Military medicine
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Review Case Reports
Pericarditis, thymic hyperplasia, and Graves' thyrotoxicosis: case report and review of the literature.
Graves' thyrotoxicosis with thymic hyperplasia and pericarditis has never been described in the literature. In this case report, we present the clinical, laboratory, and radiographic findings of a 24-year-old active duty male who was admitted for management of nonexertional, positional, pleuritic chest pain. ⋯ Laboratory findings revealed an undetectable serum thyrotropin level and further evaluation with a contrast chest computed tomography confirmed the presence of a goiter and an anterior mediastinal mass. The patient's pericarditis and thymic hyperplasia resolved with treatment of his Graves' disease.
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Tourniquet use recently became common in war, but knowledge gaps remain regarding analysis of recovered devices. The purpose of this study was to analyze tourniquets to identify opportunities for improved training. ⋯ Tourniquet counts, band routings, windlass turn numbers, and deformation rates are candidate topics for instructors to refine training.
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The Combat Ready Clamp is indicated to stop difficult inguinal bleeding on the battlefield, the most common type of junctional bleeding and now the most common cause of preventable battlefield death. The purpose of the present study is to report the data of clamp development to help appliers use it correctly. ⋯ The evidence of how the clamp works in the cadaver model showed that clamp use can plausibly be tailored to control inguinal hemorrhage from one wound, control two ipsilateral wounds with hemorrhage from one artery (e.g., common iliac artery), and control bilateral inguinal wounds (compression of the origins of bilateral common iliac arteries).
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Case Reports
Buprenorphine/naloxone therapy for opioid refractory neuropathic pain following traumatic amputation: a case series.
Phantom limb pain is a common consequence of limb amputation and is prevalent among the service members sustaining traumatic battlefield limb injuries during the conflicts in Iraq and Afghanistan. Current treatment to relieve phantom limb pain consists of physical, behavioral, and medical modalities including opioids and adjunct medications. ⋯ This case series describes four previously healthy service members who developed phantom limb pain following traumatic amputation successfully treated with buprenorphine/naloxone after failing traditional treatment. This is the first reported case series of patients expressing improved pain control with decreased frequency of phantom limb pain with the use of buprenorphine/naloxone instead of traditional opioid agonists.
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U. S. Army flight medics performed a process improvement initiative of 15 blood product transfusions on select Category A (Urgent) helicopter evacuation casualties meeting approved clinical indications for transfusion. ⋯ All casualties within a 10-minute flight time who met clinical indications were transfused. Utilization of a standard operating procedure with strict handling and administration parameters, a rigorous training and qualification program, an elaborate cold chain system, and redundant documentation of blood product units ensured that flight medic initiated transfusions were safe and effective. Research study is needed to refine the indications for prehospital blood transfusion and to determine the effect on outcomes in severely injured trauma patients.