An Unusual Presentation of Pulmonary Edema During an Ice Dive at Altitude.

Military diving operations occur in a wide range of austere environments, including high-altitude environments and cold weather environments; however, rarely do both conditions combine. Ice diving at altitude combines the physiologic risks of diving, a hypothermic environment, and a high-altitude environment all in one. Careful planning and consideration of the potential injuries and disease processes affiliated with the aforementioned physiologic risks must be considered. In this case report, we describe a Navy diver who became obtunded secondary to hypoxia during an ice dive at 2,987 m (9,800 ft) elevation and was subsequently diagnosed with high-altitude pulmonary edema. Further consideration of the environment, activities, and history does not make this a clear case, and swimming-induced pulmonary edema which physiologically possesses many overlaps with high-altitude pulmonary edema may have contributed or been the ultimate causal factor for the diver's acute response.

Recovering Coronavirus Disease Patients in the Active Duty Military Population: A Review of Current Evidence and Special Considerations for Uniformed Providers.

Patients acutely infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) coronavirus disease (COVID-19) may continue to have symptoms well beyond 2 weeks. The range of symptoms and physiological sequelae can impact medical readiness even in a relatively young and healthy cohort of service members. It is important to monitor, document, and investigate symptoms from all service members recovering from COVID-19. Military medicine must be prepared to support and manage cases of patients who are recovered from acute COVID-19 but are suffering from post-COVID-19 complications.

Myocarditis Following Immunization With mRNA COVID-19 Vaccines in Members of the US Military.

Importance: Myocarditis has been reported with COVID-19 but is not clearly recognized as a possible adverse event following COVID-19 vaccination. Objective: To describe myocarditis presenting after COVID-19 vaccination within the Military Health System. Design, Setting, and Participants: This retrospective case series studied patients within the US Military Health System who experienced myocarditis after COVID-19 vaccination between January and April 2021. Patients who sought care for chest pain following COVID-19 vaccination and were subsequently diagnosed with clinical myocarditis were included. Exposure: Receipt of a messenger RNA (mRNA) COVID-19 vaccine between January 1 and April 30, 2021. Main Outcomes and Measures: Clinical diagnosis of myocarditis after COVID-19 vaccination in the absence of other identified causes. Results: A total of 23 male patients (22 currently serving in the military and 1 retiree; median [range] age, 25 [20-51] years) presented with acute onset of marked chest pain within 4 days after receipt of an mRNA COVID-19 vaccine. All military members were previously healthy with a high level of fitness. Seven received the BNT162b2-mRNA vaccine and 16 received the mRNA-1273 vaccine. A total of 20 patients had symptom onset following the second dose of an appropriately spaced 2-dose series. All patients had significantly elevated cardiac troponin levels. Among 8 patients who underwent cardiac magnetic resonance imaging within the acute phase of illness, all had findings consistent with the clinical diagnosis of myocarditis. Additional testing did not identify other etiologies for myocarditis, including acute COVID-19 and other infections, ischemic injury, or underlying autoimmune conditions. All patients received brief supportive care and were recovered or recovering at the time of this report. The military administered more than 2.8 million doses of mRNA COVID-19 vaccine in this period. While the observed number of myocarditis cases was small, the number was higher than expected among male military members after a second vaccine dose. Conclusions and Relevance: In this case series, myocarditis occurred in previously healthy military patients with similar clinical presentations following receipt of an mRNA COVID-19 vaccine. Further surveillance and evaluation of this adverse event following immunization is warranted. Potential for rare vaccine-related adverse events must be considered in the context of the well-established risk of morbidity, including cardiac injury, following COVID-19 infection.

Acute Respiratory Infections Among Active Component Service Members Who Use Combustible Tobacco Products and/or E-cigarette/Vaping Products, U.S. Armed Forces, 2018-2019.

Smoking is known to contribute to the risk of acute respiratory illness (ARI) and long-term medical conditions but little is known about the acute health effects of e-cigarette/vaping product use. The annual electronic Periodic Health Assessment (ePHA), which includes questions related to smoking and e-cigarette/vaping product use, is a screening tool used by the U.S. Armed Forces to evaluate the health and medical readiness of military members. Based on responses to questions on ePHAs completed in 2018, active component service members (ACSMs) were categorized as e-cigarette/vaping product only users, smoking only, dual-product users (users of both cigarettes and e-cigarette/vaping products), or non-users. ACSMs in the youngest age groups were more likely than their older counterparts to use e-cigarette/vaping products. Unadjusted incidence rates of ARI were higher among e-cigarette/vaping product only users and dual-product users than smokers and nonusers. After adjusting for age, sex, service branch, and military occupation, the incidence rate of ARI among dual-product users was higher than the rate among nonusers; this difference was small but statistically significant. Improved understanding of the health impact of e-cigarette/vaping product use has the potential to inform policy related to use of these products and prevent unnecessary harm.

Decompression Sickness in the F/A-18C After Atypical Cabin Pressure Fluctuations.

BACKGROUND: The spectrum of altitude decompression sickness (DCS) is evolving as more cases of atypical pressure fluctuations occur. This ongoing change makes it a difficult condition to diagnose and even more difficult to identify. Both Flight Surgeons and Undersea Medical Officers (UMOs) must keep DCS on the differential. These two cases describe altitude DCS after unique pressure patterns, with one at a markedly lower than expected altitude for DCS. CASE REPORT: Both cases occurred in the F/A-18C and resulted in DCS requiring hyperbaric chamber treatment. The aviator in case 1 experienced an over-pressurization to an unknown depth with a subsequent rapid decompression during a carrier approach at 600 ft (182.9 m) above sea level. The aviator in case 2 experienced cabin pressure fluctuations between 9000 ft (2743.2 m) and 18,000 ft (5486.4 m). Both cases demonstrate the progression of DCS after partial treatment on ground-level oxygen therapy, and the case sequence illustrates how evaluations and protocols changed with experience. DISCUSSION: Decompression sickness is difficult to identify since it does not have a diagnostic test. These cases were even more difficult because of subtle exam findings, reliance on subjective symptoms, and atypical pressure profiles. Environmental, physiological, and psychosocial factors specific to the aviation community can delay the diagnosis and treatment. Descending in altitude and using in-flight emergency oxygen or ground-level oxygen partially treats and masks symptoms for both the aviator and the physician. The Flight Surgeons' integration within the squadron and collaboration with UMOs is important to identify the first signs of DCS and decrease time to treatment.Lee KJ, Sanou AZ. Decompression sickness in the F/A-18C after atypical cabin pressure fluctuations. Aerosp Med Hum Perform. 2018; 89(5):478-482.