Military medicine
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Hypothermia increases mortality rates and should be treated aggressively in the forward echelons of care, but no practical solution exists to accomplish such treatment. The enormous energy burden for this task requires maximal thermodynamic efficiency for a practical portable solution. This review article presents an overview of the clinical and thermodynamic challenges related to the development of a successful system for treatment of hypothermia in the forward echelons. Specific issues addressed include (1) the clinical and logistical reasons why thermal resuscitation should be attempted at all in such a difficult environment, (2) the thermodynamic reasons why warm intravenous fluids, although helpful in not worsening hypothermia, cannot safely transmit enough energy to treat established hypothermia, (3) which among the various methods of rewarming are most likely to result in successful therapy, and (4) the energetic considerations that dictate that any practical portable solution to the treatment of hypothermia must use hydrocarbon combustion as the source of heat.
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The objective of this study was to determine the effects of inspired oxygen concentration (FIO2), positive end-expiratory pressure (PEEP), and breath type on the battery life of the LTV-1000 external lithium ion battery (LiB). ⋯ Battery life of the external LiB is significantly reduced by the use of pressure control, increasing PEEP, and increasing FIO2. This information is critical to resource planning for medical missions.
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This report summarizes an outbreak of measles among five unvaccinated children living in a U. S. military community in Wiesbaden, Germany, in March to April of 2004. The index case was a 3-year-old whose parents' refusal to have their child vaccinated with measles-containing vaccine had been documented many times. ⋯ Record review revealed that only 71% of 19- to 35-month olds in the community had been vaccinated with measles-containing vaccine before the outbreak, creating a "pocket of susceptibility." Children of travelers, expatriates, and military service members are at increased risk from vaccine-preventable diseases. Vaccine refusal is increasingly common, resulting in pockets of susceptibility to vaccine-preventable diseases, and increasing the risk of outbreaks. Missed opportunities and other delays in vaccination can also contribute to these pockets of susceptibility.
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Case Reports
A case of malignant hyperthermia in a child encountered during a humanitarian assistance mission to the Philippines.
Potentially fatal operating room events have become largely preventable with advances in anesthesia and surgical technique. Nonetheless, some lethal emergencies remain unpredictable and can occur whenever general anesthesia is given. We describe a case of malignant hyperthermia encountered and treated during surgical operations concurrent with an overseas humanitarian assistance mission. This case highlights the clinical diversity of malignant hyperthemia as well as the importance of preparation for any potential adverse event wherever trigger agents may be used from the mundane to exotic locales.
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The objective of this study was to explore correlates of the use of firearms to commit suicide. ⋯ Gun ownership rates, legislation, and levels of community cohesiveness are significantly associated with the likelihood of psychiatric patients committing suicide with a gun.