Detro JF. 10(3). 10 - 13. (Journal Article)
Abstract Urinary retention is a true urologic emergency. First-line treatment with a transurethral catheter can and will fail. SOF medics need a reliable and durable method to resolve this problem using a minimal amount of resources and time. Current SOF Medical Handbook guidance for the management of unsuccessful urethral catheterization is inadequate. This article and accompanying video link, functions as a starting point for incorporating suprapubic tube placement in the training regimen and therapeutic armamentarium of SOF medical personnel. Case Scenario #1 You are a SOF medic assigned to a remote area in Africa. A Soldier is brought to you after a rollover MVA. He is noted to have an obvious pelvic fracture and on physical exam is found to have blood at the urethral meatus. On digital rectal exam his prostate is not palpable. You suspect a posterior urethral injury. A gentle pass with a transurethral catheter is unsuccessful - resistance is encountered and blood returns through the catheter, so no further advancement is attempted. The patient's suprapubic area is distended and he complains of an unbearable urge to urinate. How do you manage this soldier's urinary retention? Case Scenario #2 You are a SOF medic assigned to a remote firebase in Afghanistan. A prominent and influential tribal chief is brought into your clinic complaining of an inability to urinate. He gives a long history of urethral stricture disease treated in the past with rudimentary urethral dilations. On physical exam, he has a palpable mass to the level of the umbilicus that is dull to percussion and he describes a strong and painful urge to void when pressure is applied. You are unsuccessful in your attempts to pass a transurethral catheter. You do not have the ability or resources to perform urethral dilation. Aerial evacuation assets are not available. What do you do next?
A recent zoonotic and infectious disease field surveillance study in Honduras resulted in the discovery of Toxoplasma, Trypanosoma, Leishmania, Rickettsia, and Lyme disease with significantly high prevalence rates in a group of feral cats. All five diseases - toxoplasmosis,trypanosomiasis, leishmaniasis, rickettsiosis, and Lyme disease - were confirmed in this group of cats which maintained close contact to local civilians and U.S. personnel. These diseases are infectious to other animals and humans primarily through vector transmission or ingestion. In the austere Central and South American sites that Special Operations Forces (SOF) medics are deployed, the living conditions and close quarters are prime environments for the potential spread of infectious and zoonotic disease. This study's findings, as with previous veterinary disease surveillance studies, emphasize the critical need for continual and aggressive surveillance for zoonotic and infectious disease presence within animals in specific areas of operation (AO). The importance to SOF is that a variety of animals may be sentinels, hosts, or direct transmitters of disease to civilians and servicemembers. These studies are value-added tools to the U.S. military, specifically to a deploying or already deployed unit. The SOF medic must ensure that this value-added tool is utilized and that findings are applied to assure Special Forces Operational Detachment - Alpha (SFOD-A) health and, on a bigger scale, U.S. military force health protection and local civilian health.
Pennardt A. 10(3). 49 - 49. (Editorial)
Reproduced with permission from Prehospital Emergency Care 2009, Vol. 13, No. 3, Pages 286–294
Objectives: We explored whether there are diagnostically useful temporal trends in prehospital vital signs of trauma patients. Methods: Vital signs were monitored during transport to a level I trauma center and electronically archived. Retrospectively, we identified reliable vital signs recorded from the 0- to 7-minute interval and from the 14 to 21-minute interval during transport, and, for each subject, we computed the temporal differences between the two intervals' vital signs, the intrasubject 95% data ranges, the values during the initial 2 minutes, and the 21-minute overall means. We tested for differences between subjects with major hemorrhage versus control subjects, and computed receiver operating characteristic (ROC) curves. We conducted sensitivity analyses, exploring alternative clinical outcomes, temporal windows, and methods of identifying reliable data. Results: Comparing major hemorrhage cases versus controls, there were no discriminatory differences in temporal vital sign trends. Hemorrhage cases had significantly wider intrasubject data ranges for systolic blood pressure (SBP), respiratory rate (RR), and shock index (SI) versus controls. All results were consistent in several sensitivity analyses. Conclusions: Our findings add to a growing body of evidence that prehospital vital sign trends over 21 minutes or less are unlikely to be diagnostically useful because of substantial nondirectional fluctuations in vital signs that would obscure any subtle, progressive temporal trends. SBP, RR, and SI values were significantly different for high-acuity patients, and had more variability. Taken together, these findings suggest that higher-acuity patients experience episodes of instability rather than gradual, steady decline. Measures that account for data variability, such as taking the average of multiple measurements, may improve the diagnostic utility of prehospital vital signs.
Arne BC. 10(3). 120 - 122. (Journal Article)
Arne BC. 10(3). 123 - 125. (Journal Article)