Military medicine
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Care of casualties in the tactical combat environment should include the use of prophylactic antibiotics for all open wounds. Cefoxitin was the antibiotic recommended in the 1996 article "Tactical Combat Casualty Care in Special Operations." The present authors recommend that oral gatifloxacin should be the antibiotic of choice because of its ease of carriage and administration, excellent spectrum of action, and relatively mild side effect profile. For those casualties unable to take oral antibiotics because of unconsciousness, penetrating abdominal trauma, or shock, cefotetan is recommended because of its longer duration of action than cefoxitin.
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Emergency cricothyrotomy is a potentially lifesaving surgical procedure used to gain prompt access to an otherwise compromised and inaccessible airway. The purpose of this photoessay is to demonstrate the technique of the procedure in a step-by-step manner so that the physician can perform this intervention with ease and facility in the most stressful of circumstances.
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Review Case Reports
Collapse from exertional heat illness: implications and subsequent decisions.
The implications of the collapse of a soldier early in an exercise from exertional heat illness (EHI) are considered. Such soldiers may be at risk from a genetic predisposition. Malignant hyperthermia (MH) and isolated and improbable cases of EHI may be just two different expressions of the same mutated gene sequence. ⋯ The sedentary pilgrims succumbed to a very high external ambient temperature, the active soldiers to a huge output of internal metabolic heat. Only eventual advances in defining the genetics of MH and EHI will resolve the present confusion of the relationship between the two conditions. Meanwhile, there is a need to bypass considerations of the etiology of EHI and to identify the vulnerable and handicapped soldier by exposure after an interval of time to one or more exercise tolerance tests.
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Regional anesthesia of the hand can be used in a vast array of hand injuries and minor operations. Local infiltration techniques require multiple injections and higher doses of anesthetic the that make them less preferable to peripheral nerve blocks. Regional anesthesia can be safe and effective as long as the provider has a firm understanding of the anatomy and technique. Multiple peripheral nerve blockade at the wrist can be a safe means of exploring complex wounds to the hand in both the emergency department and the operating room with minimal tissue distortion.
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Periodontal diseases are oral disorders characterized by inflammation of the supporting tissues of the teeth. Usually, periodontitis is a progressively destructive loss of bone and periodontal ligament (loss of the attachment apparatus of the teeth). Periodontitis has documented risk factors, including but not limited to specific plaque bacteria, smoking, and diabetes mellitus. ⋯ Additionally, these studies support the central hypothesis that periodontal disease involves both a local and a systemic host inflammatory response. This knowledge of disease interrelationships may prove vital in intervention strategies to reduce patient risks and prevent systemic disease outcomes. Based on the current evidence of the periodontal-systemic disease connection, the purpose of this report is to help establish the groundwork for closer communication between physicians and periodontists in the military health care setting.