Military medicine
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Combat trauma differs from its peacetime counterpart by involving a different spectrum of injuries, occurring in austere environments, dealing with mass casualties, and embodying inherent treatment delays. Thus, civilian trauma practices may be inappropriate in certain combat settings. ⋯ The following recommendations are made. (1) Military antishock trousers are still useful in a combat setting. (2) Soft-tissue wound management should be directed by the wound rather than by the weapon. (3) Cautious avoidance of colostomy may be indicated in certain wartime colon wounds. (4) The majority of combat casualties require early vigorous fluid resuscitation. When civilian trauma experience challenges military dogma, it must be carefully considered before being applied to a combat setting.
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Biography Historical Article
New York-Tidewater Chapters' History of Military Medicine Award. The military odyssey of Norman Bethune.
While visiting the Peoples Republic of China in 1982, I became aware of the work of the Canadian, Norman Bethune, as a military surgeon. Bethune first served as a stretcher-bearer in an ambulance unit and later as a medical officer with the Allies during the First World War. He also participated in the Spanish Civil War as a military physician. ⋯ In the annals of Chinese military history, he has been given an honored place as a military surgeon and a martyr. He is also credited in China with improving the practice of battlefield medicine, as an organizer, teacher, and innovator. Bethune's fame in China is now spreading to Canada.
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A pediatric critical care transport program was initiated and organized at Naval Medical Center San Diego in January 1994. The primary goal of the program was to formally train military pediatric residents in the early stabilization and transport of the critically ill neonatal and pediatric patient. It was also felt that such a program would generate significant cost savings to the Department of Defense. We present the statistics, training protocol, and the cost savings. In addition, we surveyed previous residents who had been involved with this program to determine its perceived benefit. ⋯ In summary, we report our experience with the development of a pediatric critical care transport program. The program was developed to provide military pediatric residents instruction and experience in the stabilization and transport of critically ill children. In addition, we were able to demonstrate a significant cost avoidance.
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Polyuria with marked plasma sodium disturbance was present in 39 of 224 patients with isolated craniocerebral war injuries. Twenty-one of these 39 patients had hyponatremia (sodium level < 130 mmol/l) and polyuria. ⋯ The remaining 18 patients developed classic diabetes insipidus syndrome, and 6 of them (33%) died of hypernatremia within 30 days after trauma. The mortality in both patients with hyponatremia and patients with diabetes insipidus was higher in those with greater disturbances of plasma sodium concentration with polyuria and those with lower Glasgow Coma Scale scores.
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To report the distributions and characteristics of spouse abuse victims and offenders in the U.S. Army Central Registry from 1989 to 1997. ⋯ U.S. military populations provide unique opportunities to study family violence because of the socioeconomic "floor" under service members and their families. Comparisons between military and civil populations on precipitating circumstances, case assessment and definition, and treatment efficacy would be fruitful areas for research.