Exploring the History and Evolution of Combat Wound Care- COL(R) Evan Renz, MD

    Get ready to embark on a captivating journey through the pages of military medicine history as we speak with retired Army Colonel Dr. Evan Renz on WarDocs. Dr. Renz, a seasoned General/Trauma Surgeon and Burn Specialist with a rich trove of experience unfolds the evolution of military wound care from the era of World War II to the present day. As we trace the progression from hemorrhage control and debridement to advancements in medications, Damage Control concepts, and the use of innovative wound care technologies, Dr. Renz champions the importance of learning from our past and integrating these lessons into future military medical training.

   Drawing from his first-hand experience, Dr. Renz guides us through the intricate landscape of wound management in damage control resuscitation and surgery scenarios. We speak about the world of negative pressure wound therapy, starting from his initial use of a Wound Vac in 1997 to its evolution over the years. Experience the crux of Army Medicine as we venture into the crucial considerations surgeons must take when evaluating wounds where a tourniquet is applied to control bleeding and preserve the patient's hemodynamic stability.

   Our exploration takes a detour to the US Institute of Surgical Research Burn Center in San Antonio, where Dr. Renz shares his valuable insights on complex burns and wound care management. The discussion reveals intriguing practices such as avoiding prophylaxis antibiotics for isolated burn injuries and the strategic use of negative pressure wound treatment. Learn more about the fine balance of initiating and adjusting fluid for patients, the crucial decision-making process involved in combat wound closure, and the pressing need to pass on knowledge and training in the advances of technology. We guarantee that this episode will leave you with a newfound respect for Military Medicine and those who dedicate their lives to its advancement. So, join us for an eye-opening journey into the world of military medicine with Dr. Renz!

 

Chapters:

(0:00:00) - Military Wound Care Evolution

(0:13:59) - Wound Management in Damage Control

(0:28:44) - Burn Center and Wound Care Management

(0:46:13) - Decisions in Combat Wound Closure

 

Chapter Summaries:

(0:00:00) - Military Wound Care Evolution (14 Minutes)

Retired Army Colonel Dr Evan Renz, a General/Trauma Surgeon with extensive experience in training and working at the US Institute of Surgical Research's Burn Unit in San Antonio, provides insights into the evaluation and treatment of complex wounds. He emphasizes the critical importance of documenting and learning from our past to help prepare us for future conflicts and to make sure that these lessons are included in military medical training opportunities. We discuss the changes in wound management from World War II to today, from the importance of hemorrhage control and debridement to advancements in medications and technologies improving wound care.

 

(0:13:59) - Wound Management in Damage Control (15 Minutes)

Dr. Evan Renz discusses the importance of wound management in damage control resuscitation. He shares his experience with his first use of a Wound Vac in 1997 and how the use of negative pressure wound therapy evolved over time. We explore the special considerations surgeons must take when evaluating a wound where a tourniquet is in place and how these decisions can help preserve the patient's hemodynamic stability.

 

(0:28:44) - Burn Center and Wound Care Management (17 Minutes)

Dr. Renz explains that isolated burn injuries do not require prophylactic antibiotics; however, traumatic combat wounds should be treated with an initial dose of antibiotics in addition to a Tetanus booster.  Dr. Renz shares his experience with the use of the Wound Vac in the Burn Center and the key questions that he would ask when taking calls for burn management care. He also explains the importance of avoiding over-resuscitation and how to initiate and adjust fluid for the patient. Finally, he outlines the care that the patient would receive in regard to their wounds once they reach Role 4 or 5 facilities.

 

(0:46:13) - Decisions in Combat Wound Closure (7 Minutes)

Dr. Evan Renz shares his experience with the Emergency War Surgery manuals and the use of Wound Vacs in the field.  We also discuss the importance of repeating a primary and secondary survey with each transfer of care and how to identify when a wound can or should be closed primarily or covered by a flap or graft. Finally, Dr. Renz speaks to the importance of passing on knowledge and training in the advances of technology so that it is not forgotten.

 

Take Home Messages:

1. Military medicine has evolved significantly from the World War II era to the present day, highlighting the importance of learning from the past to enhance future medical training.
2. Advances in medications and wound management techniques, such as leaving more wounds open and exteriorizing the bowel for abdominal injuries, have marked significant milestones in military medicine.
3. Negative pressure wound therapy has seen remarkable evolution over the years and plays a crucial role in wound management in damage control resuscitation.
4. Surgeons need to make critical considerations when evaluating a wound downstream from a tourniquet in order to preserve the patient's hemodynamic stability.
5. Burn centers play a crucial role in wound care management, with innovative practices like avoiding prophylaxis antibiotics for isolated burn injuries and the strategic use of wound vac.
6. Adjusting and initiating fluid for patients and making critical decisions on combat wound closure are part of the complex process in wound care management.
7. Knowledge and training in technological advances in wound care need to be passed on to future generations to ensure continuous improvement.
8. Initial wound care at the point of injury prioritizes hemorrhage control, as highlighted by the TCCC guidelines.
9. Wound management in damage control resuscitation involves the careful evaluation and treatment of wounds and extensive documentation of each treatment process to guide subsequent care.
10. Wound care management, especially in a resource-limited setting, requires a practical approach, including bedside care, ensuring proper lighting and pain control.

 

Episode Keywords:

Military Medicine, Wound Care, Damage Control, Burn Center, Wound Management, Negative Pressure Wound Therapy, Tourniquet, Hemodynamic Stability, Prophylaxis Antibiotics, Image Control, Debridement, Fluid Management, Combat Wound Closure, War Surgery, Wound Vac, Technology Training

 

Hashtags:

#wardocs #military #medicine #podcast #MilMed #MedEd #MilitaryMedicine #CombatWoundCare #DrEvanRenz #WarDogsPodcast #MedicalEvolution #MilitaryTraining #BurnInjuries #DamageControlResuscitation #WoundVacTherapy #BattlefieldMedicine

 

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