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.     

患有氯痤疮的三氯苯酚和五氯苯酚接触工人血清二恶英和呋喃的水平

[目的]调查患有或不患有氯痤疮的三氯苯酚（trichlorophenol,TCP）或五氯苯酚（pentachlomphenol,PCP）接触工人血清的二恶英水平,并观察患氯痤疮工人的特征。[方法]收集26名PCP工人、12名TCP工人和36名没有PCP和TCP暴露史工人的血样,并测定二恶英含量。氯痤疮的确定根据工厂医疗记录。[结果]PCP工人中,患氯痤疮与未患氯痤疮的工人相比具有更高毒性当量（根据世界卫生组织）的2378-TCDD,12378-PeCDD,123678-H6CDD,123789-H6CDD和123678-H6CDF水平。而在TCP工人中,虽然曾患有氯痤疮的工人血清中2378-TCDD水平较高,但与未患有氯痤疮者的血清水平上并无明显差异。氯痤疮的公认危险因素有首次暴露年龄较小和距第一次暴露的时间较长等,但仅在接触TPC工人中得到证实。PCP工人患氯痤疮和诊断前较长的接触时间相关。[结论]氯痤疮是二恶英高暴露的良好指标。TCP和PCP接触工人的血清二恶英同系物具有明显不同的特点。     

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.