Page 6 - JSOM Fall 2019

CASE REPORT FEATURE ARTICLES
Presumptive antirelapse therapy (PART) with primaquine for Plas- Management of Hemorrhage From Craniomaxillofacial Injuries
modium vivax malaria postdeployment is an important compo- and Penetrating Neck Injury in Tactical Combat Casualty Care:
nent of the US military Force Health Protection plan. In Delayed iTClamp Mechanical Wound Closure Device: The iTClamp (In-
Diagnosis in Army Ranger: Postdeployment Primaquine- novative Trauma Care Inc., Edmonton, Alberta, Canada) is the
Induced Methemoglobinemia, the authors present a unique case first and only hemorrhage control device that uses the hydrostatic
of an active duty Army Ranger without glucose-6-phosphatase de- pressure of a hematoma to tamponade bleeding from an injured
hydrogenase or cytochrome b5 reductase deficiencies who devel- vessel within a wound. It is US FDA approved for use on multiple
oped symptomatic methemoglobinemia while taking PART after a sites and works in all compressible areas and has been demon-
deployment to Afghanistan. strated effective in over 245 field applications.

TCCC CRITICAL DECISION CASE STUDIES Deliberate Practice in Combat Application Tourniquet Place-
1 August 2018 ment by Loop Passage revealed that there were placement er-
rors in wound–tourniquet gaps revealed. Analysis of such errors
IN BRIEF uncovered what 2–3 inches meant in operation. Spiral learning
may inform the development of best readiness practices such as
I See Red: Red Light Illumination in Helicopter Air Ambulance coaching deliberate-practice sessions.
Services: Helicopter AAS increas ingly operate during darkness,
and the cockpit crew prefers a dimmed light to be used in the
cabin. We encoun tered a downside to the use of red light—some
texts and sym bols became virtually invisible. This card is 3 × 5
inches and is to help
Example of “disappearance” of white letter print on a red first-aid providers
background under dimmed red light conditions. The upper third estimate accurately the
of the vial’s medication label has a bright red background with distance to place the
white letters printed on it, stating the contained drug and drug tourniquet from the
concentration (propofol 20mg/mL). The text is clearly visible in wound.
daylight and in white light mode of the head lamp (A) but disappears
under red light condition (B). Photo taken in the medical (passenger)
compartment of our Airbus H-135 HAA helicopter at night,
illuminated only with a commercial head lamp (Black Diamond ). Review: Getting Tourniquets Right = Getting Tourniquets
®
Tight: Tourniquet application to stop limb bleeding is conceptu-
(A)
ally simple, but optimal application technique matters, generally
requires training, and is more likely with objective measures of
correct application technique. Evidence of problems with applica-
tion techniques, knowledge, and training can be ascertained from
January 2007 to August 2018 PubMed peer-reviewed papers and
in Stop The Bleed–related videos.
(B)
Airway Management for Army Reserve Combat Medics: An
Interdisciplinary Workshop showed that supplementing the train-
ing of Army Reserve combat medics with the utilization of anes-
thesia providers is an effective platform and imparted confidence
in this population of military providers.
A Comparison of the Laryngeal Handshake Method Versus the
Traditional Index Finger Palpation Method in Identifying the
Fresh whole blood (FWB) is increasingly being recognized as the Cricothyroid Membrane, When Performed by Combat Medic
ideal resuscitative fluid for hemorrhagic shock. Therefore, many Trainees supports that at present the traditional method is a supe-
military units are performing autologous blood transfusion train- rior method for successful localization of the cricothyroid mem-
ing. In Risk Associated With Autologous Fresh Whole Blood brane when performed by Army combat medic trainees.
Training, the authors report their experience performing an es-
timated 3408 autologous transfusions in training and report no In Operational Advantages of Enteral Resuscitation Follow-
instances of hemolytic transfusion reactions or other major ing Burn Injury in Resource-Poor Environments: Palatability
complications. of Commercially Available Solutions, the authors report that
enteral resuscitation may confer several advantages over intrave-
SPECIAL ARTICLE nous fluids and serve as a viable alternative for burn resuscitation,
especially under resource-poor scenarios. Future research needs
The NATO Special Operations Surgical Team Development 26 to identify what solutions and volumes are optimal for use in the
Course: A Program Overview describes the Special Operations thermally injured casualty.
Surgical Team Development Course 5-day course that is held to
teach, train, develop, and encourage NATO partner nations to The Use of Tranexamic Acid in the Prehospital Setting: A Retro-
provide robust, hardened, and clinically able surgical resus citation spective Study reports that several studies have shown a survival
teams that are capable of providing close support to Special Op- benefit for a trauma patient if TXA is used early. Data showed that
erations Forces. the rate of prehospital administration of TXA in the population

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