Page 81 - JSOM Fall 2018

2018 Research Abstracts Selection for
Podium or Poster Presentation

TOP PODIUM PRESENTATIONS
Conclusion: All regressions and correlations of SFR were sig­
Diagnosis of ARDS from Transcutaneous O nificant with PFR in the setting of combat relevant trauma.
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Saturation Measurement in a Combat-Relevant SFR is a promising useful surrogate for PFR in austere settings.
Model of Prolonged Field Care and Ground and High-
Altitude Evacuation The Influence of Social Media on
Dr Andriy I. Batchinsky, Principal Investigator; Daniel S. Wen­ Prehospital Medical Education
dorff, Research Associate; John A. Jones, Statistician; Brendan SGT Collin T. Dye, E Co, 91st BN, 95th CA, Fort Bragg, NC;
M. Beely, Research Coordinator; Teryn R. Roberts, Research SFC John Lacroix, US Army, Committee on Tactical Combat
Associate; Dr Jae Hyek Choi, Research Scientist; George Casualty Care, Fort Polk, LA; SFC Dominic Thompson, US
Harea, Research Technician; Dr Vitali Karaliou, Research Sci­ Army, AMEDD C&S, Joint Base San Antonio, TX; SSG Max
entist; and Kyle N. Sieck, Research Technician: The Geneva Dodge, New Hampshire National Guard, Hanover, NH; SFC
Foundation, Tacoma, WA; COL (r) (Dr) Leopoldo C. Cancio, Paul E. Loos, US Army Special Warfare Center and School,
Task Area Manager, US Army Institute of Surgical Research, Fort Bragg, NC; MSG (R) Harold R. Montgomery, Com­
JBSA Ft. Sam Houston, TX; Col (Dr) Michael R. Davis, USAF, mittee on Tactical Combat Casualty Care, Tampa, FL; Kate
US Army Medical Research and Material Command, Ft. Det­ Kemplin, University of Tennessee at Chattanooga, Chatta­
rick, MD; Maj (Dr) James H. Lantry III, USAF Reserve, R. nooga, TN; MAJ Andrew D. Fisher, Texas A&M College of
Adams Cowley Shock Trauma Center, Baltimore, MD; Maj Medicine Bryan, TX, Texas Army National Guard, San An­
(Dr) Valerie G. Sams, USAF, San Antonio Military Medical tonio, TX
Center, JBSA Fort Sam Houston, TX
Background: The course map to becoming a Combat Medic
Background: Diagnosis of acute respiratory distress syndrome from Basic Combat Training to Advanced Individual Train­
(ARDS) is difficult during prolonged field care (PFC). One ing is easily found on a number of online resources. Despite
determinant of ARDS is the tension of O2 in arterial blood the plethora of technological resources available today, an
(PaO2) which requires invasive blood draw and analysis and is information gap was identified by several 68W instructors.
a component of PaO2­to­FiO2 ratio (PFR) – an index of ARDS. When the official course requirements are met by a trainee,
We analyzed SPO2­ a noninvasive marker of tissue oxygen sat­ how/where can they continue their prehospital education? At
uration and assessed the SPO2­to­FiO2 ratio (SFR) as a surro­ the end of each training cycle this was a prominent question
gate for PFR. We hypothesized that SFR correlates with and asked of us. This gap led to the inception of Next Generation
is a suitable surrogate for PFR in a model of combat­ relevant Combat Medic.
trauma, PFC, and ground and high­altitude evacuation.
Methods: Study aims were to detåermine demographic charac­
Methods: Anesthetized, instrumented swine (n = 30) were teristics and decisional reasoning of medics using FOAM via
subjected to single and bilateral pulmonary contusion using specific social media outlets in efforts to independently obtain
a humane stunner; placement of unilateral and bilateral chest additional medical education. We sought to determine any re­
tubes; decompressive thoracotomy with clamping of the right lationship and/or differences between participants’ reported
hilum due to continued hemorrhage; hemorrhage to a mean subconscious (intuitive) and critical (rational) reasoning, and
arterial pressure of 40mmHg; resuscitation and reinfusion to delineate those characteristics among demographic catego­
of shed blood. Therapeutic interventions included mechani­ ries. We hypothesized that younger medics (and participant
cal ventilation, pressors, CPR, and veno­venous extracorpo­ clinicians) with less experience would identify as using ratio­
real life support. A subset (n=16) also underwent ground and nal thinking in the decisions they make whereas more experi­
high­altitude evacuation in a pressurized chamber at 5K, 8k enced clinicians would rely more on intuition when it comes
and 30K ft. We performed 113 pairwise comparisons of PFR, to making decisions.
based on arterial blood gas (I­Stat, Abbott Park, IL) and SFR Results: Social Media Utilization. When asked “has this page
based on Spo values obtained by two devices: Draeger M540 increased and/or improved your medical knowledge base?”
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(Draeger Medical, Telford, PA) and Aesculon, (Cardiotronics, 89% of participants responded “probably” to “definitely
LaJolla, CA). Linear regressions and spearman correlations yes” and 10% were neutral. Similarly, 94.26% of participants
were performed using SAS v 9.4 (Cary, NC).
stated the FOAM social media pages provided “reliable and
Results: For the Aesculon, SFR = 153.19 + 0.68*(PFR), r = 0.6091 relevant topics for discussion and practice” and more than
and p­value = <0.0001. Draeger, SFR = 156.85+0.63*(PFR), 66% stated the pages’ content augmented their ability to
r = 0.5917 and p­value = <0.0001. The combined regression treat real patients. Participants liked evidence­based practice
was SFR = 155.02 + 0.653*(PFR), r = 0.5962 and p­value = articles and studies (15%), critical thinking is encouraged
<0.0001. (15%), case studies and scenarios (15%), product/technique

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