Interprofessional Healthcare Teams in the Military: A Scoping Literature Review.
Authors: PMID: 30325431 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - October 18, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Transgender Dependent Adolescents in the U.S. Military Health Care System: Demographics, Treatments Sought, and Health Care Service Utilization.
Conclusions: This study elucidated the sociodemographic and behavioral risk profile of a sample of TGD youth in the MHS. Military and non-military health care providers across a broad spectrum of specialties should be knowledgeable about the unique psychosocial and medical needs, requisite sensitivity, and available referral options in the care of TGD youth. Assumptions about one's gender identity, sexual orientation, gender expression, or behaviors cannot be made based on birth-assigned sex. Further research is needed to investigate the health and wellbeing of TGD military-affiliated youth over time and to determine quali...
Source: Military Medicine - October 18, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Prehospital Resuscitation Performed on Hypotensive Trauma Patients in Afghanistan: The Prehospital Trauma Registry Experience.
Conclusion: Most casualties with documented hypotension after trauma in the Prehospital Trauma Registry did not receive prehospital blood or fluid intervention. Of the interventions performed, most did not match with contemporary TCCC guidelines. PMID: 30295843 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - October 9, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Feasibility of Training Physical Therapists to Implement a Psychologically Informed Physical Therapy Program for Deployed U.S. Sailors and Marines with Musculoskeletal Injuries: Corrigendum.
Authors: PMID: 30295854 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - October 9, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Uniformed Services University Women's Enrollment and Career Choices in Military Medicine: A Retrospective Descriptive Analysis.
Conclusions: Women are making significant gains in enrollment at USU, obtaining board certification at similar, and in some cases, higher rates than their civilian peers, and practicing in diverse specialties. This study provides a descriptive picture of women's enrollment and practice characteristics from a military-based medical school. Future work could examine underlying factors that may influence their school choice, career experiences, and trajectories. Future research could also focus on women's experiences of mentoring and support to better understand these factors. PMID: 30295875 [PubMed - as supplied by publi...
Source: Military Medicine - October 9, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Combat-Related Invasive Fungal Infections: Development of a Clinically Applicable Clinical Decision Support System for Early Risk Stratification: Corrigendum.
Authors: PMID: 30295878 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - October 9, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Cost and Healthcare Utilization Among Non-Elderly Head and Neck Cancer Patients in the Military Health System, a Single-Payer Universal Health Care Model.
Conclusions: To a single payer, the use of a single system of care exclusively among HNC patients is more cost-effective than use of a mixed-use system. The results suggest an over-utilization of ambulatory care services when both military and civilian care are accessed. Further investigation is needed to assess coordination between systems of care and improved efficiencies with respect to the cost and apparent over-utilization of health care services. PMID: 30295883 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - October 9, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

A Tale of Two Compulsions - Two Case Studies Using Accelerated Resolution Therapy (ART) for Obsessive Compulsive Disorder (OCD).
This article will present an overview of the theory behind the reconsolidation concept used in ART and two cases of obsessive compulsive disorder treatment using ART with outcome measures visual trend analysis. PMID: 30295890 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - October 9, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Additional Exertion, Unsupported Assertions, and Hyperhydration Confound Rhabdomyolysis Case Study.
Authors: Greene R, Fields D PMID: 30281076 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - October 5, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Deployment and Disaster Medicine in an Undergraduate Teaching Module.
Authors: Back DA, Lembke V, Fellmer F, Kaiser D, Kasselmann N, Bickelmayer J, Willy C Abstract Introduction: Modern health systems have to respond to a wide variety of catastrophic scenarios, from natural disasters to terror attacks. It is reasonable to already start educational approaches for physicians in this field at medical school level. An approach combining civilian disaster medicine and military deployment medicine can be beneficial both for clinical strategies and in undergraduate teaching. Materials and Methods: A curricular 4-week teaching module on "deployment and disaster medicine," inter...
Source: Military Medicine - October 5, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Doing What Is Right.
Authors: Weber LA, Nguyen DR Abstract Junior officers have an obligation to "lead up." They help senior officers successfully complete missions while maintaining accountability to core values and taking care of those they lead. The following case highlights one junior officer's challenge "leading up" in a very ambiguous situation. PMID: 30272203 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - October 3, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Common Data Elements in the Assessment of Military-Related PTSD Research Applied in the Consortium to Alleviate PTSD.
Conclusion: Although further research is needed to determine the incremental validity of these CDEs, preliminary analyses indicated that each mandated measure has very good internal consistency reliability. Investigators designing military-related PTSD research should consider using these field-tested CDEs to facilitate future data aggregation. Feedback based on empirical evidence or practical concerns to improve these CDEs is welcome. PMID: 30252077 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - September 26, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

A Survey of Family Planning Training, Knowledge, and Practices Among Health Care Providers Within the Military Health System at Joint Base Lewis-McChord.
Conclusions: Family planning services available to service members may be improved through enhanced provider education, targeting efficacy-based counseling and identification of barriers to access and provision of long-acting reversible contraceptive methods. PMID: 30252078 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - September 26, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Military Health Provider Training and Evaluation of a Problem-Solving Intervention to Reduce Distress and Enhance Readiness Among Service Members.
Authors: Cooper DC, Bates MJ Abstract Introduction: Department of Defense (DoD) has identified problem-solving training (PST) as a promising prevention/early intervention for mental health disorders. PST is a four-session group intervention that emphasizes building problem-solving and coping skills to mitigate emotional dysregulation and the adverse effects of stressful events. It was adapted from problem-solving therapy, which is an evidence-based, cognitive-behavioral approach that has shown effectiveness with treating depression and managing suicide risk. The current evaluation examined a pilot program that: (1)...
Source: Military Medicine - September 26, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

PWD: Treatment Platform for Both Prolonged Field Care and Definitive Treatment of Burn-Injured Warfighters.
Conclusion: This study demonstrates that the PWD is an effective platform for delivery of antibiotics and negative pressure wound therapy for the treatment of full-thickness burns. Therefore, the PWD may be utilized for both prolonged field care and definitive treatment of burn- and blast-injured warfighters. PMID: 30252082 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - September 26, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Deployment Among Active-Duty Military Women and Pregnancy-Related Hypertensive Disorders.
Authors: Nash MC, Kip K, Wang W, Custer M, O'Rourke K Abstract Introduction: Today women comprise 15% of the U.S. active-duty military, but are often overlooked in research of the Armed Forces. While some of the challenges faced by women are similar to men, they encounter unique stressors, including pregnancy-related issues. Hypertensive disorders of pregnancy (HDPs) affect 5-10% of pregnancies annually and have been linked to maternal stress, but no studies have assessed the impact of maternal military deployment on HDP incidence. Thus, the purpose of the current study was to quantify the risk of HDP among active-...
Source: Military Medicine - September 26, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Perceived Impact of Participation in a One-Time Expressive Arts Workshop.
Conclusions: Using art to express one's journey through cancer allows participants to articulate that journey "beyond language." This mixed methods study was administered by five non-professional art therapists with three having no expressive arts background. This study established that an expressive arts workshop can effectively be conducted by non-professional art therapists. The team of non-professional art therapists, who facilitated this one-time art-making workshop, demonstrated that a military member's stress can be decreased by giving them "a voice" through expressive art. PMID: 30252086 [Pu...
Source: Military Medicine - September 26, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Military Family Physicians' Practices and Perceptions About Reproductive Health Services for Deploying Women.
This study examined the reproductive health practices and perceptions among family medicine physicians caring for servicewomen. Materials and Methods: We conducted an anonymous survey of 568 registered attendees at the March, 2018 Uniformed Services Academy of Family Physicians annual meeting. The response rate was 52.8% and 69% of responders met inclusion criteria. Results: Our sample of family medicine physicians was 58.3% male and 85.3% Caucasian. In all, 18.3% were current residents, 42.9% graduated between 2008 and 2017, and 38.7% graduated before 2008. A previous deployment was reported by 55.1%. Among physic...
Source: Military Medicine - September 26, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Character Strengths of Junior Australian Army Officers.
Conclusions: The present study achieved its aims. First, it revealed five character strengths that junior officers in the Australian Army tended to see as their own chief strengths. Second, the junior officers saw their character strengths as aligned with those of their senior officers. By and large, this alignment extended across all the character strengths, regardless of their specific ranking. Subject to further experimental testing, this finding provides correlational evidence that junior officers may model their character on what they see in their senior officers. Third, in contrast, the junior officers' rankings were...
Source: Military Medicine - September 26, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

The Physiology and Biomechanics of Load Carriage Performance.
Conclusions: This review provides a comprehensive overview of these factors and suggests a new Load-Speed Index, which can be utilized to define thresholds for load and speed combinations and contribute to the understanding of the physiological and biomechanical demands of load carriage marches. The literature recommends that load and speed should be managed in order to maintain an exercise intensity ~45% VO2 max to delay time to fatigue during prolonged marches, and the Load-Speed Index corroborated this finding, identifying 47% VO2 max as a threshold above which intensity increases at a greater rate with increases in loa...
Source: Military Medicine - September 26, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Successful Use of Colistin Monotherapy as Outpatient Parenteral Antibiotic Therapy for XDR Acinetobacter Hepatic Abscesses.
Authors: Prestwood J, Chang D, McGann P, Barsoumian AE Abstract Acinetobacter baumannii is naturally resistant to several classes of antibiotics and readily develops further resistance mechanisms under antibiotic pressure. For patients infected with extremely drug-resistant organisms, effective antibiotic treatments are intravenous and often require inpatient hospitalization for monitoring and dose adjustment. A 31-year-old active duty service member, stationed in Southeast Asia, sustained thermal burns from an electrical arc injury to over 40% of his total body surface area. His hospital course was complicated by ...
Source: Military Medicine - September 26, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Formal Training for Ethical Dilemmas in Global Health.
Authors: Berkley H, Zitzman E, Jindal RM PMID: 30252094 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - September 26, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Primary Care in American Samoa: How Nurse Practitioners Created a Bridge Across an Ocean.
Authors: Schramm JF, Seibert DC, Thompson MJM, Binder MM, King Young S, Deleon PH PMID: 30252098 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - September 26, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Hospital Medicine: The U.S. Navy Experience to Date and a Proposal for Future Codification and Growth.
Authors: Shutt BJ, Quast TM, Buckland-Coffey DD PMID: 30252112 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - September 26, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

The Wounded Warrior Recovery Project: A Longitudinal Examination of Patient-Reported Outcomes Among Deployment-Injured Military Personnel.
Authors: Watrous JR, Dougherty AL, McCabe CT, Sack DI, Galarneau MR PMID: 30252116 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - September 26, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Renal Replacement Therapy Capability for the Treatment of Combat-Associated Acute Kidney Injury: A Historical Perspective to Plan for Future Conflicts.
Authors: Hoareau GL, Beyer CA, Walker LE, Chung KK, Stewart IJ Abstract Trauma-induced acute kidney injury (AKI) has affected many U.S. warfighters throughout history. We seek to provide a historical review of the epidemiology of combat-acquired AKI and to highlight the importance of adapting current renal replacement therapy (RRT) capabilities to prepare for the next armed conflict. While severe AKI was rare in the recent conflicts in Iraq and Afghanistan, an analysis of prior wars suggests that it will be more common in future combat operations characterized by prolonged evacuation times, limited resuscitation ca...
Source: Military Medicine - September 16, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

High-Reliability Uncaged: Safety Lessons From Army Aviation.
Authors: Malish RG, Sargent PD PMID: 30215752 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - September 16, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Autonomic Symptoms in Gulf War Veterans Evaluated at the War Related Illness and Injury Study Center.
Authors: Fox A, Helmer D, Tseng CL, McCarron K, Satcher S, Osinubi O Abstract Introduction: We characterized the presence of autonomic symptoms in a sample of Veterans with Gulf War Illness (GWI) using the Composite Autonomic Symptom Scale (COMPASS-31). In addition, we examined the report of autonomic symptoms across comorbid mental health conditions in this sample. Materials and Methods: Case-series follow-up of Gulf War veterans evaluated by the War Related Illness and Injury Study Center (WRIISC) between 2011 and 2016 (n = 153). Phone-based interview consisted of questionnaires designed to investigate autono...
Source: Military Medicine - September 16, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Linear Lichen Planus in the Setting of Annual Vaccination.
We present a rare case of linear lichen planus following intramuscular influenza vaccination, not associated with an injection site reaction. Immune-related dermatoses may be underreported, and a vaccine history should be considered in all patients with a skin condition that is otherwise attributed as idiopathic. PMID: 30215756 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - September 16, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Achieving Mastery of General Surgery Operative Skill in the Army Healthcare System.
Authors: Plackett TP, Brockmeyer JR, Holt DB, Rush RM, Sarkar J, Satterly SA, Seery JM, Zagol BR Abstract Introduction: Operative case volumes for military surgeons are reported to be significantly lower than civilian counterparts. Among the concern that this raises is an inability of military surgeons to achieve mastery of their craft. Material and Methods: Annual surgical case reports were obtained from seven Army military treatment facilities (MTF) for 2012-2016. Operative case volume and cumulative operative time were calculated for active duty general surgeons and for individual MTFs. Subgroup analyses wer...
Source: Military Medicine - September 16, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

PTSD as a Mediator in the Relationship Between Post-Concussive Symptoms and Pain Among OEF/OIF/OND Veterans.
Conclusions: These findings replicate and extend previous findings regarding the relationship between TBI, pain, and PTSD. Self-reported post-concussive symptoms negatively impact both pain severity and pain interference among Veterans with probable TBI, and PTSD serves as a mediator in these relationships. Clinically, these results highlight the importance of fully assessing for PTSD symptoms in Veterans with a history of TBI presenting with pain. Further, it is possible that providing effective PTSD treatment to reduce PTSD severity may provide some benefit in reducing post-concussive and pain symptoms. PMID: 3021575...
Source: Military Medicine - September 16, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Mental and Physical Health Correlates of Pain Treatment Utilization Among Veterans With Chronic Pain: A Cross-sectional Study.
Conclusions: While study conclusions may not generalize to all Veteran populations, findings suggest that Veterans with chronic pain were more likely to seek provider-management treatments when experiencing high-pain interference and high-sleep disturbance. In addition, Veterans were more likely to seek provider-management treatments when experiencing low-pain intensity and high-depression symptoms. PMID: 30215759 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - September 16, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Botulinum Toxin as a Novel Treatment for Chronic Exertional Compartment Syndrome in the U.S. Military.
Authors: Hutto WM, Schroeder PB, Leggit JC Abstract Chronic exertional compartment syndrome (CECS) is a debilitating condition that is not uncommon in athletes and military service members. The only curative treatment for this condition, surgical fascial release, was first described in 1956. In the ensuing 62 years, this has remained the standard therapy despite symptom recurrence in 45% of military service members who underwent surgery. In 2013, a case series introduced intracompartmental injections of botulinum toxin A as a non-surgical treatment option for CECS, which proved effective in 15 out of 16 patients. I...
Source: Military Medicine - September 16, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Effect of Urinary Sheath Use on Hydration Status of Fighter Pilots Under Severe Thermal Stress: An Observational Study.
Authors: Brescon C, Pegaz PY, Godet P, Malgoyre A, Charlot K Abstract Introduction: Fighter jet pilots may adopt a voluntary hypohydration strategy hours before take-off to avoid urinating in flight. This may favor sortie-induced dehydration and potentially increase flying errors. Since 2015, French pilots have used a urinary sheath (US) that appears to have resolved this problem. However, its effect has never been assessed. Methods: Urine specific gravity (USG) before and after sorties, inflight intake (water and food) and loss (sweat and urine), and changes in bodyweight were measured during 44 long (~370 min...
Source: Military Medicine - September 16, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

OEF/OIF/OND Veterans Seeking PTSD Treatment: Perceptions of Partner Involvement in Trauma-Focused Treatment.
Conclusion: We confirmed that OEF/OIF/OND veterans seeking PTSD treatment experience PTSD-related problems in romantic relationships, low-relationship satisfaction, and relationship satisfaction was positively associated with perceived communication and problem-solving skills. A minority of veterans were interested in involving significant others in their PTSD treatment; however, in the present study, veterans were not given information about the various ways that a romantic partner might be involved in treatment, and they were not presented with specific conjoint therapies (e.g., Cognitive-Behavioral Conjoint Therapy for ...
Source: Military Medicine - September 16, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Diagnosing Pemphigus Foliaceus: A Rare Blistering Disease Masquerading as a Common Dermatologic Disorder.
We present a 43-year-old African American male that presented to the dermatology clinic with an 18-month history of non-pruritic, violaceous, scaling patches and plaques most prominent on the malar cheeks, upper chest and upper back. He had been evaluated at an outside hospital with a high suspicion for cutaneous lupus erythematosus (CLE) and seborrheic dermatitis. However, repeated biopsies revealed non-specific spongiotic dermatitis, not consistent with CLE or seborrheic dermatitis. Over the subsequent months, he received treatment for both conditions without improvement in his symptoms. When he was referred to our derma...
Source: Military Medicine - September 16, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Spontaneous Coronary Artery Dissection in a 26-Year-Old-Male Soldier.
Authors: Guess JM, Madigan CG, Hudspath CB, Hurley JT, Martinho S Abstract Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndromes, which has been gaining increased recognition with the routine use of coronary angiography and intravascular imaging techniques in patients presenting with ST-elevation myocardial infarction. Here we report the case of a healthy, 26-year-old active-duty male presented to Tripler Army Medical Center for evaluation of acute onset and worsening chest pain that occurred shortly after participating in an Army physical fitness test. His initial EKG demon...
Source: Military Medicine - September 16, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Diet Macronutrient Composition, Physical Activity, and Body Composition in Soldiers During 6 Months Deployment.
Authors: Nykänen T, Pihlainen K, Santtila M, Vasankari T, Fogelholm M, Kyröläinen H Abstract Introduction: Optimal diet together with good physical fitness maintains readiness and military performance during longer deployments. The purpose of this study was to describe changes in dietary macronutrient and energy intake, total physical activity and body composition during a 6-month deployment in South Lebanon. Furthermore, associations of diet macronutrient intake and physical activity on body composition were also studied. Materials and Methods: Forty male soldiers kept a 3-day food diary and the...
Source: Military Medicine - September 16, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

An Act of Man or a Caprice of Nature?
Authors: Weisman A, Yona T, Masharawi Y PMID: 30215806 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - September 16, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Pelvic Fracture Care.
Authors: Gordon WT, Fleming ME, Johnson AE, Gurney J, Shackelford S, Stockinger ZT Abstract While combat-related pelvis fractures are more commonly open, higher energy, and complex in pattern than those seen in the civilian setting, the principles of management are similar. The primary differences are related to the austere setting in which the initial management takes place, and the lack of resources typically available. Initial management consists of cessation of hemorrhage, along with the multi-disciplinary prioritized management of associated injuries, and skeletal stabilization. This is most commonly achieved ...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Hyperkalemia and Dialysis in the Deployed Setting.
Authors: Stewart IJ, Bolanos JA, Little DJ, Chung KK, Sosnov JA, Miller N, Poirier MD, Saenz KK, McAlister VC, Moghadam S, Kao R, Stockinger ZT Abstract Acute kidney injury is a recognized complication of combat trauma. The complications associated with acute kidney injury, such as life-threatening hyperkalemia, are usually delayed in onset. In the recent conflicts, rapid evacuation of U.S. and coalition personnel generally resulted in these complications occurring at higher echelons of care where renal replacement therapies were available. In the future however, deployed providers may not have this luxury and shou...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Emergency Resuscitative Thoracotomy in the Combat or Operational Environment.
Authors: Monchal T, Martin MJ, Antevil JL, Bennett DR, DeVries WC, Zakaluzny S, Ricca RL, Tien H, Mullenix PS, Stockinger ZT Abstract Resuscitative thoracotomy has been extensively described in the civilian trauma literature and has a high mortality rate, due largely to the nature of the injuries leading to arrest. The survival rates are generally highest (10-30%) for penetrating truncal injuries and patients who arrive with vital signs and proceed to arrest or who have impending arrest. They are significantly lower (less than 5%) for blunt trauma victims, particularly those who arrest in the field or during transp...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Amputation: Evaluation and Treatment.
Authors: Gordon W, Balsamo L, Talbot M, Osier C, Johnson A, Shero J, Potter B, Stockinger ZT Abstract Combat extremity injury and amputation is a life threatening injury. Initial surgical care should focus on hemostasis followed by irrigation and debridement of contaminated and nonviable tissue. Preservation of limb length begins at the initial surgical procedure, to include retention of atypical soft tissue flaps for later reconstruction and treatment of proximal fractures. Serial irrigation and debridements are required throughout the MEDEVAC system as the evolving zone of injury becomes more mature, followed by ...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

High Bilateral Amputations and Dismounted Complex Blast Injury (DCBI).
Authors: Gordon W, Talbot M, Fleming M, Shero J, Potter B, Stockinger ZT Abstract High, combat-related bilateral lower extremity amputations rarely occur in isolation. Dismounted complex blast injury is a devastating and life-threatening constellation of multisystem injuries most commonly due to dismounted contact with improvised explosive devices. Rapid damage control resuscitation and surgery are essential to improve patient survival and minimize both early complications and late sequelae. A coordinated team approach is essential to provide simultaneous airway management, volume resuscitation (ideally with whole ...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

The Use of Frozen and Deglycerolized Red Blood Cells.
Authors: Cap A, Badloe J, Woolley T, Prat N, Gonzales R, Malloy W, Taylor A, Corley J, Pidcoke H, Reade M, Schreiber M Abstract Deglycerolized red blood cells have been used by the U.S. military for half a century, starting with the Vietnam War. Deglycerolized red blood cells have a frozen storage life of 10 years, but require special equipment to thaw and deglycerolize. The available data show no difference in either efficacy with complications when compared to standard product red blood cells. PMID: 30189057 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Frostbite and Immersion Foot Care.
Authors: Hall A, Sexton J, Lynch B, Boecker F, Davis EP, Sturgill E, Steinmetz M, Shackelford S, Gurney J, Stockinger Z, King B Abstract Historically, cold injury, hypothermia, and frostbite have been severe problems for military units on the battlefield. Kenneth D. Orr and David C. Fainer captured these difficulties in their book, Cold Injuries in Korea During Winter of 1950-51, still cited in military medical readiness training. While not common in modern conflicts, the potential exists for large numbers of these casualties in war and during training. PMID: 30189058 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Prevention of Deep Venous Thromboembolism.
Authors: Grabo DJ, Seery JM, Bradley M, Zakaluzny S, Kearns MJ, Fernandez N, Tadlock M Abstract The nature of many combat wounds puts patients at a high risk of developing deep venous thrombosis (DVT) and pulmonary embolism (PE), which fall under the broader disease category of venous thromboembolism (VTE). In addition to the hypercoagulable state induced by trauma, massive injuries to the extremities, prolonged immobility, and long fixed wing transport times to higher echelons of care are unique risk factors for venous thromboembolism in the combat-injured patient. These risk factors mandate aggressive prophylaxis...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Radiology: Imaging Trauma Patients in a Deployed Setting.
Authors: Ritter J, O'Brien S, Rivet D, Gibb I, Grimes J, Hinds S, Jessinger R, May T, Wirt M, Shackelford S, Adam O, York G, Ritchie B, Flores R, Stockinger Z Abstract Medical imaging plays a critical role in the rapid diagnosis, effective triage, and management of complex poly-trauma patients. High-quality medical imaging can be accomplished successfully in a deployed or wartime setting. Due to advances in aggressive resuscitation techniques and the speed of the latest generation computed tomography scanners (64-detector and beyond), rapid trauma scans utilizing computed tomography and ultrasound imaging can routi...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Whole Blood Transfusion.
Authors: Cap AP, Beckett A, Benov A, Borgman M, Chen J, Corley JB, Doughty H, Fisher A, Glassberg E, Gonzales R, Kane SF, Malloy WW, Nessen S, Perkins JG, Prat N, Quesada J, Reade M, Sailliol A, Spinella PC, Stockinger Z, Strandenes G, Taylor A, Yazer M, Bryant B, Gurney J Abstract Whole blood is the preferred product for resuscitation of severe traumatic hemorrhage. It contains all the elements of blood that are necessary for oxygen delivery and hemostasis, in nearly physiologic ratios and concentrations. Group O whole blood that contains low titers of anti-A and anti-B antibodies (low titer group O whole blood) c...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Burn Casualty Care in the Deployed Setting.
Authors: Driscoll IR, Mann-Salinas EA, Boyer NL, Pamplin JC, Serio-Melvin ML, Salinas J, Borgman MA, Sheridan RL, Melvin JJ, Peterson WC, Graybill JC, Rizzo JA, King BT, Chung KK, Cancio LC, Renz EM, Stockinger ZT Abstract Management of wartime burn casualties can be very challenging. Burns frequently occur in the setting of other blunt and penetrating injuries. This clinical practice guideline provides a manual for burn injury assessment, resuscitation, wound care, and specific scenarios including chemical and electrical injuries in the deployed or austere setting. The clinical practice guideline also reviews cons...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research