Journal of special operations medicine : a peer reviewed journal for SOF medical professionals最新文献

Background: Clinicians face numerous challenges when providing effective anesthesia in the setting of humanitarian crisis or armed conflict. Anesthetic supply limitations often stand as a critical gap in these environments. Due to its clinical safety profile and relatively simple production, diethyl ether (Et2O) may offer a solution in such situations.

Methods: The dehydration of ethanol (EtOH) using an acid-catalyzed reaction was conducted twice. Sulfuric acid was added to a solution of ethanol in a glass flask that was heated to approximately 145 °C, promoting the formation of Et2O and water. At this temperature, Et2O was isolated from the solution through fractional distillation and collected in a flask that was cooled in an ice bath. The distillate was analyzed using proton nuclear magnetic resonance (1H NMR) spectroscopy.

Results: Two samples of Et2O were obtained using an acid-promoted dehydration of ethanol. Analysis of the samples using 1H NMR spectroscopy led to the identification of two components, Et2O and EtOH, whose identities were confirmed by comparison of the constituent peaks to known chemical shifts. Integration of the relevant peaks suggested a Et2O purity of approximately 97%.

Conclusion: This proof-of-concept study demonstrates that relatively pure Et2O can feasibly be produced and isolated on a small scale using an acid-catalyzed dehydration reaction with fractional distillation.

Background: Ultrasonography has seen increasing integration into the clinical practice of Special Operations Combat Medics (SOCMs). However, there is limited literature available that describes SOCM use of ultrasonography. This narrative review aims to provide an overview of how SOCMs use ultrasound in clinical practice and explore proposed future applications.

Methods: A PubMed search was conducted for articles discussing ultrasonography in the context of Special Operations medicine. This search initially included a broad PubMed search followed by a targeted search limited to the Journal of Special Operations Medicine. Inclusion criteria for this targeted search encompassed articles describing ultrasound use or advocating for ultrasound use in SOCM clinical practice.

Results: The search was conducted in October 2023 and yielded 120 publications, of which 20 met inclusion criteria and are summarized in this review. Among these articles, 50% focused on cardiovascular applications, 35% on musculoskeletal applications, 20% on abdominal assessments (E-FAST exam), 15% on respiratory applications, and 10% on neurologic applications. Only 40% of the articles described operational use, while 60% advocated for use. Finally, 56.5% of the articles described diagnostic applications, while 43.5% pertained to procedural applications.

Conclusion: SOCM use of ultrasonography likely differs from in-hospital provider use of ultrasonography. To improve ultrasound education for SOCMs, educators should consider customization of the curriculum to align with the unique mission requirements of individual units and an increased emphasis on procedure-based training.

Introduction: Marksmanship is a fundamental skill for all servicemembers. However, the underlying neurophysiological differences in performance among marksmen remain unclear. Incorporating neurophysiological tracking such as functional near-infrared spectroscopy (fNIRS) may identify performance-based differences in prefrontal cortex (PFC) activation during dynamic marksmanship scenarios. This study examined cognitive load within the PFC during a simulated dynamic marksmanship scenario in non-proficient and proficient marksmen.

Methods: Twenty-four participants (12 men, 12 women) wore an fNIRS device over their forehead during a simulated stationary pistol marksmanship task (to determine proficiency status) and a dynamic shoot/no-shoot course of fire (COF) (to assess cognitive load). Relative concentrations of oxyhemoglobin (HbO2 ), deoxygenated hemoglobin (deoxygenated Hb), and total hemoglobin (total Hb) were tracked to quantify PFC activation differences in twelve proficient (=80% hit percentage) and twelve non-proficient (<80% hit percentage) marksmen.

Results: No difference in completion time was observed between groups during the dynamic COF (p=.34). However, non-proficient marksmen showed 26.3% higher HbO2 (p=.02) and 42.1% higher total Hb (p<.01) in the PFC compared to proficient marksmen.

Conclusion: Tracking PFC hemodynamic activity identified proficiency-based differences in cognitive load during a dynamic COF. Applying fNIRS during marksmanship-related tasks may be useful in developing stress resilience and mission readiness for servicemembers.

Rheumatic heart disease (RHD) has become exceedingly rare in the United States, but a recent resurgence may place military Servicemembers at increased risk for this diagnosis. Our case describes a 29-year-old U.S.-born Special Operations Forces (SOF) Soldier who presented for recurrent exertional near-syncope and progressive exercise intolerance with subsequent workup remarkable for RHD. Initial electrocardiogram was notable for benign early repolarization and intraventricular conduction delay. Cardiology evaluation with transthoracic and transesophageal echocardiograms revealed severe mitral regurgitation and rheumatic appearing mitral valve leaflets. The patient underwent a successful mechanical mitral valve replacement, requiring lifelong anticoagulation with warfarin. Depending on severity of valvular disease, treatment modalities range from conservative medical therapies to invasive and minimally invasive surgical intervention. This case demonstrates the importance for SOF medics and providers to remain vigilant of this resurging disease process. Additionally, it emphasizes the necessity for a high level of clinical suspicion in those with exertional complaints and decreased exercise tolerance to ensure timely diagnosis and treatment of rare but potentially life-threatening conditions.

Background: The prehospital availability of oxygen resources appears to be a critical limitation in military medicine. The fraction of inspired oxygen (FIO2) provided to patients is frequently lower than their pathophysiological needs. This deficit is due to the difficult mobilization of oxygen reserves and the volatile tactical pressure. Although several oxygen delivery devices are on the market, few effectively achieve optimal FIO2 levels. The double-trunk mask (DTM) represents a revolutionary solution that significantly improves the efficiency of oxygen delivery while conserving oxygen. The DTM is derived from a conventional aerosol mask. It includes two 22mm corrugated tubes secured in the side openings of the mask, each approximately 15 to 20cm in length in adults.

Methods: Following PICO screening, 15 eligible articles (prehospital, real-life settings, published 1990-2023 in English, Dutch, or French) indicated DTM's mechanisms of operation and efficacy.

Results: DTM significantly improves oxygen delivery while minimizing oxygen loss and improving pulmonary diffusion rates. The increase in PaCO2 is minimal despite the increase in material dead space.

Conclusions: This device proves invaluable when oxygen supplies are limited, such as during pandemics or war. Its use maximizes administered FIO2 while minimizing oxygen consumption, optimizing patient care in resource-limited environments.

Due to the evolving geopolitical strategy of near-peer nations, there has been a growing national interest in the Arctic region. However, Tactical Combat Casualty Care (TCCC) assessments and interventions have been shaped based on input from conflicts such as Iraq and Afghanistan. They do not consider the unique factors seen in extreme cold environments. Naval Medical Research Unit San Antonio has developed a task analysis tool, the Task Step Analysis Tool-Binary (TSAT-B), to evaluate the effects of extreme cold on tasks within the current TCCC protocols. The tool was pilot-tested using a trauma manikin in field environments in Alaska, with temperatures ranging from -2 to -35°C. As part of the TSAT-B, task steps are graded into three categories (provider, casualty, and procedure). Steps are timed, and hand temperature is measured before and after a task. Written and verbal feedback is used to enhance the binary (go/nogo) two-alternative forced-choice. The TSAT-B has proven to be a useful evaluation tool and is being offered to standardize how current TCCC protocols and proposed changes are evaluated.

Traumatic ocular injuries from both combat- and noncombat-related activity remain a significant burden in active duty Ser- vicemembers and present a diagnostic and therapeutic challenge to Special Operations medics with limited resources in far forward and remote areas. Blunt ocular injury, whether from sports or battlefield engagement, can result in a variety of eyesight-threatening injuries, including hyphema, commotio retinae, iritis, uveitis, and open globe injury. The management of these conditions often requires teleconsultation with ophthalmology and potential evacuation, which is tailored to the resources available for the Special Operations Forces medic. The authors present a case of sports-related traumatic hyphema complicated by commotio retinae in a Special Operations unmanned aircraft systems (UAS) operator, requiring teleconsultation and evacuation to specialty care. The authors additionally provide tailored prehospital strategies for the management of these unique but imperative injuries.

Posttraumatic stress can result from combat and noncombat-related experiences. Conditioning military forces to be lethal or to save lives may influence responses to stress. Training to respond to casualties and to save lives should be a universal practice among medical and non-medical personnel when preparing for combat operations and battlefield casualties. National security requires a strong military. A strong military is reliant on a strong society that is cohesive as well as economically and spiritually intact. Cohesion is vital to the overall health and development of a society. A lack of cohesion can result in excess mortality and a reduction in life expectancy. Cohesion expands social networks and increases social capital that provides support for its military and overall population. Cohesion and leadership are needed to defend our nation, preserve national security, improve societal health, and save lives.

Background: Special Operations Forces (SOF) have become the solution to many of the United States military challenges due to their ability to conduct time sensitive, clandestine, and high-risk missions. Historically, SOF were assumed to be resilient to the psychological sequelae of war, including posttraumatic stress disorder (PTSD). However, the objective burden of PTSD in SOF, particularly after traumatic brain injury (TBI), remains unknown. This study compared average PTSD symptoms over time between SOF and Conventional Forces (CF) who had sustained a TBI.

Methods: This prospective cohort study examined Servicemembers and Veterans admitted to one of five Veterans Affairs Polytrauma Rehabilitation Centers for TBI. Propensity score matching created matched samples of 205 SOF and 205 CF. The PTSD Checklist-Civilian version (PCL-C) measured PTSD symptoms at admission and 1, 2, 5, and 10 years post TBI.

Results: In a longitudinal mixed-effects model of PTSD symptoms over time grouped by TBI severity, SOF and CF had similar severity and patterns of PTSD symptoms. SOF and CF with mild TBI had more PTSD symptoms across all time points compared to those with moderate and severe TBI.

Conclusion: The evolution and severity of PTSD symptoms after TBI in SOF and CF were similar. While SOFs had higher resilience compared to CFs in previous work, SOFs are not impervious to trauma exposure and PTSD. Increasing awareness of PTSD prevalence and consequences is needed to serve SOF. Identifying those needing care and providing evidence-based PTSD treatments can have the downstream effects of reducing attrition from the service and maintaining military readiness.