title: Expect the unexpected: two cases of penetrating head and neck trauma from Operation Iraqi Freedom.
abstract: The protocol for treating penetrating head and neck trauma in a war zone differs from the standard protocol. Rather than first securing an airway, as is standard in civilian trauma cases, the primary emphasis is on assessing and controlling hemorrhage because it is the leading cause of morbidity and mortality in a battlefield setting. Once that has been addressed, we shift to standard advanced-trauma life-support protocols. We describe two cases we encountered at our combined medical clinic in Western Baghdad--one involving a 4-year old Iraqi child with an ammunition round lodged in her neck and one involving a 38-year-old female U.S. soldier with a round lodged in her right superolateral orbit. Both cases were transferred to combat support hospitals for further treatment after our initial assessment and treatment, and both had successful outcomes.
authors.affiliation: 1st Cavalry Division, Riva Ridge Aid Station, United States Army, Baghdad, Iraq. debjeet.sarkar@us.army.mil
authors.forename: Debjeet
authors.initials: D
authors.lastname: Sarkar
authors.forename: Andrew
authors.initials: A
authors.lastname: Demma
authors.forename: Dean
authors.initials: D
authors.lastname: Stulz
authors.forename: Gunther
authors.initials: G
authors.lastname: Hsue
mesh_terms: D000328:Adult; D002675:Child, Preschool; D005260:Female; D020197:Head Injuries, Penetrating / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007493:Iraq; D054542:Iraq War, 2003-2011; D019838:Neck Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D014481:United States