Military medicine
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Severe acute respiratory syndrome (SARS) is a highly infectious, rapidly progressive, emerging disease. Early diagnosis and preventive measures are key for treatment and minimization of secondary spread. In the context of the armed forces, aggressive containment measures are essential to prevent an outbreak. ⋯ In the early recovery period, potential problems during diving are caused by inadequate lung ventilation in relation to exercise level and increased breathing resistance attributable to weak respiratory muscles, with corresponding risk of hypoxia and hypercapnia, as well as decreased ability to respond to nonrespiratory problems during diving. Problems in the late recovery period include increased risk of diving complications (such as pulmonary barotrauma) resulting from fibrosis and scarring within the lung parenchyma, which are known complications of SARS. From our experience, we suggest that computed tomographic scans of the thorax, lung function tests, and careful follow-up monitoring should play a vital role in the assessment of patients during the convalescent period, before certification of fitness to dive.
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The field hospital remains a centerpiece of casualty care evacuation systems, dating back to the Civil War. Dr. ⋯ By examining the specific levels of care available on the battlefield, I review the evolution of the different types of field hospitals, focusing on the increasingly complex capabilities that evolved in the spring of 1862 in the Western Theater. I conclude that Irwin's hospital was the first practical demonstration that sufficient inpatient care could be provided on the battlefield, eliminating the need to evacuate unstable patients.
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The Naval Health Research Center conducted laboratory-based surveillance for febrile respiratory infections at the 2003 Cobra Gold Exercise in Thailand. Seventeen individuals met the case definition for febrile respiratory illness, and diagnostic specimens were obtained from 16. ⋯ Logistical challenges were overcome as laboratory-supported febrile respiratory illness surveillance was conducted during a military training exercise. With heightened concern over the potential for another global influenza pandemic, such surveillance could prove critical for the detection of emerging influenza and respiratory pathogen strains with potential for importation to the United States.
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Complex regional pain syndrome (CRPS) is a relatively common disabling disorder of unknown pathophysiology. CRPS is a variable symptom complex that probably results from multiple causes through different pathophysiological mechanisms. Changes in peripheral, central, somatosensory, autonomic, and motor processing, accompanied by pathological interactions of sympathetic and afferent systems, are observed as underlying mechanisms. Standardized early interventions for patients with extremity wounds may prevent the onset of CRPS or at least reduce the severity or duration of the condition.
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This article examines the history of battlefield tourniquets. The tourniquet, if used properly, is perhaps the leading lifesaving device available to soldiers in the field. However, tourniquet use has been surrounded throughout history by controversy and dogma which continue today. Only after examining the historical context of warfare, weapons, injuries, and medical thought can we gain insight into the proper role of the tourniquet on the modern battlefield.