Military medicine
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Pain management is vitally important to injured patients being evacuated from the warzone. A prospective assessment of real-time ratings of pain acceptability, intensity, and satisfaction of a convenience sample of 114 less severely ill and injured U. S. military patients being evacuated on Aeromedical Evacuation (AE) missions from Ramstein Air Field, Germany, to Andrews Air Force Base, Maryland, was conducted. ⋯ Over 47% of patients experienced pain that exceeded their acceptable intensity level, but of those patients with pain that was more severe than acceptable, only 10% rated their satisfaction with their pain management as poor or fair. This is the first study to provide real-time concurrent assessment of pain and pain management during en route care. The worst pain was reported for the hospital to aircraft arrival, suggesting the need for interventions to safely optimize pain management during this handoff period.
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The objective of this report was to compare the prevalence of acute respiratory distress syndrome (ARDS) and associated mortality between military service members with burns sustained during or in support of combat operations and civilian burn patients treated at a single burn center. ⋯ In a retrospective cohort study, burned military patients on mechanical ventilation had a significantly lower overall and ARDS mortality despite larger burns and more severe injury when compared to civilian burn patients. This difference appears to be largely because of age.
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Human cadavers have been used successfully as training models to practice airway management, but the lack of lifelike conditions reduces the utility of this model when softness of tissue and the ability to bleed are required for training scenarios. This report describes our "live cadaver" model, which combines lifelike conditions with real human anatomy. Five human cadavers were prepared as "live cadavers". ⋯ Multiple techniques related to airway management were practiced in setting simulating the treatment of casualties with multiple trauma to include emergency cricothyroidotomy. With this model, participants were confronted with medical situations similar to those found in traumatized live patients (e.g., blood and other body fluids filling the mouth and nose, edema of the tongue and face). With the combination of lifelike conditions and real human anatomy, our experience demonstrated that the "live cadaver" increased the training value of traditionally prepared cadaver models.
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Ibuprofen is commonly used by Soldiers in the deployed environment. This study investigated its dose-effects on in vitro coagulation. ⋯ Ibuprofen inhibited platelet aggregation at recommended doses, but did not compromise aPTT or coagulation profile until at 16 times the recommended doses and higher. Further effort is needed to clarify whether there are different dose-responses between human and pig blood samples in trauma situations.
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Exertional rhabdomyolysis is a clinical entity of significant muscle breakdown in the setting of exercise. However, clinical course and discharge criteria, once hospitalized, are poorly described. We describe 30 cases of exertional rhabdomyolysis and their hospital course. ⋯ Higher peak CK levels predicted longer length of stay. Higher serum Cr significantly correlated with lower CK levels. There did not appear to be any threshold CK for admission or discharge, however, all but one patient were discharged after CK downtrended.