Military medicine
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Advances in medical technology are giving health care providers the tools with which to keep patients alive for longer and longer periods of time. However, in our struggle to keep patients alive, we must not forget that the patient is the one who controls his or her own destiny. ⋯ Surgeons, anesthetists, operating room nurses, and others all have concerns regarding this issue, and they will be discussed here. The answer to the dilemma lies in a policy of "required reconsideration" to examine all factors of the do-not-resuscitate order and its applicability to the situation at hand.
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Austere far-forward battlefield environments present numerous obstacles in providing adequate medical care to the injured solidier. In addition to logistical constraints that limit the volume of isotonic crystalloid fluids available to resuscitate the injured soldier, hypotension, environmental and tactical conditions, and/or the presence of mass casualties can combine to lead to excessive delays in obtaining vascular access. For many years, intraosseous infusion has been a rapid, reliable method of achieving vascular access under emergency conditions in children. ⋯ S. military having recently been reissued intraosseous devices, we thought it timely to review the literature on this technique. This review discusses the efficacy and safety of intraosseous infusions of drugs and fluids, including insertion times and flow rates achieved. Although the intent is to evaluate the feasibility of the technique in the injured soldier, literature citations from studies in children, experimental animals, and human cadavers are included to support the statements made and to offer the reader the opportunity to read the original literature.
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The growing global problem of antibiotic resistance requires a worldwide surveillance strategy to characterize the magnitude of the problem, guide clinical care decisions, and assess the impact of prevention and control interventions. Because many existing antibiotic resistance surveillance activities have developed independently of one another and vary greatly in their focus, key organizations are promoting strategies to standardize surveillance activities and build collaboration to promote effective global surveillance. With medical facilities operating throughout the world to support a highly mobile beneficiary population, the Department of Defense's Military Health System could benefit from partnership with civilian efforts to achieve global antibiotic resistance surveillance. This article's overview of existing surveillance activities and new strategies provides information requisite to the Department of Defense undertaking of development of a worldwide antibiotic resistance surveillance program to complement and integrate with civilian programs.