In recent years, there has been a steady increase in injuries all over the world. Man-made and natural disasters, local military conflicts, transport and industrial accidents in 50-60% of cases of all injuries lead to combined and multiple injuries to organs and systems of the human body, and, as a result, to high sanitary losses in the first hours and days [1,2,5,13,19,21]. This article discusses intestinal injuries in combined abdominal trauma.
A few states, notably California, are experiencing large increases in the number and cost of disability settlements under workers' compensation. Claims of cumulative injury for coronary heart disease, hypertension, stroke, cancer and neuropsychiatric problems have all been interpreted as compensable under workers' compensation, even when these conditions are clearly related to the aging process. Legal precedents for such claims are building rapidly throughout the country. The resultant costs may lead to the demise of the workers' compensation system. The situation in California is discussed in detail including the legal aspects, cumulative injury claims by type of disease and age of claimants, legal costs to the individual and the employer, and the economic outlook for the workers' compensation insurance system.
In the past 20 years, there has been an increase in the incidence of head injuries caused by gunshot wounds. Penetrating brain injury is a traumatic brain injury caused by high-velocity projectiles or low-velocity sharp objects. A wound in which the projectile breaches the cranium but does not exit is referred as a penetrating wound, and an injury in which the projectile passes entirely through the head, leaving both entrance and exit wounds, is referred to as a perforating wound. A large number of these patients who survive their initial wounding will nevertheless expire shortly after admission to the hospital. Until the introduction of aseptic surgery in the last quarter of the nineteenth century, penetrating missile injuries of the brain were almost universally fatal. We have learned a great deal about gunshot wounds and their management from military experience gained during times of war, when a large number of firearm-related casualties are treated in a short period of time. Newly designed protective body armor has reduced the incidence of penetrating brain injuries significantly. Many of the victims in the vicinity of a cased explosive or an improvised explosive device will incur injuries by fragments. Blast injury is a common mechanism of traumatic brain injury among soldiers serving in war zone. Each war has had different lessons to teach. World War I for example, proved the efficacy of vigorous surgical intervention. During World War II, the importance of initial dural repair and antibiotic medication was first, debated, then acknowledged, and finally, universally accepted. The incidence of blast-induced traumatic brain injury has increased substantially in recent military conflicts. Blast-induced neurotrauma is the term given to describe an injury to the brain that occurs after exposure to a blast. Resent conflict has exposed military personnel to sophisticated explosive devices generating blast overpressure that results in secondary cellular and molecular insults to the brain parenchyma akin to diffuse brain injury. In soldiers with varying amounts of body armor, the pattern is quite different. What had previously been fatal penetrating brain injuries now become treatable brain injuries as a consequence of secondary damping of energy by the helmet. Traumatic brain injury is not prevented by a protective helmet. High- and low-frequency blast waves disrupt the blood-brain barrier and produce massive brain swelling in a very short time, thereby necessitating urgent decompressive craniectomy, and when low in energy, such blast waves may result in cytoskeletal and diffuse axonal injury that leads to neurodegeneration. Penetrating traumatic brain injury is typically identified and treated immediately mild traumatic brain injury may be missed, particularly in the presence of other more obvious injuries. In recent years there has been an apparent paradigm shift of scientific interest in long-term effects of mild traumatic brain injury and its contribution to posttraumatic stress disorder. The introduction of Guidelines for the Management of Penetrating Brain Injury has revolutionized the medical and surgical management of penetrating brain injury during the last decade. There has been a paradigm shift toward a less aggressive debridement of deep seated fragments and a more aggressive antibiotics prophylaxis in an effort to improve outcomes.
There is an increasing incidence of military traumatic brain injury (TBI), and similar injuries are seen in civilians in war zones or terrorist incidents. Indeed, blast-induced mild TBI has been referred to as the signature injury of the conflicts in Iraq and Afghanistan. Assessment involves schemes that are common in civilcian practice but, in common with civilian TBI, takes little account of information available from modern imaging (particularly diffusion tensor magnetic resonance imaging) and emerging biomarkers. The efficient logistics of clinical care delivery in the field may have a role in optimizing outcome. Clinical care has much in common with civilian TBI, but intracranial pressure monitoring is not always available, and protocols need to be modified to take account of this. In addition, severe early oedema has led to increasing use of decompressive craniectomy, and blast TBI may be associated with a higher incidence of vasospasm and pseudoaneurysm formation. Visual and/or auditory deficits are common, and there is a significant risk of post-traumatic epilepsy. TBI is rarely an isolated finding in this setting, and persistent post-concussive symptoms are commonly associated with post-traumatic stress disorder and chronic pain, a constellation of findings that has been called the polytrauma clinical triad.
Penetrating spinal cord injury (SCI) is a relatively rare entity affecting mainly young males and military personnel worldwide. These injuries are the source of permanent disabilities to the affected patient and family and have substantial social and economic concerns. This chapter is an overview of the common penetrating spinal cord injuries, their incidence worldwide, causes, primary evaluation, and treatment including medical treatment and late definitive surgical treatment. It also describes common complications and strategies preventing secondary and collateral damage and disability.
Moral injury describes the effects of violence on veterans beyond what trauma discourse can describe. I put moral injury in conversation with a separate but related concept, dirty hands. Focusing on Michael Walzer's framing of dirty hands and Jonathan Shay's understanding of moral injury, I argue that moral injury can be seen as part of the dirt of a political leader's dirty hands decisions. Such comparison can focus more attention on the broader institutional context in which such dirty hands decisions are executed, while contributing to the growing vocabulary of moral conflict, trauma, and harm. ; Moral injury describes the effects of violence on veterans beyond what trauma discourse can describe. I put moral injury in conversation with a separate but related concept, dirty hands. Focusing on Michael Walzer's framing of dirty hands and Jonathan Shay's understanding of moral injury, I argue that moral injury can be seen as part of the dirt of a political leader's dirty hands decisions. Such comparison can focus more attention on the broader institutional context in which such dirty hands decisions are executed, while contributing to the growing vocabulary of moral conflict, trauma, and harm.
Blast injuries are an increasing problem in both military and civilian practice. Primary blast injury to the lungs (blast lung) is found in a clinically significant proportion of casualties from explosions even in an open environment, and in a high proportion of severely injured casualties following explosions in confined spaces. Blast casualties also commonly suffer secondary and tertiary blast injuries resulting in significant blood loss. The presence of hypoxaemia owing to blast lung complicates the process of fluid resuscitation. Consequently, prolonged hypotensive resuscitation was found to be incompatible with survival after combined blast lung and haemorrhage. This article describes studies addressing new forward resuscitation strategies involving a hybrid blood pressure profile (initially hypotensive followed later by normotensive resuscitation) and the use of supplemental oxygen to increase survival and reduce physiological deterioration during prolonged resuscitation. Surprisingly, hypertonic saline dextran was found to be inferior to normal saline after combined blast injury and haemorrhage. New strategies have therefore been developed to address the needs of blast-injured casualties and are likely to be particularly useful under circumstances of enforced delayed evacuation to surgical care.
Although it is agreed that Traumatic Brain Injury (TBI) is not a newly discovered injury in either military or civilian medical science, the frequency of incidents during the past 7 ½ years of combat operations in Afghanistan and Iraq have cast a bright light on the subject. Definitions of TBI are most frequently recognized by starting from the idea that a specific event has caused a deviation in brain function. A diagnosis based on multiple factors will lead to classifications of TBI varying from mild to severe. The most common variable that exists in all forms of TBI is blast. Blast is undoubtedly what makes military and civilian cases of TBI divisible. Injury related to blast is categorized as resulting in a primary, secondary, tertiary, or quaternary blast injury, which is calculated by the relationship of the Soldier and the explosion. The mildest forms of TBI, normally defined as closed head injuries resulting from a primary blast are easy to diagnose in individuals that appear dazed or confused. Complexities begin to emerge in diagnosis when another gross injury, naturally, takes precedence. These cases can often be missed initially and then discovered later on during follow up care. The home station apparatus for diagnosis has significantly improved over the past few years, but inconsistencies become more frequent the further diagnosis is made from the point of an event. While significant progress has been made to help returning veterans deal with TBI, much is left to understand about the injury and care structures that continue to work to support veterans.
The ear blast injury is primary blast injury and includes rupture of tympanic membrane, destroying of ossicles, cochlea, foreign body in external auditory orifice and tympanic cavity.An object of investigations have been 106 military – average age 28, 26±6, 496 – 94 military and 12 civilians; 4 female and 102 male. Generally, in two groups 10 patients have incomplete recovery of hearing; 81 – reach complete hearing recovery after ear blast injury of and 3 – dead.The outcome of ear blast injury has a significance for the military. Hearing loss in soldiers can bring to decreasing of theirs vigilance and difficulty in performance of theirs mission. The hearing loss is the one of the leading causes for disability among military. --- Инцидентите от взривни травми нарастват през последните години на ХХ век. Това се дължи, от една страна, на индустриалната експанзия, а от друга – на увеличената употреба на взривни оръжия и неимоверното разрастване на терористичната активност в световен мащаб.Взривните травми традиционно се разделят на четири категории: първични, вторични, третични и смесени. Един човек може да бъде наранен от повече от една от тези категории. (9, 11, 12, 26, 27).Взривната травма на слуховия анализатор се характеризира като първична взривна травма и включва руптура на тъпанчевата мембрана, разрушаване на костици, кохлеарни увреди, чужди тела във външния слухов проход и тъпанчевата кухина. Взривните травми на ухото са обект на много проучвания(3, 4, 5, 6, 7, 8, 14, 15, 16, 17, 18, 20, 22, 25). Първата травма на ухо, вследствие взрив, е описана през 1872 година от Green.Първичната травма на аудиторната система предизвиква значителна заболеваемост, но често се пропуска.
In: Wong , P H 2021 , ' Moral Injury in Former Child Soldiers in Liberia ' , Journal of Child and Adolescent Trauma . https://doi.org/10.1007/s40653-021-00414-5
Moral injury (MI) is a form of traumatic stress induced by perpetrating actions that transgress a person's beliefs and values. Existing research on MI has been mostly confined to military veterans, however there is reason to believe that the risk of MI among child soldiers is higher due to their age and history of abduction. This study examined the risk of MI in former child soldiers in Liberia and tested whether age and history of abduction moderate the relationship between perpetrating violence and MI based on a sample of 459 former child soldiers. Results from regression analysis confirmed that perpetrators had a higher risk of MI. However, while younger perpetrators were more vulnerable to MI, abduction history had no statistically significant moderation effect on the risk of MI. Further analysis also revealed that the moderation effects are primarily on anxiety, avoidance and negative feelings but not re-experiencing. These findings suggest that new tests and treatment models may be required for future disarmament, demobilization, rehabilitation and reintegration (DDRR) policy.
There is a high prevalence of musculoskeletal injuries in the U.S. military which poses a major threat to military readiness. However, recent research indicates that Soldiers do not seek medical care for nearly half of their injuries. PURPOSE: Identify barriers in injury reporting using the Theory of Planned Behavior within a U.S. Army special operations aviation population. METHODS: This descriptive study utilized a self-report survey to explore injury rates, reporting rates, and perceptions of reporting behaviors. RESULTS: Of the 108 Soldiers who completed this study 77.8% experienced a MSKI in the previous 12 months and 69% sought medical care (reported their injury) to a medical provider. CONCLUSION: The construct with the least favorable mean score was subjective norm indicating Soldiers do not feel that their leadership or fellow Soldiers support them in reporting injuries. Having embedded providers and implementing behavior change interventions may encourage Soldiers to report their injuries and increase military readiness. Future research should address Soldier and leadership behavior change interventions aimed to encourage Soldiers to seek care for their injuries.
Advances in structural and functional neuroimaging have occurred at a rapid pace over the past two decades. Novel techniques for measuring cerebral blood flow, metabolism, white matter connectivity, and neural network activation have great potential to improve the accuracy of diagnosis and prognosis for patients with traumatic brain injury (TBI), while also providing biomarkers to guide the development of new therapies. Several of these advanced imaging modalities are currently being implemented into clinical practice, whereas others require further development and validation. Ultimately, for advanced neuroimaging techniques to reach their full potential and improve clinical care for the many civilians and military personnel affected by TBI, it is critical for clinicians to understand the applications and methodological limitations of each technique. In this review, we examine recent advances in structural and functional neuroimaging and the potential applications of these techniques to the clinical care of patients with TBI. We also discuss pitfalls and confounders that should be considered when interpreting data from each technique. Finally, given the vast amounts of advanced imaging data that will soon be available to clinicians, we discuss strategies for optimizing data integration, visualization and interpretation.
