Combined injuries

At present trauma is one of the three main causes of mortality along with cardiovascular and oncological diseases in the population of the Russian Federation. Amongst different variants of combined injuries, vascular-osseous injuries occupy a considerable place and are followed up by a high frequency of post operative complications (39 6%), amputations (up to 25%) and lethality (12-21%) [1-5]. 

Extensive contamination with thermal, chemical, radiation burns, and/or trauma. Severe combined injuries and probable internal contamination. First aid and treatment of life-threatening injuries, early transfer to specialized center. 

B9. Bozovic, L., Castenfors, J., Eayser, L., and Liljedahl, S. 0., Plasma renin activity in patients during and after surgical intervention. In Combined Injuries and Shook, pp. 143-150. Swed. Res. Inst. Nat. Def., Stockholm, 1968. 

A4. Altura, B. M., and Hershey, S. G., Structure-activity relationships of neurohypophyseal polypeptides in the micro-circulation. In Combined Injuries and Shock (B. Schildt and L. Thorfo, eds.), Intermedes Proceedings, pp. 185-194. Swedish Res. Inst. Natl. Defence, Stockholm, 1968. 

E4. Egdahl, R. H., Peck, L., and Mack, E., Pituitary adrenal activation following different types of trauma. In "Combined Injuries and Shock (B. Schildt and... 

Contaminated casualties. The evacuation of casualties with combined injuries requires careful observation while on route to a surgical unit and autoinjector treatment should be continued if signs of poisoning persist or worsen. Evacuating contaminated patients increases the likelihood that the contamination will spread and it also the patient s exposure to the agent. 

B. Medical commanders may expect at least 10-20 percent casualties (including fatalities) within a division-size force that has experienced a retaliatory nuclear strike. This prediction only considers injury caused from the radiation, but not from secondary injuries such as displacement, falls, fire, spills, flying fragments, rolled vehicles, etc as many of the injured will be suffering combined injuries. 

B. An accurate prediction of the number of casualties resulting from a nuclear strike is necessary for adequate medical support and should be made available to medical staff officers. Basic casualty estimations should be broken down into types of casualties so that total bed requirements can be more accurately predicted, particularly in view of the prolonged hospitalization associated with the treatment of patients with bums and combined injuries. One enemy nuclear strike on a given area can produce casualties far in excess of the treatment capability of local medical resources. The effectiveness and adequacy of the rescue, evacuation, and treatment effort during the first 24 hours after such an attack are critical. Area commanders must be informed rapidly of the magnitude of the damage and the estimated medical load in order to provide rescue and treatment resources in sufficient quantities or request the proper assistance from higher headquarters, adjacent units, or allied units. NATO AMedP-8 (Draft) provides information on the casualty rates from a nuclear detonation. 

Lymphocyte levels. In austere field conditions, lymphocyte levels may be used as a biologic dosimeter to confirm the presence of pure radiation injury but not in combined injuries. An initial blood sample for concentrations of circulating lymphocytes should be obtained as soon as possible from any patient classified as Radiation Injury Probable. After 24 hours, additional blood samples should be taken for comparison. 

F. Other Guidelines. A useful rule of thumb is, if lymphocytes have decreased by 50% and are less than 1000/mm3, then the patient has received a significant radiation exposure. In the event of combined injuries, the use of lymphocytes may be unreliable. Patients who have received severe burns or multi-system trauma often develop lymphopenia. It is important to note that individuals with concurrent viral infections would have a lymphocytosis based on their illness. 

Diagnosis and Treatment of Patient with Combined Injuries. Conventional injuries should be treated first, since no immediate life-threatening hazard exists for radiation casualties who can ultimately survive. All surgery should be completed within 36-48 hours of irradiation. 

Dose response for prompt exposure complicated by combined injury. 

Combined Injuries. Combined injuries occur when a casualty is affected by conventional weaponry and also by the use of nuclear, chemical or biological weapons. The situation in which a casualty is contaminated with a chemical agent, but not suffering from such an agent s effects is dealt with in AMedP-7 (B). Wounds that are not contaminated should be dressed in the usual way. They should then be covered with agent proof material (either impervious material or... 

CASUALTIES WITH COMBINED INJURIES Nerve Agents Mustard Phosgene Cyanide... 

Casualties with combined injuries not only have wounds that were caused by conventional weapons but also have been exposed to a chemical agent. The conventional wounds may or may not be contaminated with chemical agent. Few experimental data on this topic exist, and little has been written specifically about these casualties from experiences in World War I or the Iran-Iraq War. 

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