Battle Casualty Survival with Emergency Tourniquet Use to Stop Limb Bleeding

Background

In a previous study conducted at a combat support hospital in Iraq, we reported the major lifesaving benefits of emergency tourniquets to stop bleeding in major limb trauma. Morbidity associated with tourniquet use was minor.

Study Objectives

The objective of this study is to further analyze emergency tourniquet use in combat casualty care.

Design and Setting

This report is a continuation of our previous study of tourniquet use in casualties admitted to a combat support hospital (NCT00517166 at www.ClinicalTrials.gov).

Methods

After verifying comparable methodologies for the first study and the current study, we compared patient results for these two time periods and then pooled data to analyze outcomes with a larger sample size.

Results

The total study population was 499 (232 in the previous study and 267 in the current study). In all, 862 tourniquets were applied on 651 limbs. Survival was 87% for both study periods. Morbidity rates for palsies at the level of the tourniquet were 1.7% for study 1 and 1.5% for study 2; major limb shortening was 0.4% for both. Survival was associated with prehospital application (89% vs. 78% hospital, p < 0.01) and application before the onset of shock (96% vs. 4% after).

Conclusions

This study shows consistent lifesaving benefits and low risk of emergency tourniquets to stop bleeding in major limb trauma.     

Commissure Burn Splints: Literature Review and Prefabrication Technique Using a Visible Light–Cured Resin

Commissure burn splints reduce or eliminate the need for reconstructive surgery after injury to the perioral tissues. The literature describes the injury, immediate care, and splint treatment modalities. A technique to construct a prefabricated commissure burn splint from visible light cure resin and orthodontic wire is presented. Passive or dynamic retraction may be obtained by varying the tension of circumcranial orthodontic headgear or adjusting Velcro placed on a Velfoam strap.     

Acne Keloidalis Nuchae

In four cases of acne keloidalis nuchae, varying stages of transepithelial elimination were observed histologically, suggesting that acne keloidalis represents a transepithelial elimination disorder akin to perforating folliculitis.     

Staphylococcus aureus as a Cause of Perianal Dermatitis

Abstract: Perianal dermatitis has been reported to be caused by group A ß-hemolytic Streptococcus. We present a case caused by Staphylococcus aureus. A clinical clue pointing to this organism was the presence of satellite pustules, identifying the pathogen in perianal dermatitis is therapeutically Important, as oral penicillin VK will not be effective If 5. aureus is the true cause. Other streptococcal and staphylococcal cutaneous infections may exhibit overlapping clinical features, including scarlet fever, Impetigo, toxic shock syndrome, and cellulitis.     

Palmar Purpura: An Atypical Presentation of Childhood Dermatitis Herpetiformis

Abstract: Dermatitis herpetiformis (DH) is seen most commonly as a pruritic, papulovesicular eruption in young children or adolescents. Differentiation from other bullous diseases of childhood may be difficult. We report the first case of an adolescent in whom pruritic, palmar, purpuric macules and papules were the only manifestations of DH. The patient later developed typical vesiculobullous extensor lesions and symptomatic gluten-sensitive enteropathy (GSE). All lesions and GSE symptoms resolved with dapsone and a gluten-free diet. Our purpose is to illustrate an unusual presentation of pediatric DH.     

Ballistic injury

Wound profiles made under controlled conditions in the wound ballistics laboratory at the Letterman Army Institute of Research showed the location along their tissue path at which projectiles cause tissue disruption and the type of disruption (crush from direct contact with the projectile or stretch from temporary cavitation). Comparison of wound profiles showed the fallacy in attempting to judge wound severity using velocity alone, and laid to rest the common belief that in treating a wound caused by a high-velocity missile, one needs to excise tissue far in excess of that which appears damaged. All penetrating projectile wounds, whether civilian or military, therefore should be treated the same regardless of projectile velocity. Diagnosis of the approximate amount and location of tissue disruption is made by physical examination and appropriate radiographic studies. These wounds are contaminated, and coverage with a penicillin-type antibiotic should be provided.