Military medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Ketamine and oxycodone in the management of postoperative pain.
Relief of pain, whether post-traumatic or postoperative, is a prerequisite for the prevention of its deleterious effects on the whole organism. Unalleviated pain also increases the victim's or patient's anxiety and apprehension, which in turn increase the intensity of the pain. In the management of pain, opiates have maintained their position as the most common form of analgesic therapy despite the many side effects associated with their use. ⋯ Also, the suitability of oxycodone for field use was evaluated with respect to ketamine. Plethysmographic pulse-wave amplitude changes were compared with the pain visual analogue scale scores as measures of postoperative pain. The results of this study did not reveal any significant differences between the analgesic potencies of the studied drugs and clearly demonstrate that even suboptimal doses of both ketamine and oxycodone can provide appreciable relief of pain.
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We conducted a retrospective review of all patients with orthopedic injuries evacuated to a single medical center to evaluate the treatment and outcome of these injuries in three recent U. S. military conflicts: Operation Urgent Fury (Grenada), Operation Desert Shield/Storm (southwest Asia), and Operation Restore Hope (Somalia). Sixteen orthopedic casualties were originally treated at the medical detachment in Grenada before evacuation to the medical center. ⋯ Many of these injuries are the result of high-velocity weapons or blast injuries. Regardless of the size and/or purpose of the intervention, similar injury patterns and severity can be expected, because 51% of orthopedic patients had open fractures. Similarly, the rate of amputation associated with extremity trauma has not varied significantly since the Vietnam War.
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To determine the critical care experience encountered by three recently graduated military pediatricians at an overseas military hospital and present one model of maximizing allowable critical care training time during residency. ⋯ Graduating military pediatric residents may be faced with caring for a wide range of critically ill neonatal and pediatric patients depending on their assignment. Residency training programs, with the recent increased emphasis on primary pediatric care, will need to streamline instruction in pediatric critical care to provide maximal benefit to the resident while maintaining compliance with Residency Review Committee guidelines.