Management of Combat Injuries - The Eastern Association for the Surgery of Trauma

Thoracic trauma in military settings: a review of current practices and recommendations.

Mansky R, Scher C.

Curr Opin Anaesthesiol. 2019 Apr;32(2):227-233

Rationale for inclusion: CPG. Reviews basic principles for blunt chest trauma management, including airway management, ECMO, EDT.

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Neurosurgery and medical management of severe head injury.

McCafferty RR, Neal CJ, Marshall SA, Pamplin JC, Rivet D, Hood BJ, Cooper PB, Stockinger Z.

Mil Med. 2018 Sep 1;183(suppl_2):67-72.

Rationale for inclusion: CPG. Reviews basic principles for TBI management, including fluids, sedation, medical mgmt of ICH.

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Wartime vascular injury.

Rasmussen T, Stockinger Z, Antevil J, White C, Fernandez N, White J, White P.

Military Medicine, 183, 9/10:10, 2018

Rationale for inclusion: CPG. Provides helpful algorithm for addressing extremity vascular trauma for the non-vascular surgery. Reviews hard and soft signs and ABI. Shunt is mainstay for far forward care.

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Aural blast injury/acoustic trauma and hearing loss

Esquivel CR, Parker M, Curtis K, Merkley A, Littlefield P, Conley G, Wise S, Feldt B, Henselman L, Stockinger Z.

Mil Med. 2018 Sep 1;183(suppl_2):78-82.

Rationale for inclusion: CPG. Reviews recommendations for evaluating hearing damage and indications for ENT referral.

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Burn casualty care in the deployed setting

Driscoll IR, Mann-Salinas EA, Boyer NL, Pamplin JC, Serio-Melvin ML, Salinas J, Borgman MA, Sheridan RL, Melvin JJ, Peterson WC, Graybill JC, Rizzo JA, King BT, Chung KK, Cancio LC, Renz EM, Stockinger ZT.

Military Medicine, 183, 9/10:16, 2018

Rationale for inclusion: CPG. Reviews recommendations for determining burn size and initial resuscitation calculation. Unique to military with lack of access to subspecialists, discusses mgmt of ophthalmic injuries, inhalation injuries.

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Amputation: evaluation and treatment

Gordon W, Balsamo L, Talbot M, Osier C, Johnson A, Shero J, Potter B, Stockinger ZT.

Military Medicine, 183, 9/10:112, 2018

Rationale for inclusion: CPG for evaluation and considerations for amputation.

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Management of suspected tension pneumothorax in Tactical Combat Casualty Care: TCCC guidelines change 17-02.

Butler FK Jr, Holcomb JB, Shackelford S, Montgomery HR, Anderson S, Cain JS, Champion HR, Cunningham CW, Dorlac WC, Drew B, Edwards K, Gandy JV, Glassberg E, Gurney J, Harcke T, Jenkins DA, Johannigman J, Kheirabadi BS, Kotwal RS, Littlejohn LF, Martin M, Mazuchowski EL, Otten EJ, Polk T, Rhee P, Seery JM, Stockinger Z, Torrisi J, Yitzak A, Zafren K, Zietlow SP.

Journal of Special Operations Medicine. 18(2):19-35, Summer 2018.

Rationale for inclusion: TCCC Guideline update. Designates the location at which NDC should be performed as either the lateral site (5th ICS, ant ax line) or the anterior site (2nd ICS, midclavicular line). Risk of bleeding with anterior site. ATLS recommends lateral site as 1st choice. *Essentially equivocal- no documented complications from anterior approach, no clear benefit to lateral site being more successful.

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Dismounted Complex Blast Injuries: A Comprehensive Review of the Modern Combat Experience.

Cannon JW, Hofmann LJ, Glasgow SC, Potter BK, Rodriguez CJ, Cancio LC, Rasmussen TE, Fries CA, Davis MR, Jezior JR, Mullins RJ, Elster EA.

J Am Coll Surg. 2016 Oct;223(4):652-664.e8.

Rationale for inclusion: Dismounted Complex Blast Injury is one of the most challenging injury patterns to emerge from OEF and OIF. This paper reviews the historical perspective, demographics, initial resuscitation and management as well as complications.

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Negative pressure wound therapy in the management of combat wounds: A critical review.

Maurya S, Bhandari PS.

Advances in Wound Care. 5(9):379-389, 2016 Sep 01.

Rationale for inclusion: Reviewed benefit of NPWT- military wounds are different from civilian wounds- much more contaminated with dirt, foreign matter, bioburden. Primary closure is not recommended, and wounds need aggressive irrigation and debridement to avoid infection. NPWT helps to provide temporary wound cover during the interim period of debridement and wound closure.

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Extending the golden hour: Partial resuscitative endovascular balloon occlusion of the aorta in a highly lethal swine liver injury model.

Russo RM, Williams TK, Grayson JK, Lamb CM, Cannon JW, Clement NF, Galante JM, Neff LP

J Trauma Acute Care Surg. 2016 Mar;80(3):372-8; discussion 378-80.

Rationale for inclusion: Partial REBOA in swine model may be useful with less reperfusion injury.

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Contemporary wars and their contributions to vascular injury management.

Asensio JA, Petrone P, Perez-Alonso A, Verde JM, Martin MJ, Sanchez W, Smith S, Marini CP.

European Journal of Trauma & Emergency Surgery. 41(2):129-42, 2015 Apr.

Rationale for inclusion: Reviews advances in management of vascular injury associated with wartime "lessons learned", starting in 1904. 1946- DeBakey and Simone emphasized expeditious restoration of blood flow. 1950- Korea, more abx utilized, improved limb salvage rates.

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Prehospital and en route analgesic use in the combat setting: a prospectively designed, multicenter, observational study.

Petz LN, Tyner S, Barnard E, Ervin A, Mora A, Clifford J, Fowler M, Bebarta VS.

Military Medicine. 180(3 Suppl):14-8, 2015 Mar.

Rationale for inclusion: Ketamine has the benefit of no hypotension or respiratory depression. Can minimize opiate requirement. Prehospital, ketamine was the most commonly used analgesic drug; ketamine/ morphine were the most frequently observed combination. IV route used for 55% of drug adminstrations

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Early decompressive craniectomy for severe penetrating and closed head injury during wartime.

Bell RS, Mossop CM, Dirks MS, Stephens FL, Mulligan L, Ecker R, Neal CJ, Kumar A, Tigno T, Armonda RA.

Neurosurg Focus. 2010 May;28(5):E1.

Rationale for inclusion: This study is a large review of combat patients with head injuries who underwent decompressive craniectomy for severe TBI in theater. Craniectomy was employed for those with worse initial presentations and was noted to be associated with improved outcomes over time.

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Military traumatic brain and spinal column injury: a 5-year study of the impact blast and other military grade weaponry on the central nervous system.

Bell RS, Vo AH, Neal CJ, Tigno J, Roberts R, Mossop C, Dunne JR, Armonda RA.

J Trauma. 2009 Apr;66(4 Suppl):S104-11.

Rationale for inclusion: This is a large retrospective review of combat injured patients evacuated to a military Role V hospital for neurosurgical evaluation. This study details the epidemiology of combat related neurologic injury in the recent wars in Iraq and Afghanistan.

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Amputations in U.S. military personnel in the current conflicts in Afghanistan and Iraq.

Stansbury LG, Lalliss SJ, Branstetter JG, Bagg MR, Holcomb JB.

J Orthop Trauma. 2008 Jan;22(1):43-6.

Rationale for inclusion: This study from early in the Afghanistan and Iraq wars reviewed over 5000 patients with limb injuries. This is a detailed epidemiological review on the injury patters, level of amputations, and mechanism of injury.

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Characterization of extremity wounds in Operation Iraqi Freedom and Operation Enduring Freedom.

Owens BD, Kragh JF Jr, Macaitis J, Svoboda SJ, Wenke JC.

J Orthop Trauma. 2007 Apr;21(4):254-7.

Rationale for inclusion: Extremity wounds have been commonly reported in the most recent wars. This is an epidemiological study of a large cohort of combat injured patients with extremity injuries describing anatomic location, mechanisms of injury, and characteristics of the injuries.

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The use of temporary vascular shunts as a damage control adjunct in the management of wartime vascular injury.

Rasmussen TE, Clouse WD, Jenkins DH, Peck MA, Eliason JL, Smith DL.

J Trauma. 2006 Jul;61(1):8-12; discussion 12-5.

Rationale for inclusion: This study details over 120 combat injured patients with vascular injuries treated at far forward locations. Temporary vascular shunts were used in the management of more than 50% with resultant good outcomes.

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Contemporary management of wartime vascular trauma.

Fox CJ, Gillespie DL, O'Donnell SD, Rasmussen TE, Goff JM, Johnson CA, Galgon RE, Sarac TP, Rich NM.

J Vasc Surg. 2005 Apr;41(4):638-44.

Rationale for inclusion: This paper is from early on in the Iraq and Afghanistan wars and includes over 100 combat patients with vascular injuries. Details regarding amputation rates, vascular repair in far forward surgical settings and additional operative interventions required up-range are discussed.

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Acute arterial injuries in Vietnam: 1,000 cases.

Rich NM, Baugh JH, Hughes CW.

J Trauma. 1970 May;10(5):359-69.

Rationale for inclusion: This is a large review with data on mechanism of injury, location of injury, management choices, morbidity and mortality by another giant in military surgery, Dr. Norm Rich.

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Battle injuries of the arteries in World War II: an analysis of 2,471 cases.

Debakey ME, Simeone FA.

Ann Surg. 1946 Apr;123(4):534-79.

Rationale for inclusion: As much a historical lesson than a scientific paper, Dr. DeBakey reviews over 2000 cases of vascular injuries compared from civil war through WWII. There are detailed descriptions of anatomic injuries, amputation rates, options for repair, etc.

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