Military medicine
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Multicenter Study
Immune cytokine response in combat casualties: blast or explosive trauma with or without secondary sepsis.
The aim of this study was to assess the prognostic value of tumor necrosis factor (TNF) alpha, interleukin (IL)-8, IL-4, and IL-10 in combat casualties. Fifty-six casualties with severe trauma (blast and explosive) who developed sepsis and 20 casualties with the same severity of trauma without sepsis were enrolled in this study. Fifty-five casualties developed multiple organ dysfunction syndrome; 36 died. ⋯ Mean values of IL-8 were 60-fold, TNF-alpha were 43.5-fold, and IL-10 were 70-fold higher in the multiple organ dysfunction syndrome group (p < 0.01). Mean values of IL-8 were 2.3-fold and IL-10 were 1.4-fold higher in nonsurvivors and TNF-alpha were 2.2-fold higher in survivors (p < 0.01). IL-4 had no significance as a predictor of severity and outcome.
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A 35-year-old active duty service member sustained a 6.5% body surface area burn as a result of exposure to the chemical warfare agent sulfur mustard, which is the most severe mustard exposure of a U. S. military member since World War II that is known to us. New techniques were used to demonstrate the detectable persistence of mustard metabolites in the patient's blood for at least 41 days after exposure, validating these techniques for the first time for a human mustard patient; they were also used for the first time with human mustard blister fluid. ⋯ Although this patient's lesions were never life-threatening, he required 2 weeks of intensive burn care. He has been left with ongoing posttraumatic stress disorder and has had an incomplete dermatological recovery. In a major terrorist attack involving many patients exposed to sulfur mustard, care resources would be depleted quickly.
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The Navy-Marine Corps Combat Trauma Registry is a data repository summarizing information from data sets describing injuries sustained and treatments administered to casualties from the point of injury to rehabilitation. Among the medical facilities contributing data to the Combat Trauma Registry during Operation Iraqi Freedom were the Marine Corps forward surgical companies. The surgical companies offer resuscitative surgery, medical treatment, and temporary holding facilities, in addition to preparing patients for evacuation. ⋯ S. casualties seen were wounded in action. In contrast, >75% of the enemy prisoner of war presentations were for battle injuries. Less than 15% of the patients were held at the facilities for >24 hours.
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With rapid and frequent deployments around the world, the current high level of military operations demands combat readiness of every military member. In the U. S. ⋯ Strategies to mitigate and even eliminate these concerns include the optional use of hormonal medications to induce reversible menstrual cycle suppression. These medications, traditionally indicated for contraception, should be considered essential for female troops during training and deployment. This article, tailored specifically for military women, provides valuable information regarding the risks and benefits, as well as the various options available for menstrual cycle suppression.
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Air Force (AF)-certified registered nurse anesthetists (CRNAs) play an important role in the support of the global war on terror. The purpose of the investigation was to use an AF CRNA-specific modification of the Readiness Estimate and Deployability Index Revised for AF Nurses to assess readiness for deployment. Dimensions included clinical competency, operational competency, soldier/survival skills, personal/psychosocial/physical readiness, leadership and administrative support, and group integration/identification. ⋯ Available stateside AF CRNAs (n=105) were surveyed, with a 60% response rate. Descriptive statistics were used to describe the sample, providing a mean score for each variable. Using a 5-point scale, participants rated themselves with an overall readiness score of 4.09, which suggests that AF CRNAs perceive themselves as ready to deploy.