Military medicine
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Advances in medical technology are giving health care providers the tools with which to keep patients alive for longer and longer periods of time. However, in our struggle to keep patients alive, we must not forget that the patient is the one who controls his or her own destiny. ⋯ Surgeons, anesthetists, operating room nurses, and others all have concerns regarding this issue, and they will be discussed here. The answer to the dilemma lies in a policy of "required reconsideration" to examine all factors of the do-not-resuscitate order and its applicability to the situation at hand.
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Austere far-forward battlefield environments present numerous obstacles in providing adequate medical care to the injured solidier. In addition to logistical constraints that limit the volume of isotonic crystalloid fluids available to resuscitate the injured soldier, hypotension, environmental and tactical conditions, and/or the presence of mass casualties can combine to lead to excessive delays in obtaining vascular access. For many years, intraosseous infusion has been a rapid, reliable method of achieving vascular access under emergency conditions in children. ⋯ S. military having recently been reissued intraosseous devices, we thought it timely to review the literature on this technique. This review discusses the efficacy and safety of intraosseous infusions of drugs and fluids, including insertion times and flow rates achieved. Although the intent is to evaluate the feasibility of the technique in the injured soldier, literature citations from studies in children, experimental animals, and human cadavers are included to support the statements made and to offer the reader the opportunity to read the original literature.
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The purpose of this paper is to inquire into the relationship between Al Eskan disease and the probable exposure to chemical warfare agents by Persian Gulf War veterans. Al Eskan disease, first reported in 1991, compromises the body's immunological defense and is a result of the pathogenic properties of the extremely fine, dusty sand located in the central and eastern region of the Arabian peninsula. The disease manifests with localized expression of multisystem disorder. ⋯ We conclude that the microimpregnated sand particles in the theater of operation/Persian Gulf War depleted the immune system and simultaneously acted as vehicles for low-intensity exposure to chemical warfare agents and had a modifying-intensifying effect on the toxicity of exposed individuals. We recommend recognition of a new term, "dirty sand," as a subcategory of dirty dust/dusty chemical warfare agents. Our ongoing research efforts to investigate the health impact of chemical warfare agent exposure among Persian Gulf War veterans suggest that Al Eskan disease is a plausible and preeminent explanation for the preponderance of Persian Gulf War illnesses.
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United States military medical planning must reevaluate the practices of combat casualty resuscitation, transportation, and triage to secondary echelon care. Analysis of the experiences of other medical commands, such as that of the Israeli Defense Force, offers insight into improvements in equipment and training that are achievable with minimal cost. ⋯ Today in military medicine there exists a major deficiency of expertise in trauma care, arising through a near total lack of involvement in active trauma surgery on the part of military medical training facilities. Civilian trauma centers offer an abundance of opportunity for military-like casualty management, and successful efforts at our command have integrated active duty personnel into this experience.