Military medicine
-
Infectious complications are reported frequently in combat trauma patients treated at military hospitals. Infections in 4566 noncombat related trauma patients treated at a military trauma center were retrospectively reviewed from 1/2003 to 5/2007 using registry data. Burns, penetrating, and blunt trauma accounted for 17%, 19%, and 64%, respectively; the median age was 38 and 22% were female. ⋯ Multivariate analysis revealed associations between infection and hospital LOS, preexisting medical conditions, and lower Glasgow Coma Scale in nonburned patients. In burned patients, infection was associated with total body surface area burned and preexisting conditions (p < 0.01). Enhanced infection control in targeted trauma populations may improve outcomes.
-
Physiologic free serum cortisol may more accurately reflect adrenal function than total cortisol levels. Salivary cortisol estimates free serum cortisol. We researched the clinical viability of salivary cortisol in hospitalized patients. ⋯ Salivary cortisol is an acceptable surrogate for free serum cortisol when satisfactory salivary volumes are procured. Due to inadequate sample volumes, and contamination, it should not be generally adopted in the ICU. We identified discordance between free and total cortisol in interpreting AI, suggesting reinterpretation of seminal trials investigating physiologic corticosteroid replacement on the basis of total cortisol levels. The analysis of both free serum cortisol via ultrafiltration and salivary cortisol involved two steps: sample centrifugation followed by ELISA, suggesting consideration of widespread adoption of free serum cortisol in future investigations.
-
Comparative Study
Comparative testing of new hemostatic agents in a swine model of extremity arterial and venous hemorrhage.
To compare advanced hemostatic dressings: HemCon (HC), QuikClot ACS+ (advanced clotting sponge, and two granular agents: Celox (CX) and WoundStat (WS), with a standard field dressing in a swine model of extremity hemorrhage. ⋯ All hemostatic dressings result in significantly less blood loss and improved survival over standard gauze dressing.
-
Case Reports
Development of a complicated pain syndrome following cyanide poisoning in a U.S. soldier.
A majority of modern war wounds are caused by blasts and high-energy ballistics. Extremity injuries predominate since modern body armor does not protect these areas due to mobility limitations. ⋯ We describe a case of a soldier with CN intoxication due to ingestion of tobacco purchased from a local merchant. The soldier developed a complex neuropathic pain syndrome and was successfully treated with an inpatient high-dose intravenous ketamine infusion in combination with continuous peripheral nerve blockade.
-
Psychiatric disorders in military members require substantial medical, administrative, and financial resources, and are among the leading causes of hospitalization and early discharge. We reviewed available data to better understand the incidence of bipolar I disorder among military personnel. Defense Medical Epidemiology Database inpatient data were used. ⋯ The incidence increased over time for depressed and mixed episode types among both genders. High risk groups include women, younger individuals, and whites. This population provides insight into adult onset bipolar I disorder incidence and demographic patterns not available elsewhere and offers potential opportunities to improve its understanding.