Heat illness experience at BMH Shaibah, Basra, during Operation TELIC: May–July 2003

2021 ◽  
pp. bmjmilitary-2021-001922
Author(s):  
Jamie Coleman ◽  
S Fair ◽  
H Doughty ◽  
M J Stacey
Keyword(s):  
Military Hospital ◽  
Heat Illness ◽  
Aeromedical Evacuation ◽  
Service Personnel ◽  
Effective Interventions ◽  
British Military ◽  
Clinical Syndromes ◽  
Local Reference ◽  
Life Threatening ◽  
Care Requirement

This is an observational study of heat-related illness in UK Service Personnel deployed into summer conditions in Northern Kuwait and Southern Iraq. Among 622 hospitalisations reported during a 9-week period at the historical British Military Hospital, Shaibah, 303 consecutive admissions are reviewed in detail. Several clinical syndromes attributable to thermal stress were observed. These ranged from self-limiting debility to life-threatening failures of homeostasis, with 5.0% developing a critical care requirement. Hyponatraemia was a commonly occurring electrolyte disturbance by which, relative to the local reference range, a majority of heat-attributed admissions were affected. Reductions in measured serum sodium could be profound (<125 mmol/L in 20.1% of all heat-related casualties). Hypokalaemia was observed in half of cases, though only a minority were affected by severely low potassium (<2.5 mmol/L in 4.0%). Despite preventive measures prescribed on hospital discharge, illness and significant biochemical derangements could recur upon return to duties in the heat. We reiterate the need for primary prevention of heat illness wherever possible and importance of early, effective interventions to treat and protect Service Personnel from secondary injury. We also highlight the requirement for comprehensive assessment to inform prognostication and occupational decision-making in relation to extreme climatic heat, including aeromedical evacuation. We draw additional attention to the contribution of psychological factors in select cases and identify research questions to improve understanding of environment-induced incapacitation in general.

Hand Injuries at a British Military Hospital on Operations

2006 ◽  
Vol 31 (2) ◽  
pp. 240-243 ◽  
Author(s):  
R. E. B. ANAKWE ◽  
D. M. STANDLEY
Keyword(s):  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Hand Injuries ◽  
Military Hospital ◽  
Hand Trauma ◽  
Field Hospital ◽  
Aeromedical Evacuation ◽  
Post Conflict ◽  
British Military ◽  
The Military

The nature of military medical support necessarily changes in the transition from war fighting to the post-conflict phase. This paper examines the activity in the only British Military Hospital serving a multi-national divisional area in Iraq over 2004 during this post-conflict phase. Hand injuries were common and formed a large proportion of the workload seen at the military field hospital on operations. The overwhelming majority of hand trauma resulted in soft tissue injury. There was a clear predisposition to hand trauma for males, manual workers, combat soldiers and engineers/mechanics. While most hand injuries do not require surgical intervention, they impact on the effectiveness of the military population as a result of the large proportion of patients who are placed on restricted duties following hand trauma, 157 of 241 in this study, and the number of soldiers who require aeromedical evacuation for further treatment, 38 of 360 in this study. These injuries require that military surgeons and emergency physicians should be experienced in the initial management of hand trauma and hand trauma should be a core component of their training. The skills of the specialist hand surgeon may be required for definitive management of these injuries at a later stage.

Diving Accident Evacuations by Helicopter and Immersion Pulmonary Edema

2020 ◽  
Vol 91 (10) ◽  
pp. 806-811
Author(s):  
Laëtitia Corgie ◽  
Nicolas Huiban ◽  
Jean-Michel Pontier ◽  
François-Xavier Brocq ◽  
Jean-François Boulard ◽  
...  
Keyword(s):  
Pulmonary Edema ◽  
Decompression Sickness ◽  
Mediterranean Coast ◽  
Military Hospital ◽  
Emergency Unit ◽  
Diving Accident ◽  
Landing Zone ◽  
Diving Accidents ◽  
Non Invasive Ventilation ◽  
Life Threatening

BACKGROUND: Scuba diving activities expose divers to serious accidents, which can require early hospitalization. Helicopters are used for early evacuation. On the French Mediterranean coast, rescue is made offshore mainly by a French Navy Dauphin or at a landing zone by an emergency unit EC 135 helicopter.METHODS: We retrospectively analyzed diving accidents evacuated by helicopter on the French Mediterranean coast from 1 September 2014 to 31 August 2016. We gathered data at the Center for Hyperbaric Medicine and Diving Expertise (SMHEP) of the Sainte-Anne Military Hospital (Toulon, France), the 35 F squadron at Hyres (France) Naval Air Station, and the SAMU 83 emergency unit (Toulon, France).RESULTS: A total of 23 diving accidents were evacuated offshore by Dauphin helicopter and 23 at a landing zone on the coast by EC 135 helicopter without hoist. Immersion pulmonary edema (IPE) accounted for one-third of the total diving accidents evacuated by helicopter with identified causes. It was responsible for at least half of the deaths at the dive place. A quarter of the rescued IPE victims died because of early cardiac arrest.DISCUSSION: Helicopter evacuation is indicated when vital prognosis (IPE and pulmonary overpressure in particular) or neurological functional prognosis (decompression sickness) is of concern. IPE is the primary etiology in patients with serious dive injuries that are life-threatening and who will benefit from helicopter evacuation. A non-invasive ventilation device with inspiratory support and positive expiratory pressure must be used, in particular for IPE.Corgie L, Huiban N, Pontier J-M, Brocq F-X, Boulard J-F, Monteil M. Diving accident evacuations by helicopter and immersion pulmonary edema. Aerosp Med Hum Perform. 2020; 91(10):806811.

Severe acute pancreatitis- it's diagnosis and management- A study of 20 cases

2019 ◽  
Vol 8 (2) ◽  
pp. 17-29
Author(s):  
Mohammad Monir Hossain ◽  
S M Shakwat Hossain ◽  
Delowar Hossain
Keyword(s):  
Acute Pancreatitis ◽  
Conservative Treatment ◽  
Severe Acute Pancreatitis ◽  
Pancreatic Necrosis ◽  
Military Hospital ◽  
Fatty Tissue ◽  
Ct Findings ◽  
Contrast Enhanced Ct ◽  
Management Protocol ◽  
Life Threatening

Background: Severe acute pancreatitis is defined as pancreatitis in which there is persistent organ failure that does not resolve within 48 hours. Severe acute Pancreatitis is characterized by pancreatic necrosis, a severe systemic inflammatory response and often multiorgan failure. Severe acute pancreatitis is a serious and life threatening disease. Mortality varies from 20 to 50 percent. Objective: The objectives of this study are to develop our knowledge about presentation and diagnosis of severe acute pancreatitis, and to develop a standard management protocol to rescue that patient suffering from severe acute pancreatitis. Methods: This observational study was carried out in Combined Military Hospital (CMH) Dhaka, during the period of August 2014 - Feb 2015. A total 20 patients of severe acute pancreatitis were studied prospectively, evaluated and managed. Results: In this study, out of 20 patients 12(60%) male and 08(40%) female. Male: Female = 3:2. The youngest patient of this series was 03 years and oldest was of 55 years. First categorization of severity of acute pancreatitis was done on the basis of Ranson score. Those patients whose score is 3 or more are categorized as severe. After categorization subsequent management was planned on the basis of laboratory and CT findings. Out of 20 patients all have raised WBC, serum Calcium level decrease in 16 patients, LDH raised in 16 patients, PaO2 decrease in 14 patients, Base deficitincreased in 12 patients, and blood urea nitrate raised in 14 patients. Contrast enhanced CT scan done in all patients and 12 patients were found with reduced enhancement in pancreas, peripancreatic edema and stranding of fatty tissue and remaining 8 patients have fluid collected in peri- and retro pancreatic space. Total 12 patients were given conservative treatment. Remaining 8 patients were operated whose CT findings were reduced enhancement in pancreas and these patients were suspected for infective pancreatic necrosis. In this study 3 patients were expired. Out of these three patients, 2 patients underwent operative intervention and 1 patient was given conservative treatment. Conclusion: Severe acute pancreatitis is a life threatening condition. Its serious regional and systemic involvement causes multiple organ or system failure. Early diagnosis and effective treatment can significantly reduce the mortality and morbidity. CBMJ 2019 July: Vol. 08 No. 02 P: 17-29

Posted to Germany: Early Cold War Canadian Military Policy and Its Impact on One Family’s Experience

2021 ◽  
Author(s):  
Jayne Elliott
Keyword(s):  
Cold War ◽  
North Atlantic ◽  
Hospital Setting ◽  
Military Hospital ◽  
Military Policy ◽  
The North ◽  
Military Life ◽  
British Military ◽  
The North Atlantic ◽  
Canadian Military

In the summer of 1954, military surgeon Major Robert Elliott was posted to the British Military Hospital in Iserlohn, Germany, to provide medical care to Canadian soldiers, members of the 5,500-strong Canadian Brigade that had earlier been stationed there as part of Canada’s commitment to the North Atlantic Treaty Organization. Like many other military families, Elliott’s family had to remain behind until suitable accommodation for them could be found. Based on the letters that Elliott wrote home to his wife during their eight-month separation, this article provides a glimpse of how both old and new Canadian military policies during the early Cold War period had an impact on his work and his family. The Canadian government’s decision to place the Brigade under British control reflected, in part, the long-standing attachment to Britain, but Elliott was often frustrated with how imperial/colonial relations played out in the hospital setting. And the military’s initial reluctance to officially allow dependents to join their loved ones overseas, a new phenomenon in Canadian military life, undoubtedly contributed to his confusion and anxiety over when family quarters would finally be finished.

scholarly journals EMERGEncy ID NET: Review of a 20-Year Multisite Emergency Department Emerging Infections Research Network

2017 ◽  
Vol 4 (4) ◽  
Author(s):  
Scott Santibanez ◽  
Leah S Fischer ◽  
Anusha Krishnadasan ◽  
Bethany Sederdahl ◽  
Toby Merlin ◽  
...  
Keyword(s):  
Real Time ◽  
Clinical Care ◽  
Research Network ◽  
Emerging Infections ◽  
Prospective Data ◽  
National Network ◽  
Clinical Syndromes ◽  
Wide Range ◽  
Control And Prevention ◽  
Life Threatening

Abstract As providers of frontline clinical care for patients with acute and potentially life-threatening infections, emergency departments (EDs) have the priorities of saving lives and providing care quickly and efficiently. Although these facilities see a diversity of patients 24 hours per day and can collect prospective data in real time, their ability to conduct timely research on infectious syndromes is not well recognized. EMERGEncy ID NET is a national network that demonstrates that EDs can also collect data and conduct research in real time. This network collaborates with the Centers for Disease Control and Prevention (CDC) and other partners to study and address a wide range of infectious diseases and clinical syndromes. In this paper, we review selected highlights of EMERGEncy ID NET’s history from 1995 to 2017. We focus on the establishment of this multisite research network and the network’s collaborative research on a wide range of ED clinical topics.

scholarly journals Determination of putative virulence factors among clinical isolates of enterococci isolated from a military hospital in the eastern province of Saudi Arabia

2020 ◽  
Vol 8 (11) ◽  
pp. 3860
Author(s):  
Siju Kankalil George ◽  
M. R. Suseela ◽  
Saleh El Safi ◽  
El Moiez Ali El Nagi ◽  
Ahmed Adlan Mohammed Adam ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Virulence Factors ◽  
Clinical Isolates ◽  
Military Hospital ◽  
Clinical Samples ◽  
Haemolytic Activity ◽  
Eastern Province ◽  
Pathogenic Potential ◽  
Life Threatening ◽  
Susceptibility Patterns

Background: The pathogenic potential of enterococci to produce life-threatening infections is well-documented. The scientific community has, of late, evinced a renewed interest in the putative virulence factors of enterococci. Objective of the study was to determine the putative virulence factors of clinically isolated Enterococcus species from a military hospital and to describe the association between virulence factors and vancomycin susceptibility.Methods: A total of 245 enterococci were isolated from clinical samples collected from KFMMC, a leading military hospital in the eastern province of Saudi Arabia. Following species identification and antimicrobial susceptibility testing using the Vitek 2 system; the isolates were tested for the production of caseinase, gelatinase, biofilm, and presence of haemolysin.Results: Among the enterococcal isolates, 36.7% produced caseinase, 38% produced gelatinase, 24.1% exhibited biofilm formation, and 30.6% were positive for haemolytic activity. A significant association between vancomycin susceptibility patterns and the virulence factors, gelatinase and haemolytic activity, were noted. No significant associations were observed between vancomycin susceptibility patterns and the presence of caseinase or the formation of biofilms.Conclusions: Virulence factors are invariably produced by several clinical isolates of enterococci in our hospital, and some virulence factors are associated with vancomycin susceptibility.

Mothers’ Knowledge about Diaper Rash and Preventive Measures in Bangladesh

2021 ◽  
Vol 36 (1) ◽  
pp. 39-45
Author(s):  
Zahir Sadique ◽  
Nurunnahar Fatema Begum ◽  
Md Ferdousur Rahman Sarker ◽  
Md Nazmul Islam Bhuyian ◽  
Md Kamruzzaman
Keyword(s):  
Preventive Measures ◽  
Cross Sectional Study ◽  
Military Hospital ◽  
Cross Sectional ◽  
Outpatient Visits ◽  
Life Threatening ◽  
Knowledge And Practice ◽  
One Year ◽  
Disposable Diapers ◽  
Perineal Care

Background: Use of disposable diapers by parents for their children has grown in last few decades. Although, most of the time diaper rash is not life threatening, it is a concern for the parents, and uncomfortable and painful for children Objectives: To measure the knowledge and practice of mothers when diapering and administering perineal care to infants wearing disposable diapers and factors that can influence the frequency of the occurrence of diaper rash in children between 0-12 months in Bangladesh. Methods: This cross-sectional study was conducted during the outpatient visits of mothers and their infants at the Combined Military Hospital located in Cumilla, Bangladesh between 01 February 2015 and 31 July 2015 with their infants. A structured, self-completed, closed-ended questionnaire was provided to 110 mothers who came to visit the Pediatric outdoors. Results: Thirty-seven (33.64%) infants aged one or under were reported to have experienced diaper rash during or prior to enrolment in the study. Study analysis showed that the risk of diaper rash was significantly higher in babies who used only 1-2 diapers/day than for babies who used more than 4 diapers/day (40.0% vs 21.43%). Infants whose mothers had knowledge of the causes and preventions of diaper rash and/or who received information about the importance of the proper cleaning of the diaper area during diaper changes suffered fewer incidents of diaper rash than those whose mothers did not (24% vs 36.48%). The causes of diaper rash were described by 48.65% mothers as heat followed by 27.03% mothers by frequent stool/urine. Conclusion: Frequently changing disposable diapers and cleaning the diaper area thoroughly can reduce cases of diaper rash dramatically in children less than one year old. The knowledge of mothers regarding diaper rash is an important factor in reducing diaper rash in their children. DS (Child) H J 2020; 36(1) : 39-45

Clinical aspects of food allergy

2002 ◽  
Vol 30 (6) ◽  
pp. 901-906 ◽  
Author(s):  
P. S. Papageorgiou
Keyword(s):  
Food Allergy ◽  
Clinical Manifestations ◽  
Food Challenge ◽  
Allergic Patient ◽  
Specific Ige ◽  
Clinical Aspects ◽  
Clinical Syndromes ◽  
Life Threatening ◽  
Definition Of ◽  
Food Allergic Patient

Food allergy affects 2.5% of adults and 6–8% of children, and is a leading cause of life-threatening anaphylactic episodes. Food allergy is defined as an adverse reaction to foods that is mediated immunologically and involves specific IgE or non-IgE mechanisms. In this review only IgE-related food allergy will be considered. Many food allergens are glycoproteins, but they do not share any striking biochemical similarities. The definition of many food proteins at the molecular level has tremendously facilitated our understanding of clinical syndromes and seemingly bizarre observations. Clinical manifestations of food allergy include symptoms of the gastrointestinal, cutaneous and respiratory systems, as well as systemic anaphylaxis. The diagnosis of food allergy involves a stepwise approach, including medical history taking, demonstration of specific IgE and confirmation by oral food challenge. The management of the food-allergic patient at present consists of avoidance of the culprit food and education, while future advances may include specific immunotherapy with modified allergens or DNA vaccination.

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