The last days: The medical response of United States and allied military teams during the Afghanistan Exodus.

OBJECTIVES: The objective of this study is to describe the United States and allied military medical response during the withdrawal from Afghanistan. BACKGROUND: The military withdrawal from Afghanistan concluded with severe hostilities resulting in numerous civilian and military casualties. The clinical care provided by coalition forces capitalized on decades of lessons learned and enabled unprecedented accomplishments. METHODS: In this retrospective, observational analysis, casualty numbers, and operative information was collected and reported from military medical assets in Kabul, Afghanistan. The continuum of medical care and the trauma system, from the point of injury back to the United States was captured and described. RESULTS: Prior to a large suicide bombing resulting in a mass casualty event, the international medical teams managed distinct 45 trauma incidents involving nearly 200 combat and non-combat civilian and military patients over the preceding 3 months. Military medical personnel treated 63 casualties from the Kabul airport suicide attack and performed 15 trauma operations. US air transport teams evacuated 37 patients within 15 hours of the attack. CONCLUSION: Lessons learned from the last 20 years of combat casualty care were successfully implemented during the culmination of the Afghanistan conflict. Ultimately, the effort, teamwork, and system adaptability exemplify not only the attitudes and character of service members who provide modern combat casualty care but also the paramount importance of the battlefield learning health care system. A continued posture to maintain military surgical preparedness in unique environments remain crucial as the US military prepares for the future.Retrospective observational analysis. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level V.

Thyrotoxicosis after gastric bypass surgery prompting operative re-exploration.

In the last 10 years, gastric bypass has become an increasingly common operation performed by general surgeons. The complications resulting from this procedure can be life-threatening and are often difficult to diagnose, particularly in the immediate postoperative period. We detail a case of thyrotoxicosis manifesting on postoperative day 1 which presented with symptoms mimicking an anastomotic leak. The patient underwent a negative laparoscopy before the thyroid dysfunction was diagnosed. There is no evidence that bariatric surgery carries a greater risk of postoperative thyrotoxicosis than any other non-thyroid operation. Many of the symptoms of thyrotoxicosis, however, are similar to those of other surgery-related complications, and it should be immediately considered in the differential diagnosis of a postoperative bariatric patient with tachycardia and fever. Failure to rule out this condition may lead to unnecessary surgery.