Military medicine
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Increased central nervous system norepinephrine outflow and alpha1-adrenergic receptor responsiveness appear to be involved in the pathophysiologic processes of trauma-related nightmares in post-traumatic stress disorder. On the basis of reports that the brain-accessible alpha1-adrenergic antagonist Prazosin substantially reduced chronic combat-related nightmares among Vietnam War veterans, we evaluated Prazosin effects on combat-related nightmares among combat soldiers returning from Operation Iraqi Freedom. ⋯ Prazosin appeared highly beneficial for combat-related nightmares characteristic of post-traumatic stress disorder among troops recently returned from Operation Iraqi Freedom. These findings provide a rationale for a placebo-controlled trial to establish efficacy in this population.
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Operation Iraqi Freedom was the first large-scale combat operation involving the U.S. Marine Corps since the Persian Gulf War in 1991. Data from a combat surgical company are presented. ⋯ The time from injury to surgical care was considered long by civilian standards; however, this did not appear to affect outcomes substantially. A small percentage (5.2%) of injuries were to the torso. Hypothermia was commonly present. Because of the nature of their wounds, all patients required additional surgery after evacuation to rear area facilities. The outcomes of individual patients are not known, although it is known that only one Marine died after reaching medical care and, to date, no Marines have subsequently died of their wounds.
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The 274th Forward Surgical Team (FST) was the first FST deployed to Bagram, Afghanistan, to provide surgical care for combat casualties during the initial phases of Operation Enduring Freedom. This is an analysis of the distribution, cause, and severity of wounds for combat casualties and the surgical procedures they required. ⋯ The distribution, cause, and severity of wounds were similar to those in the Persian Gulf War, despite the obvious differences between these conflicts. The use of modern technologies, such as compact, portable, ultrasound and digital X-ray systems, expanded the capabilities of the FST. Even low-intensity conflicts can produce significant numbers of combat casualties, and the FST must be manned, trained, equipped, and supplied to treat a wide variety of combat wounds.
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Assorted casualties are expected from combat. Triage of the wounded may result in some going directly to surgery. Although every minute is essential, anesthetic care of these trauma patients must adhere to all established standards of care. ⋯ In the forward, austere military environment, anesthesia providers may experience logistical and manpower constraints when administering anesthesia. In this setting, it may be more even more crucial for preoperative recognition of MH and when this is not possible, focus must shift to perioperative detection and early treatment. The following case report emphasizes the importance of preoperative recognition and having an established MH protocol and access to dantrolene.
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The 274th Forward Surgical Team (FST) was deployed in support of Operation Enduring Freedom from October 14, 2001 to May 8, 2002. During this period, the FST was asked to perform many nondoctrinal missions. The FST was tasked with functioning as a mini-combat support hospital during the earlier phases of Operation Enduring Freedom, performing in-flight surgical procedures and resuscitation of combat wounded, conducting split operations with surgical coverage of both Karshi and Khanabad, Uzbekistan, and Bagram, Afghanistan, and leading the multinational medical coalition assembled for Operation Anaconda and other combat operations staged from Bagram. ⋯ At the time, this experience with combat casualties and the surgical care of combat wounds was the largest since the Persian Gulf War. More importantly, this account describes the flow, frequency, and type of combat casualties seen in a low-intensity conflict like that being waged currently in Afghanistan. It is hoped that this depiction will aid in the preparation, equipping, and overall utilization of surgical assets in similar future conflicts.