TCCC. Point sur la recherche US

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Prolonged field care: Un retex

Prolonged Field Care (PFC): Lessons Learned

Keenan S et Al. 

 

Un document à lire avec intérêt

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Coagulopathie traumatique. Données actuelles

Acute traumatic coagulopathy: pathophysiology and resuscitation.

Simmons JW et Al. Br J Anaesth. 2016 Dec;117(suppl 3):iii31-iii43.

 

Acute Traumatic Coagulopathy occurs immediately after massive trauma when shock, hypoperfusion, and vascular damage are present. Mechanisms for this acute coagulopathy include activation of protein C, endothelial glycocalyx disruption, depletion of fibrinogen, and platelet dysfunction. Hypothermia and acidaemia amplify the endogenous coagulopathy and often accompany trauma. These multifactorial processes lead to decreased clot strength, autoheparinization, and hyperfibrinolysis. Furthermore, the effects of aggressive crystalloid administration, haemodilution from inappropriate blood product transfusion, and prolonged surgical times may worsen clinical outcomes. We review normal coagulation using the cell-based model of haemostasis and the pathophysiology of acute traumatic coagulopathy. Developed trauma systems reduce mortality, highlighting critical goals for the trauma patient in different phases of care. Once patients reach a trauma hospital, certain triggers reliably indicate when they require massive transfusion and specialized trauma care. These triggers include base deficit, international normalized radio (INR), systolic arterial pressure, haemoglobin concentration, and temperature. Early identification for massive transfusion is critically important, as exsanguination in the first few hours of trauma is a leading cause of death. To combat derangements caused by massive haemorrhage, damage control resuscitation is a technique that addresses each antagonist to normal haemostasis. Components of damage control resuscitation include damage control surgery, permissive hypotension, limited crystalloid administration, haemostatic resuscitation, and correction of hyperfibrinolysis.

Suppression métabolique ?

Inducing metabolic suppression in severe hemorrhagic shock: Pilot study results from the Biochronicity Project.

Black GE et Al. J Trauma Acute Care Surg. 2016 Dec;81(6):1003-1011.

 

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Mettre les cellules en hibernation, du moins arrêter le fonctionnement cellulaire de manière réversible, pour pouvoir permettre aux organes une moindre souffrance le temps de corriger la/les causes et les dégâts secondaires. La suppression métabolique, pas une utopie si l'on en croit cet article. 

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BACKGROUND:

Suspended animation-like states have been achieved in small animal models, but not in larger species. Inducing metabolic suppression and temporary oxygen independence could enhance survivability of massive injury. Based on prior analyses of key pathways, we hypothesized that phosphoinositol-3-kinase inhibition would produce metabolic suppression without worsening organ injury or systemic physiology.

METHODS:

Twenty swine were studied using LY294002 (LY), a nonselective phosphoinositol-3-kinase inhibitor. Animals were assigned to trauma only (TO, n = 3); dimethyl sulfoxide only (DMSO, n = 4), LY drug only (LYO, n = 3), and drug + trauma (LY + T, n = 10) groups. Both trauma groups underwent laparotomy, 35% hemorrhage, severe ischemia/reperfusion injury, and protocolized resuscitation. Laboratory, physiologic, cytokine, and metabolic cart data were obtained. Histology of key end organs was also compared.

RESULTS:

Baseline values were similar among the groups. Compared with the TO group, the LYO group had reversible decreases in heart rate, mean arterial pressure, cardiac output, oxygen consumption, and carbon dioxide production. Compared with TO, LY + T showed sustained decreases in heart rate (113 vs. 76, p = 0.03), mean arterial pressure (40 vs. 31 mm Hg, p = 0.02), and cardiac output (3.8 vs. 1.9 L/min, p = 0.05) at 6 hours. Metabolic parameters showed profound suppression in the LY + T group. Oxygen consumption in LY + T was lower than both TO (119 vs. 229 mL/min, p = 0.012) and LYO (119 vs. 225 mL/min, p = 0.014) at 6 hours. Similarly, carbon dioxide production was decreased at 6 hours in LY + T when compared with TO (114 vs. 191 mL/min, p = 0.043) and LYO (114 vs. 195 mL/min, p = 0.034) groups. There was no worsening of acidosis (lactate 6.4 vs. 8.3 mmol/L, p = 0.4) or other endpoints. Interleukin 6 (IL-6) showed a significant increase in LY + T when compared with TO at 6 hours (60.5 vs. 2.47, p = 0.043). Tumor necrosis factor α and IL-1β were decreased, and IL-10 increased in TO and LY + T at 6 hours. Markers of liver and kidney injury were no different between TO and LY + T groups at 6 hours.

CONCLUSIONS:

Phosphoinositol-3-kinase inhibition produced metabolic suppression in healthy and injured swine without increasing end-organ injury or systemic physiologic markers and demonstrated prolonged efficacy in injured animals. Further study may lead to targeted therapies to prolong tolerance to hemorrhage and extend the "golden hour" for injured patients.

Maintenir la pression: Hydroxocobalamine ou adré ?

A prospective, randomized trial of intravenous hydroxocobalamin versus whole blood transfusion compared to no treatment for Class III hemorrhagic shock resuscitation in a prehospital swine model.

Bebarta VS et Al. Acad Emerg Med. 2015 Mar;22(3):321-30.

 

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Faire en sorte qu'il y ait plus de NO éliminé pour augmenter les résistances artérielles. Une autre manière. A relativiser toutefois car avec l'arrêt des hémorragies, la transfusion sanguine précoce doit rester l'objectif principal.

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OBJECTIVES:

The objective was to compare systolic blood pressure (sBP) over time in swine that have had 30% of their blood volume removed (Class III shock) and treated with intravenous (IV) whole blood or IV hydroxocobalamin, compared to nontreated controlanimals.

METHODS:

Thirty swine (45 to 55 kg) were anesthetized, intubated, and instrumented with continuous femoral and pulmonary artery pressure monitoring. Animals were hemorrhaged a total of 20 mL/kg over a 20-minute period. Five minutes after hemorrhage, animals were randomly assigned to receive 150 mg/kg IV hydroxocobalamin solubilized in 180 mL of saline, 500 mL of whole blood, or no treatment. Animals were monitored for 60 minutes thereafter. A sample size of 10 animals per group was determined based on a power of 80% and an alpha of 0.05 to detect an effect size of at least a 0.25 difference (>1 standard deviation) in mean sBP between groups. sBP values were analyzed using repeated-measures analysis of variance (RANOVA). Secondary outcome data were analyzed using repeated-measures multivariate analysis of variance (RMANOVA).

RESULTS:

There were no significant differences between hemodynamic parameters of IV hydroxocobalamin versus whole blood versus control group at baseline (MANOVA; Wilks' lambda; p = 0.868) or immediately posthemorrhage (mean sBP = 47 mm Hg vs. 41 mm Hg vs. 37 mm Hg; mean arterial pressure = 39 mm Hg vs. 28 mm Hg vs. 34 mm Hg; mean serum lactate = 1.2 mmol/L vs. 1.4 mmol/L vs. 1.4 mmol/L; MANOVA; Wilks' lambda; p = 0.348). The outcome RANOVA model detected a significant difference by time between groups (p < 0.001). Specifically, 10 minutes after treatment, treated animals showed a significant increase in mean sBP compared to nontreated animals (mean sBP = 76.3 mm Hg vs. 85.7 mm Hg vs. 51.1 mm Hg; p < 0.001). RMANOVA modeling of the secondary data detected a significant difference in mean arterial pressure, heart rate, and serum lactate (p < 0.001). Similar to sBP, 10 minutes after treatment, treated animals showed a significant increase in mean arterial pressure compared to nontreated animals (mean arterial pressure = 67.7 mm Hg vs. 61.4 mm Hg vs. 40.5 mm Hg). By 10 minutes, mean heart rate was significantly slower in treated animals compared to nontreated animals (mean heart rate = 97.3 beats/min vs. 95.2 beats/min vs. 129.5 beats/min; p < 0.05). Serum lactate, an early predictor of shock, continued to rise in the control group, whereas it did not in treated animals. Thirty minutes after treatment, serum lactate values of treated animals were significantly lower compared to nontreated animals (p < 0.05). This trend continued throughout the 60-minute observation period such that 60-minute values for lactate were 1.4 mmol/L versus 1.1 mmol/L versus 3.8 mmol/L. IV hydroxocobalamin produced a statistically significant increase in systemic vascular resistance compared to control, but not whole blood, with a concomitant decrease in cardiac output.

CONCLUSIONS:

Intravenous hydroxocobalamin was more effective than no treatment and as effective as whole blood transfusion, in reversing hypotension and inhibiting rises in serum lactate in this prehospital, controlled, Class III swine hemorrhage model.

Transfusion en vol: Sécurité assurée

Risk Management Analysis of Air Ambulance Blood Product Administration in Combat Operations

Powell-Dunford Net Al. Aviat Space Environ Med. 2014 Nov;85(11):1130-5

 

BACKGROUND:

Between June-October 2012, 61 flight-medic-directed transfusions took place aboard U.S. Army Medical Evacuation (medevac) helicopters in Afghanistan. This represents the initial experience for pre-hospital blood product transfusion by U.S. Army flight medics.

METHODS:

We performed a retrospective review of clinical records, operating guidelines, after-action reviews, decision and information briefs, bimonthly medical conferences, and medevac-related medical records.

RESULTS:

A successful program was administered at 10 locations across Afghanistan. Adherence to protocol transfusion indications was 97%. There were 61 casualties who were transfused without any known instance of adverse reaction or local blood product wastage. Shock index (heart rate/systolic blood pressure) improved significantly en route, with a median shock index of 1.6 (IQR 1.2-2.0) pre-transfusion and 1.1 (IQR 1.0-1.5) post-transfusion (P < 0.0001). Blood resupply, training, and clinical procedures were standardized across each of the 10 areas of medevacoperations.

DISCUSSION:

Potential risks of medical complications, reverse propaganda, adherence to protocol, and diversion and/or wastage of limited resources were important considerations in the development of the pilot program. Aviation-specific risk mitigation strategies were important to ensure mission success in terms of wastage prevention, standardized operations at multiple locations, and prevention of adverse clinical outcomes. Consideration of aviation risk mitigation strategies may help enable other helicopter emergency medical systems to develop remote pre-hospital transfusion capability. This pilot program provides preliminary evidence that blood product administration by medevac is safe.

SmO2: Utile ?

Muscle Oxygen Saturation Improves Diagnostic Association Between Initial Vital Signs and Major Hemorrhage: A Prospective Observational Study.

 

Reisner AT et Al. Acad Emerg Med. 2016 Mar;23(3):353-7.

 

L'hémorragie reste la cause principale des décès évitable et l'importance de la mise en oeuvre d'une stratégie transfusionnelle précoce est actée. Mais sur quels critères. Au delà des critères cliniques simples, on peut citer le recours au suivi des lactates. Le suivi de paramètres d'oxygénation tissulaire simple est maintenant possible. Ce qu'évoque ce document est l'emploi de la SmO2, élément déjà utilisé en médecine du sport. Le recours à un tel paramètre est donc potentiellement très intéressant si cette pertinence était confirmée et sa mesure valide avec des outils simples.

OBJECTIVES:

During initial assessment of trauma patients, vital signs do not identify all patients with life-threatening hemorrhage. We hypothesized that a novel vital sign, muscle oxygen saturation (SmO2 ), could provide independent diagnostic information beyond routine vital signs for identification of hemorrhaging patients who require packed red blood cell (RBC) transfusion.

METHODS:

This was an observational study of adult trauma patients treated at a Level I trauma center. Study staff placed the CareGuide 1100 tissue oximeter (Reflectance Medical Inc., Westborough, MA), and we analyzed average values of SmO2 , systolic blood pressure (sBP), pulse pressure (PP), and heart rate (HR) during 10 minutes of early emergency department evaluation. We excluded subjects without a full set of vital signs during the observation interval. The study outcome was hemorrhagic injury and RBC transfusion ≥ 3 units in 24 hours (24-hr RBC ≥ 3). To test the hypothesis that SmO2 added independent information beyond routine vital signs, we developed one logistic regression model with HR, sBP, and PP and one with SmO2 in addition to HR, sBP, and PP and compared their areas under receiver operating characteristic curves (ROC AUCs) using DeLong's test.

RESULTS:

We enrolled 487 subjects; 23 received 24-hr RBC ≥ 3. Compared to the model without SmO2 , the regression model with SmO2 had a significantly increased ROC AUC for the prediction of ≥ 3 units of 24-hr RBC volume, 0.85 (95% confidence interval [CI], 0.75-0.91) versus 0.77 (95% CI, 0.66-0.86; p < 0.05 per DeLong's test). Results were similar for ROC AUCs predicting patients (n = 11) receiving 24-hr RBC ≥ 9.

CONCLUSIONS:

SmO2 significantly improved the diagnostic association between initial vital signs and hemorrhagic injury with blood transfusion. This parameter may enhance the early identification of patients who require blood products for life-threatening hemorrhage.

Médecine de catastrophe en France

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Une publication qui fait le point sur la médecine de catastrophe et ses différents enjeux à la lumière de la menace terroriste actuelle. A lire avec attention ++++

 

 

Interventions salvatrices: Bien sûr mais lesquelles ?

Major incident triage: A consensus based definition of the essential life-saving interventions during the definitive care phase of a major incident

Vassallo J. et Al. Injury, Int. J. Care Injured 47 (2016) 1898–190

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Plus le contexte d'intervention est difficile soit du fait de l'environnement soit du fait du danger tactique et plus le choix des nterventions médicales doit être réflechi et restreint et mis en oeuvre par uintervenant pas forcément médecin mas formé spécifiquement à la pratique d'une action nécessaire à la survie. Ce travail identiife ainsi une trentaine de conduites essentielles à un réseau de traumatisés graves. Lire aussi cet article

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Introduction: Triage is a key principle in the effective management of major incidents. The process currently relies on algorithms assigning patients to specific triage categories; there is, however, little guidance as to what these categories represent. Previously, these algorithms were validated against injury severity scores, but it is accepted now that the need for life-saving intervention is a more important outcome. However, the definition of a life-saving intervention is unclear. The aim of this study was to define what constitutes a life-saving intervention, in order to facilitate the definition of an adult priority one patient during the definitive care phase of a major incident.

Methods: We conducted a modified Delphi study, using a panel of subject matter experts drawn from the United Kingdom and Republic of South Africa with a background in Emergency Care or Major Incident Management. The study was conducted using an online survey tool, over three rounds between July and December 2013. A four point Likert scale was used to seek consensus for 50 possible interventions, with a consensus level set at 70%.

Results: 24 participants completed all three rounds of the Delphi, with 32 life-saving interventions reaching consensus.

Conclusions: This study provides a consensus definition of what constitutes a life-saving intervention in the context of an adult, priority one patient during the definitive care phase of a major incident. The definition will contribute to further research into major incident triage, specifically in terms of validation of an adult major incident triage tool.

	Results of the Delphi Process – Life-Saving Interventions.
1	Intubation for actual airway obstruction
2	Intubation for impending airway obstruction
3	Surgical airway for airway obstruction
4	Surgical airway for impending airway obstruction
5	Needle thoracocentesis
6	Finger thoracostomy
7	Tube thoracostomy
8	Application of a chest seal (commercial/improvised)
9	Positive Pressure Ventilation for ventilatory inadequacy
10	Application of a tourniquet for haemorrhage control
11	Use of haemostatic agents for haemorrhage control
12	Insertion of an intra-osseous device for resuscitation purposes
13	Receiving uncross-matched blood
14	Receiving≥4 units of blood/blood products
15	Administration of tranexamic acid
16	Laparotomy for trauma
17	Thoracotomy for trauma
18	Pericardial window for trauma
19	Surgery to gain proximal vascular control
20	Interventional radiology for haemorrhage control
21	Application of a pelvic binder
22	ALS/ACLS protocols for a patient in a peri-arrest situation
23	ALS/ACLS protocols for a patient in cardiac arrest
24	Neurosurgery for the evacuation of an intra-cranial haematoma
25	Craniotomy
26	Burr Hole Insertion
27	Spinal nursing for a C1-3 fracture
28	Administration of a seizure-terminating medication
29	Active rewarming for initial core temp<32° celcius
30	Passive rewarming for initial core temp<32° celcius
31	Correction of low blood glucose
32	Administration of chemical antidotes

Transfusion, Thrombosis and Bleeding Management

Special Issue: Transfusion, Thrombosis and Bleeding Management

January 2015 - Volume 70, Issue Supplement s1 - Pages 1–e41

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Blood – the most important humour? (pages 1–e1)

C. R. Bailey, A. A. Klein and B. J. Hunt

Version of Record online: 1 DEC 2014 | DOI: 10.1111/anae.12930

PDF(52K)

 

Review Articles

Modern banking, collection, compatibility testing and storage of blood and blood components (pages 3–e2)

L. Green, S. Allard and R. Cardigan

☛ CPD available at http://www.learnataagbi.org

Corrected by:

Corrigendum: Modern banking, collection, compatibility testing and storage of blood and blood components

Vol. 70, Issue 3, 373, Version of Record online: 11 FEB 2015

PDF(121K)

 

Evidence and triggers for the transfusion of blood and blood products (pages 10–e3)

A. Shah, S. J. Stanworth and S. McKechnie

PDF(135K)

 

Pre-operative anaemia (pages 20–e8)

B. Clevenger and T. Richards

PDF(241K)

 

The pathophysiology and consequences of red blood cell storage (pages 29–e12)

D. Orlov and K. Karkouti

PDF(445K)

 

Red cell transfusion and the immune system (pages 38–e16)

S. Hart, C. M. Cserti-Gazdewich and S. A. McCluskey

PDF(133K)

 

The current place of aprotinin in the management of bleeding (pages 46–e17)

D. Royston

PDF(69K)

 

The current place of tranexamic acid in the management of bleeding (pages 50–e18)

B. J. Hunt

PDF(69K)

 

Practical management of major blood loss (pages 54–e20)

R. Gill

PDF(79K)

 

Management of peri-operative anti-thrombotic therapy (pages 58–e23)

J. J. van Veen and M. Makris

PDF(262K)

 

Laboratory monitoring of haemostasis (pages 68–e24)

A. Fowler and D. J. Perry

PDF(67K)

 

Point-of-care monitoring of haemostasis (pages 73–e26)

S. V. Mallett and M. Armstrong

PDF(85K)

 

Haemostatic management of obstetric haemorrhage (pages 78–e28)

R. E. Collis and P. W. Collins

PDF(281K)

 

Haemostatic management of cardiac surgical haemorrhage (pages 87–e31)

M. W. Besser, E. Ortmann and A. A. Klein

PDF(129K)

 

The pathogenesis of traumatic coagulopathy (pages 96–e34)

A. Cap and B. J. Hunt

PDF(105K)

 

Management of traumatic haemorrhage – the European perspective (pages 102–e37)

H. Schöchl, W. Voelckel and C. J. Schlimp

PDF(1142K)

 

Management of traumatic haemorrhage – the US perspective (pages 108–e38)

R. P. Dutton

PDF(61K)

 

Surgery in patients with inherited bleeding disorders (pages 112–e40)

P. K. Mensah and R. Gooding

PDF(180K)

 

The management of abnormal haemostasis in the ICU (pages 121–e41)

A. Retter and N. A. Barrett

PDF(727K)

Revue du CIMM/ICMM

Afghanistan et le bilan hollandais

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The Trauma Manual: Trauma and Acute Care Surgery

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Trauma anesthesia

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Combat Trauma. Lessons Learned from Military Operations

 

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Can J Surg: Numéro spécial 2015

Foreword

Foreword

Col Homer Tien

Can J Surg. 2015 Jun; 58(3 Suppl 3): S80. doi: 10.1503/cjs.006615

Article PubReader PDF–35KCitation

Avant-Propos

Avant-propos

Col Homer Tien

Can J Surg. 2015 Jun; 58(3 Suppl 3): S81. French. DOI : 10.1503/cjs.006715

Article PubReader PDF–32KCitation

Introduction

Introduction

BGen Jean-Robert Bernier

Can J Surg. 2015 Jun; 58(3 Suppl 3): S82. doi: 10.1503/cjs.015614

Article PubReader PDF–39KCitation

 

Introduction

Bgén Jean-Robert Bernier

Can J Surg. 2015 Jun; 58(3 Suppl 3): S83. French. DOI : 10.1503/cjs.006815

Article PubReader PDF–36KCitation

Commentaries

 

The need for a robust 24/7 subspecialty “clearing house” response for telementored trauma care

Maj Andrew W. Kirkpatrick, Douglas Hamilton, Maj Andrew Beckett, Anthony LaPorta, Susan Brien, Col Elon Glassberg, Chad G. Ball, Derek J. Roberts, Col Homer Tien

Can J Surg. 2015 Jun; 58(3 Suppl 3): S85–S87. doi: 10.1503/cjs.013914

Article PubReader PDF–65KCitation

 

Technical innovations that may facilitate real-time telementoring of damage control surgery in austere environments: a proof of concept comparative evaluation of the importance of surgical experience, telepresence, gravity and mentoring in the conduct of damage control laparotomies

Maj Andrew W. Kirkpatrick, Anthony LaPorta, Susan Brien, Tim Leslie, Col Elon Glassberg, Jessica McKee, Chad G. Ball, Heather E. Wright Beatty, Jocelyn Keillor, Derek J. Roberts, Col Homer Tien

Can J Surg. 2015 Jun; 58(3 Suppl 3): S88–S90. doi: 10.1503/cjs.014214

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Review

Advances in damage control resuscitation and surgery: implications on the organization of future military field forces

Col Homer Tien, Maj Andrew Beckett, LCol Naisan Garraway, LCol Max Talbot, Capt Dylan Pannell, Thamer Alabbasi

Can J Surg. 2015 Jun; 58(3 Suppl 3): S91–S97. doi: 10.1503/cjs.001815

Article PubReader PDF–122KCitation

Research

Medical mentorship in Afghanistan: How are military mentors perceived by Afghan health care providers?

Maj Andrew Beckett, Robert Fowler, Neil Adhikari, Laura Hawryluck, Tarek Razek, Col Homer Tien

Can J Surg. 2015 Jun; 58(3 Suppl 3): S98–S103. doi: 10.1503/cjs.012214

Correction in:

Can J Surg. 2015 Oct; 58(5): 317.

Article PubReader PDF–123KCitation

Cervical spine injury in dismounted improvised explosive device trauma

Joseph Taddeo, Maj Melissa Devine, LCol Vivian C. McAlister

Can J Surg. 2015 Jun; 58(3 Suppl 3): S104–S107. doi: 10.1503/cjs.013114

 

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Blunt splenic injury and severe brain injury: a decision analysis and implications for care

Thamer Alabbasi, Avery B. Nathens, Col Homer Tien

Can J Surg. 2015 Jun; 58(3 Suppl 3): S108–S117. doi: 10.1503/cjs.015814

Article PubReader PDF–270KCitation

 

Needle thoracostomy for tension pneumothorax: the Israeli Defense Forces experience

LTC Jacob Chen, Capt Roy Nadler, Maj Dagan Schwartz, Col Homer Tien, LTC Andrew P. Cap, Col Elon Glassberg

Can J Surg. 2015 Jun; 58(3 Suppl 3): S118–S124. doi: 10.1503/cjs.012914

Article PubReader PDF–166KCitation

 

Current use of live tissue training in trauma: a descriptive systematic review

Luis Teodoro da Luz, Bartolomeu Nascimento, Col Homer Tien, Michael J. Kim, Avery B. Nathens, Savvas Vlachos, Col Elon Glassberg

Can J Surg. 2015 Jun; 58(3 Suppl 3): S125–S134. doi: 10.1503/cjs.014114

Article PubReader PDF–177KCitation

 

Acute nontraumatic general surgical conditions on a combat deployment

Capt Dylan Pannell, Avery B. Nathens, Col Jacques Ricard, LCol Erin Savage, Col Homer Tien

Can J Surg. 2015 Jun; 58(3 Suppl 3): S135–S140. doi: 10.1503/cjs.013414

Article PubReader PDF–112KCitation

 

Factors affecting mortality of pediatric trauma patients encountered in Kandahar, Afghanistan

Capt Dylan Pannell, Jeffery Poynter, Paul W. Wales, Col Homer Tien, Avery B. Nathens, David Shellington

Can J Surg. 2015 Jun; 58(3 Suppl 3): S141–S145. doi: 10.1503/cjs.017414

Article PubReader PDF–118KCitation

 

The Canadian Armed Forces medical response to Typhoon Haiyan

LCol Erin Savage, Maj Michael D. Christian, Maj Stephanie Smith, Capt Dylan Pannell

Can J Surg. 2015 Jun; 58(3 Suppl 3): S146–S152. doi: 10.1503/cjs.013514

Article PubReader PDF–839KCitation

Discussions in Surgery

Fresh whole blood transfusion capability for Special Operations Forces

Maj Andrew Beckett, Jeannie Callum, Luis Teodoro da Luz, Joanne Schmid, Christopher Funk, Col Elon Glassberg, Col Homer Tien

Can J Surg. 2015 Jun; 58(3 Suppl 3): S153–S156. doi: 10.1503/cjs.012614

Article PubReader PDF–82KCitatio

Peau et maintien de la paix

A Review of Skin Conditions in Modern Warfare and Peacekeeping Operations

Gelman AB et Al. Mil Med. 2015 Jan;180(1):32-7

Skin is the most exposed organ of the body, and military personnel face many external skin threats. As a result, skin disease is an important source of morbidity among military personnel deployed on combat or peacekeeping operations. This article reviews the most common conditions seen by deployed military dermatologists. A PubMed search was used to identify articles in English, written between 1965 and 2014, using medical subject headings “military medicine” AND “skin disease” or “military personnel” AND “skin disease.” The five most common reasons for physician consultation for skin conditions in wartime since the Vietnam War were warts (10.7%), fungal infections (10.4%), acne (9.0%), nonspecific eczematous conditions (7.1%), and sexually transmitted diseases (6.1%). There was a significant difference in the skin conditions seen in the hot and humid climates of Vietnam and East Timor, where bacterial and fungal infections were more common reasons for consultation, and the dry climates of Bosnia and Iraq, where eczematous conditions made up a larger part of the dermatologic caseload.

Le consensus d'hartford

Les événements récents ont mis en évidence l'importance de l'organisation des soins en cas d'attentats multisites notamment par armes de guerre. Le consensus d'Hartford est une démarche majeure conduite par nos alliés américains sur la survenue de telles situations. Très globalement il s'agit d'une chaîne de survie à mettre en place, ou bien sûr les professionnels de  santé ont leur place mais aussi et surtout le citoyen et les forces de l'ordre. L'acronyme THREAT réssume la démarche: T pour Threat Suppression, H pour Hemorrage Control, RE pour Rapid Extrication to safety, A pour Assessment by medical provider, T pour transport to definitive care.

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Military medicine in the 21st

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Médecine militaire et civile

Apports de la médecine de l’avant militaire en situation préhospitalière civile

Derkenne C. et Al. Ann. Fr. Med. Urgence (2015) 5:245-251

L’évolution récente des matériels issus de la médecine de guerre pourrait profiter à la médecine préhospitalièrecivile. Des dispositifs comme les garrots ou les pansements hémostatiques sont encore très peu diffusés en pratique civile, malgré des recommandations fortes et assez anciennes de sociétés savantes civiles. Les dispositifs de lutte contre l’hypothermie en préhospitalier sont, en pratique civile, limités, là où les praticiens militaires disposent de couvertures perfectionnées et beaucoup plus efficaces. Enfin, un modèle de kit de drain thoracique, ergonomique, léger et autorisant l’autotransfusion nous paraît pouvoir avantageusement remplacer les différents moyens disponibles en Smur. Selon des données scientifiques issues essentiellement de la médecine militaire, l’utilisation de ces matériels en médecine préhospitalière civile pourrait être particulièrement utile lors de la prise en charge de traumatisés sévères.