Military medicine
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Military personnel deployed to Iraq and Afghanistan witnessed decreased numbers of soldiers killed in action and increased numbers of soldiers wounded in action. Medical personnel attribute these changes to use of improved body armor, rapid evacuation to medical treatment facilities, and use of medical technology. ⋯ This study uses modeling and simulation (M&S) to produce combat casualties, incorporate the projected benefits of field tourniquets and bandages, and examine their effects on wounded soldiers in a realistic simulated combat setting. The results show the positive benefit of using M&S to support analysis of medical technology and to inform medical research decisions.
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Neurosurgeons at David Grant Medical Center (DGMC) have had low surgeon case volumes. Meanwhile, veterans have had long waits because of inadequate neurosurgical coverage. DGMC and Department of Veteran Affairs (VA) agreed to share resources to treat an underserved VA patient population. We analyzed number of cases, admissions, relative weighted product (RWP), and outpatient visits before and after this unique military-VA agreement. ⋯ The sharing agreement resulted in 1.7-fold increase in operative cases. This military-VA venture provides military neurosurgeons with more surgical cases and provides neurosurgical care to a previously underserved patient population.
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Dexmedetomidine (DEX) is an alpha-2 receptor agonist with sedative and analgesic properties. It has been reported to preserve the patient's ability to cooperate and provide opioid sparing properties. Patients with obstructive sleep apnea (OSA) have demonstrated an increased risk for oxygen desaturation following general anesthesia. We report a case of a 64-year-old male, ASA IV with severe chronic obstructive pulmonary disease, OSA, unilateral vocal cord dysfunction, gastro-esophageal reflux disease, and congestive heart failure undergoing an awake thyroidectomy under local anesthesia and a DEX infusion. The patient was given a loading dose of DEX of 1 mcg/kg and an infusion ranging from 0.2 to 1.0 g/kg/hr. He received a total of 250 mcg of fentanyl and 7.5 mg of ketorolac throughout the case. ⋯ This case demonstrates the successful use of a DEX infusion along with local anesthesia administered by the surgeon for an awake thyroidectomy.
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Rupture of the long head of the biceps is usually seen in older adults, in conjunction with rotator cuff tears or tenosynovitis secondary to chronic subacromial impingement; it is rarely seen as a result of trauma. We present the case of a young active patient who denied prodromal symptoms but ruptured the long head of the biceps brachii tendon (LHB) while performing 25-pound biceps curls. Upon examination, the patient was noted to have a readily apparent biceps defect and decreased strength. ⋯ At the 6-week follow-up evaluation, the patient had regained full range of motion. By 6 months, he had regained his previous strength. This case demonstrates an unusual presentation of a LHB rupture in a young healthy man with no prodromal symptoms.