Military medicine
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Comparative Study
Screening CT angiography for detection of blunt carotid and vertebral artery injury in the setting of combat-related trauma.
Blunt carotid and vertebral artery injury (BCVI) is a relatively rare injury reported in the civilian sector and is associated with high morbidity and mortality. The purpose of our study was to use an optimized computed tomography angiography protocol in the deployed setting to determine the prevalence of BCVI in a consecutive patient population having experienced recent wartime-related traumatic injuries. From July 2008 to September 2009, a total of 307 consecutive trauma patients were included in this study. ⋯ There was no statistically significant difference between the prevalence of BCVI in the deployed setting and the civilian sector. We speculate that in our study population, the relatively decreased prevalence of cervical spinal fractures (3.3%) observed may counter the theoretical increased risk of vascular injury from blast trauma, ultimately producing a similar prevalence of overall BCVI compared to civilian study populations. Based on our observations, we cannot advocate for or against more liberalized screening of BCVI in the deployed setting, and military physicians may elect to continue screening for these injuries with currently established and accepted practice guidelines developed in civilian trauma populations.
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Report the efficacious use of stellate ganglion blocks (SGBs) in treating the anxiety symptoms of four patients diagnosed with combat-related post-traumatic stress disorder (PTSD) and discuss possible mechanisms of action to explain these findings. ⋯ Selective blockade of the right stellate ganglion at C6 is a minimally invasive procedure with an excellent safety profile that may provide sustained relief of PTSD symptoms. The procedure may also provide benefit for those who are resistant to psychotropic intervention.
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Comparative Study
Humanitarian care by a forward surgical team in afghanistan.
The mission of a Forward Surgical Team (FST) is to provide immediate lifesaving surgery to wounded U.S. and coalition forces. The degree of humanitarian surgical care provided to civilians is a topic of controversy. ⋯ This is the first report of humanitarian surgical care provided by surgeons of a FST in Afghanistan. Time and resource investment was minimal with no evidence of a negative impact on the primary mission of the FST.
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Refeeding syndrome is an under-recognized complication of starvation. Presented is a 26-year-old Marine recruit who was found to have hypothermia, mental status changes, and rhabdomyolysis after purposeful weight loss with calorie restriction in conjunction with an arduous exercise program. With rest and food, the patient developed refeeding syndrome, with hypophosphatemia requiring prolonged intravenous replacement. His case is unique in illustrating both malnutrition and refeeding syndrome in someone who appeared to be healthy and was exercising strenuously up to the point of hospital admission.
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Case Reports
Simultaneous bilateral anterior shoulder fracture dislocation following a seizure: a case report.
Simultaneous, bilateral, anterior dislocations of the glenohumeral joint are rare, most attributable to major trauma. Seizure disorders and electrocution are a common cause of glenohumeral and fracture dislocations although these are most commonly posterior injuries. We present an interesting case report of diagnosis and treatment of an active duty sailor with bilateral anterior shoulder fracture dislocations following a seizure.