Military medicine
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We conducted a retrospective review of all patients with orthopedic injuries evacuated to a single medical center to evaluate the treatment and outcome of these injuries in three recent U. S. military conflicts: Operation Urgent Fury (Grenada), Operation Desert Shield/Storm (southwest Asia), and Operation Restore Hope (Somalia). Sixteen orthopedic casualties were originally treated at the medical detachment in Grenada before evacuation to the medical center. ⋯ Many of these injuries are the result of high-velocity weapons or blast injuries. Regardless of the size and/or purpose of the intervention, similar injury patterns and severity can be expected, because 51% of orthopedic patients had open fractures. Similarly, the rate of amputation associated with extremity trauma has not varied significantly since the Vietnam War.
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Randomized Controlled Trial Comparative Study Clinical Trial
Ketamine and oxycodone in the management of postoperative pain.
Relief of pain, whether post-traumatic or postoperative, is a prerequisite for the prevention of its deleterious effects on the whole organism. Unalleviated pain also increases the victim's or patient's anxiety and apprehension, which in turn increase the intensity of the pain. In the management of pain, opiates have maintained their position as the most common form of analgesic therapy despite the many side effects associated with their use. ⋯ Also, the suitability of oxycodone for field use was evaluated with respect to ketamine. Plethysmographic pulse-wave amplitude changes were compared with the pain visual analogue scale scores as measures of postoperative pain. The results of this study did not reveal any significant differences between the analgesic potencies of the studied drugs and clearly demonstrate that even suboptimal doses of both ketamine and oxycodone can provide appreciable relief of pain.
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To determine the critical care experience encountered by three recently graduated military pediatricians at an overseas military hospital and present one model of maximizing allowable critical care training time during residency. ⋯ Graduating military pediatric residents may be faced with caring for a wide range of critically ill neonatal and pediatric patients depending on their assignment. Residency training programs, with the recent increased emphasis on primary pediatric care, will need to streamline instruction in pediatric critical care to provide maximal benefit to the resident while maintaining compliance with Residency Review Committee guidelines.
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This descriptive, correlational study was conducted to explore factors (nurses and staff, doctors, waiting and convenience issues, and tests and treatments) and specific interpersonal behaviors affecting Department of Defense patient satisfaction in a military emergency department (ED). Data from a random sample of 534 patients using a mail-back questionnaire (N = 178) revealed that military patients who perceived the staff to have treated them courteously, taken their problems seriously, and paid attention to them during their stay were more satisfied with their military ED encounter. ⋯ Our findings suggest that a patient's perception of the ED encounter, particularly the interactions between the patient and staff, ultimately influence satisfaction. Significant improvements in patient satisfaction might be realized if quality improvement efforts focus on providing ED staff specific training in interpersonal interactions.