Military medicine
-
Comparative Study
Advance directives and do-not-resuscitate orders on general medical wards versus the intensive care unit.
The records of 335 patients admitted to the general medicine wards and to the medical intensive and coronary care unit (MICCU) at Brooke Army Medical Center were retrospectively reviewed to assess the frequency of advance directives and "do not resuscitate" (DNR) designations. Two hundred sixty-seven (79.7%) were admitted to the ward and 68 (20.3%) were admitted to the MICCU. Advance directives were executed in 14.9% of patients. ⋯ There were no statistical differences in mean length of stay, presence of advance directives, or documentation of advance directives in ward versus MICCU patients. However, there was a statistical difference in the number of deaths in the MICCU as compared with that on the ward (9.7 vs. 2.7%, p < 0.05). The frequency of advance directives and DNR designations did not differ between ward and MICCU patients in this population, although there was a trend for greater DNR designations in the MICCU environment.
-
Case Reports
Intracranial insertion of a nasopharyngeal airway in a patient with craniofacial trauma.
Intracranial insertion of a nasopharyngeal airway is an unusual and catastrophic complication of airway management in the patient with a severe closed head injury. We present an unfortunate 43-year-old patient with intracranial insertion of a nasopharyngeal airway during trauma resuscitation. The nasopharyngeal airway was removed. ⋯ Oropharyngeal airways may be used to assist with ventilation. However, it is preferable to definitively secure the airway through inline endotracheal intubation or with surgical techniques in this patient population. Should violation of the skull base occur, removal is accomplished in the controlled environment of the operating room.
-
The Department of Defense (DoD) has engaged in West Nile virus (WNV) surveillance and response since 1999. In 2002, the three Services continued their cooperative, multidisciplinary approach to the WNV outbreak. Activities included a doubling of mosquito surveillance and vector control responses, extension of and doubling of bird and nonhuman mammal surveillance to all four continental United States regions, expanded diagnostic testing by DoD laboratories, and installation environmental clean up and personnel protection campaigns. ⋯ The surveillance detected WNV on 44 DoD installations. It led directly to vector control and prevention activities, and there were no confirmed cases of WNV reported in the DoD force. This multi-Service effort is a surveillance template for future outbreaks that threaten DoD force health.
-
Advances in medical technology provide the modern day field anesthetist with the extra edge to meet the challenges faced in the harsh environment of the battlefield and enhance the survivability of casualties. The tasks of triage, resuscitation, and administration of anesthesia can be facilitated with the use of new airway devices, portable ventilators, and monitoring devices. Before such equipment is used in the field, the anesthetist must carefully weigh the advantages and disadvantages and must be cognizant of the limitations of individual devices in different environmental settings. These devices should ideally be portable, lightweight, rugged in construction, durable, easy to use (requiring minimal training and supervision), readily replaceable, and cost-effective.
-
West Nile virus infection has quickly become a feared cause of neurologic disability and death, particularly when it presents with encephalitis. Recent epidemics in endemic regions of Eurasia and Africa, as well as its recent spread to North America, have highlighted the need for all physicians to be aware of its clinical presentation and course. In particular, because of the increased susceptibility of West Nile virus infection during outdoor activities, as well as during travel to the Middle East and Southeastern Europe, military physicians should be informed about case recognition, management, and prevention to maintain the health of soldiers and their families.