Military medicine
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The predominant bacteria and antimicrobial susceptibilities were surveyed from a deployed, military, tertiary care facility in Baghdad, Iraq, serving U. S. troops, coalition forces, and Iraqis, from August 2003 through July 2004. We included cultures of blood, wounds, sputum, and urine, for a total of 908 cultures; 176 of these were obtained from U. ⋯ The 732 cultures obtained from the predominantly Iraqi population were Klebsiella pneumoniae (13%), Acinetobacter baumannii (11%), and Pseudomonas aeruginosa (10%); coagulase-negative staphylococci represented 21% of these isolates. These differences in prevalence were all statistically significant, when compared in chi2 analyses (p < 0.05). Antimicrobial susceptibility testing demonstrated broad resistance among the Gram-negative and Gram-positive bacteria.
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Bacterial contamination of war wounds occurs either at the time of injury or during the course of therapy. Characterization of the bacteria recovered at the time of initial trauma could influence the selection of empiric antimicrobial agents used to prevent infection. In the spring of 2004, U. ⋯ Our assessment of war wound bacterioly soon after injury reveals a predominance of Gram-positive organisms of low virulence and pathogenicity. The presence of MRSA in wounds likely reflects the increasing incidence of community-acquired MRSA bacteria. These data suggest that the use of broad-spectrum antibiotics with efficacy against more resistant, Gram-negative bacteria, such as Pseudomonas aeruginosa and Acinetobacter spp., is unnecessary in early wound management.
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The U. S. military services, drawing on the experiences of civilian trauma systems in monitoring trauma care delivery, have begun to implement their own registries, emphasizing injury incidence and severity in a combat environment. This article introduces and describes the development of the U. ⋯ The Navy-Marine Corps Combat Trauma Registry is composed of data sets describing events that occur from the point of injury through the medical chain of evacuation and on to long-term rehabilitative outcomes. Data were collected from Navy-Marine Corps level 1B, 2, and 3 medical treatment facilities. Data from the official combat period were analyzed to present a variety of preliminary findings that indicate, among other things, how many and for what type of injury casualties were evacuated, specific mechanisms of injury, and types of injuries treated at the medical treatment facilities.
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Today's military is experiencing rapid advances in technology and in manpower utilization. The Army Medical Department is redesigning the structure and function of deployable hospital systems as part of this effort. ⋯ The lived experiences of five nurse practitioners deployed to Operation Iraqi Freedom are presented. Data gathered during the deployment and an analysis of the literature clearly support expanded and legitimized roles for these health care professionals in future conflicts and peacekeeping operations.
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Casualties incurred during the assault on Punta Paitilla Airfield during Operation Just Cause were evaluated through reviews of records and interviews with the participants. There were eight initial casualties. ⋯ Rapid control of external exsanguination was the technique most likely to prevent death. Tourniquets were applied to three lower extremities for two casualties, without sequelae.