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Zhang LY, Zhang HY. Torso hemorrhage: noncompressible? never say never. Eur J Med Res 2024; 29:153. [PMID: 38448977 PMCID: PMC10919054 DOI: 10.1186/s40001-024-01760-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/29/2024] [Indexed: 03/08/2024] Open
Abstract
Since limb bleeding has been well managed by extremity tourniquets, the management of exsanguinating torso hemorrhage (TH) has become a hot issue both in military and civilian medicine. Conventional hemostatic techniques are ineffective for managing traumatic bleeding of organs and vessels within the torso due to the anatomical features. The designation of noncompressible torso hemorrhage (NCTH) marks a significant step in investigating the injury mechanisms and developing effective methods for bleeding control. Special tourniquets such as abdominal aortic and junctional tourniquet and SAM junctional tourniquet designed for NCTH have been approved by FDA for clinical use. Combat ready clamp and junctional emergency treatment tool also exhibit potential for external NCTH control. In addition, resuscitative endovascular balloon occlusion of the aorta (REBOA) further provides an endovascular solution to alleviate the challenges of NCTH treatment. Notably, NCTH cognitive surveys have revealed that medical staff have deficiencies in understanding relevant concepts and treatment abilities. The stereotypical interpretation of NCTH naming, particularly the term noncompressible, is the root cause of this issue. This review discusses the dynamic relationship between TH and NCTH by tracing the development of external NCTH control techniques. The authors propose to further subdivide the existing NCTH into compressible torso hemorrhage and NCTH' (noncompressible but REBOA controllable) based on whether hemostasis is available via external compression. Finally, due to the irreplaceability of special tourniquets during the prehospital stage, the authors emphasize the importance of a package program to improve the efficacy and safety of external NCTH control. This program includes the promotion of tourniquet redesign and hemostatic strategies, personnel reeducation, and complications prevention.
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Affiliation(s)
- Lian-Yang Zhang
- Department of Trauma Surgery, War Trauma Medical Center, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Hua-Yu Zhang
- Department of Trauma Surgery, War Trauma Medical Center, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, China.
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Qiu T, Chen M, Gao S, Huang J, Wang W, Wang L, Li H. Application effect study of a combination of TeamSTEPPS with modularization teaching in the context of clinical instruction in trauma care. Sci Rep 2024; 14:4712. [PMID: 38409342 PMCID: PMC10897387 DOI: 10.1038/s41598-024-55509-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 02/24/2024] [Indexed: 02/28/2024] Open
Abstract
To explore the effect of a combination of Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) with modularization teaching in the context of clinical instruction in trauma care. A total of 244 nursing students who participated in clinical practice in orthopaedic wards from March 2020 to April 2022 were divided into two groups that received the same trauma care teaching content. The control group (n = 119) used the traditional teaching approach, and the experimental group (n = 125) utilized a combination of TeamSTEPPS with a modularization teaching model. A questionnaire was used to assess students' theoretical knowledge, practical skills, self-concepts and professional benefits after one month with the goal of determining their end-of-course performance. The theoretical knowledge scores obtained by the control group and the experimental group were 89.56 ± 4.06 and 91.62 ± 2.84, respectively, and these results were statistically significant (P < 0.05). Students preferred the combination of TeamSTEPPS with the modularization teaching model to the traditional instructional method in terms of practical skills, professional self-concepts and professional benefits (P < 0.05). The application of the combination of TeamSTEPPS with modularization teaching in the context of clinical instruction in trauma care made significant contributions to nursing students' mastery of theoretical knowledge and practical skills, enhanced their sense level of professional identity, instilled a correct occupational ideology in such students, and enhanced the professional benefits they were able to obtain.
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Affiliation(s)
- Tieying Qiu
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Min Chen
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Suyuan Gao
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Jin Huang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Weixing Wang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Liping Wang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, 410011, China.
| | - Haiyang Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, 410011, China.
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Zhang HY, Guo Y, Huang XY, Li Y, Zhang LY. An online survey of non-compressible torso hemorrhage: training is needed. World J Emerg Med 2022; 13:297-300. [PMID: 35837559 PMCID: PMC9233977 DOI: 10.5847/wjem.j.1920-8642.2022.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/02/2022] [Indexed: 02/19/2024] Open
Affiliation(s)
- Hua-yu Zhang
- Department of Trauma Surgery, War Trauma Medical Center, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Yong Guo
- Department of Trauma Surgery, War Trauma Medical Center, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Xiao-ying Huang
- Department of Trauma Surgery, War Trauma Medical Center, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Yang Li
- Department of Trauma Surgery, War Trauma Medical Center, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Lian-yang Zhang
- Department of Trauma Surgery, War Trauma Medical Center, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, Chongqing 400042, China
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Liu GD, Wang N, Wang HM, Li X, Shao JJ, Liu ZF, Jiang M, Wang L, Wang ZK, Li M, Cao XY, Wang J, Zhang R, Chen YD. Military medical research on internal diseases in modern warfare: new concepts, demands, challenges, and opportunities. Mil Med Res 2021; 8:20. [PMID: 33712087 PMCID: PMC7953602 DOI: 10.1186/s40779-021-00313-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 03/05/2021] [Indexed: 12/25/2022] Open
Abstract
Battlefield internal medicine aims at the treatment of combatants and noncombatants with various internal diseases on the battlefield. The military medical research on battlefield internal diseases focuses on the pathogenesis, clinical management, and prevention of internal diseases under military war conditions. In both wartime and peacetime, the soldiers suffer from more internal diseases than surgical wounds. With the introduction of high-tech weapons, including chemical, physical, and biological agents, a large number of special internal illnesses and casualties will appear in future wars. The battles often occur in special environments, such as high or low temperatures, plateau or polar areas, and micro- or hyper-gravity. The current theories of battlefield internal medicine are mainly derived from wars decades ago and cannot meet the needs of military medical support under the conditions of modern warfare. Therefore, the military medical research on battlefield internal medicine should be based on contemporary military situations, focus on the purpose of treating battlefield internal diseases, and adhere to the actual needs of the troops in peacetime and wartime. We should investigate the pathogenesis of battlefield internal diseases and explore the threats that may arise in future wars to ensure the advancement of battlefield internal medicine. This review highlights new concepts, demands, challenges, and opportunities for the further development of military medical research on battlefield internal medicine.
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Affiliation(s)
- Guang-Dong Liu
- Division of Health Services, Chinese PLA General Hospital & Chinese PLA Medical School, Beijing, 100853, China
| | - Nan Wang
- Division of Health Services, Chinese PLA General Hospital & Chinese PLA Medical School, Beijing, 100853, China
| | - Hai-Ming Wang
- Department of Cardiovascular Medicine, Chinese PLA General Hospital & Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China
| | - Xin Li
- Department of Health Services, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Jun-Jie Shao
- The First Clinical Medical College of Inner Mongolia Medical University, Hohhot, 010059, China
| | - Zi-Fan Liu
- Department of Cardiovascular Medicine, Chinese PLA General Hospital & Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China
| | - Min Jiang
- Department of Cardiovascular Medicine, Chinese PLA General Hospital & Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China
| | - Lin Wang
- Department of Cardiovascular Medicine, Chinese PLA General Hospital & Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China
| | - Zi-Kai Wang
- Department of Gastroenterology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Meng Li
- Department of Hematology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Xue-Ying Cao
- Department of Nephrology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Jiang Wang
- Department of Respiratory and Intensive Medicine, Chinese PLA General Hospital, Beijing, 100853, China
| | - Ran Zhang
- Department of Cardiovascular Medicine, Chinese PLA General Hospital & Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China.
| | - Yun-Dai Chen
- Department of Cardiovascular Medicine, Chinese PLA General Hospital & Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China.
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