首页 > 最新文献

Journal of special operations medicine : a peer reviewed journal for SOF medical professionals最新文献

英文 中文
Heat Tolerance Testing and the Return to Duty Decision: A Two-Year Case Cohort Analysis. 耐热测试与重返工作岗位的决定:为期两年的病例队列分析。
Rachel M Kester, Preetha A Abraham, Jeffrey C Leggit, Jacob B Harp, Josh B Kazman, Patricia A Deuster, Francis G O'Connor

Background: Among individuals with prior exertional heat illness (EHI), heat tolerance testing (HTT) may inform risk and return to duty/activity. However, little is known about HTT's predictive validity, particularly for EHI recurrence. Our project sought to demonstrate the predictive validity of HTT in EHI recurrence and HTT's utility as a diagnostic tool in exertional heat stroke (EHS).

Methods: Participants with prior EHS were recruited for the study by a physician's referral and were classified as heat tolerant or intolerant after completing demographics and an HTT. Participants were further categorized as single/simple (SS) EHI or recurrent/complex (RC) EHI by conducting a retrospective record review of the following two years. We calculated the positive (PPV) and negative predictive values (NPV) of HTT.

Results: The retrospective review of HTT records was used to categorize 44% of Servicemembers as RC, with 77% classified as heat tolerant, 14% as heat intolerant, and 9% as borderline. When borderline cases were classified as heat intolerant, HTT had a high NPV, indicating a high probability that heat-tolerant individuals did not have recurrent EHI. When borderline cases were classified as heat tolerant, NPV and sensitivity decreased while specificity increased.

Conclusion: We demonstrated that the HTT had a 100% NPV for future EHI over two years of follow-up for Servicemembers with a history of recurrent heat injury and negative HTT results. An HTT can provide critical data points to inform return to duty decisions and timelines by predicting the risk of EHI recurrence.

背景:对于曾经患过劳累性热病(EHI)的人,热耐受测试(HTT)可为风险和重返岗位/活动提供参考。然而,人们对耐热试验的预测效力知之甚少,尤其是对高温热病复发的预测效力。我们的项目旨在证明耐热试验对中暑复发的预测有效性,以及耐热试验作为劳累性中暑(EHS)诊断工具的实用性:方法: 通过医生转介,招募曾有过中暑经历的参与者参与研究,并在完成人口统计学和 HTT 后将其分为耐热和不耐热两类。通过对随后两年的记录进行回顾性审查,进一步将参与者分为单次/简单(SS)EHI 或复发/复杂(RC)EHI。我们计算了 HTT 的阳性预测值(PPV)和阴性预测值(NPV):通过对 HTT 记录的回顾性审查,我们将 44% 的军人归类为 RC,其中 77% 被归类为耐热,14% 被归类为不耐热,9% 被归类为边缘病例。当边缘病例被归类为不耐热者时,HTT 的 NPV 很高,表明耐热者很有可能没有复发性 EHI。当边缘病例被归类为耐热病例时,NPV 和灵敏度下降,而特异性上升:我们证明,在对有复发性热损伤病史且 HTT 结果为阴性的军人进行两年随访后,HTT 对未来 EHI 的 NPV 值为 100%。高温热损伤测试可提供重要的数据点,通过预测高温热损伤复发的风险,为重返岗位的决策和时间安排提供依据。
{"title":"Heat Tolerance Testing and the Return to Duty Decision: A Two-Year Case Cohort Analysis.","authors":"Rachel M Kester, Preetha A Abraham, Jeffrey C Leggit, Jacob B Harp, Josh B Kazman, Patricia A Deuster, Francis G O'Connor","doi":"10.55460/W7TV-MBRZ","DOIUrl":"10.55460/W7TV-MBRZ","url":null,"abstract":"<p><strong>Background: </strong>Among individuals with prior exertional heat illness (EHI), heat tolerance testing (HTT) may inform risk and return to duty/activity. However, little is known about HTT's predictive validity, particularly for EHI recurrence. Our project sought to demonstrate the predictive validity of HTT in EHI recurrence and HTT's utility as a diagnostic tool in exertional heat stroke (EHS).</p><p><strong>Methods: </strong>Participants with prior EHS were recruited for the study by a physician's referral and were classified as heat tolerant or intolerant after completing demographics and an HTT. Participants were further categorized as single/simple (SS) EHI or recurrent/complex (RC) EHI by conducting a retrospective record review of the following two years. We calculated the positive (PPV) and negative predictive values (NPV) of HTT.</p><p><strong>Results: </strong>The retrospective review of HTT records was used to categorize 44% of Servicemembers as RC, with 77% classified as heat tolerant, 14% as heat intolerant, and 9% as borderline. When borderline cases were classified as heat intolerant, HTT had a high NPV, indicating a high probability that heat-tolerant individuals did not have recurrent EHI. When borderline cases were classified as heat tolerant, NPV and sensitivity decreased while specificity increased.</p><p><strong>Conclusion: </strong>We demonstrated that the HTT had a 100% NPV for future EHI over two years of follow-up for Servicemembers with a history of recurrent heat injury and negative HTT results. An HTT can provide critical data points to inform return to duty decisions and timelines by predicting the risk of EHI recurrence.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139742643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prescreened Whole O Blood Group Walking Blood Bank Capabilities for Nontraditional Maritime Medical Receiving Platforms: A Case Series. 非传统海上医疗接收平台的预选全 O 血型步行血库能力:案例系列。
Raymond K Chang, Burke P Boyle, Mike O Udoh, Joshua M Maestas, Joseph A Gehrz, Eddy Ruano, Leticia Banker, Andrew P Cap, Jeffrey W Bitterman, Travis G Deaton, Jonathan D Auten

Background: Tactical Combat Casualty Care (TCCC) guidelines recognize low-titer group O whole blood (LTOWB) as the resuscitative fluid of choice for combat wounded. Utilization of prescreened LTOWB in a walking blood bank (WBB) format has been well described by the Ranger O low-titer blood (ROLO) and the United States Marine Corps Valkyrie programs, but it has not been applied to the maritime setting.

Methods: We describe three WBB experiences of an expeditionary resuscitative surgical system (ERSS) team, attached to three nontraditional maritime medical receiving platforms, over 6 months.

Results: Significant variations were identified in the number of screened eligible donors, the number of LTOWB donors, and the timely arrival at WBB activation sites between the platforms. Overall, 95% and 84% of the screened eligible group O blood donors on the Arleigh Burke Class Destroyer (DDG) and Nimitz Class Aircraft Carrier (CVN), respectively, were determined to be LTOWB. However, only 37% of the eligible screened group O blood donors aboard the Harper's Ferry Class Dock Landing Ship (LSD) were found to be LTOWB. Of the eligible donors, 66% did not complete screening, with 52% citing a correctable reason for nonparticipation.

Conclusion: LTOWB attained through WBBs may be the only practical resuscitative fluid on maritime platforms without inherent blood product storage capabilities to perform remote damage control resuscitation. Future efforts should focus on optimizing WBBs through capability development, education, and training efforts.

背景:战术战斗伤员救护(TCCC)指南认为,低滴度 O 型全血(LTOWB)是治疗战斗伤员的首选复苏液体。游骑兵 O 型低滴度全血(ROLO)和美国海军陆战队 Valkyrie 计划对以步行血库(WBB)形式使用预检 O 型低滴度全血进行了详细描述,但尚未应用于海上环境:我们描述了一个远征复苏外科系统(ERSS)小组在 6 个月内的三次 WBB 经验,该小组隶属于三个非传统的海上医疗接收平台:结果:在筛选合格供体的数量、LTOWB 供体的数量以及及时到达 WBB 启动地点方面,各平台之间存在显著差异。总体而言,在阿利-伯克级驱逐舰(DDG)和尼米兹级航空母舰(CVN)上,分别有 95% 和 84% 经过筛选的合格 O 型血献血者被确定为 LTOWB。然而,在哈珀渡口级船坞登陆舰(LSD)上经过筛选的合格 O 型血献血者中,只有 37% 被确定为 LTOWB。在符合条件的献血者中,66% 的人没有完成筛查,其中 52% 的人提出的不参加筛查的原因是可以纠正的:结论:在没有固有血液制品储存能力的海上平台上,通过 WBB 获得的 LTOWB 可能是进行远程损伤控制复苏的唯一实用复苏液。未来的工作重点应该是通过能力开发、教育和培训工作来优化 WBB。
{"title":"Prescreened Whole O Blood Group Walking Blood Bank Capabilities for Nontraditional Maritime Medical Receiving Platforms: A Case Series.","authors":"Raymond K Chang, Burke P Boyle, Mike O Udoh, Joshua M Maestas, Joseph A Gehrz, Eddy Ruano, Leticia Banker, Andrew P Cap, Jeffrey W Bitterman, Travis G Deaton, Jonathan D Auten","doi":"10.55460/PC7T-LML9","DOIUrl":"10.55460/PC7T-LML9","url":null,"abstract":"<p><strong>Background: </strong>Tactical Combat Casualty Care (TCCC) guidelines recognize low-titer group O whole blood (LTOWB) as the resuscitative fluid of choice for combat wounded. Utilization of prescreened LTOWB in a walking blood bank (WBB) format has been well described by the Ranger O low-titer blood (ROLO) and the United States Marine Corps Valkyrie programs, but it has not been applied to the maritime setting.</p><p><strong>Methods: </strong>We describe three WBB experiences of an expeditionary resuscitative surgical system (ERSS) team, attached to three nontraditional maritime medical receiving platforms, over 6 months.</p><p><strong>Results: </strong>Significant variations were identified in the number of screened eligible donors, the number of LTOWB donors, and the timely arrival at WBB activation sites between the platforms. Overall, 95% and 84% of the screened eligible group O blood donors on the Arleigh Burke Class Destroyer (DDG) and Nimitz Class Aircraft Carrier (CVN), respectively, were determined to be LTOWB. However, only 37% of the eligible screened group O blood donors aboard the Harper's Ferry Class Dock Landing Ship (LSD) were found to be LTOWB. Of the eligible donors, 66% did not complete screening, with 52% citing a correctable reason for nonparticipation.</p><p><strong>Conclusion: </strong>LTOWB attained through WBBs may be the only practical resuscitative fluid on maritime platforms without inherent blood product storage capabilities to perform remote damage control resuscitation. Future efforts should focus on optimizing WBBs through capability development, education, and training efforts.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139974554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Tactical Combat Casualty Care (TCCC) Guidelines: 25 January 2024. 战术战斗伤员护理 (TCCC) 指南:2024 年 1 月 25 日。
Travis G Deaton, Brendon Drew, Harold R Montgomery, Frank K Butler
{"title":"Tactical Combat Casualty Care (TCCC) Guidelines: 25 January 2024.","authors":"Travis G Deaton, Brendon Drew, Harold R Montgomery, Frank K Butler","doi":"10.55460/QT3B-XK5B","DOIUrl":"10.55460/QT3B-XK5B","url":null,"abstract":"","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139747759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
When Minutes Matter: A Comparison of Whole Blood Collection Techniques. 分秒必争:全血采集技术比较。
Russell Wier, Samuel Walther, Catherine Woodard, Cole S Jordan, Kevin J Matthews, Travis G Deaton, Brendon Drew, Terence Byrne, Gregory J Zarow

Background: Fast and reliable blood collection is critical to emergency walking blood banks (WBB) because mortality significantly declines when blood is quickly administered to a warfighter with hemorrhagic shock. Phlebotomy for WBB is accomplished via either the "straight stick" (SS) or "ruggedized lock" (RL) method. SS comprises a 16-gauge phlebotomy needle connected to a blood collection bag via tubing. The RL device collects blood through the same apparatus, but has a capped, intravenous (IV) catheter between the needle and the donor's arm. This is the first study to compare these two methods in battlefield-relevant metrics.

Methods: Military first responders and licensed medical providers (N=86) were trained in SS and RL as part of fresh whole blood training exercises. Outcomes included venipuncture success rates, time to IV access, blood collection times, total time, and user preferences, using a within-subjects crossover design. Data were analyzed using ANOVA and nonparametric statistics at p<0.05.

Results: SS outperformed RL in first venipuncture success rates (76% vs. 64%, p=0.07), IV access times (448 [standard error of the mean; SE 23] vs. 558 [SE 31] s, p<0.01), and blood collection bag fill times (573 [SE 48] vs. 703 [SE 44] s, p<0.05), resulting in an approximate 3.5-minute faster time overall. Survey data were mixed, with users perceiving SS as simpler and faster, but RL as more reliable and secure.

Conclusion: SS is optimal when timely collection is imperative, while RL may be preferable when device stability or replacing the collection bag is a consideration.

背景:快速可靠的血液采集对紧急步行血库(WBB)至关重要,因为如果能迅速为失血性休克的战士输血,死亡率就会大大降低。步行血库的抽血是通过 "直刺法"(SS)或 "加固锁定法"(RL)完成的。直刺法包括一根 16 号抽血针,通过管道连接到采血袋。RL 设备通过相同的仪器采血,但在针头和献血者手臂之间有一根带帽的静脉注射 (IV) 导管。这是首次在战场相关指标方面对这两种方法进行比较的研究:方法:作为新鲜全血培训演习的一部分,军事急救人员和持证医疗服务提供者(N=86)接受了 SS 和 RL 培训。结果包括静脉穿刺成功率、静脉注射时间、采血时间、总时间和用户偏好,采用受试者内交叉设计。采用方差分析和非参数统计对数据进行了分析:在首次静脉穿刺成功率(76% vs. 64%,p=0.07)、静脉输液时间(448 [均值标准误差;SE 23] s vs. 558 [SE 31] s,p=0.07)方面,SS 均优于 RL:当必须及时采集时,SS 是最佳选择,而当需要考虑设备稳定性或更换采集袋时,RL 可能更可取。
{"title":"When Minutes Matter: A Comparison of Whole Blood Collection Techniques.","authors":"Russell Wier, Samuel Walther, Catherine Woodard, Cole S Jordan, Kevin J Matthews, Travis G Deaton, Brendon Drew, Terence Byrne, Gregory J Zarow","doi":"10.55460/N87K-W6BZ","DOIUrl":"10.55460/N87K-W6BZ","url":null,"abstract":"<p><strong>Background: </strong>Fast and reliable blood collection is critical to emergency walking blood banks (WBB) because mortality significantly declines when blood is quickly administered to a warfighter with hemorrhagic shock. Phlebotomy for WBB is accomplished via either the \"straight stick\" (SS) or \"ruggedized lock\" (RL) method. SS comprises a 16-gauge phlebotomy needle connected to a blood collection bag via tubing. The RL device collects blood through the same apparatus, but has a capped, intravenous (IV) catheter between the needle and the donor's arm. This is the first study to compare these two methods in battlefield-relevant metrics.</p><p><strong>Methods: </strong>Military first responders and licensed medical providers (N=86) were trained in SS and RL as part of fresh whole blood training exercises. Outcomes included venipuncture success rates, time to IV access, blood collection times, total time, and user preferences, using a within-subjects crossover design. Data were analyzed using ANOVA and nonparametric statistics at p<0.05.</p><p><strong>Results: </strong>SS outperformed RL in first venipuncture success rates (76% vs. 64%, p=0.07), IV access times (448 [standard error of the mean; SE 23] vs. 558 [SE 31] s, p<0.01), and blood collection bag fill times (573 [SE 48] vs. 703 [SE 44] s, p<0.05), resulting in an approximate 3.5-minute faster time overall. Survey data were mixed, with users perceiving SS as simpler and faster, but RL as more reliable and secure.</p><p><strong>Conclusion: </strong>SS is optimal when timely collection is imperative, while RL may be preferable when device stability or replacing the collection bag is a consideration.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140040842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Derivation of a Procedural Performance Checklist for Bifemoral Veno-Venous Extracorporeal Membrane Oxygenation Cannula Placement in Operational Environments. 双股静脉体外膜肺氧合插管在操作环境中的程序性能检查表的推导。
Elizabeth Karyn Powell, Richard Betzold, Rishi Kundi, Douglas Anderson, Daniel Haase, Meaghan Keville, Samuel Galvagno

Background: Veno-venous extracorporeal membrane oxygenation (VV ECMO) is a low-frequency, high-intensity procedure used for severe lung illness or injury to facilitate rapid correction of hypoxemia and respiratory acidosis. This technology is more portable and extracorporeal support is more frequently performed outside of the hospital. Future conflicts may require prolonged causality care and more specialized critical care capabilities including VV ECMO to improve patient outcomes. We used an expert consensus survey based on a developed bifemoral VV ECMO cannulation checklist with an operational focus to establish a standard for training, validation testing, and sustainment.

Methods: A 36-item procedural checklist was provided to 14 experts from multiple specialties. Using the modified Delphi method, the checklist was serially modified based on expert feedback.

Results: Three rounds of the study were performed, resulting in a final 32-item checklist. Each item on the checklist received at least 70% expert agreement on its inclusion in the final checklist.

Conclusion: A procedural performance checklist was created for bifemoral VV ECMO using the modified Delphi method. This is an objective tool to assist procedural training and validation for medical providers performing VV ECMO in austere environments.

背景:静脉体外膜氧合(VV ECMO)是一种低频率、高强度的程序,用于严重肺部疾病或损伤,以促进快速纠正低氧血症和呼吸性酸中毒。这种技术更便于携带,体外支持也更多地在医院外进行。未来的冲突可能需要长时间的因果关系护理和更专业的重症监护能力,包括 VV ECMO,以改善患者的预后。我们根据已开发的双股口 VV ECMO 插管核对表进行了专家共识调查,并以操作为重点,以建立培训、验证测试和维持的标准:方法: 向来自多个专科的 14 位专家提供了一份包含 36 个项目的程序检查表。方法:向来自多个专科的 14 位专家提供了一份 36 个项目的程序检查表,并根据专家的反馈意见,采用改良德尔菲法对检查表进行了连续修改:结果:研究进行了三轮,最终形成了 32 个项目的核对表。核对表上的每个项目至少有 70% 的专家同意将其纳入最终核对表:结论:使用改良德尔菲法为双股动脉 VV ECMO 创建了程序性能核对表。这是一个客观的工具,可帮助在艰苦环境中执行 VV ECMO 的医疗服务提供者进行程序培训和验证。
{"title":"Derivation of a Procedural Performance Checklist for Bifemoral Veno-Venous Extracorporeal Membrane Oxygenation Cannula Placement in Operational Environments.","authors":"Elizabeth Karyn Powell, Richard Betzold, Rishi Kundi, Douglas Anderson, Daniel Haase, Meaghan Keville, Samuel Galvagno","doi":"10.55460/Y177-KRQV","DOIUrl":"10.55460/Y177-KRQV","url":null,"abstract":"<p><strong>Background: </strong>Veno-venous extracorporeal membrane oxygenation (VV ECMO) is a low-frequency, high-intensity procedure used for severe lung illness or injury to facilitate rapid correction of hypoxemia and respiratory acidosis. This technology is more portable and extracorporeal support is more frequently performed outside of the hospital. Future conflicts may require prolonged causality care and more specialized critical care capabilities including VV ECMO to improve patient outcomes. We used an expert consensus survey based on a developed bifemoral VV ECMO cannulation checklist with an operational focus to establish a standard for training, validation testing, and sustainment.</p><p><strong>Methods: </strong>A 36-item procedural checklist was provided to 14 experts from multiple specialties. Using the modified Delphi method, the checklist was serially modified based on expert feedback.</p><p><strong>Results: </strong>Three rounds of the study were performed, resulting in a final 32-item checklist. Each item on the checklist received at least 70% expert agreement on its inclusion in the final checklist.</p><p><strong>Conclusion: </strong>A procedural performance checklist was created for bifemoral VV ECMO using the modified Delphi method. This is an objective tool to assist procedural training and validation for medical providers performing VV ECMO in austere environments.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139567648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Social Determinant of Unconventional Resilience Tactical Engagement with Bonding Patterns. 非常规复原力战术参与结合模式的社会决定因素。
Erika Ann Jeschke, Jared Wyma-Bradley, Jay B Baker, John Dorsch, Sarah L Huffman

Building upon our strategic framework and operational model, we will discuss findings from our ethnographic study, entitled: "The Impact of Catastrophic Injury Exposure on Resilience in Special Operations Surgical Teams (SOSTs)," to explain the tactical nature and importance of social determinants within our new characterization of unconventional resilience. Our fourth paper in this series, will explain how bonding patterns establish the quality of intra- and interpersonal connections that create a tensive conduit for the pressure of performance within our operational model, allowing for dynamic freedom of maneuver to take place in ambiguity. We will use qualita- tive quotes to illustrate various ways SOST medics relate to themselves, other people, and the Special Operations Forces (SOF) culture. To achieve our goals, we will: 1) provide an in- troduction to social determinants as tactical engagement with unconventional resilience; 2) define the social determinant of bonding patterns as extrapolated from qualitative data as well as use qualitative data to thematize various types of bonding patterns; and 3) relate tactical engagement with bonding pat- terns to our metaphor of bag sets. We conclude by gesturing to the importance of bonding patterns in orienting SOF medics' proprioception and kinesthesia in the SOF performance space.

在我们的战略框架和行动模式的基础上,我们将讨论我们的人种学研究结果,题为 "灾难性伤害暴露对特种作战外科小组(SOSTs)复原力的影响",以解释在我们对非常规复原力的新描述中社会决定因素的战术性质和重要性。本系列的第四篇论文将解释纽带模式如何建立内部和人际关系的质量,从而在我们的行动模式中为绩效压力创造一个紧张的渠道,使动态的自由行动在模糊中进行。我们将使用有质量的引语来说明 SOST 医护人员与自己、他人和特种作战部队(SOF)文化的各种关系。为了实现我们的目标,我们将1)介绍非常规复原力战术参与的社会决定因素;2)定义从定性数据中推断出的纽带模式的社会决定因素,并使用定性数据将各种类型的纽带模式专题化;3)将纽带模式的战术参与与我们的包组隐喻联系起来。最后,我们将指出结合模式在确定 SOF 医护人员在 SOF 表演空间中的本体感觉和运动感觉方向方面的重要性。
{"title":"Social Determinant of Unconventional Resilience Tactical Engagement with Bonding Patterns.","authors":"Erika Ann Jeschke, Jared Wyma-Bradley, Jay B Baker, John Dorsch, Sarah L Huffman","doi":"10.55460/IFK1-RCU4","DOIUrl":"10.55460/IFK1-RCU4","url":null,"abstract":"<p><p>Building upon our strategic framework and operational model, we will discuss findings from our ethnographic study, entitled: \"The Impact of Catastrophic Injury Exposure on Resilience in Special Operations Surgical Teams (SOSTs),\" to explain the tactical nature and importance of social determinants within our new characterization of unconventional resilience. Our fourth paper in this series, will explain how bonding patterns establish the quality of intra- and interpersonal connections that create a tensive conduit for the pressure of performance within our operational model, allowing for dynamic freedom of maneuver to take place in ambiguity. We will use qualita- tive quotes to illustrate various ways SOST medics relate to themselves, other people, and the Special Operations Forces (SOF) culture. To achieve our goals, we will: 1) provide an in- troduction to social determinants as tactical engagement with unconventional resilience; 2) define the social determinant of bonding patterns as extrapolated from qualitative data as well as use qualitative data to thematize various types of bonding patterns; and 3) relate tactical engagement with bonding pat- terns to our metaphor of bag sets. We conclude by gesturing to the importance of bonding patterns in orienting SOF medics' proprioception and kinesthesia in the SOF performance space.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139693480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Use of Tourniquets in the Russo-Ukrainian War. 俄乌战争中止血带的使用。
Igor M Samarskiy, Eduard M Khoroshun, Yurii Vorokhta

Aim: The objective of the study was to evaluate the use of tourniquets in the Russo-Ukrainian war.

Methods: The type, number, and duration of tourniquets per limb, the clinical course of limb injuries, and the functional status of the injured limbs during the 24 hours post-injury were evaluated in military hospital facilities for the period of 2014-2022. Statistical frequencies and variances were analyzed.

Results: During active hostilities, the medical units of the Southern Operational Command received 2,496 patients with limb injuries that required the application of tourniquets. Lower extremity injuries were predominantly observed (84.4%). A single tourniquet was used in 1,538 cases (61.6%), whereas two tourniquets were used in 533 (21.4%), and three tourniquets in 425 cases (17.0%). During the 2014- 2021 period, Esmarch's tourniquet was most commonly used. However, in 2022, it was mostly replaced by the Combat Application Tourniquet and similar systems (e.g., Sich, Dnipro). The duration of the tourniquet use ranged from 50 to 380 minutes (mean 205.9 [standard error 8.1] min), which prolonged ischemia in a significant number of cases. Limb amputations, mainly due to extensive necrosis, were performed in 92 cases (3.7%). In addition to 101 deaths (4.0% of patients), 11 cases of severe tourniquet syndrome were encountered. The limb was salvaged in 9 cases (81.8%).

Conclusion: Prompt triage and evacuation of injured combatants can save affected limbs, even when the duration of tourniquet use exceeds 2 hours. Tourniquet syndrome can be prevented using a hemostatic tourniquet.

目的:本研究旨在评估俄乌战争中止血带的使用情况:方法:对 2014-2022 年期间军队医院设施中每条肢体使用止血带的类型、数量和持续时间、肢体损伤的临床过程以及受伤后 24 小时内受伤肢体的功能状态进行评估。对统计频率和方差进行了分析:结果:在现行敌对行动期间,南部作战司令部的医疗单位共接收了 2496 名需要使用止血带的肢体受伤患者。主要是下肢受伤(84.4%)。1 538 例(61.6%)使用了单止血带,533 例(21.4%)使用了双止血带,425 例(17.0%)使用了三止血带。在 2014-2021 年期间,埃斯马奇止血带最为常用。但在 2022 年,它大多被战斗应用止血带和类似系统(如 Sich、Dnipro)所取代。止血带的使用时间从 50 分钟到 380 分钟不等(平均 205.9 [标准误差 8.1]分钟),这延长了大量病例的缺血时间。有 92 例(3.7%)患者因肢体大面积坏死而截肢。除 101 例死亡病例(占患者总数的 4.0%)外,还有 11 例出现严重止血带综合征。9例(81.8%)患者的肢体得以挽救:结论:即使止血带使用时间超过 2 小时,对受伤战斗人员进行及时分流和后送也能挽救受影响的肢体。使用止血带可以预防止血带综合症。
{"title":"The Use of Tourniquets in the Russo-Ukrainian War.","authors":"Igor M Samarskiy, Eduard M Khoroshun, Yurii Vorokhta","doi":"10.55460/CB0O-GYYX","DOIUrl":"10.55460/CB0O-GYYX","url":null,"abstract":"<p><strong>Aim: </strong>The objective of the study was to evaluate the use of tourniquets in the Russo-Ukrainian war.</p><p><strong>Methods: </strong>The type, number, and duration of tourniquets per limb, the clinical course of limb injuries, and the functional status of the injured limbs during the 24 hours post-injury were evaluated in military hospital facilities for the period of 2014-2022. Statistical frequencies and variances were analyzed.</p><p><strong>Results: </strong>During active hostilities, the medical units of the Southern Operational Command received 2,496 patients with limb injuries that required the application of tourniquets. Lower extremity injuries were predominantly observed (84.4%). A single tourniquet was used in 1,538 cases (61.6%), whereas two tourniquets were used in 533 (21.4%), and three tourniquets in 425 cases (17.0%). During the 2014- 2021 period, Esmarch's tourniquet was most commonly used. However, in 2022, it was mostly replaced by the Combat Application Tourniquet and similar systems (e.g., Sich, Dnipro). The duration of the tourniquet use ranged from 50 to 380 minutes (mean 205.9 [standard error 8.1] min), which prolonged ischemia in a significant number of cases. Limb amputations, mainly due to extensive necrosis, were performed in 92 cases (3.7%). In addition to 101 deaths (4.0% of patients), 11 cases of severe tourniquet syndrome were encountered. The limb was salvaged in 9 cases (81.8%).</p><p><strong>Conclusion: </strong>Prompt triage and evacuation of injured combatants can save affected limbs, even when the duration of tourniquet use exceeds 2 hours. Tourniquet syndrome can be prevented using a hemostatic tourniquet.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139974555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Deployed Combat Use of Methoxyflurane for Analgesia. 在部署的战斗中使用甲氧基氟烷镇痛。
Steven Gremel Schauer, Andrew D Fisher, Michael D April

Background: The U.S. Military needs fast-acting, non-opioid solutions for battlefield pain. The U.S. Military recently used morphine auto-injectors, which are now unavailable. Off-label ketamine and oral transmucosal fentanyl citrate use introduces challenges and is therefore uncommon among conventional forces. Sublingual suftentanil is the only recent pain medication acquired to fill this gap. Conversely, methoxyflurane delivered by a handheld inhaler is promising, fast-acting, and available to some partner forces. We describe methoxyflurane use reported in the Department of Defense Trauma Registry (DODTR).

Methods: We requested all available DODTR encounters from 2007 to 2023 with a documented intervention or assessment within the first 72 hours of care. We analyzed casualties who received methoxyflurane in the prehospital setting using descriptive statistics.

Results: There were 22 encounters with documented methoxyflurane administration. The median patient age was 23 (range 21-31) years. All were men. The largest proportion was partner force (50%), followed by U.S. Military (27%). Most (64%) sustained battle injuries. Explosives were the most common mechanism of injury (46%), followed by firearms (23%). The median injury severity score was 5 (range 1-17). The most frequent injuries were serious injuries to the extremities (27%), and 23% of patients (5) received a tourniquet. One-half of the casualties received concomitant pain medications. Only three casualties had multiple pain scores measured, with a median pain score change of -3 on a scale of 10.

Conclusion: Methoxyflurane use in deployed combat shows both feasibility and usability for analgesia.

背景:美国军方需要快速起效、非阿片类药物的战场止痛解决方案。美军最近使用了吗啡自动注射器,但现在已经无法使用。标签外使用氯胺酮和枸橼酸芬太尼口服液会带来挑战,因此在常规部队中并不常见。舌下含服舒芬太尼是最近获得的唯一一种止痛药物,填补了这一空白。相反,通过手持吸入器给药的甲氧氟烷前景广阔、见效快,一些伙伴部队也可以使用。我们描述了国防部创伤登记处(DODTR)报告的甲氧氟烷使用情况:我们申请了 2007 年至 2023 年期间所有可用的 DODTR 病例,这些病例都记录了在护理的最初 72 小时内进行的干预或评估。我们使用描述性统计方法分析了在院前环境中接受甲氧氟醚治疗的伤员:结果:共有 22 次有记录的甲氧氟烷用药。患者年龄中位数为 23 岁(21-31 岁不等)。所有患者均为男性。最大比例是伙伴部队(50%),其次是美国军队(27%)。大多数人(64%)在战斗中受伤。爆炸是最常见的受伤机制(46%),其次是枪支(23%)。受伤严重程度的中位数为 5(范围为 1-17)。最常见的伤害是四肢重伤(27%),23%的患者(5 人)接受了止血带治疗。二分之一的伤员同时服用了止痛药物。只有 3 名伤员进行了多次疼痛评分,疼痛评分变化的中位数为-3(10 分):结论:在部署的战斗中使用甲氧氟醚镇痛显示出了可行性和可用性。
{"title":"Deployed Combat Use of Methoxyflurane for Analgesia.","authors":"Steven Gremel Schauer, Andrew D Fisher, Michael D April","doi":"10.55460/X2OD-UYUQ","DOIUrl":"10.55460/X2OD-UYUQ","url":null,"abstract":"<p><strong>Background: </strong>The U.S. Military needs fast-acting, non-opioid solutions for battlefield pain. The U.S. Military recently used morphine auto-injectors, which are now unavailable. Off-label ketamine and oral transmucosal fentanyl citrate use introduces challenges and is therefore uncommon among conventional forces. Sublingual suftentanil is the only recent pain medication acquired to fill this gap. Conversely, methoxyflurane delivered by a handheld inhaler is promising, fast-acting, and available to some partner forces. We describe methoxyflurane use reported in the Department of Defense Trauma Registry (DODTR).</p><p><strong>Methods: </strong>We requested all available DODTR encounters from 2007 to 2023 with a documented intervention or assessment within the first 72 hours of care. We analyzed casualties who received methoxyflurane in the prehospital setting using descriptive statistics.</p><p><strong>Results: </strong>There were 22 encounters with documented methoxyflurane administration. The median patient age was 23 (range 21-31) years. All were men. The largest proportion was partner force (50%), followed by U.S. Military (27%). Most (64%) sustained battle injuries. Explosives were the most common mechanism of injury (46%), followed by firearms (23%). The median injury severity score was 5 (range 1-17). The most frequent injuries were serious injuries to the extremities (27%), and 23% of patients (5) received a tourniquet. One-half of the casualties received concomitant pain medications. Only three casualties had multiple pain scores measured, with a median pain score change of -3 on a scale of 10.</p><p><strong>Conclusion: </strong>Methoxyflurane use in deployed combat shows both feasibility and usability for analgesia.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139984481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Sterile Instrument Storage in an Austere Environment: Are Sterile Peel Packaging and Cellulose Wrapping Equivalent? 严酷环境中的无菌器械储存:无菌剥离包装和纤维素包装是否等同?
Nathan Lanham, Christopher M Belyea, David Marcello, Allan B Wataka, Lillian Musila

Background: Recommendations for optimal temperature and humidity for sterile instrument storage vary according to different sources. Furthermore, there are limited data comparing methods of packing smaller, lightweight, low-profile instruments. The purpose of this study was to compare sterile peel packaging and sterile cellulose wrapping for sterile instrument storage in an austere environment characterized by elevated temperature and humidity.

Methods: Stainless steel screws were sterilized and stored in either sterile peel packaging, sterile cellulose wrapping, or no packaging. Four groups were evaluated. Group 1 consisted of four screws in a sterile peelpack envelope and served as a time-zero control. Group 2 consisted of two groups of five screws, each packaged with blue sterilization cellulose wrap. Group 3 consisted of two groups of five screws, each packaged in sterile peel-pack envelopes. Group 4 consisted of 10 non-sterile unpackaged screws, which served as controls. Screws from groups 2, 3, and 4 were then cultured for 6 and 12 weeks. Temperature and humidity values were recorded in the instrument storage area.

Results: Average temperature was 21.3°C (SD 1.2°C; range 18.9°C-27.2°C) and average humidity was 51.7% (SD 3.9%; range 39%- 70%). Groups 1 (time-zero control) and 2 (sterile cellulose wrapping) demonstrated no growth. After 6 and 12 weeks, groups 3 (sterile peel packaging) and 4 (control) demonstrated bacterial growth.

Conclusion: The most common culture isolates were gram-positive rods and two common nosocomial Staphylococcius species. Sterile peel packaging was not found to be equivalent to sterile cellulose wrapping in austere environmental conditions.

背景:无菌器械储存的最佳温度和湿度建议因来源不同而各异。此外,比较小型、轻便、低调器械的包装方法的数据也很有限。本研究的目的是比较无菌果皮包装和无菌纤维素包装在温度和湿度升高的严酷环境中储存无菌器械的方法:方法:对不锈钢螺钉进行灭菌处理,然后分别用无菌去皮包装、无菌纤维素包装或无包装进行储存。评估分为四组。第 1 组包括装在无菌去皮包装袋中的四颗螺钉,作为时间零对照。第 2 组包括两组,每组 5 颗螺钉,均使用蓝色灭菌纤维素包装。第 3 组包括两组,每组五颗螺钉,用无菌剥离包装袋包装。第 4 组包括 10 颗未经消毒的无包装螺钉,作为对照组。然后将第 2、3 和 4 组的螺钉分别培养 6 周和 12 周。记录器械存放区的温度和湿度值:平均温度为 21.3°C(标准差为 1.2°C;范围为 18.9°C-27.2°C),平均湿度为 51.7%(标准差为 3.9%;范围为 39%-70%)。第 1 组(时间为零的对照组)和第 2 组(无菌纤维素包裹)没有出现生长现象。6 周和 12 周后,第 3 组(无菌果皮包装)和第 4 组(对照组)出现细菌生长:最常见的培养分离物是革兰氏阳性杆菌和两种常见的鼻腔葡萄球菌。在严酷的环境条件下,无菌果皮包装并不等同于无菌纤维素包装。
{"title":"Sterile Instrument Storage in an Austere Environment: Are Sterile Peel Packaging and Cellulose Wrapping Equivalent?","authors":"Nathan Lanham, Christopher M Belyea, David Marcello, Allan B Wataka, Lillian Musila","doi":"10.55460/EB2S-XTB5","DOIUrl":"10.55460/EB2S-XTB5","url":null,"abstract":"<p><strong>Background: </strong>Recommendations for optimal temperature and humidity for sterile instrument storage vary according to different sources. Furthermore, there are limited data comparing methods of packing smaller, lightweight, low-profile instruments. The purpose of this study was to compare sterile peel packaging and sterile cellulose wrapping for sterile instrument storage in an austere environment characterized by elevated temperature and humidity.</p><p><strong>Methods: </strong>Stainless steel screws were sterilized and stored in either sterile peel packaging, sterile cellulose wrapping, or no packaging. Four groups were evaluated. Group 1 consisted of four screws in a sterile peelpack envelope and served as a time-zero control. Group 2 consisted of two groups of five screws, each packaged with blue sterilization cellulose wrap. Group 3 consisted of two groups of five screws, each packaged in sterile peel-pack envelopes. Group 4 consisted of 10 non-sterile unpackaged screws, which served as controls. Screws from groups 2, 3, and 4 were then cultured for 6 and 12 weeks. Temperature and humidity values were recorded in the instrument storage area.</p><p><strong>Results: </strong>Average temperature was 21.3°C (SD 1.2°C; range 18.9°C-27.2°C) and average humidity was 51.7% (SD 3.9%; range 39%- 70%). Groups 1 (time-zero control) and 2 (sterile cellulose wrapping) demonstrated no growth. After 6 and 12 weeks, groups 3 (sterile peel packaging) and 4 (control) demonstrated bacterial growth.</p><p><strong>Conclusion: </strong>The most common culture isolates were gram-positive rods and two common nosocomial Staphylococcius species. Sterile peel packaging was not found to be equivalent to sterile cellulose wrapping in austere environmental conditions.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139998296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Occlusion Pressures of Tactical Pneumatic Tourniquet 2". 战术气动止血带 2 的闭合压力"。
Piper Lynn Wall, Charisse M Buising, Dani Eernisse, Taylor Rentschler, Christopher Winters, Catherine Hackett Renner

Background: The Tactical Pneumatic Tournqiuet 2" (TPT2, 5.1cm-wide deflated) allows total average applied pressure measurement, which should be useful toward development of emergency-use limb tourniquet certification devices.

Methods: The TPT2 hand bulb was replaced with stopcocks and syringes, allowing filling with continuous pressure measurement. Forearm and mid-thigh applications involved two sets of five Doppler-based pulse gone/return pairs. Second set pulse gones were chosen a priori for occlusion pressures (preliminary work indicated greater consistency in second sets).

Results: All 68 forearms occluded (30 female, 38 male, median circumference 17.8cm, range 14.6-23.5cm; median second set of pulse gone tourniquet pressures 176mmHg, range 128-282mmHg). Fifty-five thighs occluded (median circumference 54.3cm, range 41.6-62.4cm; median systolic pressure 126mmHg, range 102-142mmHg; median second set of pulse gone pressures 574mmHg, range 274-1158mmHg). Thirteen thigh applications were stopped without occlusion because of concerning pressures combined with no indication of imminent occlusion and difficulties forcing more air into the TPT2 (3 female, 10 male, peak pressures from 958-1377mmHg, median 1220mmHg, p<.0001 versus occluded thighs; median circumference 63.3cm, range 55.0-72.9cm, p<.0001 versus occluded thighs; median systolic pressure 126mmHg, range 120-173mmHg, p<.019 versus occluded thighs). Thigh TPT2 impression widths on five subjects after occlusion were as follows: 3.5cm, occlusion 274mmHg; 2.8cm, occlusion 348mmHg; 2.9cm, occlusion 500mmHg; 2.8cm, occlusion 782mmHg; 2.7cm, occlusion 1114mmHg.

Conclusions: Though probably useful to tourniquet certification, the required pressures for thigh occlusion make the TPT2 undesirable for any clinical use, emergency or otherwise.

背景:战术气动止血带 2"(TPT2,瘪后 5.1 厘米宽)可以测量总平均应用压力,这对开发紧急使用的肢体止血带认证设备应该很有用:方法:用塞子和注射器取代 TPT2 手用球囊,可在连续测量压力的情况下进行充气。前臂和大腿中部的应用涉及两组五对基于多普勒的脉搏通/断。第二套脉搏通路是根据闭塞压力事先选择的(初步工作表明第二套脉搏通路的一致性更高):结果:68 个前臂全部闭塞(女性 30 个,男性 38 个,中位周长 17.8 厘米,范围 14.6-23.5 厘米;第二组脉搏消失止血带压力中位数 176mmHg,范围 128-282mmHg)。55 条大腿闭塞(周长中位数 54.3 厘米,范围 41.6-62.4 厘米;收缩压中位数 126mmHg,范围 102-142mmHg;第二组脉搏消失压力中位数 574mmHg,范围 274-1158mmHg)。有 13 次大腿应用在没有闭塞的情况下被停止,原因是压力令人担忧,而且没有迹象表明即将闭塞,也很难将更多空气注入 TPT2(3 名女性,10 名男性,峰值压力为 958-1377mmHg,中位数为 1220mmHg,p 结论:尽管 TPT2 可能对止血带认证有用,但大腿闭塞所需的压力使其在任何临床应用中都不可取,无论是紧急情况还是其他情况。
{"title":"Occlusion Pressures of Tactical Pneumatic Tourniquet 2\".","authors":"Piper Lynn Wall, Charisse M Buising, Dani Eernisse, Taylor Rentschler, Christopher Winters, Catherine Hackett Renner","doi":"10.55460/P75U-HM00","DOIUrl":"10.55460/P75U-HM00","url":null,"abstract":"<p><strong>Background: </strong>The Tactical Pneumatic Tournqiuet 2\" (TPT2, 5.1cm-wide deflated) allows total average applied pressure measurement, which should be useful toward development of emergency-use limb tourniquet certification devices.</p><p><strong>Methods: </strong>The TPT2 hand bulb was replaced with stopcocks and syringes, allowing filling with continuous pressure measurement. Forearm and mid-thigh applications involved two sets of five Doppler-based pulse gone/return pairs. Second set pulse gones were chosen a priori for occlusion pressures (preliminary work indicated greater consistency in second sets).</p><p><strong>Results: </strong>All 68 forearms occluded (30 female, 38 male, median circumference 17.8cm, range 14.6-23.5cm; median second set of pulse gone tourniquet pressures 176mmHg, range 128-282mmHg). Fifty-five thighs occluded (median circumference 54.3cm, range 41.6-62.4cm; median systolic pressure 126mmHg, range 102-142mmHg; median second set of pulse gone pressures 574mmHg, range 274-1158mmHg). Thirteen thigh applications were stopped without occlusion because of concerning pressures combined with no indication of imminent occlusion and difficulties forcing more air into the TPT2 (3 female, 10 male, peak pressures from 958-1377mmHg, median 1220mmHg, p<.0001 versus occluded thighs; median circumference 63.3cm, range 55.0-72.9cm, p<.0001 versus occluded thighs; median systolic pressure 126mmHg, range 120-173mmHg, p<.019 versus occluded thighs). Thigh TPT2 impression widths on five subjects after occlusion were as follows: 3.5cm, occlusion 274mmHg; 2.8cm, occlusion 348mmHg; 2.9cm, occlusion 500mmHg; 2.8cm, occlusion 782mmHg; 2.7cm, occlusion 1114mmHg.</p><p><strong>Conclusions: </strong>Though probably useful to tourniquet certification, the required pressures for thigh occlusion make the TPT2 undesirable for any clinical use, emergency or otherwise.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139673651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Journal of special operations medicine : a peer reviewed journal for SOF medical professionals
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1