Commit 3520af7f authored by Rachel Clipp's avatar Rachel Clipp
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Updated combat multitrauma scenario and system methodology. Final clean up of...

Updated combat multitrauma scenario and system methodology. Final clean up of the heat stroke and combined scenarios. Added references to Source.bib.
parent ee5b145f
......@@ -488,7 +488,48 @@ A team of soldiers is conducting a patrol when an explosive device detonates, in
*Table 9. The validation results for the Combat Multitrauma Showcase scenario.*
</center>
See <a href="CombatMultitraumaValidation.pdf">Combat Multitrauma Validation Matrix</a> for complete details on validation.
| Segment | Notes | Action Occurrence Time (s) | Sample Scenario Time (s) | Heart Rate (beats/min) Mean Arterial Pressure (mmHg) Cardiac Output (mL/min) Mean Central Venous Pressure (mmHg) "Respiration Rate
(Breaths/min)" "Oxygen Saturation
(fraction)" "Tidal Volume
(mL)"
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | ---
| "Begin Tension Pneumothorax
(Left side, closed, severity 0.75)
Begin Massive Hemorrhage
(Right leg, rate 350 mL/min)" | "Massive hemorrhage from the right leg.
350 mL/min
Tension pneumothorax has progressed untreated for 2 minutes." | 60 | 120 </span>|<span class="success"> "~25% Increase@cite gutierrez2004clinical
Tachycardia @cite leigh2005tension" </span>|<span class="success"> "NC or decrease @cite leigh2005tension
" </span>|<span class="success"> Decrease @cite guyton2006medical </span>|<span class="success"> Increase @cite echt1974effective </span>|<span class="success"> "40 @cite chrisp2000action
14-20 @cite gutierrez2004clinical
Tachypnea @cite waisman2013transient @cite army200968w @cite leigh2005tensio" </span>|<span class="success"> Decrease @cite chrisp2000action @cite army200968w @cite leigh2005tension @cite khorasani2008assessment </span>|<span class="success"> "~25% Decrease @cite waisman2013transient
"
| "Non-tourniquet bleeding control
(Manual pressure reduces hemorrhage to 50 mL/min)
" | "A pressure dressing is applied
Tension pneumothorax has progressed untreated for 3 minutes." | 120 | 180 </span>|<span class="success"> "~25% Increase @cite gutierrez2004clinical
Tachycardia @cite leigh2005tension" </span>|<span class="success"> "NC or decrease @cite leigh2005tension
" </span>|<span class="success"> Decrease @cite guyton2006medical </span>|<span class="success"> Increase @cite echt1974effective </span>|<span class="success"> "40 @cite chrisp2000action
14-20 @cite gutierrez2004clinical
Tachypnea @cite waisman2013transient @cite army200968w @cite leigh2005tensio" </span>|<span class="success"> "Decrease@cite chrisp2000action @cite khorasani2008assessment
Plateaus @cite waisman2013transient" </span>|<span class="success"> "~25% Decrease @cite waisman2013transient
"
| Needle Decompression | A needle decompression procedure is applied on the affected side. | 180 | 420 </span>|<span class="warning"> 90 - 110 @cite metoyer2016SME </span>|<span class="success"> Decreases @cite guyton2006medical </span>|<span class="success"> Decrease @cite guyton2006medical </span>|<span class="success"> "
NC or Slight Decrease @cite bergeronSME" </span>|<span class="success"> Back to Baseline @cite bergeronSME </span>|<span class="success"> "Increase > 0.95 @cite rim2011life
" </span>|<span class="success"> Back to Baseline @cite bergeronSME
| "Tourniquet Application
(Hemorrhage completely controlled, rate 0 mL/min)" | A "tourniquet" is applied to the hemorrhaging leg. | 420 | 450 </span>|<span class="success"> "117.9 @cite khorasani2008assessment
Possibly no significant change @cite price2006novel
" </span>|<span class="success"> NC @cite guyton2006medical </span>|<span class="success"> NC @cite guyton2006medical </span>|<span class="warning"> "
NC or Slight Decrease @cite bergeronSME" </span>|<span class="success"> Back to Baseline @cite bergeronSME </span>|<span class="success"> Back to Baseline @cite bergeronSME </span>|<span class="success"> Back to Baseline @cite bergeronSME
| "Intravenous Fluid Resuscitation
(Saline, 500 mL at rate of 100 mL/min)" | Saline is administered over 5 minutes at a rate of 100 mL/min. | 450 | 570 </span>|<span class="success"> "Slight decrease because of partial correction of the hypovolemia.@cite metoyer2016SME
Stress-Induced Moderate Tachycardia @cite bergeronSME" </span>|<span class="success"> "Increase @cite grmec2009relationship
" </span>|<span class="success"> Increase @cite guyton2006medical </span>|<span class="success"> Move toward Baseline @cite bergeronSME </span>|<span class="success"> Back to Baseline @cite bergeronSME </span>|<span class="success"> Back to Baseline @cite bergeronSME </span>|<span class="success"> Back to Baseline @cite bergeronSME
| "Narcotics (Morphine) Administration
(5 mL of morphine IV at concentration of 1 mg/mL)" | A bolus of 5 mg of morphine is administered intravenously. Saline administration continues | 570 | 730 </span>|<span class="success"> Decrease @cite Morgan2006Clinical </span>|<span class="success"> Mild Decrease @cite Morgan2006Clinical Increase @cite guyton2006medical </span>|<span class="success"> Increase @cite guyton2006medical </span>|<span class="success"> Mild Decrease @cite bergeronSME </span>|<span class="success"> 15-20% Decrease @cite Morgan2006Clinical </span>|<span class="success"> "
Decrease @cite drummond2010oxygen" </span>|<span class="success"> Moderate Decrease @cite bergeronSME
<center>
<table border="0">
......@@ -580,14 +621,6 @@ For direct calc = 2.3045e-5*(core-37.1) NOTE this may be low @cite Benzinger1969
Possible slight decrease @cite Bouchama2002heat, @cite Benzinger1969heat" </span>|<span class="success"> Increase @cite rmetoyer2016SME </span>|<span class="success"> Decreasing with treatment @cite rmetoyer2016SME </span>|<span class="success"> < Core @cite Benzinger1969heat </span>|<span class="success">
For direct calc = 2.3045e-5*(core-37.1) NOTE this may be low @cite Benzinger1969heat </span>|
A blood chemistry panel assessment is completed at the end of the scenario. The results are shown in Table 11.
<center><br>
*Table 11. The validation results for the blood chemistry assessment for the heat stroke patient.*
</center>
<center>
<table border="0">
<tr>
......@@ -610,7 +643,7 @@ A blood chemistry panel assessment is completed at the end of the scenario. The
A 17 year old female leaves her Alaskan home in the mid-winter to retrieve a newspaper. The door closes as she exits the house. She is stuck outside for 45 minutes where it is -10<sup>o</sup>C. When the woman's housemates realize that she is outside, they bring her back in and sit her next to a fire.
<center><br>
*Table 12. The validation results for the Environmental Exposure Showcase scenario.*
*Table 11. The validation results for the Environmental Exposure Showcase scenario.*
</center>
| Segment | Notes | Action Occurrence Time (s) | Sample Scenario Time (s) | Heart Rate (beats/min) | "Mean Arterial Pressure
......@@ -649,13 +682,6 @@ Back to baseline @cite rmetoyer2016SME" </span>|<span class="success"> Increasin
</center>
<center><i>Figure 14. Select outputs from the %Environment Exposure showcase scenario.</i></center>
### %COVID-18
<center><br>
*Table 13. The validation results for the COVID-19 Showcase scenario.*
</center>
## Conclusion
The engine has successfully leveraged the CDM to model and
......
Methodology Sources and References
@book{army200968w,
title ={68W advanced field craft: combat medic skills},
author ={Army, US and others},
year ={2009},
publisher ={Jones \& Bartlett Publishers}
}
@article{rim2011life,
title ={Life-threatening simultaneous bilateral spontaneous tension pneumothorax-a case report},
author ={Rim, Taegeun and Bae, Joo Suck and Yuk, Yong Soo},
journal ={The Korean journal of thoracic and cardiovascular surgery},
volume ={44},
number ={3},
pages ={253},
year ={2011},
publisher ={Korean Society for Thoracic and Cardiovascular Surgery}
}
@article{drummond2010oxygen,
title ={Oxygen saturation decreases acutely when opioids are given during anaesthesia},
author ={Drummond, Gordon B and Lafferty, B},
journal ={British journal of anaesthesia},
volume ={104},
number ={5},
pages ={661--663},
year ={2010},
publisher ={Oxford University Press}
}
@article{waisman2013transient,
title ={Transient decrease in PaCO 2 and asymmetric chest wall dynamics in early progressing pneumothorax},
author ={Waisman, Dan and Faingersh, Anna and Levy, Carmit and Colman-Klotzman, Ifat and Rotschild, Avi and Lichtenstein, Oscar and Landesberg, Amir},
journal ={Intensive care medicine},
volume ={39},
number ={1},
pages ={137--145},
year ={2013},
publisher ={Springer}
}
@article{chrisp2000action,
title ={Action stat: Tension pneumothorax},
author ={Chrisp, Delila R},
journal ={Nursing2020},
volume ={30},
number ={5},
pages ={33},
year ={2000},
publisher ={LWW}
}
@article{echt1974effective,
title ={Effective compliance of the total vascular bed and the intrathoracic compartment derived from changes in central venous pressure induced by volume changes in man},
author ={Echt, Martin and Duweling, Johannes and Gauer, Otto H and Lange, Lothar},
journal ={Circulation research},
volume ={34},
number ={1},
pages ={61--68},
year ={1974},
publisher ={Am Heart Assoc}
}
@article{satsumae2013magnesium,
title ={Magnesium sulfate attenuates tourniquet pain in healthy volunteers},
author ={Satsumae, Tsuyoshi and Yamaguchi, Hiroshi and Inomata, Shinichi and Tanaka, Makoto},
journal ={Journal of anesthesia},
volume ={27},
number ={2},
pages ={231--235},
year ={2013},
publisher ={Springer}
}
@article{grmec2009relationship,
title ={Relationship between mean arterial pressure and end-tidal partial pressure of carbon dioxide during hemorrhagic shock and volume resuscitation},
author ={Grmec, Stefek and Golub, Mirjam and Jelatancev, Alina},
journal ={Signa vitae: journal for intesive care and emergency medicine},
volume ={4},
number ={1},
pages ={24--26},
year ={2009},
publisher ={Pharmamed Mado Ltd.}
}
@article{price2006novel,
title ={Novel electrocardiographic changes associated with iatrogenic pneumothorax},
author ={Price, James W},
journal ={American Journal of Critical Care},
volume ={15},
number ={4},
pages ={415--419},
year ={2006},
publisher ={AACN}
}
@article{khorasani2008assessment,
title ={Assessment of Moderate to Severe Abdominal Blood Loss Using Peripheral to Central Blood Oxygen Saturation},
author ={Khorasani, Zadeh and Elyassi, H and Gharaei, B and Yavari, P},
journal ={Advances in medical sciences},
volume ={53},
number ={1},
pages ={87},
year ={2008},
publisher ={Elsevier Limited}
}
@article{leigh2005tension,
title ={Tension pneumothoraxtime for a re-think?},
author ={Leigh-Smith, S and Harris, T},
journal ={Emergency medicine journal: EMJ},
volume ={22},
number ={1},
pages ={8},
year ={2005},
publisher ={BMJ Publishing Group}
}
@article{gutierrez2004clinical,
title ={Clinical review: hemorrhagic shock},
author ={Gutierrez, Guillermo and Reines, HDavid and Wulf-Gutierrez, Marian E},
journal ={Critical care},
volume ={8},
number ={5},
pages ={1-9},
year ={2004},
publisher ={BioMed Central}
}
@article{williams2005rewarming,
title ={Rewarming of healthy volunteers after induced mild hypothermia: a healthy volunteer study},
author ={Williams, AB and Salmon, A and Graham, P and Galler, D and Payton, MJ and Bradley, M},
......
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