Military medicine
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As clinicians continue to gain experience with the use of emergency cricothyrotomy, a need exists to continue to explore methods to perfect both the technique and the equipment used. The clinician in the austere military environment may be forced to be innovative in the design of such a device. ⋯ The emergency airway device was compared with the needle cricothyrotomy technique. The control profile for the return of acceptable oxygen saturation and arterial oxygen levels was more closely matched by the emergency airway device than by the needle cricothyrotomy technique.
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In previous studies, the use of mechanical ventilation in a push-over configuration with the Ohmeda Universal Portable Anesthesia Complete vaporizer was evaluated by bench testing and clinical application. During the clinical evaluation, it was noted that airway pressure transmitted back through the vaporizer during inspiration affected performance based on the concentration of inhalation agent delivered. This study evaluated the effects of airway pressure on vaporizer performance and established concentration curves for clinically significant incremental increases in airway pressure. Vaporizer performance was consistent, predictable, and correlated with the data obtained in previous studies.
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The cases of eight Special Forces soldiers who sustained cold weather-related injuries while conducting winter training as part of Operation Arctic Saber in the Northwest Territories and Arctic Circle are reported. Environmentally related injuries can represent difficult diagnostic and treatment challenges in the field. ⋯ Mission requirements, equipment utilization, and environmental exposure place soldiers at particular risk for cold weather-related injuries in such austere settings. Nonetheless, with appropriate education and safety precautions, these potentially life-threatening risks can be greatly minimized.
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The factors assumed to exert an influence on the outcomes of 176 patients who sustained head injuries through projectiles during the Croatian War were evaluated. The type of projectile, wound age, retained foreign bodies, and patient sex and age had no significant influence on outcome. ⋯ Infections were more common in patients with retained foreign bodies in wounds that were older than 48 hours (43%) and in patients with cerebrospinal fluid fistulas (50%). In assessing the outcomes of missile head injuries in wartime, the Glasgow Coma Scale score, type of head wound, site of skull penetration, endocranial projectile path, intracranial hematomas, and complications, especially infectious, represent reliable predictors of outcome.
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We reviewed a total of 2,525 snakebite patients in Bangkok. Of these, 1,415 were bitten by venomous snakes, 91 by neurotoxic snakes of genus Naja or Bungarus and 1,324 by snakes of family Viperidae or Crotalidae. Seventy-one percent of bites were on the lower extremity. ⋯ Care of a snakebite victim should consist of immobilization and bandaging of the bitten limb with elastic bandages during transport to the hospital, early surgical debridement of necrotic tissue, appropriate infusion of antivenin, aggressive respiratory support, management of shock and infection, and peritoneal dialysis or hemodialysis. Incision of bite wounds, suctioning, application of ice, and tourniquets are of no proven value and may be dangerous. All snakebite victims in southeast Asia should survive if they receive early competent care.