Navigating the Management of an F-16 Pilot Following Spontaneous Splenic Rupture.

BACKGROUND: Little consensus exists on the best practices for post-acute care of patients who suffer splenic injury but retain functional splenic tissue. Moreover, no published guidance or case reports exist for managing pilots in this demographic, making the flight surgeon's task particularly difficulty as he/she attempts to apply the best available evidence for a patient population exposed to unique occupational hazards.CASE REPORT: We describe the case of an F-16 pilot who suffered a spontaneous splenic rupture due to infectious mononucleosis and required splenic artery embolization for hemodynamic stabilization. Despite the salvage of a significant portion of his spleen, the pilot was managed as an asplenic patient due to concern that: 1) splenic artery embolization compromised the function of his spleen; and 2) his status as a military aviator placed him at increased risk of infection due to frequent travel. He received appropriate vaccinations for an asplenic patient, fever precautions, and amoxicillin-clavulanic acid for immediate use if he developed fever. After discussion with the Aeromedical Consult Service, who felt the aviator had minimal risk of a poor outcome, he was returned to flying status. Since returning to flying status he has logged over 15 h of flight time, routinely experiencing 8-9 +Gz without difficulty.DISCUSSION: This case provides a successful approach to the management of pilots of high-performance aircraft who suffer splenic injury but retain functional splenic tissue, and provides precedent for safely returning these patients to flying status following recovery.Tanael M, Saul S. Navigating the management of an F-16 pilot following spontaneous splenic rupture. Aerosp Med Hum Perform. 2019; 90(12):1061-1063.

Rash, Radiculopathy, and Cognitive Biases.

BACKGROUND: Physicians rely on intuition and pattern recognition to rapidly evaluate and treat patients. While the realities of our medical system require liberal use of these heuristics to efficiently make clinical decisions, such thinking patterns are error-prone-leaving the clinician at the whims of their cognitive biases.CASE REPORT: We describe a case of Lyme disease in which a pilot's rash and radicular pain were misdiagnosed on two separate occasions until, nearly a month after initially seeking medical care, the pilot was appropriately diagnosed and treated.DISCUSSION: This case highlights Lyme disease's mimicry of other common diseases and underscores the need to use slower, more deliberate evaluation in conjunction with pattern recognition and intuition to provide optimal care to flyers.Saul S, Tanael M. Rash, radiculopathy, and cognitive biases. Aerosp Med Hum Perform. 2019; 90(7):652-654.