ABSTRACT

Ketamine continues to demonstrate its utility and safety in the austere and prehospital environment, but myths persist regarding the frequency of behavioral disturbances and unpleasant reactions. These myths have led to protocolled midazolam co-administration. Properties of midazolam and other benzodiazepines have the potential to cause significant morbidity and potential mortality. Because of this risk, benzodiazepines should only be administered when the treating provider determines that the patient's symptoms warrant it. We also present evidence that agitation and altered mental status (AMS) encountered with ketamine occurs during titration of lower pain control regimens and is much less likely to occur with higher doses. As such, in most prehospital situations, the treatment for this "incomplete dissociation" is more ketamine, not the addition of a potentially dangerous benzodiazepine.

ABSTRACT

The Department of Defense (DoD) continues to emphasize operational readiness, lethality, and optimal performance. Performance psychology is a critical aspect of and central dimension to human performance optimization in support of Preservation of the Force and Family (POTFF) and Total Force Fitness (TFF). The delivery of performance psychology services must continue to evolve to maximize its potential for enhancing combat performance and supporting psychological readiness in warfighters across all branches of service. The authors (1) provide a brief history of the evolution of military psychology; (2) explore how performance psychology complements and broadens approaches to support warfighter health and readiness; and (3) present a set of strategies to advance performance psychology services toward an aspirational model. Such strategies will more effectively promote best practices to better target operational performance, complement existing health and medical service delivery, and encompass a systems approach to sustainable training. Moreover, these strategies aim to increase return on investment of psychological readiness efforts for warfighters across all branches of service.

ABSTRACT

Background: In locations in which access to resuscitative therapy may be limited, treating polytraumatized patients present a challenge. There is a pressing need for adjuncts that can be delivered in these settings. To assess these adjuncts, a model representative of this clinical scenario is necessary. We aimed to develop a hemorrhage and polytrauma model in the absence of fluid resuscitation. Materials and Methods: This study consisted of two parts: pulmonary contusion dose-finding (n = 6) and polytrauma with evaluation of varying hemorrhage volumes (n = 6). We applied three, six, or nine nonpenetrating captive bolt-gun discharges to the dose-finding group and obtained computed tomography (CT) images. We segmented images to assess contusion volumes. We subjected the second group to tibial fracture, pulmonary contusion, and controlled hemorrhage of 20%, 30%, or 40% and observed for 3 hours or until death. We used Kaplan-Meier analysis to assess survival. We also assessed hemodynamic and metabolic parameters. Results: Contusion volumes for three, six, and nine nonpenetrating captive bolt-gun discharges were 24 ± 28, 50 ± 31, and 63 ± 77 cm3, respectively (p = .679). Animals receiving at least six discharges suffered concomitant parenchymal laceration, whereas one of two swine subjected to three discharges had lacerations. Mortality was 100% at 12 and 115 minutes in the 40% and 30% hemorrhage groups, respectively, and 50% at 3 hours in the 20% group. Conclusion: This study characterizes a titratable hemorrhage and polytrauma model in the absence of fluid resuscitation. This model can be useful in evaluating resuscitative adjuncts that can be delivered in areas remote to healthcare access.

Keywords: Polytrauma model; pulmonary contusion; controlled hemorrhage; tibial fracture; delayed medical care; prolonged casualty care; prolonged field care

The JSOM podcast digs deeper into the articles and subjects that matter to our readers. Our podcast hosts, Captains Alex Merkle and Josh Randles, tackle articles from the journal based on merit, interest, and application for operators in the field.

Current Episode

In this episode of the JSOM Podcast, Alex and Josh review:

Feasibility of Obtaining Intraosseous and Intravenous Access Using Night Vision Goggle Focusing Adaptors by Alexander Iteen, MD, and colleagues (p. 56)

The Efficacy of Vancomycin Powder in Mitigating Infection of Open Penetrating Trauma Wounds on the Battlefield: An Evidence-Based Review by Brett R. TerBeek, 18B, 18F, MPAS, and colleagues (p. 76)

Development of a Swine Polytrauma Model in the Absence of Fluid Resuscitation by Hassam Abdou, MD, and colleagues (p. 77, Winter 2021 Edition)

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