Military medicine
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The tympanic membrane (TM) has long been viewed as an indicator of primary blast injury. A primary blast injury occurs due overpressure occurring as a result of the detonation of high explosives. ⋯ The use of the perforation of the tympanic membrane as an indicator of a primary blast injury missed a range of up to 50% of those suffering a primary blast injury to the lung. The status of the tympanic membrane following exposure to a blast does not preclude the need for further investigations for a primary blast injury and the clinician needs to evaluate the patient dependent on their particular exposure to an explosion.
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The Combat Wound Initiative (CWI) program is a collaborative, multidisciplinary, and interservice public-private partnership that provides personalized, state-of-the-art, and complex wound care via targeted clinical and translational research. The CWI uses a bench-to-bedside approach to translational research, including the rapid development of a human extracorporeal shock wave therapy (ESWT) study in complex wounds after establishing the potential efficacy, biologic mechanisms, and safety of this treatment modality in a murine model. ⋯ These clinical research data are analyzed using machine-based learning algorithms to develop predictive treatment models to guide clinical decision-making. Future CWI directions include additional clinical trials and study centers and the refinement and deployment of our genetically driven, personalized medicine initiative to provide patient-specific care across multiple medical disciplines, with an emphasis on combat casualty care.
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Hypothermia increases mortality rates and should be treated aggressively in the forward echelons of care, but no practical solution exists to accomplish such treatment. The enormous energy burden for this task requires maximal thermodynamic efficiency for a practical portable solution. This review article presents an overview of the clinical and thermodynamic challenges related to the development of a successful system for treatment of hypothermia in the forward echelons. Specific issues addressed include (1) the clinical and logistical reasons why thermal resuscitation should be attempted at all in such a difficult environment, (2) the thermodynamic reasons why warm intravenous fluids, although helpful in not worsening hypothermia, cannot safely transmit enough energy to treat established hypothermia, (3) which among the various methods of rewarming are most likely to result in successful therapy, and (4) the energetic considerations that dictate that any practical portable solution to the treatment of hypothermia must use hydrocarbon combustion as the source of heat.
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Review Case Reports
Meralgia paresthetica due to body armor wear in U.S. soldiers serving in Iraq: a case report and review of the literature.
Meralgia paresthetica is a disorder of the lateral femoral cutaneous nerve that results in symptoms of anterolateral thigh paresthesias and dysesthesias without associated loss of reflexes or motor weakness. Chronic meralgia paresthetica, not related to traumatic or lesion-producing compression of the nerve, is associated with obesity, pregnancy, tight-fitting garments, as well as specific duty uniform belts used by police officers and carpenters. ⋯ S. soldiers in Iraq experienced symptoms of meralgia paresthetica, most likely due to repetitive wear of protective body armor. Although use of protective body armor is proven to be lifesaving, modifications to improve current equipment may help to decrease morbidities such as meralgia paresthetica.
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With rapid and frequent deployments around the world, the current high level of military operations demands combat readiness of every military member. In the U. S. ⋯ Strategies to mitigate and even eliminate these concerns include the optional use of hormonal medications to induce reversible menstrual cycle suppression. These medications, traditionally indicated for contraception, should be considered essential for female troops during training and deployment. This article, tailored specifically for military women, provides valuable information regarding the risks and benefits, as well as the various options available for menstrual cycle suppression.