Military medicine
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On October 22, 2005, a preventive medicine team deployed with the 212th Mobile Army Surgical Hospital to assist with earthquake relief efforts in Pakistani-controlled Kashmir. These efforts included core field preventive medicine but quickly extended into other efforts. In collaboration with the host nation and other organizations, the preventive medicine team performed additional support for operations outside the U. ⋯ Training and collaborative relationships with other government agencies, such as the U. S. Agency for International Development, and with nongovernmental organizations should continue to be developed.
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A 22-year-old African American U. S. sailor presented with an intermittent pruritic eruption precipitated by mild activity for the last 2 years. She developed an extremely pruritic papular rash that would quickly coalesce into larger wheals following any exercise, light activity such as vacuuming, or taking hot showers. ⋯ Previous treatment with antihistamines and steroids had failed to control her symptoms. She was diagnosed with cholinergic urticaria, successfully controlled with a combination of cetirizine, montelukast, and propanolol. She has since been returned to full military duty and is able to exercise regularly.
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The use of a tourniquet to control bleeding is a necessity in both surgical and prehospital settings. Tourniquet application, if performed properly, can be a lifesaving procedure, particularly in a traumatic setting such as the battlefield. A tourniquet is easily applied and requires the use of a relatively uncomplicated piece of equipment. ⋯ Here we present five case reports of improper tourniquet applications on the battlefield that resulted in nerve damage. We conclude that there is a need for improved training among medical personnel in the use of tourniquets, as well as a need for an adjustable-pressure, commercial-type sphygmomanometer cuff with a large surface area that is appropriate for application to all limbs parts. We also recommend that, in cases requiring the use of a tourniquet, the caregiver remove the tourniquet every 2 hours and assess the bleeding; if the bleeding has stopped, then the tourniquet should be replaced with a pressure bandage to minimize tissue damage.
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Surgical cricothyroidotomy is the airway of choice in combat. It is too dangerous for combat medics to perform orotracheal intubation, because of the time needed to complete the procedure and the light signature from the intubation equipment, which provides an easy target for the enemy. The purpose of this article was to provide a modified approach for obtaining a surgical airway in complete darkness, with night-vision goggles. ⋯ Combat medics can perform the three-step surgical cricothyroidotomy quickly and efficiently in complete darkness. An elastic bougie is required to place a larger endotracheal tube. No additional surgical equipment is needed.