Military medicine
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Case Reports
"HOOAH!" A case of pneumomediastinum in the military training environment; Hamman's sign 71 years later.
A previously healthy 20-year-old male trainee developed chest pain, shortness of breath, and neck pain after repeatedly shouting "Hooah!" during a motivational squad competition. He was found to have developed a pneumomediastinum with soft tissue crepitus of the neck. ⋯ Unique to the military training environment, vigorous shouting, including "Hooah!" as a motivational stimulus, can have barotraumatic consequences. The term "spontaneous" as applied to a pneumomediastinum diagnosis is examined and the auscultatory finding of "Hamman's sign" is reviewed.
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Explosions can cause devastating injuries by various wounding mechanisms. Injuries due to the primary pressure wave are rarely life threatening and those that are lethal are uncommon. ⋯ There is much overlap in treatment of these wounds, and a detailed description is beyond the scope of this review. A brief summary of the initial surgical and nonsurgical management of blast injury that is useful for civilian and military clinicians is provided.
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The objective of this study was to determine the effectiveness of lactated Ringer's (LR) solution, sodium hydroxyethyl starch (hetastarch), and dopamine (DA) on diaphragm shortening (DS), diaphragm blood flow (DBF), diaphragm hydrogen peroxide (H2O2), and diaphragm apoptosis following hemorrhagic shock (HS). Sprague-Dawley rats were assigned to the following groups: HS, LR, LR plus DA, hetastarch, and hetastarch plus DA. After removing 40% of the blood volume, with exception of the HS group, an equal volume of resuscitation fluid was administered. ⋯ H2O2 and apoptosis decreased with LR administration. H2O2 and apoptosis were decreased to a much greater extent with LR plus DA, hetastarch, and hetastarch plus DA infusions. In conclusion, LR plus DA, hetastarch, and hetastarch plus DA maintained DS and DBF, which may be attributed to the decreases in reactive oxygen species as reflected by H2O2 and apoptosis.