Combat Medicine: Basic and Clinical Research in Military, Trauma, and Emergency Medicine

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The effects of treatment were lasting, and the patient accomplished a successful transition to an independent maintenance program. Conclusion: Needling techniques have the potential to expedite favorable physical therapy outcomes for active-duty service members suffering from chronic mechanical and degenerative neck pain. The dramatic improvements observed in this case warrant additional exploration of treatment efficacy and delineation of best practices in the delivery of these techniques. Keywords: pain, neck ; physical therapy ; dry needling ; acupuncture ; acupuncture, battlefield ; pain management.

As the United States continues to increase its use of Special Operations Forces worldwide, treatment of craniomaxillofacial CMF trauma must be adapted to meet the needs of the warfighter. The remoteness of Special Operations can result in potentially longer times until definitive treatment may be reached.

Severe CMF trauma can result in substantial hemorrhage and airway compromise. These can be immediately life threatening and must be addressed expeditiously. Numerous devices and techniques for airway management have been made available to the forward provider. A thorough review of nonsurgical and surgical airway management of the patient with facial injury for the forward provider and providers at receiving facilities is provided in this article.

Techniques to address flail segments of the facial skeleton are critical in minimizing airway compromise in these patients. There are many methods to control hemorrhage from the head and neck region. Hemorrhage control is critical to ensure survival in the austere environment and allow for transport to a definitive care facility. Associated injuries to the cervical spine, globe, skull base, carotid artery, and brain must be carefully evaluated and addressed in these patients.

Management of vision- threatening orbital compartment syndrome is critical in patients with CMF injuries. Because the head and neck region remains relatively vulnerable in the warfighter, combat CMF trauma will continue to occur.

Chapter Modern Combat Casualty Care | Trauma, 7e | AccessSurgery | McGraw-Hill Medical

Forward providers will benefit from a review of the acute treatment of CMF traumatic injury. Properly triaging and treating facial injuries is necessary to afford the best chance of survival for patients with a devastating combat CMF injury. Keywords: craniomaxillofacial trauma ; airway management ; acute care ; hemorrhage ; ocular trauma. Smedick BC , van Wyck D. Acute compartment syndrome ACS involving the leg can occur in association with various traumatic and nontraumatic conditions, and it can have serious longterm consequences when unrecognized or untreated.

We present the case of a year-old Army paratrooper who developed acute anterior and lateral compartment syndrome of the lower extremity after being immobilized in an aircraft for hours with several hundred pounds of equipment compressing his lower extremities.

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To our knowledge, this is the first documented case of ACS occurring as a result of prejump conditions. ACS of the extremity should be considered in any Soldier who is required to bear heavy loads, is immobilized for several hours at a time, and complains of symptoms such as extremity pain, numbness, and weakness. Keywords: acute compartment syndrome, pressure ; immobilization. Keywords: infectious disease ; hepatitis E virus ; acute icteric hepatitis.

Pyotraumatic dermatitis a. Although not acutely life threatening, these lesions are extremely pruritic and distracting and significantly interfere with the canine's operational effectiveness and ability to stay on task.

Combat Medicine

The review discusses a case, including clinical presentation, diagnosis, treatment, and prognosis. Keywords: Operational K9s ; dog keepers ; pyotraumatic dermatitis ; hot spot ; acute moist dermatitis. Rhabdomyolysis is a common syndrome that can range from asymptomatic to a severe life-threatening condition. It is the result of acute muscle fiber necrosis leading to cell lysis and subsequent transfer of those byproducts into the circulatory system. In addition, the electrolytes contained within these cells are leached into the blood stream, which can lead to significant electrolyte abnormalities.

The etiology of rhabdomyolysis is broad and includes inherited diseases, drugs, toxins, muscle compression or overexertion, infections, and more. We describe five patients assigned to various companies within th Special Operations Aviation Regiment Airborne that developed exertional rhabdomyolysis of the bilateral upper extremities between June and January In this case series we will describe the events leading up to the diagnosis, lack of risk factors or family history, diagnostic criteria, treatment, and future concerns related to the condition.

Keywords: rhabdomyolysis ; acute renal failure ; myoglobinuria ; creatinine kinase ; overexertion exercise.

Conkright W , Deuster PA. Modern-day warfare and operational tempo require Special Operations Forces SOF personnel to be ready and able to perform optimally on the battlefield at all times. To do this, US Special Operations Command has invested in high-performance training centers and human performance staff, including performance dietitians. Performance dietitians are critical, because it is widely recognized that nutrition affects all aspects of health and performance, particularly for the SOF Operator.

Combat medic

These aspects include everything from physical and sensory to psychosocial and cognitive factors, as well as environmental exposures and genetic predispositions. The impact of nutrition on performance has been well established, with specific recommendations and position stands on fueling for athletics from multiple international organizations. However, sports nutrition guidelines are based on outcomes from sample means rather than individual changes in performance.

Precision performance nutrition solutions must include a systems-based approach and consider the individuality of the Operator along with their interactions with their environment. The purpose of this article is to summarize what is known about performance nutrition and outline what can be done to move toward personalized precision nutrition.

We discuss pitfalls and challenges with regard to mission-specific goals, optimization versus adaptation, and longitudinal tracking; and present our view of the future. Keywords: adaptation ; fueling ; longitudinal tracking ; metabolomics ; microbiome ; military ; nutrigenomics ; personalized nutrition. The "sports nutrition" market is expected to be one of the fastest growing segments because a "performance edge" is certainly desirable within the military.

DS products are readily available in retail stores on military bases, over the Internet, and in niche stores near military bases. Thus, use of some DSs raises a number of unique concerns, particularly considering the potential for interactions among combinations of DS ingredients and concurrent medications taken under military operational conditions. This article briefly reviews selected DS regulations, identifies concerns and risks related to various DS products, and describes the purpose, functions, and resources of Operation Supplement Safety.

Examples of regulatory concerns, adverse events, red flags, and tools are provided to help SOF communities sustain their health and performance. Keywords: adulteration ; human performance ; new dietary ingredient ; regulations ; tainted products ; supplements. TCCC has previously recommended interventions that can effectively prevent 4 of the top 5 causes of prehospital preventable death in combat casualties-extremity hemorrhage, junctional hemorrhage, airway obstruction, and tension pneumothorax- and deaths from these causes have been markedly reduced in US combat casualties.

  • Plant Cell and Tissue Culture.
  • Rush Advanced Trauma Training Program;
  • Modern Combat Casualty Care | Trauma, 8e | AccessSurgery | McGraw-Hill Medical.
  • See a Problem?;
  • Conformal Tensors. (First Note);
  • Military medicine.
  • Mechanics of Wood Machining?

Noncompressible torso hemorrhage NCTH is the last remaining major cause of preventable death on the battlefield and often causes death within 30 minutes of wounding. Additionally, Zone 1 Resuscitative Endovascular Balloon Occlusion of the Aorta REBOA can provide temporary control of bleeding in the abdomen and pelvis and improve hemodynamics in casualties who may be approaching traumatic cardiac arrest as a result of hemorrhagic shock.

Although Special Operations units are now using whole blood far-forward, this capability is not routinely present in other US combat units at this point in time. REBOA is not envisioned as care that could be accomplished by a unit medic working out of his or her aid bag. This intervention should be undertaken only by designated teams of advanced combat medical personnel with special training and equipment. Leptospirosis is a bacterial zoonosis with worldwide distribution and is potentially lethal to those infected if left untreated.

Due to the global posture of the U. Special Operations community, there is a seemingly perfect overlap of the regions in which they deploy and areas with concurrent endemic leptospirosis infection. Furthermore, Special Operations Forces SOF personel are known for working by, with, and through the host nation defense force, who tend to be commonly affected and often serve as a reservoir for this infection.

Other risk factors including the usage of infected military working dogs, contaminated training sites, and certain recreational activities associated with water increase the danger of exposure for this cohort. Due to this increased risk of leptospirosis by U. Special Operations service members, medical providers within this community must understand and utilize proper preventive medicine, prophylaxis, early detection, diagnosis, and treatment for this potentially lethal infection.

Keywords: leptospirosis ; operational medicine ; adventure racing ; zoonosis ; zoonotic disease ; spirochetes ; working dogs ; Special Operations. The administration of blood products to battlefield casualties in the prehospital arena has contributed significantly to the survival of critically injured patients in Afghanistan over the past 5 years.

Given as part of an established military "chain of survival," blood product administration has represented a step-change improvement in capability for both UK and US tactical aeromedical evacuation TACEVAC platforms. Further study of military prehospital casualty data is under way to identify additional physiological parameters that will allow simple scoring tools in the remote setting to guide the administration of prehospital blood products.

Keywords: trauma ; prehospital ; blood products ; military ; scoring tool ; tactical ; aeromedical evacuation. Special Operations Forces and their accompanying tactical multipurpose canines MPCs who are involved in repeated live-fire exercises and military operations have the potential for increased blood lead levels and toxicity due to aerosolized and environmental lead debris. Clinical lead-toxicity symptoms can mimic other medical disorders, rendering accurate diagnosis more challenging. The objective of this study was to examine baseline lead levels of MPCs exposed to indoor firing ranges compared with those of nontactical military working dogs MWDs with limited or no exposure to the same environment.

In the second part of the study, results of a commercially available, human-blood lead testing system were compared with those of a benchtop inductively coupled plasma-mass spectrometry ICP-MS analysis technique.

Blood samples from 18 MPCs were tested during routine clinical blood draws, and six samples from a canine group with limited exposure to environmental lead nontactical MWDs were tested for comparison. There was a high correlation between results of the commercial blood-testing system compared with ICP-MS when blood lead levels were higher than 4.

Both testing methods recorded higher blood lead levels in the MPC blood samples than in those of the nontactical MWDs, although none of the MPC samples tested contained lead levels approaching those at which symptoms of lead toxicity have previously been reported in animals i. Keywords: heavy metal toxicity ; aerosolization ; lead, blook toxicity analysis ; canines, multipurpose ; dogs, military working. Background: Recent efforts to improve the quality of care in the Afghanistan theater have focused on extremity compartment syndrome, a common, disabling, and costly problem.

To identify opportunities to improve care, the present survey was undertaken to observe the use of two standard methods-the traditional, improvised method and the common, off-the-shelf method-for determining intracompartmental pressures in the lower extremities of combat casualties. Methods: As part of a quality of care improvement effort during Operation Enduring Freedom, all combat casualties presenting to a forward surgical team at Forward Operating Base Shank from August to November with lower-extremity major trauma were evaluated for signs and symptoms of compartment syndrome.

Results: Ten casualties had pressure measurement surveyed simultaneously using both methods. A two one-sided test analysis demonstrated a mean difference of A repeated-measures analysis yielded a p value of. Conclusion: The main finding of the quality of care effort was that clinicians received similar information from use of two standard methods for far forward measurement of pressures to detect extremity compartment syndrome. This finding may help clinicians improve the quality of care in the theater in detecting, diagnosing, and monitoring compartment syndrome.

Keywords: fascia wounds ; injuries ; emergency medical services ; Afghan Campaign present ; military medicine.

Basic and Clinical Research in Military, Trauma, and Emergency Medicine