Definitive Management of a Traumatic Airway: Case Report.

Maxillofacial and neck trauma from penetrating injuries present unique challenges for anesthesia providers and surgeons. In the austere conditions of a combat setting these challenges may be amplified due to limited resources and injury severity. Currently there is a lack of evidence and consensus on how to best manage a traumatized airway in this situation. The authors of this paper present the successful emergency management of a traumatized airway from a severe maxillofacial and neck-penetrating wound. A stepwise team approach using strong communication and a global mental model facilitated definitive airway management in this case allowing for safe transport to definitive care.

Rare Use of Posterolateral Thoracotomy in an Austere Environment.

A 25-year-old local national male presented to a split Forward Surgical Team after impalement of the posterior chest with a metal fragment. The patient was hemodynamically normal, but no imaging was available to determine the depth of penetration or the size of the internal portion of the fragment. This case represents a rare indication for posterolateral thoracotomy in an austere trauma setting.

A Novel Use of the Erector Spinae Block in the Austere Environment.

A 25 year-old male presented with penetrating chest trauma to a split forward surgical team located in an austere setting. Due to limited resources and a minimal monitoring in-transit a regional anesthetic was placed for pain control. This is the first description of an Erector Spinae Block utilized in a far forward combat setting.

Comparison of Resuscitative Protocols for Bupropion Overdose Using Lipid Emulsion in a Swine Model.

AIMS: The aim of this study was to investigate the effects of different treatment combinations on bupropion recovery as well as time to return of spontaneous circulation. METHODS: We conducted an eight group, randomized, experiment to evaluate combinations of epinephrine, vasopressin, and lipids on the restoration of cardiac function in Yorkshire pigs. After tracking the animals' baseline vitals for 10 minutes, we injected the animals with bupropion (35 mg/kg) and initiated a randomized protocol 2 minutes after cardiac arrest. RESULTS: Results demonstrated that animal survival given treatment combinations including epinephrine were statistically superior to any other group (p < 0.001, Fishers' exact test). The odds of survival with use of epinephrine vs. other options were 22:1 (5.47, 88.43). Further, all animals receiving only lipids died. Cox survival analysis with bootstrapped parameter estimates provided evidence that the rapidity of cardiac recovery was maximized with a combination of epinephrine and lipids (p < 0.05). CONCLUSIONS: Lipids may require an additional chemical catalyst in order to be effective in cardiac recovery. Epinephrine and lipids combined shortened recovery time for surviving animals.