Military medicine
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A pediatric critical care transport program was initiated and organized at Naval Medical Center San Diego in January 1994. The primary goal of the program was to formally train military pediatric residents in the early stabilization and transport of the critically ill neonatal and pediatric patient. It was also felt that such a program would generate significant cost savings to the Department of Defense. We present the statistics, training protocol, and the cost savings. In addition, we surveyed previous residents who had been involved with this program to determine its perceived benefit. ⋯ In summary, we report our experience with the development of a pediatric critical care transport program. The program was developed to provide military pediatric residents instruction and experience in the stabilization and transport of critically ill children. In addition, we were able to demonstrate a significant cost avoidance.
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Polyuria with marked plasma sodium disturbance was present in 39 of 224 patients with isolated craniocerebral war injuries. Twenty-one of these 39 patients had hyponatremia (sodium level < 130 mmol/l) and polyuria. ⋯ The remaining 18 patients developed classic diabetes insipidus syndrome, and 6 of them (33%) died of hypernatremia within 30 days after trauma. The mortality in both patients with hyponatremia and patients with diabetes insipidus was higher in those with greater disturbances of plasma sodium concentration with polyuria and those with lower Glasgow Coma Scale scores.