Military medicine
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Review Historical Article
Review: the influence of armed conflict on the development of critical care medicine.
This manuscript reviews the historic underpinnings of critical care medicine (CCM) during armed conflict, the means and techniques healthcare providers in the military have used to practice CCM in austere environments, and the ongoing developments in the practice of CCM by military health care clinicians. These developments influence contemporary civilian trauma practice and practice in intensive care units and vice versa. A symbiosis between civilian and military intensivists and traumatologists involves much crosstalk and sharing of experiences and best practices that has influenced and improved care in combat zones and in civilian emergency departments, operating rooms, and intensive care units.
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The purpose of this study was to assess the validity of the 1-mile walk (Rockport Walk Test) as a predictor of VO(2max) and determine whether the 1-mile walk is a reliable alternative to the 1.5-mile run in moderately fit to highly fit U. S. Air Force males. ⋯ For the 1-mile walk, there were no significant differences between measured and predicted VO(2max) (p = 0.177, r = 0.817). There were no significant differences (p = 0.573) between points scored in the Air Force Fitness Test for the 1-mile walk and 1.5-mile run tests. In conclusion, the 1-mile walk test is a valid predictor of VO(2max) and can be used as an alternative fitness test to the 1.5-mile run in assessing cardiovascular fitness in Air Force males.
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Heat and moisture exchangers (HMEs) are used for airway humidification in mechanically ventilated patients and have been evaluated only under hospital conditions. U. S. ⋯ This study evaluated 10 commercial HMEs using a test system that simulated aeromedical evacuation conditions. Although the American National Standards Institute recommends inspired air to be at an absolute humidity value of > or = 30 mg/L for mechanically ventilated patients, the highest absolute humidity by any HME was approximately 20 mg/L. Although none of the HMEs were able to maintain a temperature high enough to achieve the humidity standard of the American National Standards Institute, the clinical significance of this standard may be less important than the relative humidity maintained in the respired air, especially on evacuation flights of short duration.
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Management of combat casualties should optimize outcomes by appropriate patient triage, prehospital care, and rapid transport to the most capable medical facility, while avoiding overwhelming individual facilities. ⋯ In a cross border setting, airlifting the urgent casualties to farther away level I trauma centers provides appropriate care for them, while not crossing the "surge capacity" line for the near-by medical centers.
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Historical Article
Orthopedic surgery in the United States Army: a historical review.
The contribution of American military surgeons to the development of orthopedic surgery has not previously been explored. The experiences of American military surgeons in conflicts from the Civil War to Iraq and Afghanistan have advanced the orthopedic discipline, resulting in important developments within the field, as well as scientific discoveries that have benefited both the civilian and military communities. From advances in wound care, to spinal surgery, intramedullary nailing of long bone fractures, and external fixation, American military surgeons have been pioneers of orthopedic surgery. The goal of this review was to survey the American military orthopedic experience from the American Revolution to the wars in Iraq and Afghanistan.