Military medicine
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Exertional Heat Illness with associated ischemic hepatitis (IH) is a common occurrence among military trainees; however, few specific therapies exist if unresponsive to appropriate supportive measures. A 27-year-old basic combat trainee presented with altered mental status, renal insufficiency, rhabdomyolysis, and a core temp of 107.9 °F after collapsing during a run, leading to the diagnosis of heat stroke. While the patient's azotemia and creatinine kinase levels rapidly improved with aggressive intravenous hydration, transaminases continued to increase to nearly 155 times the upper limit of normal. ⋯ The mortality of IH among critically ill patients has been estimated to be as high as 60%, with those demonstrating coagulopathy especially at risk. NAC is shown to improve the transplant-free survival rate in non-acetaminophen related ALF, consistent with its proposed mechanisms of improving hepatic blood flow and conjugating toxic metabolites. NAC therapy should be considered early in the course of heat injury-mediated IH to reduce reperfusion injury, improving transplant free outcomes.
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The electronic health record (EHR) has created additional administrative burdens on providers to perform data entry while trying to engage with the patient during the health care visit. Providers have become frustrated and distracted with the documentation requirements which further hindered connectivity, and communication with the patient. The utilization of medical scribes in the outpatient clinical setting was a strategy shown to enhance patient and provider interaction, decrease clinician's administrative tasks, and promote satisfaction among providers and patients. This was an innovative quality improvement pilot project to improve the patient and provider experience using scribes in an outpatient setting. ⋯ In multiple settings, documentation requirements burden providers. The consideration of scribes could foster work life balance, retention, and wellness. The patient and provider experience was strengthened through the utilization of medical scribes, so future research centered on the provider and patient experience could be beneficial to organizations. Further study of the scribe's experience, especially considering the positive comments from the hospital corpsmen that participated as scribes during the project, could provide beneficial outcomes. Navy Medicine is advancing every opportunity to strengthen clinical and operational readiness, health and partnerships to provide the highest quality care and promote wellness for our patients. This type of quality improvement initiative could positively support readiness, quality and wellness for our organization, providers, and patients.
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Lepromatous leprosy represents a cutaneous infection by the bacterium Mycobacterium leprae. Once considered a common, fatal disease, leprosy has become increasingly rare with modern, inexpensive antibiotics. Most healthcare workers will never encounter a case of leprosy due to the low prevalence of the disease. ⋯ As the incidence of reported leprosy cases continues to decline, disease education on diagnosis and treatment is imperative to enhance early detection and intervention. Understanding the populations at risk for leprosy and its insidious presentation will aid the practitioner in minimizing disease burden for both U. S. servicemembers and our foreign partners.
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Physical exam and angiography have important roles in the diagnosis of traumatic lower extremity vascular injury with similar reported high rates of sensitivity and specificity. It has been previously shown that CTA is not universally indicated in the setting of acute lower extremity trauma when a reliable physical examination is obtained. As such, the purpose of this study was to determine if obtaining a CTA following physical examination altered the clinical care of patients following high-energy lower extremity trauma and the generalizability to the military population. ⋯ This study suggests that physical exam alone achieves a high sensitivity for vascular injury in lower extremity trauma. Physical exam excluded all lower extremity ischemia without the need for advanced imaging. While CTA was useful to confirm and localize the source of acute vascular injury, the majority of vascular injuries identified on CTA did not affect immediate clinical care and lead to additional unnecessary procedures. However, in patients with suspected vascular injury, a negative CTA was also used as rationale for immediate discharge from the emergency department without further clinical observation. When applied to the deployed military setting the results of this study support the use of physical exam to accurately diagnose limb threatening ischemia at the time of injury or Role 1 facilities with CTA reserved for diagnosing the level of the vascular injury and for potential patient clearance prior to prolonged evacuation.
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The purpose of the current study was to examine if isometric peak force and rate of force development (RFD) were related to the ability to successfully perform a simulated casualty evacuation task in both unweighted and weighted conditions. ⋯ Isometric deadlift peak force represents an important determinant for the success of a simulated casualty evacuation task and may be a useful marker to include in periodic fitness evaluations of military personnel.