ABSTRACT

Esophageal perforations, though rare, are critical injuries because of the risk of rapid progression to mediastinitis and sepsis. Traumatic perforations, especially those following blunt trauma, carry high mortality, and explosive injuries may cause such damage. Here, we describe the case of a 38-year-old male with a history of opioid use disorder and hepatitis C who suffered a mid-esophageal perforation after a pressurized diesel fuel cap exploded, hitting his face. He presented with intraoral burns, chest pain, subcutaneous emphysema, and pneumomediastinum. Endoscopic evaluation confirmed the perforation, and he was successfully treated with esophageal stenting and IV antibiotics. Follow-up imaging showed no persistent leak, and he was discharged with plans for stent removal. This case highlights the importance of considering esophageal injury in explosive trauma and suggests that while endoscopic management is effective, operative readiness is crucial in resource-Xlimited and military settings, where explosive trauma is more common.

Keywords: esophageal perforation; explosive injury; trauma; endoscopic stent

Real-time Reduction in Optic Nerve Sheath Diameter Following Hypertonic Saline Bolus in a Patient with Penetrating Traumatic Brain Injury: A Case Report

Alexandri M, Smith TM, Mitchell CA, Ausman C, Brillhart DB 25(3). 87

Abstract:

The Joint Trauma System Clinical Practice Guideline on Traumatic Brain Injury Management in Prolonged Field Care recommends the use of ultrasound measurement of optic nerve sheath diameter (ONSD) in the neurologic assessment of unconscious patients without ocular injury. This recommendation is well-founded in the literature, and support is growing for use of ONSD measurement for monitoring of neurocritical patients, especially in resource-limited and austere environments, including military theaters of operation. Our patient presented as a level 1 trauma patient with a penetrating traumatic brain injury (TBI). ONSD measurements taken before, during, and after administration of a 250mL bolus of 3% hypertonic saline showed a downward trend in ONSD measurement, from 5.4 to 4.8mm in the right eye, and 7.6 to 6.3mm in the left eye, within 20 minutes. Our review of the literature identified studies in which ONSD decreased following treatment of symptomatic hyponatremia with 3% hypertonic saline, as well as cases in which ONSD decreased in real time following lumbar puncture and external ventricular drain placement. Many studies also demonstrate the usefulness of ONSD for screening and monitoring of patients with TBI. Ours is the first reported instance of which we are aware showing real-time reduction in ONSD following treatment with 3% hypertonic saline in a patient with a penetrating TBI. ONSD measurement has potential for neurocritical monitoring in austere, resource-limited environments, including prolonged field care. Further study is needed to interrogate the accuracy and reliability of ONSD measurement as a tool for assessing treatment efficacy in patients with TBI, both blunt and penetrating.

Keywords: penetrating traumatic brain injury; elevated intracranial pressure; optic nerve sheath diameter; ultrasound; 3% hypertonic saline; case report

ABSTRACT

Background: Heat loss through intravenous (IV) tubing during a fresh whole blood (FWB) transfusion in austere environments can result in unhealthy fluid administration temperatures for patients. This research study aimed to quantify the amount of heat loss through the IV tubing during austere blood transfusions and propose mitigation methods, such as utilizing thermal insulation around the IV tubing and reducing the overall length of the tubing. Methods: Experiments were conducted in an environmental chamber where fluid temperature was controlled at the inlet of the IV tubing, while the resulting outlet fluid temperatures and volumetric flow rates were measured. The temperature within the environmental chamber was systematically reduced by 3°C from the first collection starting at 20°C to a final collection at -39°C. 

Results: Heat loss analysis revealed that 40.9 (SD 3.4) W of heat was lost, even when the ambient temperature was 20 °C. As the environmental temperature reached -39°C, the heat loss through the IV tubing increased to 168 (SD 17.4) W. Conclusion: Significant heat loss occurs through IV tubing during blood transfusions in cold austere environments. Mathematical models suggest that thermal insulation around the IV tubing and reducing overall tubing length could effectively mitigate these losses.

Keywords: transfusion; fresh whole blood; IV tubing; heat loss; insulation; austere environments

Current Episode is Fall 2025

Our JSOM podcast team will be reviewing the following articles for our newest podcast: 

Penetrating Axilla Injuries in Ceramic Plate Coverage: Matthew unpacks a compelling case series on the effectiveness of four-plate body armor systems in protecting vital axillary structures, drawing from his own experience as a Ranger medic.

https://jsomonline.org/product/penetrating-axilla-injuries-and-ceramic-plate-coverage-a-special-operations-case-series/

Mitigating Heat Loss in IV Tubing During Austere Blood Transfusions: Sydney reviews a West Point study quantifying how cold environments impact transfusion safety—and what innovations might help preserve blood temperature in the field.

https://jsomonline.org/product/mitigating-heat-loss-in-iv-tubing-during-austere-blood-transfusions/

Lab Evaluation of Four Ukrainian-Manufactured Tourniquets: Jessica breaks down a comparative study assessing the performance, durability, and design of Ukrainian tourniquets under simulated battlefield conditions.

https://jsomonline.org/product/lab-evaluation-of-four-ukrainian-manufactured-tourniquets/

Plus, Dr. Dan Godbee highlights two additional must-read articles on prehospital blood use and JSOM’s ongoing commitment to mentoring medics through the publishing process.



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