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Featured Articles

Winter 2008

Fentanyl For Pain Control In Special Operations

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Kacprowicz RF, Johnson TR, Mosely DS. 08(1). 48 - 53. (Journal Article)

Abstract

Opiate medications have been used for the control of severe pain due to combat trauma for hundreds of years. Morphine has long been the drug of choice for use on the battlefield, but it has several limitations which can make it difficult to use in modern warfare. Since its discovery in 1963, fentanyl has gradually emerged as one of the most effective alternatives to morphine. With fewer adverse effects and multiple routes of administration, fentanyl appears to be a very effective choice for the management of moderate to severe pain due to combat trauma. Available data support the use of fentanyl in Special Operations, but only after a thorough review of the pharmacology, adverse effects, dosing, and routes of administration.

Lateral Canthotomy In Orbital Compartment Syndrome: Special Operations Medics On The Battlefield Can Save The Eye

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Burns GD, DeLellis SM. 08(1). 54 - 57. (Journal Article)

Abstract

The primary medical role of the Special Operations Forces (SOF) Medic is to stabilize the patient and prevent loss of life, limb, and eyesight on the battlefield. Significant time and resources are invested to ensure that SOF Medics are the best trained and most proficient combat Medics in the world. While considerable focus is placed on teaching the intricacies of saving life and limb, it seems as though only tacit emphasis is placed on the preservation of eyesight. Loss of vision can mean not only decrement of lifestyle for the patient, but could also mean loss to the military of a highly trained operator with years of irreplaceable experience. It is the conclusion of the authors that in addition to the current approach of medical management for orbital compartment syndrome, the skills to perform a lateral canthotomy and cantholysis could easily be introduced into the SOF medical training curriculum. This is a relatively straightforward procedure which could significantly reduce the morbidity from a potentially blinding injury.

Fascioliasis and Fasciolopsiasis: Similar Names, Similar Diseases?

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Bowden L. 08(1). 58 - 67. (Journal Article)

Abstract

This article reviews plant-borne helminth infections caused by Fasciola hepatica/gigantica and Fasciolopsis buski. Besides having similar names, both infections are caused by trematodes (flatworms or flukes). As with nearly all helminth infections, eosinophilia may be present, there is usually a delayed clinical presentation, and diagnosis is made with the proper identification of parasite eggs in the stool or serological testing. However, fascioliasis and fasciolopsiasis have more similarities including: egg morphology, parasite development, the involvement of aquatic plants and snails in the lifecycle, and preventive measures. Despite these similarities there are some important differences including: geographical distribution, definitive hosts, clinical presentation, and treatment. The SOF medical professional will have a greater understanding and be able to more easily identify both of these infections by being able to compare and contrast the two. Though these are not the most common helminth infections, these diseases are prevalent and may be of particular importance to providers working in Southeast Asia or South America.

The Military Acute Concussion Evaluation (MACE)

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French L, McCrea M, Baggett MR. 08(1). 68 - 77. (Journal Article)

Abstract

Traumatic brain injury (TBI), in both times of peace and times of war is a significant public health issue for the military. Even at its most mild, TBI (concussion) can degrade fighting effectiveness, put individuals at increased risk for another injury, and in some cases cause persistent difficulties in cognition, and aspects of physical and emotional functioning. Key to the appropriate treatment of those with TBI is the identification of those that have suffered TBI. This article describes one such tool for the identification of TBI in a military setting, the Military Acute Concussion Evaluation (MACE) including its history, administration, and interpretation.

Surgery In Afghanistan: A Light Model For Field Surgery During War

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Fosse E, Husum H. 08(1). 101 - 105. (Previously Published)

Previously published in Injury (1992) 23, (6), 401-404. Printed in Great Britain. Permission granted to republish in JSOM.

Abstract

Owing to a poor capability for evacuation, mobile medical teams were sent to the area of Gazni in Afghanistan to work with local paramedics as part of a medical programme for the area. The teams were equipped to perform major surgery. During one month a surgical team inside Afghanistan performed 53 operations. The operations were performed in the patients' homes at night. The team had to move frequently so as not to be spotted by the Soviet and government surveillance. Equipment equivalent to a light field hospital was stored in a safe place and the team carried supplies for one or two days on their bicycles. One postoperative death and one wound infection were recorded. It is concluded that adequate surgery can be performed inside territories where enemy forces have air control and under primitive conditions with an acceptable rate of complications. However, due to the nature of the guerrilla warfare with scattered military confrontations over vast areas, the average time between injury and treatment for war casualties was 36 hours.

Tactical Combat Casualty Care In The Assault On Punta Paitilla Airfield

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Mucciarone JJ, Llewellyn C, Wightman JM. 08(1). 106 - 110. (Previously Published)

Originally published in Military Medicine, 171,8:687,2006. Permission granted to republish in the JSOM.

Abstract

Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814. The opinions and assertions herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Uniformed Services University, the U.S. Navy or U.S. Air Force, the U.S. Department of Defense, or the U.S. government. This is a U.S. government work. There are no restrictions on its use. This manuscript was received for review in August 2005 and was accepted for publication in November 2005.

Pain Management In The Prehospital Environment

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McManus JG, Sallee DR. 08(1). 111 - 119. (Previously Published)

Previously published in Emerg Med Clin N Am 23 (2005) 415431. Permission granted to republish in the JSOM.

Gunshotwounds In Militaryworking Dogs

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Baker JL, Truesdale CA. 08(1). 120 - 121. (Journal Article)