Military medicine
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This retrospective study evaluated the prevalence of posttraumatic stress disorder (PTSD) diagnosis among military servicemembers referred for Sanity Boards (n = 229), which is a military evaluation for competence to stand trial (CST) and criminal responsibility (CR). This study further explored the degree to which PTSD was considered a "severe mental disease or defect," the degree to which PTSD was associated with an opinion of not criminally responsible (NCR), and the degree to which PTSD was associated with incompetence to stand trial (IST). ⋯ PTSD is often considered a "severe mental disease or defect" during Sanity Board evaluations, which differs from the legal standard for "severe mental disease or defect" used by the military justice system. Forensic practitioners consulting with the military justice system acknowledge that PTSD is a "severe mental disease or defect" often, but they rarely opine that PTSD renders a servicemember NCR. In the rare instance where PTSD was opined to render a servicemember NCR, the symptom of dissociation caused an inability to appreciate the nature and quality or wrongfulness of the action.
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Tension pneumothorax is a common cause of preventable death in trauma. Needle decompression is the traditional first-line intervention but has high failure rates. We sought to evaluate the effectiveness and expedience of needle thoracostomy, surgical tube thoracostomy, and Reactor™ thoracostomy - a novel spring-loaded trocar insertion device. ⋯ Needle thoracostomy provides a rapid intervention for tension pneumothorax, but is associated with unacceptably high failure rates. Reactor™ thoracostomy was effective, expedient, and may provide a useful and technically simpler first-line treatment for tension pneumothorax or tension-induced pulseless electrical activity.