Journal of the Royal Army Medical Corps
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Sickle cell trait, as opposed to the disease, is a rare condition with fewer medical complications. We present a case of a 24 year old Army recruit, who required multiple fasciotomies for limb compartment syndrome, associated with sickle cell trait. We discuss the management, complications and screening programmes of the condition and make suggestions for the training of sickle cell trait personnel in planning a career in the Armed Forces.
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Undifferentiated febrile illnesses have been a threat to British expeditionary forces ever since the Crusades. The infections responsible were identified during the Colonial Era, both World Wars and smaller conflicts since, but nearly all remain a significant threat today. Undiagnosed febrile illnesses have occurred amongst British troops in Helmand, Afghanistan since 2006 and so a fever study was performed to identify them. ⋯ These cases probably represent the "tip of an iceberg" for British and Allied forces. More resources for diagnostic facilities and follow-up of patients are required to improve the management and surveillance of "Helmand Fever" cases; until then doxycycline 100 mg twice daily for 2 weeks should be given to all troops who present with an undifferentiated febrile illness in Helmand, Afghanistan. Patients with acute Q fever should be followed-up for at least 2 years to exclude chronic Q fever. Prevention of these diseases requires a better understanding of their epidemiology, but prophylaxis with doxycycline and possibly Q fever vaccine should be considered.
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Science and mountain exploration are closely linked throughout history. A large array of studies of varying complexity have been performed in conditions of hypobaric hypoxia, some on field studies, some in hypobaric chambers. ⋯ Field studies in the mountains are challenging to design and undertake and need to balance practicalities (e.g. limited power supply) with scientific objectives. This article examines the history and rationale for high altitude research and discusses the challenges of organising a field study.
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Frostbite is a thermal injury that can occur when temperatures drop low enough for tissue to freeze. On rewarming the tissues, an inflammatory process develops which is often associated with tissue loss. ⋯ Practical advice is given on both the field and hospital management and how to seek expert advice from remote situations. The review also discusses newer developments in frostbite treatment such as intra-vascular thrombolysis and adjunctive treatments such as the use of intravenous vasodilators.
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Review
Causes of injuries in the mountains: a review of worldwide reports into accidents in mountaineering.
This review presents a selection of sources from the UK and around the world that have reported on both incidents and accidents in the mountains. Common themes are extracted to illustrate the circumstances under which accidents, injuries and fatalities occur and the underlying factors that have contributed to incidents in the first place. ⋯ The purpose of highlighting these issues is to allow those undertaking them to understand where the greatest risks lie. This enables the individual, team leaders, rescue services and those involved in the overall management of wilderness areas to plan accordingly, with the aim of reducing injuries and deaths.