.008

Cited by 75 publications

(30 citation statements)

References 67 publications

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“…However, musculoskeletal injuries must be assessed and managed properly and appropriately so life and limb are not jeopardized 24 .Severe crush injuries cause the release of myoglobin which may precipitate in the renal tubules and result in renal failure 25 . Swelling into an intact musculofascial space may cause an acute compartment syndrome that, if not diagnosed and treated, may lead to lasting impairment and loss of use of the extremity 26 .…”

Section: Musculoskeletal Trauma:-mentioning

confidence: 99%

Atls –A Systematic Review

Mittal¹,

Rathi²,

Raghaw.³

2016

IJAR

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Section: Musculoskeletal Trauma:-mentioning

confidence: 99%

Atls –A Systematic Review

Mittal¹,

Rathi²,

Raghaw.³

2016

IJAR

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“…Increased pressure may improve perfusion in nonconstricted vascular beds, but may also reverse important haemostatic reflexes and exert excessive pressure on fragile extravascular clots 12 . Fluid administration leading to increased blood pressure in the setting of active haemorrhage predictably increases rebleeding and overall blood loss, a fact first noted during World War I and rediscovered episodically in every major conflict since 13,14 .…”

Section: Hazards Of Resuscitationmentioning

confidence: 99%

Resuscitative strategies to maintain homeostasis during damage control surgery

Dutton

2011

British Journal of Surgery

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Background: Successful outcome from damage control surgery (DCS) depends as much on elements of resuscitation and non-operative management as on details of the procedure itself. The early management of patients in haemorrhagic shock has undergone substantial revision in the past decade and is now known as 'haemostatic resuscitation'.Methods: An updated literature review describing the anaesthetic and resuscitative management of patients with active, ongoing traumatic haemorrhage was distilled to present the current knowledge of the pathophysiology, recommended treatments and areas of active controversy.Results: Current practice in military and civilian trauma centres is described, along with the degree of evidence in support of clinical decisions. Resuscitation of patients with ongoing traumatic haemorrhage has changed substantially in the past two decades. Optimal management now includes deliberate hypotension to minimize blood loss, early use of blood products (especially plasma) and administration of antifibrinolytic therapy. Areas of debate include the role of clotting factor concentrates and depth of anaesthesia. Conclusion: Resuscitation strategies during DCS may be as important as the anatomical repair itself.Recommendations include avoidance of hypothermia, maintenance of a lower than normal blood pressure, and early support of the coagulation system in patients likely to require massive transfusion. Controversies include the optimal ratio of plasma to red blood cells for empirical resuscitation, the ideal role of clotting factor concentrates, and the potential benefit of early, deep anaesthesia. Future research will centre on the complex interaction between the humoral elements of coagulation and the vascular endothelium that regulates perfusion, clotting and integrity of the circulation.

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“…US (1961)(1962)(1963)(1964)(1965)(1966)(1967)(1968)(1969)(1970)(1971)(1972)(1973), 67% during the Civil War (1861-1865), and 58% during the Revolutionary War (1775-1783) [1]. The dramatic improvements in casualty survival can be attributed to many factors, including advances in body armor, improvements in far forward trauma surgical and resuscitation techniques, improved battlefield hemorrhage control, enhanced blood product availability, and rapid evacuation to higher medical capability [2,3]. Unfortunately, as survival rates in the current conflicts achieve new heights, improvements in the management of pain in wounded warriors have been far less dramatic.…”

Section: Introductionmentioning

confidence: 99%

“…Historically, the American military has emphasized opioid-based pain management [3]. Although the success of opioid medications in pain management is without question, their use includes significant side effects that can be lethal in the austere combat environment [4,5].…”

Section: Introductionmentioning

confidence: 99%

Treating Pain on the Battlefield: A Warrior’s Perspective

Buckenmaier¹,

Brandon-Edwards²,

Borden³

et al. 2010

Curr Pain Headache Rep

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The current conflicts in Afghanistan (Operation Enduring Freedom; commenced October 2001) and Iraq (Operation Iraqi Freedom; commenced March 2003) have been remarkable due to the more than 90% survival rate among wounded warriors. Although this statistic is a historic achievement by the military's medical services, other medical issues have taken on greater emphasis as more casualties from war survive than ever before. Pain management of United States wounded, in particular, has been a medical issue of increasing importance, as modern understanding of the detrimental effects of pain on recovery and rehabilitation becomes clearer. In this review, a warrior's perspective of military pain management is explored and potential for improvement discussed.

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Lessons Learned from Modern Military Surgery

Cited by 75 publications

References 67 publications

Atls –A Systematic Review

Atls –A Systematic Review

Resuscitative strategies to maintain homeostasis during damage control surgery

Treating Pain on the Battlefield: A Warrior’s Perspective

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