Cardiomyopathy induced by sinus tachycardia in combat wounded: a case study.

Tachycardia induced cardiomyopathy is a potentially lethal cause of heart failure generally because of atrial tachycardia and less frequently ventricular tachycardia. We present two cases of Marines with severe traumatic blast injuries secondary to improvised explosive device attacks whose hospital courses included amputation, massive blood transfusions, and multiple surgeries. Both patients had prolonged sinus tachycardia averaging >110 beats per minute and developed depressed left ventricular function, which recovered when treated with ß blockers. Sinus tachycardia is often considered a physiological response to stress, and the purpose of this manuscript is to describe the cardiac injury apparently related to a prolonged stress response. In addition, the literature does not clearly recommend controlling heart rates in trauma patients with persistent sinus tachycardia, but it is a therapeutic option that should be considered by providers.

Perioperative differences between bone bridging and non-bone bridging transtibial amputations for wartime lower extremity trauma.

BACKGROUND: The distal bone bridge transtibial amputation technique requires additional intraoperative surgical steps when compared to the non-bone bridging technique. Comparative functional data is not available showing a clearly superior outcome from either technique. Identifying perioperative differences could influence a surgeon's decision regarding the technique of amputation to be performed. This study's purpose was to compare perioperative differences between bone bridging transtibial amputation and non-bone bridging amputation techniques. MATERIALS AND METHODS: A retrospective review from April 2004 to April 2007 identified 37 consecutive patients with 42 transtibial amputations as a result of wartime blast injuries. Twenty-two non-bone bridging and twenty bone bridging amputations were performed. Statistical comparisons of intraoperative time, tourniquet time, estimated blood loss, the need for postoperative transfusion and frequency of wound complications was performed. RESULTS: The bone bridging amputation technique had significantly longer operative times (178.5 vs. 112.2 minutes, p<0.0005) and tourniquet times (114.8 vs. 71.0 minutes, p<0.0005). Regardless of technique used, amputations performed within the zone of injury had a 66.7% wound complication rate (p<0.0005). There was not a statistically significant difference in reoperation for wound complications between groups when controlling for zone of injury: bone bridge (6.3%) and non-bone bridge (0.0%). Amputation closure performed within the zone of injury was a significant predictor for subsequent wound problems regardless of amputation technique. CONCLUSION: Longer operative and tourniquet times should not be considered a contraindication to utilizing the bone bridging amputation technique in younger and otherwise healthy patients. Both amputation techniques have comparable rates of short term wound complications and associated blood loss. Wound closure for traumatic amputations should not be performed through the zone of injury.