A Comparative Study Between Two Combat Injury Severity Scores.

INTRODUCTION: In recent years, specific trauma scoring systems have been developed for military casualties. The objective of this study was to examine the discrepancies in severity scores of combat casualties between the Abbreviated Injury Scale 2005-Military (mAIS) and the Military Combat Injury Scale (MCIS) and a review of the current literature on the application of trauma scoring systems in the military setting. METHODS: A cross-sectional, descriptive, and retrospective study was conducted between May 1, 2005, and December 31, 2014. The study population consisted of all combat casualties attended in the Spanish Role 2 deployed in Herat (Afghanistan). We used the New Injury Severity Score (NISS) as reference score. Severity of each injury was calculated according to mAIS and MCIS, respectively. The severity of each casualty was calculated according to the NISS based on the mAIS (Military New Injury Severity Score-mNISS) and MCIS (Military Combat Injury Scale-New Injury Severity Score-MCIS-NISS). Casualty severity were grouped by severity levels (mild-scores: 1-8, moderate-scores: 9-15, severe-scores: 16-24, and critical-scores: 25-75). RESULTS: Nine hundred and eleven casualties were analyzed. Most were male (96.37%) with a median age of 27 years. Afghan patients comprised 71.13%. Air medevac was the main casualty transportation method (80.13). Explosion (64.76%) and gunshot wound (34.68%) mechanisms predominated. Overall mortality was 3.51%. Median mNISS and MCIS-NISS were similar in nonsurvivors (36 [IQR, 25-49] vs. [IQR, 25-48], respectively) but different in survivors, 9 (IQR, 4-17) vs. 5 (IQR, 2-13), respectively (P < .0001). The mNISS and MCIS-NISS were discordant in 34.35% (n = 313). Among cases with discordant severity scores, the median difference between mNISS and MCIS-NISS was 9 (IQR, 4-16); range, 1 to 57. CONCLUSION: Our study findings suggest that discrepancies in injury severity levels may be observed in one in three of the casualties when using mNISS and MCIS-NISS.

Hemodynamic impact of increasing time between fentanyl and propofol administration during anesthesia induction: a randomised, clinical trial.

BACKGROUND AND OBJECTIVE: Anesthesia induction can produce severe propofol dose-dependent hypotension. Fentanyl coadministration reduces the catecholaminergic response to orotracheal intubation allowing propofol dose reduction. The aim of this study is to determine whether the hemodynamic response is improved by increasing the time between fentanyl and propofol administration and reducing the dose of the latter without increasing the time to achieve optimal hypnosis. METHODS: After approval by the Research Ethics Committee, patients undergoing non-cardiac surgery with endotracheal intubation were randomized by a computer-generated table into six time-dose groups (1 or 2 minutes/1, 1.5, or 2 mg.kg-1 of propofol). Patients with high bronchoaspiration risk, a difficult airway, hemodynamic instability, or anesthetic allergies were excluded. After giving intravenous fentanyl (2 µg.kg-1), each group received different doses of propofol after 1 or 2 minutes. Noninvasive blood pressure (BP) and heart rate (HR) were measured at pre-induction, pre-intubation, and post-intubation. Time to hypnosis (bispectral index < 60) was also recorded. RESULTS: Of the 192 recruited patients, 186 completed the study (1 min group n = 94; 2 min group n = 92). It was observed that HR and BP decreased after propofol administration and increased after intubation in all groups (p < 0.0001). In patients over 55 years, the 2 min - 2 mg.kg-1 group showed the greatest systolic BP reduction (36 ±â€¯12%) at pre-intubation, while the 1 min - 1.5 mg.kg-1 group showed the least hemodynamic alteration between pre- and post-intubation (-4 ±â€¯13%). No significant differences were found in younger patients or in the time to reach hypnosis between the six groups. While no cases of severe bradycardia were recorded, 5,4% of the sample required vasopressors. CONCLUSION: Increasing the time between the administration of fentanyl and propofol by up to two minutes results in greater hypotension in patients over 55 years.

Use of Oxygen Tissue Monitoring in Patients With Compartment Syndrome: Two Clinical Cases and Literature Review.

Compartment syndrome is defined as the pathology caused by the increase of pressure within a muscular compartment to the point where the vascular perfusion necessary for the viability of the tissues included therein is reduced. The diagnosis is established by clinical exam and pressure measurement. Measurement of intracompartmental pressure is an invasive method with no option of easy continuous monitoring. Continuous tissue oximetry, using near-infrared light spectroscopy, can estimate soft-tissue oxygenation several centimeters below the sensor placement. This method of monitoring has been used successfully in the diagnosis of compartment syndrome, presenting itself as a non-invasive method of continuous measurement that can be a very useful alternative in complex situations or doubtful cases. We present two clinical cases of patients with acute compartment syndrome, in which the use of near-infrared light spectroscopy was determinant, both for the diagnosis and to verify the surgical treatment performed.

Analysis of Production, Impact, and Scientific Collaboration on Difficult Airway Through the Web of Science and Scopus (1981-2013).

BACKGROUND: Bibliometrics, the statistical analysis of written publications, is an increasingly popular approach to the assessment of scientific activity. Bibliometrics allows researchers to assess the impact of a field, or research area, and has been used to make decisions regarding research funding. Through bibliometric analysis, we hypothesized that a bibliometric analysis of difficult airway research would demonstrate a growth in authors and articles over time. METHODS: Using the Web of Science (WoS) and Scopus databases, we conducted a search of published manuscripts on the difficult airway from January 1981 to December 2013. After removal of duplicates, we identified 2412 articles. We then analyzed the articles as a group to assess indicators of productivity, collaboration, and impact over this time period. RESULTS: We found an increase in productivity over the study period, with 37 manuscripts published between 1981 and 1990, and 1268 between 2001 and 2010 (P < .001). The difficult airway papers growth rate was bigger than that of anesthesiology research in general, with CAGR (cumulative average growth rate) since 1999 for difficult airway >9% for both WoS and Scopus, and CAGR for anesthesiology as a whole =0.64% in WoS, and =3.30% in Scopus. Furthermore, we found a positive correlation between the number of papers published per author and the number of coauthored manuscripts (P < .001). We also found an increase in the number of coauthored manuscripts, in international cooperation between institutions, and in the number of citations for each manuscript. For any author, we also identified a positive relationship between the number of citations per manuscript and the number of papers published (P < .001). CONCLUSIONS: We found a greater increase over time in the number of difficult airway manuscripts than for anesthesiology research overall. We found that collaboration between authors increases their impact, and that an increase in collaboration increases citation rates. Publishing in English and in certain journals, and collaborating with certain authors and institutions, increases the visibility of manuscripts published on this subject.

In vitro thromboelastometric evaluation of the efficacy of frozen platelet transfusion.

BACKGROUND: Although frozen platelets are extensively used in remote locations and military environments, scientific evidence of their efficacy is scarce. The objective of this study was to evaluate the in vitro hemostatic efficacy of frozen versus fresh platelet transfusions by rotational thromboelastometry (ROTEM) to ascertain whether the freezing and thawing process impaired platelet contribution to clot strength. METHODS: An experimental study was performed using platelet in vitro transfusions. Blood samples were collected from 12 patients with non-autoimmune thrombocytopenia. The samples were each transfused with one of 6 pairs of fresh platelet concentrates and platelet concentrates frozen with dimethylsulfoxyde. Optical platelet counts, coagulation studies and ROTEM (EXTEM and FIBTEM) were performed for the baseline and the post-transfusion samples. RESULTS: Only fresh platelet transfusions significantly increased the EXTEM maximum clot firmness (MCF) and maximum clot elasticity (MCE) over baseline (p<0.001), achieving values within the normal range. The frozen platelet contribution to MCE was negligible. However, the EXTEM clotting time (CT) was significantly (p<0.001) shorter after the frozen platelet transfusion compared with the fresh platelet transfusion. The EXTEM clot formation time (CFT) was significantly shortened after the transfusion of fresh platelets (p=0.002). CONCLUSION: The ROTEM analysis assessment indicates a dual effect in frozen platelet transfusion: it produces a hypercoagulable state (shortening of CT), and a second, more predominant effect of frozen platelets' functionality impairment compared with fresh platelets (shorter MCF/MCE and longer CFT).

Derrame pericárdico severo tras traumatismo torácico de 15 días de evolución / Severe Pericardial Effusion After 15 Days Evolution Chest Trauma

No disponible

Hallazgo radiológico durante la preanestesia realizada en zona del tercer mundo / Radiological finding during preanesthesia in third world area

No disponible

Analysis of evacuations from areas of operation to the Spanish Role 4 medical treatment facility (2008-2013).

Since 1987, the Spanish Armed Forces have deployed their troops in a multitude of conflicts and natural disasters worldwide. The Spanish Military Medical Corps has the ability to deploy Role 1, Role 2, and one Role 3 medical treatment facilities. It also has a Role 4 in operation, the "Gómez Ulla" Central Hospital of Defense, in Madrid. The aim of this study is to describe the type of Spanish casualties evacuated from different areas of operation to the Role 4 from 2008 to 2013. A retrospective, cross-sectional study was performed on a sample of 232 patients. Among these, 211 (91%) were noncombat casualties: 126 because of illness, 53 because of an accident, and 32 because of sports injuries. The remaining 21 (9%) were combat casualties: 11 from improvised explosive devices and 10 from gunfire. Afghanistan, followed by Lebanon, is the operational area where most evacuees originate. The authors consider it essential that the Spanish Armed Forces rely on a Role 4 medical treatment facility as part of their medical support to international operations.

Miocardiopatía de Takotsubo sin presencia de dolor torácico durante el postoperatorio de histerectomía / No disponible

No disponible

«Ketamina y midazolam por vía intramuscular en el tratamiento de quemaduras en zona de guerra» / No disponible

No disponible

Gunshot and improvised explosive casualties: a report from the Spanish Role 2 medical facility in Herat, Afghanistan.

OBJECTIVE: To provide an analysis of casualties treated during medical evacuation (MEDEVAC) or/and at the Spanish Role 2 in Herat, Afghanistan, including type of weapon, injuries, and effects of protective measures. METHOD: A retrospective analysis was carried out concerning patients who had suffered injuries from either gunshot or explosive devices treated during MEDEVAC or/and at this facility during the period 2005-2008. RESULTS: The total number of cases analyzed was 256. The majority of the casualties were produced by explosive devices (71%). The anatomical regions most affected were the lower limbs (48%). There was a higher New Injury Severity Score in casualties wounded by gunshot (14 +/- 1) than in those wounded by explosive devices (8.5 +/- 1.5) (p < 0.001). Surgical procedures for injuries caused by gunshots were 1.7 times more likely than for those due to explosive devices (95% confidence interval: 1.4 to 2.1). Protective devices were used only by 25% of casualties. CONCLUSIONS: The injury score indices of firearm casualties were higher than the explosive device casualties' injury score indices. The possible reasons for this finding are discussed.