Military medicine
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Explosions can cause devastating injuries by various wounding mechanisms. Injuries due to the primary pressure wave are rarely life threatening and those that are lethal are uncommon. ⋯ There is much overlap in treatment of these wounds, and a detailed description is beyond the scope of this review. A brief summary of the initial surgical and nonsurgical management of blast injury that is useful for civilian and military clinicians is provided.
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The objective of this study was to determine the effectiveness of lactated Ringer's (LR) solution, sodium hydroxyethyl starch (hetastarch), and dopamine (DA) on diaphragm shortening (DS), diaphragm blood flow (DBF), diaphragm hydrogen peroxide (H2O2), and diaphragm apoptosis following hemorrhagic shock (HS). Sprague-Dawley rats were assigned to the following groups: HS, LR, LR plus DA, hetastarch, and hetastarch plus DA. After removing 40% of the blood volume, with exception of the HS group, an equal volume of resuscitation fluid was administered. ⋯ H2O2 and apoptosis decreased with LR administration. H2O2 and apoptosis were decreased to a much greater extent with LR plus DA, hetastarch, and hetastarch plus DA infusions. In conclusion, LR plus DA, hetastarch, and hetastarch plus DA maintained DS and DBF, which may be attributed to the decreases in reactive oxygen species as reflected by H2O2 and apoptosis.
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We used an anonymous self-reported questionnaire to assess posttraumatic stress disorder symptoms, relationship concerns, and treatment preferences including interest in family-focused interventions among 100 National Guard Soldiers who were recently redeployed from Iraq or Afghanistan. We found that the majority of married or partnered soldiers were concerned about getting along with their partners, while the majority of parents were concerned about their child-rearing practices. Posttraumatic stress disorder symptoms were significantly associated with the degree of relationship concerns. Soldiers showed a striking preference for family-based interventions over individual treatment, highlighting the importance of developing family-based interventions tailored to address post-deployment mental health and co-occurring family problems.
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The purpose of this project was to create a teaching module and evaluation tool for the prehospital assessment of patients with head injuries using the Full Outline of UnResponsiveness (FOUR) Score scale. The teaching module consisted of an overview of brain injury scales, general characteristics of the Glasgow Coma Scale (GCS) and the FOUR Score, demonstrations of the FOUR Score, and evaluation of the teaching module by participants. Participants determined that the FOUR Score is a viable alternative to the GCS, but took longer time to assess patients. Development of a more rapidly obtained FOUR Score, called the EMBR, is one option that may make this a viable alternative to the GCS.