Vasopressin Administration During Fluid Resuscitation Alters Expression of Epigenetic Enzymes of Renal Artery in a Pig Model of Hemorrhagic Shock
Jillian M Piaggione, MD1, Lee-Ann M Murata, MSc2, Catherine F Uyehara, PhD2, Dao H Ho, PhD2. 1Department of General Surgery, Tripler Army Medical Center, 2Department of Clinical Investigation, Tripler Army Medical CenterObjectives. Trauma accounts for ~50% of combat-related deaths. Rapid blood loss from trauma can lead to hemorrhagic shock resulting in organ damage. Renal function… Continue Reading
TOO FAST, OR NOT FAST ENOUGH? THE FAST EXAM IN PATIENTS WITH NON-COMPRESSIBLE TORSO HEMORRHAGE
Woo S Do, MD1, Matthew J Eckert, MD1, Ronald Chang, MD2, Erin E Fox, PhD2, Charles E Wade, PhD2, John B Holcomb2, Matthew J Martin1. 1Legacy Emmanuel Medical Center, Portland, OR, 2Center for Translational Injury Research, University of Texas Health Science Center, Houston, TXObjectives: Trauma surgeons assessing patients with non-compressible torso hemorrhage (NCTH) often rely… Continue Reading
Surgery at Sea: Are Military Surgery Training Programs Preparing New Graduates for Shipboard Surgery?
Matthew D Nealeigh, DO, Walter B Kucera, MD, Matthew J Bradley, MD, E. Matthew Ritter, MD, W. Brian Sweeney, MD, Elliot M Jessie, MD, Carlos J Rodriguez, DO. Uniformed Services University / Walter Reed National Military Medical CenterIntroduction: Recent decades brought revolutionary applications of technology to address surgical disease. Residency programs appropriately integrated advances into… Continue Reading
Saline Hydro-Flotation is Superior to Bioresorable Membranes in Decreasing Intra-Abdominal Adhesion Formation in a Rat Model
John Kuckelman, Morgan Barron, Kevin Kniery, Jeffrey Kay, Joseph Kononchik, Zachary Hoffer, Vance Sohn. Madigan Army Medical CenterINTRODUCTION: Adhesion formation after laparotomy remains a major cause of post-operative morbidity. Hyaluronate/carboxymethylcellulose membranes (HAC) are costly bioresorbable membranes that represent current anti-adhesion therapy. Alternatively, hydro-flotation using saline theoretically provides a transient barrier during adhesion formation. We sought… Continue Reading
Prolonged Field Care – The U.S. Air Force Pararescue Experience
Erik DeSoucy, DO1, Seth Zweben, NREMTP2, Stacy Shackelford, MD3, Joseph J DuBose, MD1, Russ S Kotwal, MD, MPH3, Harold R Montgomery, SOATP3, Sean Keenan, MD4, Stephen C Rush, MD2. 1David Grant Medical Center, 2U.S. Air Force Pararescue, 3Joint Trauma System, 4Special Operations Command, EuropeIntroduction: United States Air Force Pararescue is an elite special operations force… Continue Reading
Plasma Co-Administration Improves Resuscitation with Tranexamic Acid or Prothrombin Complex in a Porcine Hemorrhagic Shock Model
John P Kuckelman, Morgan Barron, MD, Donald Moe, Michael Lallemand, John McClellan, Shannon Marko, Matthew Eckert, Matthew Martin. Madigan Army Medical CenterOBJECTIVE: Traumatic coagulopathy has now been well characterized, but still carries high rates of mortality due to bleeding. A "factor-based" resuscitation strategy using pro-coagulant drugs and factor concentrates in lieu of plasma is being… Continue Reading
Outcomes following administration of tranexamic acid in military traumatic brain injury
Patrick F Walker, MD, Joseph D Bozzay, MD, Luke R Johnston, MD, Eric A Elster, MD, Carlos J Rodriguez, DO, Matthew J Bradley, MD. Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MarylandOBJECTIVES: Tranexamic acid (TXA) may be a useful adjunct for military patients with… Continue Reading
Multimodal Pain Control in the Humanitarian Setting
Jonathan L Halbach, DO, Paul Lewis, DO, Jason Brill, MD, James Wallace, MD, Ashley Zander, DO, Mike VanGent, DO, Kyle Gadbois, MD. Naval Medical Center San DiegoObjective: The prescribing of narcotic pain medication during humanitarian medical missions presents an ethical dilemma with the potential for adverse events without reliable follow-up. Some countries prohibit the distribution… Continue Reading
Mobile Forward Looking Infrared Technology Allows Rapid Assessment of Resuscitative Endovascular Balloon Occlusion of the Aorta in Hemorrhage and Blackout Conditions
Morgan R Barron, MD, John Kuckelman, DO, John McClellan, MD, Michael Derickson, MD, Cody Phillips, DO, Shannon Marko, DVM, Kyle Sokol, MD, Rowan Sheldon, MDMatthew Eckert, MD, Matthew Martin, MD. Madigan Army Medical CenterIntroduction: Objective assessment of final REBOA position and adequate distal occlusion is clinically limited, particularly in patients with hemorrhagic shock. We propose… Continue Reading
Medical Management of Severe Traumatic Brain Injury in Afghanistan at Forward Deployed Surgical Units Demonstrates a Potential Knowledge or Utilization Gap in Patient Management
G Baluh, MD, E Mann-Salinas, PhD, A Staudt, PhD, J Gurney, MD, S Shackelford, MD, J Nielsen, MD, T Becker, MD. SAMMCObjectives: Military surgeons deployed to locations with limited resources, i.e. Role 2 medical treatment facilities (MTF), are often required to care for patients sustaining severe traumatic brain injuries (sTBI). It is paramount in sTBI… Continue Reading
Mastery of General Surgery: An Impossible Task In The Army Healthcare System
Timothy P Plackett, DO, MPH1, Joel R Brockmeyer, MD2, Danielle B Holt, MD3, Robert M Rush, Jr, MD4, Joy Sarkar, MD5, Steven A Satterly, MD1, Jason M Seery, MD6, Bradley R Zagol, MD7. 1Womack Army Medical Center, 2Eisenhower Army Medical Center, 3Walter Reed National Military Medical Center, 4Madigan Army Medical Center, 5Brian Allgood Army Community… Continue Reading
Interim Analysis of a Prospective, Randomized Phase II Trial of Trastuzumab vs Trastuzumab + E75 for the Prevention of Recurrence in HER2 Overexpressing Breast Cancer Patients
Tommy A Brown, MD1, John W Myers, MD1, Kaitlin M Peace, MD1, Jennifer K Litton, MD2, Rashmi Murthy, MD3, Timothy J Vreeland, MD2, Diane F Hale, MD1, Garth S Herbert, MD1, Guy T Clifton, MD1, Mark O Hardin, MD4, George E Peoples, MD5, Elizabeth A Mittendorf, MD2. 1Department of Surgery, Brooke Army Medical Center, 2The… Continue Reading
INHIBITION OF TLR-4 ATTENUATES SYSTEMIC IMMUNE RESPONSE IN HEMORRHAGIC SHOCK
Samuel W Hoppe, MD, William Chang, MD, Michael Kilbourne, MD, Balakrishna M Prasad, PhD. Dwight D Eisenhower Army Medical CenterOBJECTIVES: Activation of toll-like receptor 4 (TLR-4) by damage associated molecular patterns (DAMPs) has been implicated in the systemic activation of the immune system in hemorrhagic shock. This immune response may be deleterious in some patients. … Continue Reading
Improving Fasciotomy Performance: A Focused Needs Assessment for Military Surgeon Simulation Training
Walter B Kucera, MD, Matthew D Nealeigh, DO, Brenton Franklin, MD, Mark Bowyer, MD, W. Brian Sweeney, MD, E. Matthew Ritter, MD. Uniformed Services University / Walter Reed National Military Medical CenterObjectives: Many injuries from the wars in Iraq and Afghanistan involve extremity trauma secondary to blasts. The wounding patterns from these blasts predispose patients to… Continue Reading
IMPROVING COLORECTAL CANCER SCREENING WITHIN MILITARY FACILITIES BY UTILIZING STANDARDIZED QUALITY METRICS
Michelle Ganyo, MD, Lawson Robert, MD, Amanda Cimsit, MD. Naval Medical Center San DiegoINTRODUCTION: In 2015, the American Society of Gastrointestinal Endoscopy/American College of Gastroenterology Task Force on Quality in Endoscopy released updated guidelines on measuring quality in colonoscopy. This identified metrics and provided benchmark goals to serve as proxy measures for the quality of… Continue Reading