Military medicine
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Traumatic brain injury (TBI) is the leading cause of combat casualties in modern war with an estimated 20% of casualties experiencing head injury. Since the release of the Brain Trauma Foundation's Guidelines for the Management of Severe Traumatic Brain Injury in 1995, recommendations for management of TBI have included the avoidance of routine hyperventilation. However, both published and anecdotal data suggest that many patients with TBI are inappropriately ventilated during transport, thereby increasing the risk of morbidity and mortality from secondary brain injury. ⋯ The use of a novel ventilator that limits RR and VT may be useful in preventing hyperventilation in TBI patients. Didactic education and simulator-based feedback training may not have significant impact on improving ventilation practices in prehospital providers.
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Cryotherapy is a widely utilized topical treatment for various dermatological conditions. While generally safe and effective, it carries potential risks, such as frostbite injury. Frostbite, a vascular condition causing skin and tissue freezing, is usually associated with prolonged exposure to freezing environments. ⋯ The implemented treatment regimen resulted in significant clinical improvements with minimal long-term structural damage. This case underscores the clinical value of establishing clear management guidelines for cryotherapy administration in cutaneous conditions. Such guidelines are essential to ensure optimal dosing, minimize adverse sequelae, and improve overall prognosis.
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Deployed military personnel may be at risk for developing acute and chronic lung disease. Prior studies of this patient population have revealed that unexplained exertional dyspnea is the most common diagnosis despite an extensive evaluation. There is a concern that an occult disorder may be affecting this population. This study evaluated the role for bronchoalveolar lavage (BAL) fluid analysis in the evaluation of chronic deployment-associated dyspnea. ⋯ The addition of BAL cytology did not help differentiate those patients with unexplained dyspnea from other etiologies.