RESUMEN
BACKGROUND: Tourniquet use recently became common in war, but knowledge gaps remain regarding analysis of recovered devices. The purpose of this study was to analyze tourniquets to identify opportunities for improved training. METHODS: We analyzed tourniquets recovered from deceased service members serving in support of recent combat operations by a team at Dover Air Force Base from 2010 to 2012. Device makes and models, breakage, deformation, band routing, and windlass turn numbers were counted. RESULTS: We recovered 824 tourniquets; 390 were used in care and 434 were carried unused. Most tourniquets were recommended by the Committee on Tactical Combat Casualty Care (Combat Application Tourniquet [CAT] or Special Operations Forces Tactical Tourniquet). The band was routed once through the buckle in 37% of used CATs, twice in 62%, and 1% had none. For tourniquets with data, the windlass turn number averaged 3.2 (range, 0-9). The CAT windlass turn number was associated positively with tourniquet deformation as moderate or severe deformation began at 2 turns, increased in likelihood stepwise with each turn, and became omnipresent at 7 or more. CONCLUSIONS: Tourniquet counts, band routings, windlass turn numbers, and deformation rates are candidate topics for instructors to refine training.
Asunto(s)
Tratamiento de Urgencia/instrumentación , Capacitación en Servicio , Medicina Militar , Personal Militar , Torniquetes , Diseño de Equipo , Extremidades/lesiones , Hemorragia/terapia , Humanos , Guerra de Irak 2003-2011 , Torniquetes/estadística & datos numéricos , GuerraRESUMEN
Pneumocystis carinii pneumonia (PCP) can be diagnosed by direct microscopic examination of induced sputum or by bronchoalveolar lavage (BAL). However, many institutions have little diagnostic success with induced sputum, and BAL is invasive and expensive. This prospective, blinded study assessed oral washes as a more convenient specimen than either sputum or BAL fluid and used a dissociation-enhanced lanthanide fluoroimmunoassay time-resolved fluorescent hybridization polymerase chain reaction (PCR) detection system that is feasible for clinical laboratories. The study assessed 175 oral washes, each paired with either an induced sputum that was positive for Pneumocystis or a BAL sample. The PCR test based on the Pneumocystis major surface glycoprotein primers had a sensitivity of 91% and a specificity of 94%, compared with a test based on mitochondrial large subunit rRNA primers, which had a sensitivity of 75% and a specificity of 96%. These results suggest that oral washes can provide a useful sample for diagnosis of PCP when a sensitive PCR detection system is used.