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

Catastrophic Non-Survivable Brain Injury Care-Role 2/3.
Authors: Neal CJ, Bell RS, Carmichael JJ, DuBose JJ, Grabo DJ, Oh JS, Remick KN, Bailey JA, Stockinger ZT Abstract A catastrophic brain injury is defined as any brain injury that is expected to result in permanent loss of all brain function above the brain stem level. These clinical recommendations will help stabilize the patient so that they may be safely evacuated from theater. In addition to cardiovascular and hemodynamic goals, special attention must be paid to their endocrine dysfunction and its treatment-specifically steroid, insulin and thyroxin (t4) replacement while evaluating for and treating diabetes ins...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Inhalation Injury and Toxic Industrial Chemical Exposure.
Authors: Saeed O, Boyer NL, Pamplin JC, Driscoll IR, DellaVolpe J, Cannon J, Cancio LC Abstract Toxic industrial chemicals include chlorine, phosgene, hydrogen sulfide, and ammonia have variable effects on the respiratory tract, and maybe seen alone or in combination, secondary to inhalation injury. Other considerations include the effects of cyanide, carbon monoxide, and fire suppressants. This Clinical Practice Guideline (CPG) will provide the reader with a brief overview of these important topics and general management strategies for each as well as for inhalation injury. Chlorine, phosgene, hydrogen sulfide, an...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Blunt Abdominal Trauma, Splenectomy, and Post-Splenectomy Vaccination.
Authors: Stockinger Z, Grabo D, Benov A, Tien H, Seery J, Humphries A Abstract Unlike penetrating abdominal injuries where the decision to operate is relatively straight forward, those combat casualties that sustain blunt abdominal trauma offer more of a diagnostic and clinical challenge. For unstable patients with a positive focused abdominal sonography in trauma or diagnostic peritoneal lavage, exploratory laparotomy should be undertaken immediately. All grade IV-V splenic injuries should undergo splenectomy, patients undergoing attempted splenic salvage should be monitored in the Role 3 facility and embolization...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Anesthesia for Trauma Patients.
Authors: Tobin JM, Barras WP, Bree S, Williams N, McFarland C, Park C, Steinhiser D, Stone RC, Stockinger Z Abstract An improved understanding of the pathophysiology of combat trauma has evolved over the past decade and has helped guide the anesthetic care of the trauma patient requiring surgical intervention. Trauma anesthesia begins before patient arrival with warming of the operating room, preparation of anesthetic medications and routine anesthetic machine checks. Induction of anesthesia must account for potential hemodynamic instability and intubation must consider airway trauma. Maintenance of anesthesia is a...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Airway Management for Trauma Patients.
Authors: Walrath BD, Harper S, Barnard E, Tobin JM, Drew B, Cunningham C, Kharod C, Spradling J, Stone C, Martin M Abstract Trauma airway management is a critical skill for medical providers supporting combat casualties since it is an integral component of damage control resuscitation and surgery. This clinical practice guideline presents methods for optimizing the airway management of patients with traumatic injury in the operational medical treatment facility environment. The guidelines represent the knowledge and experience of 10 co-authors from 3 allied countries representing Emergency Medicine, Surgery and Ane...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

MRI in Management of Mild TBI/Concussion in the Deployed Setting.
This article is a brief discussion of when MRI is appropriate. PMID: 30189068 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Unexploded Ordnance Management.
Authors: Oh JS, Seery JM, Grabo DJ, Ervin MD, Wertin TM, Hawks RP, Benov A, Stockinger ZT Abstract The purpose of this Clinical Practice Guide is to provide details on the procedures to safely remove unexploded ordnance from combat patients, both loose and impaled, to minimize the risks to providers and the medical treatment facility while ensuring the best outcome for the patient. Military ordnance, to include bullets, grenades, flares, and explosive ordnance, retained by a patient can be a risk to all individuals and equipment along the continuum of care. This is especially true from the point of injury to the fi...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Damage Control Resuscitation.
Authors: Cap AP, Pidcoke HF, Spinella P, Strandenes G, Borgman MA, Schreiber M, Holcomb J, Tien HC, Beckett AN, Doughty H, Woolley T, Rappold J, Ward K, Reade M, Prat N, Ausset S, Kheirabadi B, Benov A, Griffin EP, Corley JB, Simon CD, Fahie R, Jenkins D, Eastridge BJ, Stockinger Z Abstract Damage control resuscitation (DCR) is a strategy for resuscitating patients from hemorrhagic shock to rapidly restore homeostasis. Efforts are focused on blood product transfusion with whole blood or component therapy closely approximating whole blood, limited use of crystalloid to avoid dilutional coagulopathy, hypotensive resu...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Treatment of Suspected Invasive Fungal Infection in War Wounds.
Authors: Rodriguez CJ, Tribble DR, Malone DL, Murray CK, Jessie EM, Khan M, Fleming ME, Potter BK, Gordon WT, Shackelford SA Abstract Invasive fungal wound infections (IFIs) were an unexpected complication associated with blast-related wounds during Operation Enduring Freedom. Between 2010 and 2012, IFI incidence rates were as high as 10-12% for patients injured during Operation Enduring Freedom and admitted to the intensive care unit at the Landstuhl Regional Medical Center. Independent risk factors for the development of IFIs include dismounted blast injuries, above knee amputations and massive (>20 units) pac...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Infection Prevention in Combat-Related Injuries.
Authors: Saeed O, Tribble DR, Biever KA, Crouch HK, Kavanaugh M Abstract Wound infections play an important role in the morbidity and mortality of service members injured in combat. The exigent and often long road to recovery can be complicated by healthcare-associated infections caused by multidrug-resistant organisms. The outcome is not only financially taxing but also can be life threatening. This Clinical Practice Guideline (CPG) will provide the reader with a brief overview of this topic, easy and equitable strategies to implement, and significantly reduce the exposure and possible contamination and spread of ...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Nutritional Support Using Enteral and Parenteral Methods.
Authors: Tadlock MD, Hannon M, Davis K, Lancman M, Pamplin J, Shackelford S, Martin M, Stockinger Z Abstract The purpose of this Clinical Practice Guideline is to provide an approach for optimal nutritional support in the postinjury period for those injured in combat. Indications and contraindications for enteral and parenteral nutrition are addressed. Timing of nutritional support, nutritional goals, energy requirements, and ideal formula selection for various types of traumatic injuries are addressed. Challenges encountered providing nutrional support for the traumatically injured in the deployed environment are ...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Drowning Management.
Authors: Parenteau M, Stockinger Z, Hughes S, Hickey B, Mucciarone J, Manganello C, Beeghly A Abstract Highly skilled swimmers and aquatically adaptable service members such as U.S. Navy Divers, Sea, Air and Land (SEAL) Teams, and Explosive Ordnance Disposal (EOD) technicians, die every year from drowning. Drowning is the cause of over 500,000 deaths annually across the globe. This Clinical Practice Guideline (CPG) provides an overview of drowning and associated conditions based on the best available current medical evidence. Unlike basic life support and advanced cardiac life support protocols, rescue breathing sh...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Cervical and Thoracolumbar Spine Injury Evaluation, Transport, and Surgery in the Deployed Setting.
Authors: Neal CJ, McCafferty RR, Freedman B, Helgeson MD, Rivet D, Gwinn DE, Rosner MK Abstract This Cervical and Thoracolumbar Spine Injury Evaluation, Transport, and Surgery Clinical Practice Guideline (CPG) is designed to provide guidance to the deployed provider when they are treating a combat casualty who has sustained a spine or spinal cord injury. The CPG objective for the treatment and the movement of these patients is to maintain spinal stability through transport, perform decompression when urgently needed, achieve definitive stabilization when appropriate, avoid secondary injury, and prevent deterioratio...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Acute Extremity Compartment Syndrome and the Role of Fasciotomy in Extremity War Wounds.
Authors: Gordon WT, Talbot M, Shero JC, Osier CJ, Johnson AE, Balsamo LH, Stockinger ZT Abstract Acute compartment syndrome (CS) is a frequent and potentially devastating complication of blunt and penetrating extremity injuries. Extremity war injuries are particularly susceptible to CS due to associated vascular injuries; high Injury Severity Score; extensive bone and soft tissue injury; and frequent transportation that may limit close monitoring of the injured extremity. Treatment consists of prompt fasciotomy of all compartments in the involved segment, over their full length. Delayed or incomplete fasciotomy is ...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Wartime Vascular Injury.
Authors: Rasmussen T, Stockinger Z, Antevil J, White C, Fernandez N, White J, White P Abstract Wartime vascular injury can be particularly challenging due to the complexity of the case, concomitant injuries, resource limitations, and often lack of expertise of the operating surgeon. The proliferation of vascular shunting has been of particular importance as a damage control surgery technique to restore perfusion and temporize the immediate need for definitive repair necessary for limb salvage, particularly in austere locations. Diagnosis of vascular injury can be made using a variety of techniques, from physical ex...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

JTS CPG Development Process.
Authors: Spott MA, Burelison DR, Kurkowski CR, Stockinger ZT PMID: 30189078 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Orthopedic Trauma: Extremity Fractures.
Authors: Osier C, Smith C, Stinner D, Rivera J, Possley D, Finnan R, Bode K, Stockinger Z Abstract Fractures continue to account for a large proportion of combat-related injuries. The basic tenets of irrigation, debridement, soft tissue care, and vigilant monitoring/fasciotomy for acute compartment syndrome persist. Closed management of fractures with splinting or casting is acceptable. If time and facility allow, external fixation of fractures offer many advantages over closed treatment but require knowledge, experience and skill in the safe placement of pins. The care of host nationals presents unique challenges ...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Military Preventable Death Conceptual Framework: A Systematic Approach for Reducing Battlefield Mortality.
Authors: Janak J, Stockinger Z, Mazuchowski E, Kotwal R, Sosnov J, Montgomery H, Butler F, Shackelford S, Gurney J, Spott M, Finelli L, Smith DJ Abstract The National Academies of Sciences, Engineering, and Medicine Report on Zero Preventable Deaths highlighted the need for a military and civilian partnership to take lessons learned from the wars in Iraq and Afghanistan and incorporate them into a national learning trauma care system. One of the specific objectives in the report was to establish military preventable death metrics. Upon further inspection, it became apparent that the Department of Defense did not ha...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Trauma Management of Military Working Dogs.
This article is covers the most common urgent MWD care challenges HCPs may face. PMID: 30189081 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

The Joint Trauma System: History in the Making.
Authors: Spott MA, Kurkowski CR, Stockinger Z PMID: 30189082 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Neurosurgery and Medical Management of Severe Head Injury.
Authors: McCafferty RR, Neal CJ, Marshall SA, Pamplin JC, Rivet D, Hood BJ, Cooper PB, Stockinger Z Abstract Management of the patient with moderate to severe brain injury in any environment can be time consuming and resource intensive. In the austere or hostile environment, the challenges to deliver care to this patient population are magnified. These guidelines have been developed by acknowledging commonly recognized recommendations for neurosurgical and neuro-critical care patients and augmenting those evaluations and interventions based on the experience of neurosurgeons, trauma surgeons, and intensivists who h...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

The Joint Trauma System and the Fog of War.
Authors: Stockinger ZT PMID: 30189084 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

The DoD Trauma Registry Versus the Electronic Health Record.
This article will clear the confusion between the two systems, using the Joint Trauma System's (JTS) Department of Defense (DoD) Trauma Registry (DoDTR), the approved enterprise wide trauma registry for the military, as an example. PMID: 30189085 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Aural Blast Injury/Acoustic Trauma and Hearing Loss.
Authors: Esquivel CR, Parker M, Curtis K, Merkley A, Littlefield P, Conley G, Wise S, Feldt B, Henselman L, Stockinger Z Abstract Hearing is a critical sense to military performance. The ability to detect, identify, and localize sounds, the ability to maintain spatial awareness on the battlefield and the awareness to control one's own noise production can be vital to troop's stealth, survivability, and lethality. Hazardous noise is an environmental public health threat encountered in training at war, and in many off-duty activities. The risk to hearing and the resultant damage from any of these hazardous exposures ...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for Hemorrhagic Shock.
Authors: Cannon J, Morrison J, Lauer C, Grabo D, Polk T, Blackbourne L, Dubose J, Rasmussen T Abstract This clinical practice guideline (CPG) reviews the range of accepted management approaches to profound shock and post-traumatic cardiac arrest and establishes indications for considering Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as a hemorrhage control adjunct. The specific management approach - within the parameters of mission, resources, and tactical situation - will depend on the casualty's physical location, mechanism and pattern of injury, and the experience level of the surgeon. The o...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Acute Respiratory Failure.
Authors: Cannon J, Pamplin J, Zonies D, Mason P, Sine C, Cancio L, McNeill J, Colombo C, Osborn E, Ricca R, Allan P, DellaVolpe J, Chung K, Stockinger Z Abstract Acute respiratory distress syndrome (ARDS) is a condition affecting critically ill patients, characterized by pulmonary inflammation and defects in oxygenation due to either direct or indirect injury to the lungs. These guidelines will define the diagnosis and management of ARDS, particularly among combat casualties and patients in the deployed environment. The cornerstone of management of ARDS involves maintaining adequate oxygenation while avoiding furth...
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

The Joint Trauma System Teams Dedicated to Optimizing Combat Casualty Care.
Authors: Spott MA, Kurkowski CR PMID: 30189089 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - September 8, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research