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30/06/2017

Trauma sonore: Protection et corticoïdes

Acute Acoustic Trauma among Soldiers during an Intense Combat.

 
 
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On a toujours tendance à l'oublier un peu. Mais mieux vaut prévenir que guérir par le port de protections adaptées en particulier chez les porteurs d'armes lourdes et les opérateurs radios qui doivent faire l'objet d'un ciblage "éducationnel". Le port de bouchons de protection de type EAR semblerait plus complexe à utiliser. Une amélioration notable peut être obtenue par une corticothérapie avec un équivalent de 1 mg/kg de prednisone démarré dans la première semaine 

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BACKGROUND:

During military actions, soldiers are constantly exposed to various forms of potentially harmful noises. Acute acoustic trauma (AAT) results from an impact, unexpected intense noise ≥140 dB, which generates a high-energy sound wave that can damage the auditory system.

PURPOSE:

We sought to characterize AAT injuries among military personnel during operation "Protective Edge," to analyze the effectiveness of hearing protection devices (HPDs), and to evaluate the benefit of steroid treatment in early-diagnosed AAT injury.

RESEARCH DESIGN:

We retrospectively identified affected individuals who presented to military medical facilities with solitary or combined AAT injuries within 4 mo following an intense military operation, which was characterized with an abrupt, intensive noise exposure (July-December 2014).

STUDY SAMPLE:

A total of 186 participants who were referred during and shortly after a military operation with suspected AAT injury.

INTERVENTIONS:

HPDs, oral steroids.

DATA COLLECTION AND ANALYSIS:

Data extracted from charts and audiograms included demographics, AAT severity, worn HPDs, first and last audiograms and treatment (if given). The Student's independent samples t test was used to compare continuous variables. All tests were considered significant if p values were ≤0.05.

RESULTS:

A total of 186 participants presented with hearing complaints attributed to AAT: 122, 39, and 25 were in duty service, career personnel, and reservists, with a mean age of 21.1, 29.2, and 30.4 yr, respectively. Of them, 92 (49%) participants had confirmed hearing loss in at least one ear. Hearing impairment was significantly more common in unprotected participants, when compared with protected participants: 62% (74/119) versus 45% (30/67), p < 0.05. Tinnitus was more common in unprotected participants when compared with protected participants (75% versus 49%, p = 0.04), whereas vertigo was an uncommon symptom (5% versus 2.5%, respectively, p > 0.05). In the 21 participants who received steroid treatment for early-diagnosed AAT, bone-conduction hearing thresholds significantly improved in the posttreatment audiograms, when compared with untreated participants (p < 0.01, for 1-4 kHz).

CONCLUSIONS:

AAT is a common military injury, and should be diagnosed early to minimize associated morbidity. HPDs were proven to be effective in preventing and minimizing AAT hearing sequelae. Steroid treatment was effective in AAT injury, if initiated within 7 days after noise exposure.

| Tags : blast

Intra-osseux: Pas un gadget

En route intraosseous access performed in the combat setting

 
 
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Dans cette étude 2 blessés sur 3 font l'objet d'une tentative d'abord vasculaire, réussie dans 93% des cas. L'abord intra-osseux est fait dans près de 12% des cas et représente le seul accès dans près de 6% des blessés pris en charge avec un taux de succès de 88%. 
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OBJECTIVE:

To describe and compare vascular access practices used by en route care providers during medical evacuation (MEDEVAC).

DESIGN:

This was a retrospective cohort study. Medical records of US military personnel injured in combat and transported by MEDEVAC teams were queried.

PATIENTS:

The subjects were transported by military en route care providers, in the combat theater during Operation Enduring Freedom (OEF) between January 2011 and March 2014. The authors reviewed 1,267 MEDEVAC records of US casualties and included 832 subjects that had vascular access attempts.

MAIN OUTCOME MEASURES:

The outcome measures for this study were vascular access success rates, including intravenous (IV) and intraosseous (IO) attempts. Subjects were grouped by type of vascular access: None, peripheral intravenous (PIV), IO, and PIV + IO (combination of PIV and IO) and by vascular access (PIV or IO) success (No versus Yes). Survival rate, in-flight events, ventilator, intensive care and in hospital days, and 30-day outcomes were compared among groups.

STATISTICAL ANALYSIS:

The authors used chisquare or Fisher's exact tests to evaluate categorical variables. Analysis of variance (ANOVA) or Kruskal-Wallis tests were used for continuous variables.

RESULTS:

Vascular access was attempted in 832 (66 percent) of the 1,267 subjects transported by MEDEVAC during this study period. The majority (n = 758) of the access attempts were PIV of which 93 percent (706/758) were successful. In 74 subjects, IO was the only access attempted with an 85 percent (n = 63) success rate. The overall success rate with IO placement was 88 percent.

CONCLUSIONS:

Intraosseous access has been used successfully in the combat setting and accounts for approximately 12 percent of vascular access in the MEDEVAC population the authors studied.

| Tags : intraosseux

14/06/2017

Albumine préhospitalière: Idée qui fait son chemin

Albumin for Prehospital Fluid Resuscitation of Hemorrhagic Shock in Tactical Combat Casualty Care

 

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Une publication récente de Kheirabadi BS et Al. (1) évoque l'intérêt potentiel de l'albumine concentrée, notammment son pouvoir tampon important, pour la prise en charge de l'hémorragie, usage qu'il ne faut pas confondre avec celui de l'albumine à 4% dont l'emploi reste controversé (2) après l'étude SAFE (3). Lire ce point (5)

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Optimal fluid resuscitation on the battlefield in the absence of blood products remains unclear. Contemporary Combat medics are generally limited to hydroxyethyl starch or crystalloid solutions, both of which present significant drawbacks. Obtaining US Food and Drug Administration (FDA)-approved freeze-dried plasma (FDP) is a top casualty care research priority for the US Military. Interest in this agent reflects a desire to simultaneously expand intravascular volume and address coagulopathy. The history of FDP dates to the Second World War, when American expeditionary forces used this agent frequently. Also fielded was 25% albumin, an agent that lacks coagulation factors but offers impressive volume expansion with minimal weight to carry and requires no reconstitution in the field. The current potential value of 25% albumin is largely overlooked. Although FDP presents an attractive future option for battlefield prehospital fluid resuscitation once FDA approved, this article argues that in the interim, 25% albumin, augmented with fibrinogen concentrate and tranexamic acid to mitigate hemodilution effects on coagulation capacity, offers an effective volume resuscitation alternative that could save lives on the battlefield 

| Tags : hémorragie