Military medicine
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Prehospital care in the combat environment has always been of great importance to the U.S. military, and trauma resuscitation has remained a cornerstone. More evidence continues to demonstrate the advantages of intervention with early transfusion of blood products at the point of injury. The military has recognized these benefits; as such, the Department of Defense Joint Trauma System and the Committee on Tactical Combat Casualty Care have developed new advanced resuscitation guidelines, which now encourage the use of whole blood (WB) in the prehospital setting. ⋯ WB has become the favored transfusion product as it provides all of the components of blood in a convenient package that is easy to store and transport. Specifically, group O WB containing low titers of anti-A and -B antibodies has become the transfusion product of choice, offering the ability to universally fluid resuscitate patients despite not knowing their blood group. This new ability to obtain low titer group O WB has transformed the approach to the management of hemorrhagic shock in the prehospital combat environment.
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Case Reports
A Bariatric Curveball: A Rare Case of Recurrent Lactobezoars after Roux-en-Y Gastric Bypass Surgery.
Bariatric surgery is a major risk factor for bezoar formation secondary to decreased gastric motility, gastric acidity, and pyloric function.1 This case is about a 49-year-old female veteran, 3 weeks status-post Roux-en-Y gastric bypass surgery, who presented with acute abdominal pain and oral intolerance. After being diagnosed with a bezoar and esophagogastroduodenoscopic removal, the patient had immediate relief of symptoms. ⋯ Lactobezoars are composed of milk and mucous proteins and are commonly found in neonates with immature gastrointestinal tracts.7 This unusual complication demonstrates how current dietary recommendations encouraging dairy consumption to meet daily protein requirements may have increased this patient's risk for lactobezoar formation. This case illustrates the importance of balancing the risks and benefits of macronutrient requirements after bariatric surgery with postsurgical bezoar complications.
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Back pain and its associated complications are of increasing importance among military members. The sacroiliac joint (SIJ) is a common source of chronic low back pain (LBP) and functional disability. Many patients suffering from chronic LBP utilize opioids to help control their symptoms. ⋯ After failure of traditional treatments, she was given an ultrasound-guided PRP injection of the SIJ which drastically decreased her pain and disability and eventually allowed for complete opioid cessation. Her symptom relief continued 1 year after the injection. This case demonstrates the potential of ultrasound-guided PRP injections as a long-term treatment for chronic LBP caused by SIJ dysfunction in military service members, which can also aid in the weaning of chronic opioid use.
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The ocular trauma score (OTS) is a widely used predictive tool in determining the visual prognosis of ocular injuries. Intraocular-foreign-body (IOFB)-type injuries comprise the leading type of open-globe injuries (OGI) in ocular combat injuries. However, there are scarce reports evaluating the efficacy of OTS in IOFB-type injuries. Only one study is available that explored the validity of OTS in combat-related IOFB injuries with a limited number of eyes. The aim of this study is to confirm the predictive value of OTS in lethal-weapon (LW)-related OGI with IOFB. ⋯ Visual outcome of this type of ocular injury may be unpredictable due to more frequent discouraging results. OTS failed to predict visual outcome in first three OTS categories in this study. Therefore, OTS appears to be verified only in better (OTS categories 4 and 5) categories.
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The National Statistical Yearbook of Defense 2018 issued by the Republic of Korea (ROK) Ministry of National Defense reported that the number of patients using military hospitals steadily increased from 2008 to 2017. However, in the outpatient clinic statistics for years 2015-2017 from the ROK Armed Forces Medical Command, the amount of medical care received from some medical departments, such as the infection medicine, surgery, and anesthesiology departments, decreased. Therefore, the purpose of this study was to observe the differences in incidence of military personnel's unmet healthcare needs according to number of diseases by type. ⋯ This study suggests that unmet healthcare needs are influenced by the number of disease by the type of ROK military personnel. It is therefore necessary to strive to reduce the number of military personnel who experience unmet healthcare needs through this data.