Navigation Links
Military experts provide civilian surgeons with guidance on handling bomb blast injuries
Date:11/22/2010

Hospitals all over the world need to be aware of how to treat emergency blast injuries and military surgeons can provide valuable knowledge and advice to their civilian counterparts based on their experience of battlefield injuries. That is the driving force behind two papers published online by BJS, the British Journal of Surgery.

"The current inquest into the 2005 London bombings - and the recent international security alerts - provide a timely reminder that surgeons could be called on at a moment's notice to deal with blast injuries" says consultant surgeon Mr Jonothan Earnshaw, joint Editor-in-Chief of the journal. "That is why we believe that these papers are required reading for any surgeons who could find themselves dealing with the aftermath of a terrorist attack."

Military surgeons from the Royal Centre for Defence Medicine at the Queen Elizabeth Hospital Birmingham, UK, reviewed all cases of vascular trauma in battle injured service personnel over a five-year period ending January 2008. They used data collated by the Joint Theatre Trauma Registry, which covers all members of HM Armed Forces who have received acute trauma care as a result of the conflicts in Iraq and Afghanistan.

They found that 110 of the 1,203 patients sustained injuries to named vessels and that 60 per cent died before there was an opportunity for surgical intervention, including all 25 patients who sustained major vascular injuries to the abdomen or thorax.

Just under half of the 76 soldiers who suffered vascular injuries to their upper or lower limbs survived long enough for surgery, with one post-operative death among the 37 patients. Interventions on 38 limbs included 15 amputations, four vessel litigations and 19 definitive limb revascularisation procedures. Four of these latter procedures were not successful, leading to three further amputations.

"Amputation or vessel litigation is often required to control damage or save the lives of operable, but critically injured, patients with extremity injuries, but good limb salvage rates can be achieved in casualties able to withstand revascularisation" says co-author Lieutenant Colonel Nigel Tai. "Despite marked progress in battlefield trauma care, surgery is rarely an option in vascular injuries to the torso."

The authors say that their study has led to a number of conclusions regarding military vascular injuries:

  • Torso vascular injuries are highly lethal and very few patients will survive long enough for surgery.

  • While neck wounds are less immediately fatal, the number of patients dying after surgery is high when the major cause of the injury is a blast or multiple vessels are injured.

  • Peripheral vascular injuries are less fatal, but often occur in conjunction with trauma to other vital organs and that combination can lead to death.

  • Casualties with isolated extremity vascular injuries will usually survive to reach hospital, if the bleeding has been controlled, and less than half of cases will have anatomic and physiologic factors that indicate immediate amputation. Limb revascularisation can often be carried out successfully when such factors are not present.

In their paper on abdominal trauma in primary blast injury (PBI) Lieutenant Colonel Jeff Garner and colleagues from the Rotherham NHS Foundation Trust, UK, reviewed 61 research papers. Nine of these provided sufficient information to enable them to calculate the incidence of abdominal PBI.

"Blast injuries are not common in civilian settings and poorly understood by most clinicians who work outside areas of active warfare" says Lieutenant Colonel Garner. "Primary blast injuries result from the interaction of the blast wave with the body and typically affect gas-containing organs such as the ears, lungs and the gastrointestinal tract. The aim of our study was to investigate injuries sustained to the abdomen following primary blast exposure."

Key findings of the review included:

  • Secondary abdominal blast injury from penetrating fragments and pulmonary PBI are more common in blast injuries and of greater concern than abdominal PBI in most circumstances.

  • However, abdominal PBI has the potential for significant death and illness, as problems may present many days after blast exposure. For example, a gastrointestinal mural haematoma may perforate up to 14 days after injury.

  • Experimental evidence exists to help surgeons decide which mural haematomas are at most risk of delayed perforation and need to be resected to minimise this risk.

  • The incidence of abdominal PBI rates in survivors following air blasts ranged from 1.3 to 33 per cent, with an overall incidence of three per cent. Incidence rates were higher when blasts took place in enclosed spaces (6.7 per cent) than open spaces (5.6 per cent) and could reach up to 69 per cent in underwater blasts.

  • The terminal ileum and caecum were the most commonly affected organs.

  • Surgical treatment of abdominal PBI is similar to abdominal trauma resulting from other causes.

"Over the past two decades we have witnessed mass casualty bombings across the world" says Lieutenant Colonel Garner. "These incidents underline the importance of civilian surgeons having a good understanding of the pathophysiology of blast injuries. Studying injuries sustained during armed conflicts provides valuable insight into this area of emergency medicine."


'/>"/>

Contact: Annette Whibley
wizard.media@virgin.net
Wiley-Blackwell
Source:Eurekalert

Related medicine news :

1. Retired Military Brass Support First Ladys Call to Reduce Child Obesity, Improve Nutrition
2. Senate Inaction On Medicare Hurts Seniors, Military and Boomers
3. First Virtual Optical Store Serves Military Personnel
4. Haven Behavioral War Heroes Hospital to Offer Comprehensive Psychiatric Treatment for Military Service Members
5. Carefx to Provide Clinical Workflow Solutions for Military Health System
6. Study Finds Military Prone to Infection With H1N1 Flu
7. Military develops multi-purpose green decontaminants for terrorist attack sites
8. Raleigh Surgeon Offers Deep Savings on LASIK and PRK as a Thank You to Military, Police and Fire Personnel
9. Most Military Couples Satisfied With Their Relationships
10. Institute of HeartMath's Military Service Appreciation Fund Gives Soldiers Peace of Mind
11. The Skin Center Medical Spa in Pittsburgh Helps Military Recruits Meet Enlisting Requirements
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:5/26/2017)... ... ... Rob Lowe acts as host and helps educate and inform the public using the ... can reconnect with America as it explores some of the best places to hike ... an inventive new place for a family vacation, and have discovered hiking. Many will ...
(Date:5/26/2017)... ... May 26, 2017 , ... “Just What Happened in the Garden of Eden”: retells the stories ... Eden” is the creation of published author, Penelope Colt, mother, trader, horse farmer, artist and ... NYC when she was three. At six, they moved to Dayton, Ohio, where Penny ...
(Date:5/24/2017)... ... 2017 , ... Dr. Alan I. Benvenisty, MD is dual board certified in ... known for his distinguished expertise and experience in the diagnosis and treatment of vascular ... treating renovascular disease and aortic aneurysm . He is known for his minimally ...
(Date:5/24/2017)... ... 2017 , ... Patients who want to receive cosmetic dentistry procedures such as ... Bedich for a consultation, with or without a referral. Dr. Bedich enjoys improving the ... , Dr. Bedich offers a variety of cosmetic dentistry services at his practice ...
(Date:5/24/2017)... ... 2017 , ... Medic CE , a Career Step company, is sponsoring ... hosted by the Journal of Emergency Medical Services (JEMS). The free webinar, to be ... by Captain Rommie Duckworth, LP, a career fire captain as well as founder and ...
Breaking Medicine News(10 mins):
(Date:5/9/2017)... PORTLAND, Ore. , May 9, 2017 /PRNewswire/ ... company that provides technology solutions to improve the ... reported financial results for the first quarter ended ... that our products enable our customers to identify ... them to intervene before events like heart attacks ...
(Date:5/6/2017)...  May is Stroke Awareness Month and Omron Healthcare ... methods to prevent a stroke: monitor and manage your ... and Prevention, undetected and uncontrolled hypertension is a leading ... leader in personal heart health technology, recently evolved its ... and stroke and is advancing a national public education ...
(Date:5/4/2017)... Clarius Mobile Health, a digital healthcare ... this week at the American Congress of Obstetricians ... San Diego, CA from May ... perfect tool for clinicians to easily confirm pregnancy, ... pregnancy-related complications like ectopic pregnancy and placenta previa," ...
Breaking Medicine Technology: