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Yang H, Dai C, Zhang D, Chen C, Ye Z, Zhong X, Jia Y, Jiang R, Du W, Zong Z. Empirical and modified hemostatic resuscitation for liver blast injury combined with seawater immersion: A preliminary study. Chin J Traumatol 2024:S1008-1275(24)00081-6. [PMID: 39142966 DOI: 10.1016/j.cjtee.2024.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 06/05/2024] [Accepted: 07/01/2024] [Indexed: 08/16/2024] Open
Abstract
PURPOSE To compare the effects of empirical and modified hemostatic resuscitation for liver blast injury combined with seawater immersion. METHODS Thirty rabbits were subjected to liver blast injury combined with seawater immersion, and were then divided into 3 groups randomly (n = 10 each): group A (no treatment after immersion), group B (empirical resuscitation with 20 mL hydroxyethyl starch, 50 mg tranexamic acid, 25 IU prothrombin complex concentrate and 50 mg/kg body weight fibrinogen concentrate), and group C (modified resuscitation with additional 10 IU prothrombin complex concentrate and 20 mg/kg body weight fibrinogen concentrate based on group B). Blood samples were gathered at specified moments for assessment of thromboelastography, routine coagulation test, and biochemistry. Mean arterial pressure, heart rate, and survival rate were also documented at each time point. The Kolmogorov-Smirnov test was used to examine the normality of data distribution. Multigroup comparisons were conducted with one-way ANOVA. RESULTS Liver blast injury combined with seawater immersion resulted in severe coagulo-fibrinolytic derangement as indicated by prolonged prothrombin time (s) (11.53 ± 0.98 vs. 7.61 ± 0.28, p<0.001), activated partial thromboplastin time (APTT) (s) (33.48 ± 6.66 vs. 18.23 ± 0.89, p<0.001), reaction time (R) (min) (5.85 ± 0.96 vs. 2.47 ± 0.53, p<0.001), decreased maximum amplitude (MA) (mm) (53.20 ± 5.99 vs. 74.92 ± 5.76, p<0.001) and fibrinogen concentration (g/L) (1.188 ± 0.29 vs. 1.890 ± 0.32, p = 0.003), and increased D-dimer concentration (mg/L) (0.379 ± 0.32 vs. 0.051 ± 0.03, p = 0.005). Both empirical and modified hemostatic resuscitation could improve the coagulo-fibrinolytic states and organ function, as indicated by shortened APTT and R values, decreased D-dimer concentration, increased fibrinogen concentration and MA values, lower concentration of blood urea nitrogen and creatine kinase-MB in group B and group C rabbits in comparison to that observed in group A. Further analysis found that the R values (min) (4.67 ± 0.84 vs. 3.66 ± 0.98, p = 0.038), APTT (s) (23.16 ± 2.75 vs. 18.94 ± 1.05, p = 0.001), MA (mm) (60.10 ± 4.74 vs. 70.21 ± 3.01, p < 0.001), and fibrinogen concentration (g/L) (1.675 ± 0.21 vs. 1.937 ± 0.16, p = 0.013) were remarkably improved in group C than in group B at 2 h and 4 h after injury. In addition, the concentration of blood urea nitrogen (mmol/L) (24.11 ± 1.96 vs. 21.00 ± 3.78, p = 0.047) and creatine kinase-MB (U/L) (85.50 ± 13.60 vs. 69.74 ± 8.56, p = 0.013) were lower in group C than in group B at 6 h after injury. The survival rates in group B and group C were significantly higher than those in group A at 4 h and 6 h after injury (p < 0.001), however, there were no statistical differences in survival rates between group B and group C at each time point. CONCLUSIONS Modified hemostatic resuscitation could improve the coagulation parameters and organ function better than empirical hemostatic resuscitation.
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Affiliation(s)
- Haoyang Yang
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Army Medical University, Chongqing, 400037, China
| | - Chenglin Dai
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Army Medical University, Chongqing, 400037, China
| | - Dongzhaoyang Zhang
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Army Medical University, Chongqing, 400037, China
| | - Can Chen
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Army Medical University, Chongqing, 400037, China
| | - Zhao Ye
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Army Medical University, Chongqing, 400037, China
| | - Xin Zhong
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Army Medical University, Chongqing, 400037, China
| | - Yijun Jia
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Army Medical University, Chongqing, 400037, China
| | - Renqing Jiang
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Army Medical University, Chongqing, 400037, China
| | - Wenqiong Du
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Army Medical University, Chongqing, 400037, China
| | - Zhaowen Zong
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Army Medical University, Chongqing, 400037, China.
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Fink AM, Milbrath GR. A concept analysis of nurses in conflicts after World War II. J Adv Nurs 2023; 79:31-47. [PMID: 36218173 PMCID: PMC10092232 DOI: 10.1111/jan.15454] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/01/2022] [Accepted: 09/21/2022] [Indexed: 12/15/2022]
Abstract
AIM We analysed nurses' experiences during military conflicts since World War II. BACKGROUND Nurses have successfully reduced morbidity and mortality in populations affected by wars; despite centuries of nurses' global involvement in wars, there is limited knowledge about their experiences. METHOD We used Rodger's evolutionary concept analysis methodology to understand the antecedents, attributes, consequences, context and implications of nurses' war-related experiences. We analysed data from quantitative and qualitative research, media reports, editorials, historical reviews and published accounts of nurses' experiences in many locations, including Afghanistan, Bosnia, Croatia, Korea, Kosovo, Iran, Iraq, Israel, Palestine, Russia, Somalia, Ukraine and Vietnam. FINDINGS Two antecedent conditions preceded nurses' war involvement: actively responding to human suffering and having resources for readiness. Nurses were defined by five attributes: sacrifice, resourcefulness, tunnel-vision, survival mindset and comradery. We also found evidence for seven consequences; nurses saved lives (reduced morbidity and mortality), however, some nurses faced professional burnout/disillusionment, restricted practice authority, isolation and post-traumatic stress after war. In addition, growth and pacifism were consequences for some nurses who were exposed to war. CONCLUSION The findings of our concept analysis illustrate how nurses have fulfilled critical life-saving roles, but some nurses' post-war experiences were debilitating, stigmatized and unsupported. We conclude that research about the resourcefulness, innovations and resiliency nurses have developed during wars is essential, and professional support mechanisms must be developed to prevent post-traumatic stress, burnout and attrition from the profession. Governments can use utilize the knowledge nurses developed during wars to expand emergency preparedness skillsets and promote nurses as the leaders of international efforts to promote peace. NO PATIENT OR PUBLIC CONTRIBUTION Patients, service users, caregivers and members of the public were not involved in conducting this concept analysis or preparing the manuscript. IMPACT STATEMENT By understanding nurses' involvement with post-WWII conflicts, we have demonstrated the significant public health contributions, challenges and personal and professional growth experienced by nurses. Nurses' war-related knowledge should be utilized to innovate healthcare practices during disasters and to advise policymakers in developing, implementing and evaluating peace-promoting operations.
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Affiliation(s)
- Anne M Fink
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Gwyneth R Milbrath
- Midwest Nursing History Research Center and Department of Population Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
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Establishment of a combat damage control surgery training platform for explosive combined thoraco-abdominal injuries. Chin J Traumatol 2022; 25:193-200. [PMID: 35331606 PMCID: PMC9252934 DOI: 10.1016/j.cjtee.2022.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 12/31/2021] [Accepted: 01/18/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE It is challenging to prepare military surgeons with the skills of combat damage control surgery (CDCS). The current study aimed to establish a damage control surgery (DCS) training platform for explosive combined thoraco-abdominal injuries. METHODS The training platform established in this study consisted of 3 main components: (1) A 50 m × 50 m square yard was constructed as the explosion site. Safety was assessed through cameras. (2) Sixteen pigs were injured by an explosion of trinitrotoluene attached with steel balls and were randomly divided into the DCS group (accepted DCS) and the control group (have not accepted DCS). The mortality rate was observed. (3) The literature was reviewed to identify the key factors for assessing CDCS, and testing standards for CDCS were then established. Expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards. Then, a 5-day training course with incorporated tests was used to test the efficacy of the established platform. In total, 30 teams attended the first training course. The scores that the trainees received before and after the training were compared. SPSS 11.0 was employed to analyze the results. RESULTS The high-speed video playback confirmed the safety of the explosion site as no explosion fragments projected beyond the wall. No pig died within 24 h when DCS was performed, while 7 pigs died in the control group. After a literature review, assessment criteria for CDCS were established that had a total score of 100 points and had 4 major parts: leadership and team cooperation, resuscitation, surgical procedure, and final outcome. Expert questionnaire results showed that the scientific score was 8.6 ± 1.25, and the feasibility score was 8.74 ± 1.19. When compared with the basic level, the trainees' score improved significantly after training. CONCLUSION The platform established in this study was useful for CDCS training.
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Pires MPO, Peterlini MAS, Ullman AJ, Bulmer AC, Rickard CM, Pedreira MLG. Effect of warming and infusion of red blood cell concentrates on markers of haemolysis: An ex vivo simulation study. Aust Crit Care 2020; 34:235-240. [PMID: 33069589 DOI: 10.1016/j.aucc.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/06/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Transfusion of red blood cell (RBC) concentrates is a common procedure to restore blood volume and tissue oxygen delivery in patients with trauma. Although RBC warmers may prevent hypothermia, some warming or infusion equipment may lead to haemolysis and patient injury. OBJECTIVES The aim of this study was to test the effect of (i) RBC warming and (ii) administration via manual vs. pump infusion on haemolysis. METHODS This experimental ex vivo study studied haemolysis markers of RBC injury. The sample consisted of 90 RBC infusions in two simulations, randomly, 45 warmed RBC infusions and 45 nonwarmed RBC infusions, in two or three stages: before the intervention (baseline-warming, N= 45; nonwarming, N= 45), after water bath warming at 42 °C (warmed, N= 45), and then after the warmed or nonwarmed RBCs were infused by manual or pump infusion at a rate of 100 mL/h (infusion-warming, N= 45; nonwarming, N= 45). RESULTS Warmed RBCs showed significantly lower total haemoglobin (Hb) and haematocrit levels and increase in free Hb levels, haemolysis levels, and lactate dehydrogenase (LDH) activity (all p<0.05) than baseline RBCs. Pump infusion RBCs were associated with reduced total Hb and increased free Hb, haemolysis, and potassium (K) levels (all p<0.05) compared with warmed RBCs. In contrast, manual infusion of warmed RBCs resulted in significantly reduced total Hb levels and increased LDH activity (both <0.05). After infusion, total Hb, free Hb, haematocrit, haemolysis, and LDH values were significantly different for warmed vs. nonwarmed RBCs (p<0.05). CONCLUSIONS Haemolysis biomarkers increase with RBC warming and infusion, especially when using infusion pumps. Critically ill patients should be carefully monitored for possible complications during and after RBC infusion.
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Affiliation(s)
- Maria Paula Oliveira Pires
- Safety, Technology and Care Research Group, Department of Paediatric Nursing, Universidade Federal de São Paulo (Federal University of Sao Paulo), R. Napoleão de Barros, 754 - Vila Clementino, Sao Paulo, SP, 04024-002, Brazil; Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, 170 Kessels Road Nathan, Qld, 4111, Brisbane, Queensland, Australia; Paulista University, Health Sciences Institution, R. Vergueiro, 1211 - Aclimação, Sao Paulo, SP, 01533-000, Brazil.
| | - Maria Angélica Sorgini Peterlini
- Safety, Technology and Care Research Group, Department of Paediatric Nursing, Universidade Federal de São Paulo (Federal University of Sao Paulo), R. Napoleão de Barros, 754 - Vila Clementino, Sao Paulo, SP, 04024-002, Brazil.
| | - Amanda J Ullman
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, 170 Kessels Road Nathan, Qld, 4111, Brisbane, Queensland, Australia.
| | - Andrew C Bulmer
- Alliance for Vascular Access Teaching and Research Group, School of Medical Science, Menzies Health Institute Queensland, Griffith University, Parklands Dr Southport, Qld, 4215, Gold Coast, Queensland, Australia.
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, 170 Kessels Road Nathan, Qld, 4111, Brisbane, Queensland, Australia.
| | - Mavilde Luz Gonçalves Pedreira
- Safety, Technology and Care Research Group, Department of Paediatric Nursing, Universidade Federal de São Paulo (Federal University of Sao Paulo), R. Napoleão de Barros, 754 - Vila Clementino, Sao Paulo, SP, 04024-002, Brazil; Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, 170 Kessels Road Nathan, Qld, 4111, Brisbane, Queensland, Australia.
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Progress on combat damage control resuscitation/surgery and its application in the Chinese People's Liberation Army. J Trauma Acute Care Surg 2020; 87:954-960. [PMID: 31574061 DOI: 10.1097/ta.0000000000002344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Damage control resuscitation (DCR) and damage control surgery (DCS) has now been developed as a well-established standard of care for severely injured civilian patients worldwide. On the other hand, the application of combat DCR/DCS has saved the lives of thousands of severely injured casualties in several wars during the last two decades. This article describes the great progress on DCR/DCS in the last two decades and its application in the Chinese People's Liberation Army (PLA). The main development of the advanced theories of combat DCR/DCS including the global integration of DCR/DCS, application of remote battlefield DCR, balanced hemostatic resuscitation in combat hospitals and enhancement of en route DCR. There are two key factors that determine the feasibility of combat DCR: one is the availability of resources and supplies to implement the advanced theories of combat DCR/DCS, the other is the availability of qualified personnel who master the skills needed for the implementation of DCR/DCS. In the PLA, the advanced theories of combat DCR/DCS have now been widely accepted, and some of related advanced products, such as fresh-frozen plasma, packed red blood cells, and platelets, have been available in Level III medical facilities. In conclusion, great progress in combat DCR/DCS has been achieved in recent years, and the Chinese PLA is keeping good pace with this development, although there is still room for improvement.
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Zong ZW, Chen SX, Qin H, Liang HP, Yang L, Zhao YF. Chinese expert consensus on echelons treatment of pelvic fractures in modern war. Mil Med Res 2018; 5:21. [PMID: 29970166 PMCID: PMC6029371 DOI: 10.1186/s40779-018-0168-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/13/2018] [Indexed: 01/18/2023] Open
Abstract
The characteristics and treatment of pelvic fractures vary between general conditions and modern war. An expert consensus has been reached based on pelvic injury epidemiology and the concepts of battlefield treatment combined with the existing levels of military medical care in modern warfare. According to this consensus, first aid, emergency treatment and early treatment of pelvic fractures are introduced in three separate levels. In Level I facilities, simple triage and rapid treatment following the principles of advanced trauma life support are recommended to evaluate combat casualties during the first-aid stage. Re-evaluation, further immobilization and fixation, and hemostasis are recommended at Level II facilities. At Level III facilities, the main components of damage control surgery are recommended, including comprehensive hemostasis, a proper resuscitation strategy, the treatment of concurrent visceral and blood vessel damage, and battlefield intensive care. The grading standard for evidence evaluation and recommendation was used to reach this expert consensus.
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Affiliation(s)
- Zhao-Wen Zong
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, ChongQing, 400038, China.
| | - Si-Xu Chen
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, ChongQing, 400038, China
| | - Hao Qin
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, ChongQing, 400038, China
| | - Hua-Ping Liang
- First Department, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Lei Yang
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, ChongQing, 400038, China
| | - Yu-Feng Zhao
- Department of Trauma Surgery, Daping Hospital, Army Medical University, ChongQing, 400042, China
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Zong ZW, Zhang LY, Qin H, Chen SX, Zhang L, Yang L, Li XX, Bao QW, Liu DC, He SH, Shen Y, Zhang R, Zhao YF, Zhong XZ. Expert consensus on the evaluation and diagnosis of combat injuries of the Chinese People's Liberation Army. Mil Med Res 2018; 5:6. [PMID: 29502527 PMCID: PMC5809991 DOI: 10.1186/s40779-018-0152-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 01/18/2018] [Indexed: 11/22/2022] Open
Abstract
The accurate assessment and diagnosis of combat injuries are the basis for triage and treatment of combat casualties. A consensus on the assessment and diagnosis of combat injuries was made and discussed at the second annual meeting of the Professional Committee on Disaster Medicine of the Chinese People's Liberation Army (PLA). In this consensus agreement, the massive hemorrhage, airway, respiration, circulation and hypothermia (MARCH) algorithm, which is a simple triage and rapid treatment and field triage score, was recommended to assess combat casualties during the first-aid stage, whereas the abbreviated scoring method for combat casualty and the MARCH algorithm were recommended to assess combat casualties in level II facilities. In level III facilities, combined measures, including a history inquiry, thorough physical examination, laboratory examination, X-ray, and ultrasound examination, were recommended for the diagnosis of combat casualties. In addition, corresponding methods were recommended for the recognition of casualties needing massive transfusions, assessment of firearm wounds, evaluation of mangled extremities, and assessment of injury severity in this consensus.
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Affiliation(s)
- Zhao-Wen Zong
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of Trauma Surgery, Daping Hospital, Army Medical University, Chongqing, China.
| | - Lian-Yang Zhang
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of Trauma Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Hao Qin
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of Trauma Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Si-Xu Chen
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of Trauma Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Lin Zhang
- Special Slinic Department of Bethune Medical Profession Sergeant School, Shijiazhuang, China
| | - Lei Yang
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of Trauma Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Xiao-Xue Li
- Research Institute of Disaster Medicine, General Hospital of Chinese People's Armed Police Forces, Beijing, China
| | - Quan-Wei Bao
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of Trauma Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Dao-Cheng Liu
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of Trauma Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Si-Hao He
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of Trauma Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Yue Shen
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of Trauma Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Rong Zhang
- Military Medical Training Brigade of Chinese People's Liberation Army, Hutubi, Xinjiang, Uygur Autonomous Region, China
| | - Yu-Feng Zhao
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of Trauma Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Xiao-Zheng Zhong
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of Trauma Surgery, Daping Hospital, Army Medical University, Chongqing, China
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Gurney JM, Holcomb JB. Blood Transfusion from the Military’s Standpoint: Making Last Century’s Standard Possible Today. CURRENT TRAUMA REPORTS 2017. [DOI: 10.1007/s40719-017-0083-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Briley A, Seed PT, Tydeman G, Ballard H, Waterstone M, Sandall J, Poston L, Tribe RM, Bewley S. Reporting errors, incidence and risk factors for postpartum haemorrhage and progression to severe PPH: a prospective observational study. BJOG 2014; 121:876-88. [PMID: 24517180 PMCID: PMC4282054 DOI: 10.1111/1471-0528.12588] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To quantify reporting errors, measure incidence of postpartum haemorrhage (PPH) and define risk factors for PPH (≥500 ml) and progression to severe PPH (≥1500 ml). DESIGN Prospective observational study. SETTING Two UK maternity services. POPULATION Women giving birth between 1 August 2008 and 31 July 2009 (n = 10 213). METHODS Weighted sampling with sequential adjustment by multivariate analysis. MAIN OUTCOME MEASURES Incidence and risk factors for PPH and progression to severe PPH. RESULTS Errors in transcribing blood volume were frequent (14%) with evidence of threshold preference and avoidance. The incidences of PPH ≥500, ≥1500 and ≥2500 ml were 33.7% (95% CI 31.2-36.2), 3.9% (95% CI 3.3-4.6) and 0.8% (95% CI 0.6-1.0). New independent risk factors predicting PPH ≥ 500 ml included Black African ethnicity (adjusted odds ratio [aOR] 1.77, 95% CI 1.31-2.39) and assisted conception (aOR 2.93, 95% CI 1.30-6.59). Modelling demonstrated how prepregnancy- and pregnancy-acquired factors may be mediated through intrapartum events, including caesarean section, elective (aOR 24.4, 95% CI 5.53-108.00) or emergency (aOR 40.5, 95% CI 16.30-101.00), and retained placenta (aOR 21.3, 95% CI 8.31-54.7). New risk factors were identified for progression to severe PPH, including index of multiple deprivation (education, skills and training) (aOR 1.75, 95% CI 1.11-2.74), multiparity without caesarean section (aOR 1.65, 95% CI 1.20-2.28) and administration of steroids for fetal reasons (aOR 2.00, 95% CI 1.24-3.22). CONCLUSIONS Sequential, interacting, traditional and new risk factors explain the highest rates of PPH and severe PPH reported to date.
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Affiliation(s)
- A Briley
- Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, St Thomas' Hospital CampusLondon, UK
| | - PT Seed
- Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, St Thomas' Hospital CampusLondon, UK
| | - G Tydeman
- NHS Fife, Royal Victoria HospitalKirkcaldy, Fife, UK
| | - H Ballard
- Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, St Thomas' Hospital CampusLondon, UK
| | - M Waterstone
- Dartford and Gravesham NHS Trust, Darent Valley HospitalDartford, Kent, UK
| | - J Sandall
- Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, St Thomas' Hospital CampusLondon, UK
| | - L Poston
- Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, St Thomas' Hospital CampusLondon, UK
| | - RM Tribe
- Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, St Thomas' Hospital CampusLondon, UK
| | - S Bewley
- Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, St Thomas' Hospital CampusLondon, UK
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Paul S, Debien B. [Tourniquet use in civil and military medicines]. ACTA ACUST UNITED AC 2014; 33:248-55. [PMID: 24581622 DOI: 10.1016/j.annfar.2013.12.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 12/20/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The purpose of this literature review is, after a history and a point about current situation, to present the military use and precautions of use of tourniquet for civil and military medicine. DATA SOURCES A review of the Anglo-Saxon and French literature was performed in PUBMED database, from 1962 to 2012. The research was conducted using the following keywords: "tourniquet", "complications", "haemorrhage", "emergency", "military medicine", used alone or in combination. DATA EXTRACTION The extracted data concerned the history, the epidemiology, the interest of tourniquet during peacetime and wartime, adverse effects and the ratio benefit/risk. DATA SYNTHESIS The tourniquet is "a device which is tightened, in case of haemorrhage, around a limb in order to slow or stop the venous or arterial circulation before surgery…". This item is thus used in surgery to reduce intraoperative bleeding and in emergency medicine as a rescue technique for bleeding places non accessible to compression or to other technical hemostasis. It is also used for treating bleeding of mass casualties. However, its use is too poorly managed by health professionals and it remains risky. Recent armed conflicts have yet revived its day use. CONCLUSION The tourniquet has utility in times of war and in peacetime. In each case, indications and complications must be known.
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Affiliation(s)
- S Paul
- Département d'anesthésie et réanimation, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92141 Clamart, France.
| | - B Debien
- Département d'anesthésie et réanimation, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92141 Clamart, France
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Nelson T, Wall C, Driver J, Simpson R. Op HERRICK Primary Care Casualties: The Forgotten Many. J ROY ARMY MED CORPS 2012; 158:252-5. [DOI: 10.1136/jramc-158-03-22] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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