Military medicine
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Review Case Reports
Collapse from exertional heat illness: implications and subsequent decisions.
The implications of the collapse of a soldier early in an exercise from exertional heat illness (EHI) are considered. Such soldiers may be at risk from a genetic predisposition. Malignant hyperthermia (MH) and isolated and improbable cases of EHI may be just two different expressions of the same mutated gene sequence. ⋯ The sedentary pilgrims succumbed to a very high external ambient temperature, the active soldiers to a huge output of internal metabolic heat. Only eventual advances in defining the genetics of MH and EHI will resolve the present confusion of the relationship between the two conditions. Meanwhile, there is a need to bypass considerations of the etiology of EHI and to identify the vulnerable and handicapped soldier by exposure after an interval of time to one or more exercise tolerance tests.
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Furuncular myiasis is a parasitic infestation of human and other vertebrate tissues by fly larvae of primarily two species: Dermatobia hominis (human botfly, t6rsalo, or berne) in Mexico and South and Central America and Cordylobia anthropophaga (tumbu fly or mango fly) in Africa. Cuterebra species (rabbit and rodent botflies) are also rarely reported to cause furuncular myiasis only within the United States. Although these species inhabit different geographic regions and have different life cycles, their clinical presentations can be similar. ⋯ We review the life cycles of human botflies and key aspects of their clinical presentation, differential diagnosis, and various therapeutic modalities. Most physicians may never encounter myiasis and attribute a patient's complaints to an insect bite or skin infection that will heal without treatment. However, the diagnosis of furuncular myiasis should be considered by remembering the basic elements of this condition: recent travel history to the tropics and a sterile, persistent furuncle with sensations of movement and pain.
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The timing, location, and participants in a mass casualty scenario cannot be predicted. Nurses may be involved in performing triage, yet there is no published documentation of military nurses' ability to triage. ⋯ The most significant areas associated with higher scores on the Triage Test were: completion of Advanced Cardiac Life Support, advanced certification as a Certified Registered Nurse Anesthetists, Certified Emergency Nurse, or Critical Care Registered Nurse, and attendance to the Medical Management of Nuclear Weapons Course. An improved average score for nurses overall was also noted when compared with previous work with the Darnall MASCAL Triage Test.
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Musculoskeletal disorders are among the most common causes of disability in the military population. The objectives of this study were to assess the frequency of musculoskeletal disabilities in police force personnel and to determine the association between disabilities and age, rank, and different job types. The population studied were 2600 Islamic Republic of Iran police force disability cases from March 1997 to March 1998. ⋯ There were associations between specific jobs and musculoskeletal disabilities. According to present data, musculoskeletal disorders account for one-quarter of disability cases in police force personnel. Prevention programs, especially in high-risk groups, should be considered.
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Randomized Controlled Trial Clinical Trial
Axillary brachial plexus blockade: an evaluation of three techniques.
Surgical procedures to the distal humerus, elbow, and proximal forearm are ideally suited to regional anesthetic techniques. Selection of the preferred approach is determined by the innervation of the surgical site, the risks of regional anesthesia-related complications, and the preference and experience of the anesthesiologist. The axillary approach to the brachial plexus is the most commonly used because of its ease of performance, patient acceptance, safety, and reliability, particularly for hand and forearm surgery. ⋯ Axillary blockade performed using the combined technique had higher a success rate than blockade performed with the transarterial and Winnie techniques. Our results suggest that all three techniques are reliable for axillary blockade. But the onset, complete blockade time, and quality of analgesia were better with the combined technique than with the transarterial and Winnie techniques.