Military medicine
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To review the principles of extracorporeal membrane oxygenation (ECMO) and to describe the recent advancements in ECMO technology that permit use of this rescue therapy for severe lung injury in combat casualties. ⋯ Advances in ECMO technology now enable the stabilization and aeromedical evacuation of even the most critically ill combat casualties with severe lung injury.
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Post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) are common injuries among returning combat veterans from the wars in Iraq and Afghanistan. Although these combat injuries have been associated with increased sleep disruption, little is known about the nature and specificity of sleep problems within these common injury categories. ⋯ Among recently redeployed combat veterans, clinically significant sleep disturbances and problems with sleep-disordered breathing are common but nonspecific findings across primary diagnoses of PTSD, TBI, major depression, and anxiety disorder, whereas more subtle differences in sleep architecture and arousals as measured by overnight PSG recordings were modestly, but significantly, effective at distinguishing among the diagnostic groups.
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Brugada syndrome (BS) is a cardiac rhythm disturbance that predisposes patients to sudden cardiac death. Brugada is classically described with specific electrocardiographic (EKG) findings of ST elevation and right bundle branch block in precordial leads and is an often unrecognized contributor to sudden cardiac death. ⋯ His classic findings of Brugada pattern on EKG demonstrated reversibility with clinical defervescence. In patients with a suggestive history, a normal EKG cannot definitively rule out BS as the Brugada pattern can be unmasked by stress, which in this case was represented by a pneumonia-induced fever.
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Negative-pressure pulmonary edema (NPPE) is an infrequent but known postoperative complication following endotracheal intubation and general anesthesia. We report a case of a healthy 24-year-old man requiring intensive care unit management for NPPE following a routine surgical procedure. This article discusses how rare but serious the complication of NPPE can be; it also describes the diagnosis, evaluation, and treatment from one institution's experience.