Myocardial Bridging, the Hidden Risk Factor for Ischemia.

Myocardial bridging is an uncommon cause of a quite common emergency department complaint for chest pain and is often associated with left ventricular hypertrophy. We present a case of an otherwise healthy middle-aged U.S. military service member who presented with acute coronary syndrome which was ultimately determined to be the result of myocardial bridging.

COVID-19 Outbreak in A Forward-Deployed Expeditionary Military Command: A Retrospective Review on Preventative Measures and Outbreak Characteristics.

BACKGROUND: An outbreak of coronavirus disease 2019 (COVID-19) occured within a land based 2,000-member cohort stationed on a remote air base in the Middle East from June to August 2020. We retrospectively reviewed base characteristics and mitigation measures instituted during the outbreak. We also reviewed documentation on the individuals that were either quarantined or placed in isolation and provide data on demographics, real-time reverse transcriptase polymerase chain reaction (rRT-PCR) results, occupation, and workdays lost. RESULTS: During the reporting period, 46 individuals or 3.84% of the population had a positive COVID-19 rRT-PCR test. Aviation personnel represented 50% of the COVID-19 positive tests. Sixteen percent of health care personnel were tested positive. Overall, 10% of personnel were placed in isolation or quarantine, resulting in the loss of 1,552 workdays. CONCLUSIONS: The data show a disproportionate impact on healthcare workers and personnel involved in aviation operations. The purpose of this study is 2-fold: to describe the characteristics of the outbreak and to highlight the effectiveness of mitigation measures implemented to control it during military operations. This study may serve to inform medical professionals and military leaders in the management of a similar outbreak in a congregate living setting.

Pseudotumor Cerebri with Blindness.

Pseudotumor cerebri, or idiopathic intracranial hypertension (IIH), is a syndrome of elevated intracranial pressure (ICP) of unknown etiology that occurs predominantly in obese women of childbearing age. Pseudotumor cerebri literally means "false brain tumor". It is a "diagnosis of exclusion" therefore a complete work-up to rule out life-threatening causes for increased ICP must be performed through a comprehensive history, complete physical examination, diagnostic imaging, and cerebrospinal fluid (CSF) analysis before the diagnosis can be made. The authors present the case of a young woman with headache, and near blindness due to pseudotumor cerebri. The presentation, diagnosis, and treatment options are discussed.

An Uncommon Presentation of the Common Sinusitis.

A nine-year-old child was brought to the emergency room by her mother because of an upper respiratory infection symptoms and forehead swelling. The patient was seen by the emergency department physician and diagnosed with an upper respiratory infection; the forehead swelling was felt to be related to forceful coughing. The patient and patient's mother returned on a second visit because the forehead swelling had not improved. A CT scan of the head was subsequently done which demonstrated pansinusitis.

Phalangeal Fracture Secondary to Hammering One's Finger.

The authors report the case of a man who smashed his finger while using a hammer, resulting in a fracture-dislocation. The description of this injury type and the emergency management is discussed.

Clinical practice guideline adherence during Operation Inherent Resolve.

BACKGROUND: The Joint Trauma System (JTS) clinical practice guidelines (CPGs) contributed to the decrease in battlefield mortality over the past 15 years. However, it is unknown to what degree the guidelines are being followed in current military operations. METHODS: A retrospective review was performed of all patients treated at three separate US Army Role II facilities during the first 10 months of Operation Inherent Resolve in Iraq. Charts were reviewed for patient demographics, clinical care, and outcomes. Charts were also reviewed for compliance with JTS CPGs and Tactical Combat Casualty Care recommendations. RESULTS: A total of 114 trauma patients were treated during the time period. The mean age was 26.9 ± 10.1 years, 90% were males, and 96% were host nation patients. The most common mechanisms of injury were blast (49%) and gunshot (42%). Records were compliant with documenting a complete set of vitals in 58% and a pain score in 50% of patients. Recommendations for treatment of hypothermia were followed for 97% of patients. Tranexamic acid was given outside guidelines for 6% of patients, and for 40%, it was not determined if the guidelines were followed. Recommendations for initial resuscitative fluid were followed for 41% of patients. Recommendations for antibiotic prophylaxis were followed for 40% of intra-abdominal and 73% of soft tissue injuries. Recommendations for tetanus prophylaxis were followed for 90% of patients. Deep vein thrombosis prophylaxis was given to 32% of patients and contraindicated in 27%. The recommended transfusion ratio was followed for 56% of massive transfusion patients. Recommendations for calcium administration were followed for 40% of patients. When composite scores were created for individual surgeons, there was significant variability between surgeons with regard to adherence to guidelines. CONCLUSIONS: There is significant deviation in the adherence to the CPGs. LEVEL OF EVIDENCE: Epidemiologic study, level IV.