Military medicine
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Case Reports
Mysterious Cause of Respiratory Failure and Multilobar Atelectasis in a 17-Month-Old Male.
A 17-month-old male presented to a community hospital emergency department in respiratory distress suggestive of reactive airway exacerbation or pneumonia. He rapidly deteriorated into fulminant respiratory failure with multilobar atelectasis. He was managed with continuous albuterol, intravenous antibiotics, corticosteroids, intubation, and vasopressors. ⋯ Outpatient investigation after discharge revealed dysphagia, milk allergy, and eosinophilic esophagitis. In this case, it is highly probable that aspiration secondary to dysphagia and eosinophilic esophagitis led to respiratory failure. This case demonstrates the possible rapid decompensation from aspiration due to insidious inflammation of the esophagus and dysphagia in an otherwise anatomically normal toddler.
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Military free fall or high-altitude low-opening parachute jumps play a key role in special operations tactics, though injury patterns in these operators are not well characterized. In contrast to lower-altitude static line paratroopers, free fall operators require precise parachute deployment after a prolonged descent, with the potential for high-velocity trauma. This report describes a 33-year-old Marine Corps Reconnaissance operator who sustained left comminuted basicervical femoral neck fracture requiring cephalomedullary nail internal fixation with a full recovery. This femoral neck fracture highlights the high-energy injuries experienced by these invaluable operators, especially when conducting combat or night jumps.
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Intracranial subdural empyema is a rare clinical entity with incidence estimates of 0.1 per 100,000 people. The condition is most often the sequela of a primary infection elsewhere and carries a high morbidity and mortality. The authors present the case of a 22-year-old active duty soldier on mission on the southern border of the United States. ⋯ The patient was promptly transferred to a military tertiary care center where further workup including pivotal imaging confirmed subdural empyema and right transverse sinus thrombosis. Given the rapid patient deterioration associated with subdural empyema, the emergent intravenous antibiotics, neurosurgical consultation, and subsequent collection evacuation performed are likely to credit for saving this soldier's life. This case highlighted an atypical and time-sensitive etiology for a common complaint in the active duty population, which underscores the requirement for evacuation to higher roles of care in those soldiers with a similar diagnosis.